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Heart Failure

Understanding Heart Failure

Heart failure is a condition whereby the heart muscle becomes weak and is no longer able to pump blood as effectively for the body to function normally. When the heart grows weaker, the blood flows through the body at a slower rate. As the heart condition worsens, the patient will experience difficulty in breathing caused by the accumulated fluid in the air sacs of the lungs. The fluid which retains in the lungs makes it difficult to breathe, causing coughing and wheezing. Many people suffering from heart failure also experience swollen feet, ankles or abdomen as a result of accumulation of fluid in organs. This is why heart failure is sometimes known as congestive heart failure.


Many people with heart failure are unaware of their condition because some of the most common symptoms of heart failure, such as feeling tired and breathlessness, are often mistaken as normal signs of ageing.

  • Rapid and irregular heartbeat
  • Feeling fatigue
  • Shortness of breath, even during rest
  • Swelling in the feet, ankles or abdomen
  • Sudden weight gain in a few days from fluid retention
  • Persistent cough or wheezing
  • Loss of appetite and feeling nauseated
  • Heart failure can cause permanent damage to the heart, if left untreated. As the heart continues to weaken and loses its ability to pump blood, the symptoms become even more severe.

Heart failure can affect a person's ability to carry out normal daily activities. The damage may even come to a point where medications can no longer provide relief and the only solution left may be a heart transplant.


Heart failure often develops after other medical conditions have damaged or weakened the heart. Such medical conditions include:

  • Coronary artery disease (hardening/narrowing/clogging of heart vessels)
  • Heart attack
  • High blood pressure (hypertension)
  • Faulty heart valves
  • Cardiomyopathy (damage to the heart muscle by a virus or alcohol)
  • Heart defects present at birth
  • Other medical conditions such as diabetes, chronic kidney disease and thyroid disease

Are you at risk?

There are a number of diseases, medical conditions and other factors that can place people at a higher risk for heart failure. Not everyone with these risk factors will develop heart failure. However, the extra pressure these other medical conditions place on the heart may eventually lead to heart failure. The chances of developing heart failure are especially high in people who have more than one of these risk factors:

  • High blood pressure
  • Coronary artery disease
  • Heart attack
  • Irregular heartbeats
  • Diabetes
  • Sleep apnea (inability to breathe properly while sleeping)
  • Congenital heart defects
  • Viral infection
  • Alcohol abuse
  • Kidney condition
  • High cholesterol
  • Smoking
  • Family history of heart failure or other cardiovascular diseases


To diagnose heart failure, your doctor will review your medical history and perform a physical examination. Your doctor will also check the presence of risk factors such as high blood pressure. After conducting the physical examination, your doctor will require you to undergo blood tests and a chest X-ray, followed by an Echocardiogram. Echocardiogram is the most important test which shows what your ejection fraction, or "EF", is. The ejection fraction is a measurement of how well your heart is pumping. People with a healthy heart usually have an ejection fraction of 60% or higher. Most people with heart failure have an ejection fraction of 40% or below.


The keys to managing heart failure are to:

  • Take your medications as prescribed
  • Watch your fluid and salt intake
  • Balance between activity and rest
  • Be aware of signs and symptoms of heart failure
  • Monitor your weight daily
  • Track your medical appointments

Treatments may also include:

  • Treatment for underlying causes, such as coronary artery disease, heart valve disease and high blood pressure.
  • Surgical treatments such as coronary artery bypass surgery, valve surgery, left ventricular reconstruction surgery and heart transplant for patients with severe conditions.
  • Implanted devices such as pacemakers and implantable cardiac defibrillators to control abnormal heart rhythms.
  • Cardiac Resynchronisation Therapy (CRT), a technique in which a special type of pacemaker is implanted to coordinate and synchronise heart muscle contractions.


The best way to prevent heart failure is to make changes in your lifestyle to lower your risk of developing heart disease. It is also important to control certain medical conditions, such as high blood pressure or diabetes, to reduce your chances of developing heart failure. Measures you can take to prevent heart failure are as follows:

  • Quit smoking
  • Control your level of cholesterol
  • Control your blood pressure
  • Control your diabetes
  • Exercise regularly
  • Limit alcohol intake


Find out more information from:

Health Promotion Board
National Healthcare Group
National Heart Centre Singapore
Singapore Heart Foundation
Heart Failure Online


1. When is it suitable for me to go back to work?

Before you decide to head back to work, you should undergo an exercise stress test to assess your capacity for activities. While most patients with heart failure are usually fit to carry out simple task such as lifting and carrying items up to a maximum weight of 5 kilograms, it is advisable to consult your doctor before performing such tasks.

2. When is it ideal for me to engage in physical activities?

Similarly, patients with a history of heart failure should undergo an exercise test to assess their individual exercise capacity. The exercise test will also be able to assess the likelihood of arrhythmias, a heart rate disorder that can be caused by physical activity. Alternatively, patients can consult a cardiac rehabilitation specialist or exercise physiologist for a personalised fitness regimen. It is important to note that patients with an ejection fraction (EF) of less than 35% may be at an increased risk for heart rate disorder or pulmonary congestion.

3. What activities should I avoid?

Patients with heart failure should avoid any physical activities that can cause them to become breathless, feel tired or giddy. In short, patients should avoid strenuous exercises such as swimming, wakeboarding, etc.

4. What foods should I limit?

Patients should try to limit themselves to fresh food such as vegetables and fruits. They should avoid unhealthy food that is oily, high in sodium or processed. Patients should also limit their alcohol consumption to just one drink a day or simply avoid it.

5. How much salt can I take?

A safe amount of sodium or salt depends largely on the severity of the patient's condition. While the recommended amount of sodium is 2400 milligrams, patients who fall under the category of Class III-IV heart failure should limit their sodium intake to less than 2000 milligrams.

6. Is it safe for me to drive?

Patients who experience arrhythmia (heart rate disorder) should avoid driving.

This article is reproduced with the permission from Agency for Integrated Care (AIC) and Singapore Sliver Pages.

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