Understanding Types of Heart Failure

Introduction

Heart failure (HF) is a chronic condition where the heart is unable to pump blood effectively. It is a serious medical condition that can affect quality of life and requires proper treatment. Understanding different types of heart failure helps in determining the right course of treatment.

Classification of Heart Failure

Heart failure is classified based on the affected part of the heart and its function.

1. Heart Failure with Reduced Ejection Fraction (HFrEF)

• Also known as systolic heart failure.
• The heart muscle becomes weak and cannot pump blood effectively.
• Ejection fraction (EF) is reduced to ≤40%.
• Common causes: Coronary artery disease, heart attacks, high blood pressure, and myocarditis.
• Symptoms: Shortness of breath, fatigue, fluid retention, swelling in the legs.

2. Heart Failure with Preserved Ejection Fraction (HFpEF)

• Also called diastolic heart failure.
• The heart muscle remains strong but becomes stiff, making it difficult for the heart to fill with blood properly.
• Ejection fraction remains normal (≥50%), but the heart does not relax well between beats.
• Common causes: Hypertension, obesity, diabetes, and aging.
• Symptoms: Similar to HFrEF – breathlessness, fatigue, and fluid retention.

3. Heart Failure with Mildly Reduced Ejection Fraction (HFmrEF)

• A newer category for patients with an ejection fraction between 41-49%.
• Considered an intermediate group between HFrEF and HFpEF.
• Risk factors and symptoms are similar to the other two types.

Classification by Affected Side

Heart failure can also be classified based on whether the left side or right side of the heart is affected.

1. Left-sided Heart Failure

• The most common type.
• Fluid builds up in the lungs, leading to pulmonary congestion.
• Symptoms: Shortness of breath (especially when lying down), persistent cough, and wheezing.

2. Right-sided Heart Failure

• Often caused by left-sided heart failure.
• Fluid builds up in the body, causing swelling in the lower limbs and abdomen.
• Symptoms: Swollen legs, ascites (fluid in the abdomen), liver congestion.

Stages of Heart Failure (ACC/AHA Stages)

Heart failure is also categorized by severity: 1. Stage A – High risk but no symptoms. 2. Stage B – Structural heart disease but no symptoms. 3. Stage C – Symptoms of heart failure present. 4. Stage D – Severe symptoms, requiring advanced treatments (e.g., heart transplant).

Conclusion

Different types of heart failure require tailored treatment approaches. Recognizing symptoms early and seeking appropriate medical care can improve outcomes and quality of life.

Source recommendations

1. American Heart Association Guidelines on Heart Failure

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063
2. https://www.heart.org/en/health-topics/heart-failure
3. https://professional.heart.org/en/guidelines-and-statements
4. https://www.heart.org/en/professional/quality-improvement/get-with-the-guidelines/get-with-the-guidelines-heart-failure
5. https://professional.heart.org/en/science-news/-/media/832EA0F4E73948848612F228F7FA2D35.ashx

2. European Society of Cardiology Guidelines on Heart Failure

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure
2. https://academic.oup.com/eurheartj/article/42/36/3599/6358045
3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Focused-Update-on-Heart-Failure-Guidelines
4. https://academic.oup.com/eurheartj/article/44/37/3627/7246292
5. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines