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Heart failure

What is heart failure?

Heart failure (HF) is a common condition that develops after the heart becomes damaged or weakened by diseases of the heart including heart attacks and other medical conditions. HF occurs when the pumping action of your heart is not strong enough to move blood around, especially during increased activity or under stress. In addition, the heart muscle may not relax properly to accommodate the flow of blood back from the lungs to the heart. These abnormalities in heart function can cause fluid to back up in your lungs and in other parts of your body such as your ankles. The congestion in your lungs and lack of oxygen may make you feel tired and short of breath. Sometimes the fluid in your lungs can accumulate to the point where it can cause a life-threatening condition called acute pulmonary edema, requiring emergency treatment.

Heart failure is on the rise as more people survive heart attacks and other acute heart conditions. As people with damaged hearts are living longer, they become more susceptible to heart failure. It is estimated that there are about 600,000 Canadians living with heart failure.

Heart failure is a serious condition. There is no cure. However, with lifestyle changes and treatment options, you can manage your condition very well. Many patients can lead a full and normal life. Learning about your heart failure is an important first step in managing your condition.

Understanding Heart Failure

What causes heart failure?

Heart failure has many causes or underlying risk factors. The most common is damage to the heart muscle caused by a heart attack (myocardial infarction).

The second most common cause of heart failure is high blood pressure (hypertension). If left undiagnosed and untreated for a long period, hypertension can lead to heart failure. It is important to get your blood pressure checked at least once every two years or more often if your physician recommends you do so.

Less common causes include:

  • Heart valves that are not working properly by being too narrow or leaky (heart valve disease)
  • Infection causing inflammation of the heart muscle (endocarditis or myocarditis)
  • Excessive use of alcohol or drugs
  • Diabetes
  • Being obese or overweight
  • High blood cholesterol
  • Heart muscle disease of unknown causes
  • Other medical conditions such as thyroid diseases or anemia

Last reviewed: September 2015
Last modified: September 2015


When your heart doesn’t pump well and congestion occurs, you may experience some of these symptoms. Contact your doctor or healthcare provider if any of the following occurs:
  • increased shortness of breath, especially when lying flat
  • sudden gain of more than 1.5 kg (3 pounds) over 1 to 2 days, or 2.5 kg (5 pounds) in a single week
  • bloating or feeling full all the time
  • cough or cold symptoms that last for longer than a week
  • tiredness, loss of energy or extreme tiredness
  • loss of or change in appetite
  • increased swelling of the ankles, feet, legs, sacrum (base of the spine) or abdomen (stomach area)
  • increased urination at night

Heart failure zones give you an easy way to see changes in your heart failure symptoms. This chart will tell you when you need to get help. Check every day to see which zone you are in.

Making a Diagnosis of heart failure

Your doctor will take your medical history, examine you and have you take some tests to determine if you have heart failure and how it should be treated and managed. Doctors may use several tests and procedures such as:
Blood test and BNP (Brain natriuretic peptide) test
Electrocardiogram (ECG)
Chest X-ray
Stress test
Coronary angiogram

You many need to have other tests, too. Make sure you ask what each involves, what it is for when you will get the results.



Last reviewed: September 2015
Last modified: September 2015

Treatment for heart failure

Your doctor and healthcare team may recommend medication or surgery and may suggest lifestyle changes such as healthy eating and physical activity. This may include a recommendation to consume at least 1g of Omega 3 daily.


You may need to take a combination of medications including one or more of these:

Here are some tips for taking your medications properly: 

  • Take your medications regularly.
  • If you experience side effects, do not stop or change your dosages without speaking to your specialists or family doctor first.
  • Do not take any over-the-counter anti-inflammatory medications (such as ibuprofen or naproxen); speak with your pharmacists and doctor before taking any other over-the-counter medications such as vitamins, natural health products or herbal remedies.  

Surgery and device therapy

Depending on the severity and nature of your heart failure, your doctor may also recommend surgery or device therapy to treat your condition. People with heart failure may be considered for:  

  • Cardiac resynchronization therapy (CRT)
  • Bi-ventricular pacing (special pacemaker that paces both the left and right-sided chambers of the heart)
  • Implantable cardioverter defibrillator (ICD)
  • Left ventricular assist device 
  • Heart transplantation

If you also have blocked coronary arteries, you might also be a candidate for:

Read more about surgery and other procedures.



Last reviewed: September 2015
Last modified: September 2015

Managing your heart failure

Currently there is no cure for heart failure but early diagnosis, lifestyle changes and appropriate drug treatments can help you lead a normal and active life, stay out of hospital and live longer.

Use Heart Failure Zones to recognize and understand the symptoms of heart failure and determine the best response to stay in balance.

Here are important steps you need to take to help manage your heart failure:

  • Take your medications regularly as instructed by your healthcare provider. Use this medication chart to keep you on track.
  • Weigh yourself daily in the morning (after going to the bathroom but before breakfast) and keep a written record of your weight. If you gain or lose 2 kg (4 lb) or more in 2 days or 2.5 kg (5 lbs) or more in a week, contact your heart failure clinic or family doctor.
  • Drink no more than 1.5 to 2 litres (6 to 8 regular glasses) of fluids per day. This includes all beverages such as coffee, tea, water, juice, and milk as well as soups. At least half of your daily fluid intake should be water. Your healthcare provider may ask you to adjust your fluid intake depending on your body’s blood sodium levels.  Learn more about heart failure and fluid restriction
  • Eat less than 2,000 mg of salt (sodium) per day from all foods (read food labels, watch out for sources of sodium in prepared foods). If you have been also diagnosed with high blood pressure (hypertension), reduce your sodium intake to 1,500 mg or less a day. Speak with your healthcare provider about the right sodium level for you.  Read more about sodium restriction.
  • Become more physically active to help strengthen your heart and improve blood flow. Be sure to discuss your physical activity with your healthcare team before starting any program or new routine. Engage in activities such as walking at your own pace. Increase your levels of activity a small amount each day.  Read more about why people with heart failure should keep active.
  • Exercise is a planned physical activity.  All types of exercise involve increasing the heart rate and strengthening muscles.  Read more about why people with heart failure should exercise.
  • Get plenty of sleep and manage your stress levels. Identify any sources of stress so you can take steps to address the problem with your healthcare team.
  • Eat a healthy diet based on Canada’s Food Guide by choosing plenty of vegetables and fruit, eating whole grains frequently, choosing low-fat meats and alternatives prepared with little sodium or added fat, as well as low fat milk and alternatives (such as soy milk). Read more about Healthy Eating.
  • Eat plenty of fibre. Because of the restricted fluid levels and some medications you may be prescribed (such as diuretics), you may experience constipation, which may cause strain on your heart. 
  • Reduce your alcohol intake to no more than one drink per day (this is equal to a 150 mL / 5 oz. glass of wine, 350 mL / 10 oz. beer or one 50 mL / 1 ½ oz  spirits or mixed drink). In some types of heart failure cases, alcohol must be totally avoided. Speak to your physician if this applies to you. Alcohol may interfere with medications, increase blood pressure or affect your heart, so it is important to speak with your doctor about this issue.
  • Decrease or avoid caffeine consumption to prevent increased heart rates or abnormal heart rhythms.
  • Become smoke-free. Smoking greatly increases your risk for heart attack and worsens heart failure.  For more information on how to quit, call Canadian Cancer Society’s Smokers' Helpline at 1-877-513-5333 or visit the Smokers’ Helpline Online program.   You can also call Health Canada’s 1-800 Quit Lines or visit the Health Canada and search “quit smoking”.
  • It is recommended that patients with heart failure have their flu shots once a year and pneumococcal vaccine once in their lifetime.




Last reviewed: September 2015
Last modified: September 2015

Palliative care

Some people living with heart failure can benefit from end-of-life care (also called palliative care). It can comfort you and your family. Learn more about end-of-life care.

If you want to get more information about end-of-life care, talk to your healthcare providers. You can also visit Public Health Agency of Canada and Health Canada. The Canadian Hospice Palliative Care Association has a directory of end-of-life care services across the country and a caregiver resource list. The Canadian Virtual Hospice has an Ask an Expert Service and a discussion forum where you can talk to end-of-life specialists and people interested in palliative care.

The PREPARE website helps you make medical decisions that reflect your values and effectively communicate your wishes to others. has a starter kit to help you and your family talk about your wishes for end-of-life.


Last reviewed: September 2015
Last modified: September 2015