What to Know About the Different Types of Heart Failure

James Grant, M.D.

| 3 min read

James D. Grant, M.D., is senior vice president and c...

The term, “heart failure” can be confusing to many people and cast an air of immediate doom. Yet, depending on the type, heart failure can be a chronic condition lasting many years.
Heart failure occurs when the heart cannot pump blood as well as it should. When this happens, individuals may experience fatigue, shortness of breath and swelling.

Risk factors for heart failure

Some people are more at risk for developing heart failure, due to family history, other conditions or lifestyle habits. These include:
  • Chronic kidney disease
  • Coronary artery disease
  • Diabetes
  • Excessive alcohol consumption or substance use
  • Heart valve problems
  • High blood pressure
  • Obesity
  • Older age
  • Smoking
Individuals can reduce their chances of developing heart failure by adopting healthy habits and working with their care team on a health plan.

What are the different types of heart failure?

There are several different types of heart failure, each with unique causes and treatments.

Heart failure with reduced ejection fraction (HFrEF)

HFrEF, or systolic heart failure, occurs when the heart's left side has trouble pumping blood. Often, this is due to weakened heart muscles, commonly caused by:
  • Heart attacks
  • Enlarged heart muscles
  • High blood pressure
  • Heart infections
Individuals with HFrEF may experience coughing or wheezing from the buildup of fluid; swelling in the legs and feet; trouble breathing during activity; and fatigue.
Treatment often involves medications to help the heart pump better, such as ACE inhibitors or beta-blockers; devices like pacemakers or defibrillators; and lifestyle changes to reduce salt and add exercise.

Heart failure with preserved ejection fraction (HFpEF)

In HFpEF, or diastolic heart failure, the heart’s pumping ability is normal, but the heart's left side has trouble relaxing and filling with blood. Often, the heart is stiff.
This type of heart failure can be caused by obesity, diabetes, high blood pressure and aging.
Individuals with HFpEF may experience coughing and wheezing; swelling; fatigue; and breathlessness.
Treatment usually involves diuretics to reduce fluid buildup and keeping other issues under control such as blood pressure, diabetes, or irregular heartbeats.

Heart failure with mildly reduced ejection fraction (HFmrEF)

This is a middle category where the heart's pumping ability is slightly reduced. It shares features with both HFrEF and HFpEF and has the same causes and symptoms as HFrEF and HFpEF.
Treatment is often the same as that for HFrEF.

Right-sided heart failure

In right-sided heart failure, the heart’s right side cannot properly pump blood to the lungs, causing blood to back up in the body. Common causes include lung diseases, blood clots in the lungs, and left-sided heart failure.
Individuals with right-sided heart failure may experience abdominal swelling, bulging neck veins, swollen feet and ankles, and a loss of appetite or nausea.
To treat right-sided heart failure, doctors will treat the original cause, and they may use diuretics to remove extra fluid.

Acute vs. chronic heart failure

Acute heart failure is an urgent matter that requires immediate care. It comes on quickly, and is often caused by heart attacks, high blood pressure spikes, or valve issues. Physicians treat acute heart failure with medications to stabilize symptoms.
Chronic Heart Failure develops slowly and lasts a long time. Individuals with chronic heart failure can manage it with ongoing treatment, lifestyle changes, and regular check-ups.
Understanding an individual’s type of heart failure helps to determine the appropriate course of treatment. Medicines, lifestyle changes, and in some cases devices, can improve symptoms.
Individuals with heart failure, or those with symptoms of heart failure, should consult with their physician to determine a diagnosis and treatment plan.
James D. Grant is the executive vice president and chief medical officer of Blue Cross Blue Shield of Michigan. For more health tips, visit BCBSM.MIBlueDaily.com.
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