You may not have any symptoms of heart failure, or the symptoms may be mild to severe. Symptoms can be constant, or can come and go. Symptoms are due to the changes that occur in your heart and body and include:

• Shortness of breath or difficulty breathing with exercise, at rest, or when lying flat in bed. Shortness of breath occurs when fluid backs up into the lungs (congestion) or when your body does not have enough oxygen-rich blood to let you go on with your activity or exercise without a rest period. Even though you think of breathing as a lung problem, your heart condition can cause periods of shortness of breath. In some cases, symptoms may cause you to wake up suddenly at night, disrupting your normal sleep patterns.
• A dry, hacking cough or wheezing
• Swollen ankles, legs and abdomen, and weight gain. Less blood to the kidneys causes you to retain fluid and water, resulting in edema (swelling) and water weight gain.
• Need to urinate while resting at night. Gravity causes more blood to get to the kidneys when you are lying down.
• Tiredness (fatigue) and weakness during exercise or activities occur because the heart is not pumping enough oxygen-rich blood to major organs and muscles.
• Dizziness, confusion, difficulty concentrating or fainting may occur because the heart is not pumping enough oxygen-rich blood to the brain.
• Rapid or irregular heartbeats (palpitations): When the heart muscle does not pump well, the heartbeat speeds up to help the heart get enough oxygen-rich blood to major organs and muscles, or the heartbeat may become abnormal.
• Other symptoms include a feeling of fullness (bloating) in your stomach, loss of appetite or nausea.
• If you have heart failure, you may have one or all of these symptoms. Sometimes, people with heart failure do not have any symptoms.

Systolic left ventricular dysfunction (or systolic heart failure) occurs when the muscle in the heart’s left ventricle doesn’t contract with enough force, so less oxygen-rich blood is pumped throughout the body.

Heart failure with preserved left ventricular function (diastolic heart failure) occurs when the heart contracts normally, but the ventricles do not relax properly or are stiff, and less blood enters the heart during normal filling.

Your ejection fraction (EF) is used to measure how well your heart pumps with each beat to determine the level of systolic dysfunction. Data obtained on an echocardiogram can tell us if you have heart failure with diastolic dysfunction.

Left ventricular ejection fraction (LVEF) is the measurement of how much blood is being pumped out of the left ventricle of the heart (the main pumping chamber) with each contraction. 

Right ventricular ejection fraction (RVEF) is the measurement of how much blood is being pumped out of the right side of the heart to the lungs for oxygen. In most cases, the term "ejection fraction" refers to LVEF.
  Ejection fraction is usually expressed as a percentage. A normal heart pumps a little more than half the heart’s blood volume with each beat.

A normal LVEF ranges from 55% to 70%. An LVEF of 65, for example, means that 65% of the total amount of blood in the left ventricle is pumped out with each heartbeat.
The LVEF may be lower when the heart muscle has become damaged due to a heart attack, heart muscle disease (cardiomyopathy) or other causes.

A reduced EF may confirm a diagnosis of systolic heart failure. In diastolic failure, the EF is normal, since the heart pumps normally. Often, the heart is also enlarged. An EF of less than 35% increases the risk of life-threatening irregular heartbeats that can cause sudden cardiac arrest (loss of heart function) and sudden cardiac death. An implantable cardioverter defibrillator (ICD) may be recommended.

Patients who develop severe, advanced heart failure may benefit from special treatments, such as cardiac transplantation or a ventricular assist device (VAD). If your quality of life is very poor or your doctor has told you that your condition is very severe, please ask about other treatments.
Your EF can go up and down, based on your heart condition and the therapies that have been prescribed.
  Your EF can be measured in your doctor’s office during tests such as:

• Ultrasound of the heart (echocardiography)
• Magnetic resonance imaging (MRI) scan of the heart
• Nuclear medicine scan (multiple gated acquisition [MUGA]) of the heart; also called a nuclear stress test

If you have a heart condition, it is important for you and your doctor to know your EF. Your EF can help your doctor determine the best course of treatment for you and the effectiveness of the therapies that have been prescribed.

You should have your EF measured when you are first diagnosed with a heart condition, and again as needed, based on changes in your condition. Ask your doctor how often you should have your EF checked.
  Heart failure is caused by many things that damage the heart muscle, including:

• Coronary artery disease (also called coronary atherosclerosis) — a disease of the arteries that supply blood and oxygen to the heart. Coronary artery disease occurs when the normal lining of the arteries breaks down, the walls of the arteries thicken, and deposits of fat and plaque block the flow of blood through the arteries. The arteries that supply blood to the heart become very narrowed and the heart can no longer respond to increased activity. Extra strain on the heart may result in chest pain (angina pectoris) and other symptoms of heart disease.
• Heart attack — occurs when a coronary artery becomes blocked, stopping the flow of blood to the heart muscle and damaging it. All or part of the heart muscle becomes cut off from its supply of oxygen. A heart attack can damage the heart muscle, resulting in a scarred area which does not function.
• Cardiomyopathy — damage to the heart muscle from causes other than artery or blood flow problems. Causes include viruses, alcohol or drug abuse and genetics.
• Heart defects present at birth
• Diabetes
• High blood pressure (hypertension) —Blood pressure is the force of blood pushing against blood vessel walls. High blood pressure means the pressure in the arteries is above the normal range.
• Arrhythmia (abnormal heart rhythms)
• Kidney disease
• Obesity (being overweight)
• Medications — some chemotherapy agents

Heart failure often occurs when several diseases or conditions are present at once
  Together, you and your doctor or nurse will discuss your treatment options. Your doctor or nurse will determine which treatment methods are right for you. More information about heart failure treatments and management is included later in this notebook.
  Heart failure management is a team effort, and you are the key player on the team.
Your heart doctor or nurse will prescribe your medications and manage other medical problems. Other team members, including nurses, dietitians, pharmacists, exercise specialists and social workers, will help you achieve success. Most important, it is up to YOU to take your medications, make dietary changes, live a healthy lifestyle, keep your follow-up appointments and be an active member of the team.