Heart failure does not mean the heart has stopped. It means the heart is not pumping efficiently enough to meet the body’s needs. Let’s look at the causes, symptoms, diagnosis, medicines, device treatments, diet, and lifestyle changes that help patients manage heart failure and live well.
Heart failure affects approximately 8-10 million people in India, making it one of the most common reasons for hospitalisations in adults over 60. Despite its name, heart failure is not a sudden event like a cardiac arrest. It is a chronic condition in which the heart gradually loses its ability to pump blood efficiently.
The good news is that with the right treatment, diet, and lifestyle changes, most patients with heart failures can live full and active lives. This guide explains everything a patient and their family needs to know.
What Is Heart Failure?
Heart failure occurs when the heart muscle is too weak or too stiff to pump the blood the body needs. The kidneys respond by retaining fluid, and this builds up in the lungs, legs, and abdomen. This is why congestive heart failure is sometimes used to describe the condition.
Types of Heart Failures
Doctors classify heart failures by the ejection fraction, which is the percentage of blood the heart pumps out with each beat. A normal ejection fraction is above 55 percent.
• HFrEF (Heart Failure with Reduced Ejection Fraction): The heart muscle is weakened and pumps less than 40 percent of blood out per beat. This is the most common type and responds well to medicines.
• HFpEF (Heart Failure with Preserved Ejection Fraction): The heart muscle is stiff and does not relax properly even though the ejection fraction appears normal. This is more common in older patients and those with diabetes or high blood pressure.
Left-Sided, Right-Sided, and Congestive Heart Failure
• Left-sided heart failure: Causes breathlessness and fluid in the lungs because the left ventricle cannot pump blood to the body efficiently.
• Right-sided heart failure: Causes swelling in the legs, ankles, and abdomen because the right ventricle cannot pump blood to the lungs efficiently.
• Congestive heart failure: Refers to fluid buildup affecting both sides, and is the most advanced and most commonly-discussed form.
Symptoms of Heart Failure
Recognising heart failure symptoms early leads to faster treatment and better outcomes. Symptoms tend to worsen gradually and may be mistaken for ageing or poor fitness.
Common Symptoms
• Breathlessness on exertion or when lying flat at night
• Swollen ankles, legs, or abdomen due to fluid retention
• Persistent fatigue and weakness, even with minimal activity
• Rapid or irregular heartbeat, sometimes felt as palpitations
• Persistent dry cough, particularly at night
• Reduced ability to exercise or climb stairs compared to before
Warning Signs That Need Emergency Care
Go to the emergency department immediately if any of the following occur:
• Sudden severe breathlessness or inability to breathe lying down
• Coughing up pink or frothy sputum
• Chest pain combined with breathlessness
• Sudden weight gain of more than 2 kg in 24 hours, which indicates acute fluid retention
• Fainting or loss of consciousness
How Is Heart Failure Diagnosed?
Diagnosis of heart failure combines clinical assessment with investigations that measure the heart’s structure, electrical activity, and blood markers. The key tests are:
| Test | What It Measures | Why It Matters |
| 2D Echocardiogram | Ejection fraction, heart wall motion, valve function | The most important test — determines type and severity of heart failure |
| ECG | Electrical activity of the heart | Identifies arrhythmias, previous heart attack, and heart muscle strain |
| Chest X-ray | Heart size, fluid in the lungs | Confirms fluid congestion and enlargement |
| BNP or NT-proBNP blood test | Hormone released by stressed heart muscle | Elevated levels confirm heart failure and guide treatment intensity |
The 2D echocardiogram is the cornerstone of heart failure diagnosis. If you are referred for cardiac testing, understanding the difference between an echo test and an ECG helps you know what each test is measuring and why both are needed.
Regular monitoring of ejection fraction and BNP levels is essential for adjusting treatment over time. Many patients with heart failure require a repeat echo every 6 months to 1 year to track their response to treatment.
Medicines for Heart Failure: Guideline-Directed Medical Therapy
Guideline-Directed Medical Therapy, or GDMT, refers to the combination of four evidence-based drug classes that are proven to reduce hospitalisations, improve the quality of life, and extend survival in heart failure treatment. Together, these four pillars reduce the risk of hospitalisation by up to 40 percent when used consistently.
| Drug Class | How It Helps | Common Examples |
| ACE inhibitors or ARBs or ARNIs | Relax blood vessels and reduce the heart’s workload | Enalapril, Ramipril, Sacubitril-Valsartan |
| Beta-blockers | Slow the heart rate and reduce strain on the heart muscle | Carvedilol, Bisoprolol, Metoprolol |
| Mineralocorticoid Receptor Antagonists (MRA) | Reduce fluid retention and prevent heart muscle scarring | Spironolactone, Eplerenone |
| SGLT-2 Inhibitors | Originally a diabetes drug, now proven to reduce heart failure hospitalisations and deaths | Dapagliflozin, Empagliflozin |
In addition to the four pillars, diuretics such as furosemide are prescribed to relieve fluid overload. They reduce breathlessness and swelling quickly but do not improve long-term survival on their own. They are an add-on to GDMT, not a replacement for it.
Stopping or skipping these medicines is one of the most common triggers for acute heart failure hospitalisation. Even when patients feel well, the medicines are working to prevent deterioration.
Device-Based Treatment for Heart Failure
For patients whose heart failure remains severe despite optimal medical therapy, cardiac resynchronisation therapy and implantable defibrillators offer additional protection and improvement in heart function.
Cardiac Resynchronisation Therapy (CRT)
In some patients with heart failure, the left and right ventricles beat out of sync with each other, wasting energy and reducing the heart’s pumping efficiency. CRT uses a special pacemaker with leads placed in both ventricles to coordinate their contraction. Patients eligible for CRT typically have a low ejection fraction (below 35 percent) and an abnormal ECG pattern called left bundle branch block.
CRT significantly improves symptoms, exercise capacity, and survival in suitable patients. It can even reverse some of the structural changes in the heart over time. Learn more about permanent pacemaker therapy and how device-based treatments are implanted.
ICD and AICD (Implantable Cardioverter Defibrillator)
Patients with severely reduced ejection fraction are at higher risk of sudden cardiac death from dangerous arrhythmias. An ICD monitors the heart rhythm continuously and delivers an electric shock to restore normal rhythm if a life-threatening arrhythmia is detected. The device works automatically, without requiring the patient to do anything.
An ICD is recommended for patients with an ejection fraction below 35 per cent who remain at high risk despite three months of optimal medical therapy. Some devices combine CRT and ICD functions in a single device called a CRT-D.
Diet and Nutrition for Heart Failure Patients
Diet plays a critical role in heart failure management in India. The wrong foods cause fluid retention and trigger hospitalisations. The right diet keeps the heart stable and reduces symptom burden significantly..
What to Restrict
• Salt: Limit sodium intake to under 2 grammes per day. Read food labels, as most processed foods contain hidden sodium.
• Fluid: in advanced heart failure, doctors may recommend limiting total fluid intake to 1.5 to 2 litres per day to prevent fluid overload.
• Alcohol: alcohol weakens the heart muscle over time and worsens heart failure in most patients.
Foods to Avoid
• Pickles, papads, and chutneys, which are very high in sodium
• Processed meats, canned foods, and instant noodles
• Namkeen, salted chips, and packaged snacks
• Excess dairy and full-fat products
Heart-Healthy Indian Foods
A heart-healthy diet plan for heart failure patients should emphasise:
• Daliya (broken wheat) and oats for fibre and slow-release energy
• Leafy green vegetables such as spinach, methi, and palak
• Fish such as rohu or surmai, which are rich in omega-3 fatty acids
• Fruits such as apples, pears, and guavas, which are low in sodium and high in potassium
• Pulses and lentils in moderate quantities for protein without excess fluid load
Daily Weighing
Patients with heart failure should weigh themselves every morning before eating, after using the bathroom. A weight gain of more than 1 kg to 2 kgs over 24 hours to 48 hours indicates fluid retention and requires immediate contact with the treating cardiologist. For a broader guide on best foods for heart health, including specific recipes suitable for Indian households, see the dedicated nutrition blog.
Exercise and Lifestyle for Heart Failure Patients
Contrary to what many patients believe, complete rest is not recommended for heart failure. Supervised exercise through cardiac rehabilitation is one of the most effective non-drug treatments for improving the quality of life and reducing hospitalisation risk.
Safe Exercises
The following exercises are generally safe for stable heart failure patients, subject to clearance from a cardiologist:
• Brisk walking for 20 minutes to 30 minutes, 5 days a week, at a pace that allows conversation
• Light yoga and stretching, focusing on breathing and gentle movement rather than intense postures
• Breathing exercises and pranayama to strengthen respiratory muscles and improve oxygen efficiency
What to Avoid
• Heavy lifting or resistance exercise without specific medical clearance
• Exercise in extreme heat or humidity, which increases cardiac strain
• Strenuous activity without warming up or during any period of worsening symptoms
Lifestyle Changes
Alongside exercise, the following lifestyle changes are essential for managing heart failure in the long term:
• Stop smoking completely: Smoking accelerates heart muscle damage and worsens symptoms
• Limit or eliminate alcohol: Even moderate consumption can worsen heart function in most patients
• Prioritise sleep: 7 to 8 hours of good quality sleep reduces cardiac stress
• Manage stress Through relaxation techniques, meditation, or counselling, as chronic stress raises blood pressure and worsens heart failure
For specific guidance on which exercises are best for the heart at different stages of recovery, the exercise guide covers safe activity levels, from rehabilitation through return to normal life.
Living With Heart Failure
A diagnosis of heart failure is not a death sentence. Millions of patients worldwide live full, meaningful lives with this condition. The key is consistent management, regular monitoring, and acting quickly when symptoms change.
Self-Monitoring at Home
• Weigh yourself every morning and contact your doctor if weight rises by more than 1 kg overnight or 2 kg in 48 hours
• Monitor for increasing breathlessness, especially when lying flat or climbing stairs
• Watch for ankle swelling that is worse than your usual baseline
• Keep a daily symptom diary to share at each outpatient appointment
When to Go to the Emergency Department
• Sudden severe breathlessness that does not improve with rest
• Chest pain or pressure
• Fainting or near-fainting
• Rapid weight gain of more than 2 kg in 24 hours
• Coughing up frothy or blood-tinged sputum
Regular outpatient follow-up every 3 months to 6 months is essential for adjusting the medication doses and monitoring the heart function. Patients who stay consistently engaged with their cardiology team have significantly lower rates of hospitalisation and better long-term outcomes than those who attend only when symptoms worsen.
Frequently Asked Questions
Can heart failure be cured?
In some cases, yes. When heart failure is caused by a reversible condition such as a viral infection, thyroid disease, or alcohol use, treating the underlying cause can restore normal heart function. However, in most patients with heart failure treatment, the goal is long-term management rather than cure, and many patients achieve excellent quality of life with the right medicines and lifestyle changes.
How long can a person live with heart failure?
Survival with heart failure has improved dramatically over the past 20 years due to GDMT, device therapy, and better monitoring. Many patients with optimally treated heart failure live for 10 or more years after diagnosis. The key predictors of outcome are how early treatment is started, how consistently medicines are taken, and whether complications such as arrhythmias are identified and managed early.
Is heart failure the same as a heart attack?
No. A heart attack is a sudden event caused by a blocked artery cutting off blood supply to the heart muscle. Heart failure is a chronic condition in which the heart’s pumping capacity has been reduced over time. A heart attack can cause heart failure if it damages enough heart muscle, but heart failure has many other causes as well.
Can heart failure get better with treatment?
Yes, significantly. Many patients see meaningful improvement in ejection fraction and symptoms within 3 months to 6 months of starting GDMT. Some achieve near-normal ejection fraction with consistent treatment. Cardiac resynchronisation therapy can further reverse structural changes in the heart in appropriate patients.
What is the most important thing to avoid with heart failure?
Salt is the most critical dietary restriction for heart failure patients. Excess sodium causes fluid retention, which worsens breathlessness and swelling and is one of the most common triggers for acute hospitalisation. Skipping prescribed medicines is equally dangerous. Both can be avoided with patient education, consistent follow-up, and daily self-monitoring at home.
Riverside B&J Hospital’s heart failure clinic offers comprehensive management, including GDMT, CRT, and ICD therapy. Our cardiologists specialise in advanced heart failure care in Mumbai.
