Heart Failure

A Global Health Pandemic: What is Heart Failure?

By Michael MacDonald

One of the leading cardiovascular diseases that take a toll on health globally is heart failure. According to the Centres for Disease Control and Prevention (CDC), 6 million American adults are diagnosed with heart failure. In Singapore, heart failure is common, affecting 1 in 20 Singaporeans.

What is Heart Failure?

Heart failure is a clinical syndrome that manifests as a group of symptoms like breathlessness and leg swelling caused by the inability of the heart to pump blood to the body efficiently. Congestive heart failure is another term for heart failure.

Heart failure can be acute or chronic according to its onset.

Acute heart failure has a sudden and rapid onset. It can occur during massive myocardial infarction, pulmonary embolism, cardiac tamponade, or valvular rupture. Symptoms of acute heart failure may develop rapidly over days or weeks. Chronic heart failure develops more slowly over time. It generally manifests with leg swelling and shortness of breath on exertion.

Who Is at Risk of Developing Heart Failure?

The following are groups of people who are more vulnerable to developing heart failure:

  • More common as you get older
  • People with hypertension, diabetes, and cholesterol problems
  • Family history of heart failure
  • Obesity
  • People with existing heart conditions, such as cardiomyopathy and valvular heart disease
  • Excessive alcohol consumption
  • Previous heart attack or coronary artery disease

Men and women are equally affected by heart failure.

What are the Signs and Symptoms of Heart Failure?

Heart Failure Signs & Symptoms

Common signs and symptoms of heart failure are:

  1. Difficulty breathing during activity or even at rest
  2. Constant exhaustion or tiredness and fatigue
  3. Fluid retention in the lungs and peripheries - leg swelling
  4. Persistent cough
  5. Fast heart rate
  6. Dizziness
  7. Decrease exercise tolerance

How Heart Failure is Diagnosed?

Heart Failure How it is diagnosed

Your heart specialist will ask detailed questions about your family history and medical health. They will also conduct a physical examination and ask you how you feel.

Diagnosing heart failure can be challenging as the condition develops over time. However, the following diagnostic evaluation can help identify the causes of heart failure.

Blood Tests Imaging Tests Other Investigations
  • Complete blood count
  • Electrolyte checks
  • Liver and renal function tests
  • Hormonal checks
  • Lipid profile
  • (Brain Natriuretic Peptide) BNP levels
  • Troponin levels
  • Glycosylated hemoglobin (HbA1c)
  • Chest Xray
  • Electrocardiogram (ECG)
  • Echocardiogram
  • Angiography
  • Cardiac MRI
  • Computed tomography (CT scan)
  • Urinalysis
  • Peak flow or spirometry

Is Heart Failure Reversible?

In some patients with the right treatment it can be reversed.

It has a high mortality rate as high as 50%, dependent on the stage of heart failure.

However, heart failure can be well-controlled. By taking your medication and having regular check-ups with your heart specialist, symptoms can improve.

What is the Management for Heart Failure?

The treatment for heart failure focuses on symptom control and slow down the progress of the disease. Ideally it should be managed by a heart failure specialist.

  • Medication – There are multiple medications that can be used to successfully reduce symptoms and prevent death
  • Consume a high-fiber diet, and avoid unhealthy fats and excessive salt.
  • Exercise regularly as guided by your cardiologist.
  • Stop excessive alcohol consumption.
  • Quit smoking.
  • Manage stress.
  • Maintain optimal body weight.
  • Monitor blood pressure and sugar levels.
  • Regular follow-ups with your heart specialist.
  • There are also several advanced treatments that can be used in some patients like stents, pacemakers, artificial hearts and heart transplants.

What is Cardiac Rehabilitation?

Cardiac rehabilitation is a personalized care plan and rehabilitation approach. It aims to provide education and support to manage the existing cardiac condition. The rehabilitation is not only limited to patient information but may also involve family members.

Cardiac rehabilitation is an individualized approach for long-term recovery and helps decrease the chance of having another cardiac event. It is a vital process to reduce hospital admission and help improve the quality of life.

Cardiac rehabilitation includes:

  • Education and information sessions
  • Physical exercise component
  • Promotion of self-care
  • Psychological support and wellbeing
  • Meeting support groups
  • Physiotherapy
  • Behavioral therapy
  • Money issues support
  • Counseling such as smoking cessation

People with stable heart failure can benefit from cardiac rehabilitation. They can attend on-site sessions or do it at home. Ask your heart doctor about it for further information.


Heart failure is not only a national but a global public health burden. Over the years, the prevalence rate has been upsurging, with older people mainly affected. If you have shortness of breath or leg swelling, see a heart specialist now. Heart failure without treatment gets worse quickly and may lead to death.

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