Heart failure

What is heart failure?

Heart failure does not mean the heart has stopped. It means the heart cannot pump enough blood to meet the body's needs, or cannot fill properly between beats. This can lead to reduced blood flow to tissues and a build-up of fluid, particularly in the lungs, legs, and abdomen.

There are two main forms:

• Heart failure with reduced ejection fraction (HFrEF) occurs when the heart muscle is weakened and cannot contract with enough force to pump blood out effectively. It is commonly associated with conditions such as coronary artery disease or a previous heart attack.

• Heart failure with preserved ejection fraction (HFpEF) occurs when the heart muscle becomes stiff and cannot relax properly between beats, impairing filling rather than pumping. This form is increasingly common, particularly in older adults, women, and people with diabetes or high blood pressure.

Both forms cause the same debilitating symptoms and carry significant long-term risk if unmanaged.

Symptoms of heart failure

Heart failure can cause symptoms related to reduced cardiac output and fluid build-up. Symptoms vary between people and may overlap with those of other heart and lung conditions. Common signs include:

• Breathlessness during activity, or when lying flat at night

• Persistent fatigue and reduced exercise tolerance

• Swelling in the ankles, feet, or legs from fluid buildup

• A persistent cough or wheeze, sometimes with frothy or pink-tinged mucus

• Rapid or irregular heartbeat

• Reduced ability to concentrate or think clearly

• Feeling full quickly or losing appetite

• Needing to urinate more frequently at night

Symptoms often develop gradually and can initially be mistaken for ageing, reduced fitness, or other health problems before becoming severe enough to prompt medical attention.

What causes heart failure?

Heart failure develops when the heart is damaged or placed under sustained stress it cannot adapt to. Common contributing causes include:

• Coronary artery disease is the most common cause. Reduced blood supply to the heart muscle causes damage that weakens its pumping ability over time.

• High blood pressure forces the heart to work harder with every beat. Over years, this causes the muscle to thicken and stiffen, impairing both pumping and relaxation.

• Diabetes directly damages the heart muscle and accelerates coronary artery disease, contributing to both forms of heart failure.

• Cardiomyopathy is a disease of the heart muscle itself, caused by genetic factors, viral infection, alcohol, or other conditions.

• Valvular heart disease places extra mechanical load on the heart, causing progressive dilation or hypertrophy.

• Atrial fibrillation causes irregular, rapid heart contractions that, over time, weaken the heart muscle.

• Obesity and metabolic syndrome increase cardiac workload and promote systemic inflammation that accelerates myocardial damage.

• Thyroid dysfunction both hypo and hyperthyroidism directly affect heart muscle function and output.

How is heart failure detected?

Heart failure is detected through a combination of cardiac imaging and blood tests that assess cardiac stress and the underlying conditions driving it.

Cardiac MRI Elfcare's full body MRI includes the thorax, where the heart is directly imaged. It can identify chamber enlargement, wall thickening, and structural changes consistent with heart failure.

Blood tests Elfcare's panel includes the key markers of cardiac stress and metabolic risk:

• NT-proBNP is the most important blood marker for heart failure. It is released by the heart when it is under pressure or working harder than normal. Elevated levels are a strong signal of cardiac stress and reduced pump function, often detectable before significant symptoms develop.

• Troponin reflects heart muscle cell damage. It is not in Elfcare's standard panel but is arranged through follow-up assessment when cardiac injury is suspected.

• HbA1c and glucose assess blood sugar control, a major driver of heart failure risk and progression.

• Total cholesterol, LDL, and triglycerides assess cardiovascular risk from atherosclerosis, the most common underlying cause.

• TSH, Free T3, and Free T4 assess thyroid function, which directly affects heart rate, rhythm, and muscle performance.

• CRP reflects systemic inflammation, which accelerates myocardial damage and contributes to heart failure progression.

• Creatinine, cystatin C, and eGFR assess kidney function. Heart failure and kidney disease frequently coexist and worsen each other, and kidney function guides medication choices.

• Sodium and potassium are critical electrolytes for heart muscle function. Imbalances affect heart rhythm and are closely monitored in heart failure management.

• Ferritin and iron assess for iron deficiency, which is present in up to 50% of heart failure patients and independently worsens outcomes.

Body composition analysis (AMRA) Elfcare's AMRA body composition analysis measures visceral fat and muscle mass with clinical precision. Excess visceral fat is a direct driver of the metabolic conditions most closely linked to heart failure, and low muscle mass is an independent predictor of poor outcomes in established disease.

Why early detection matters

Heart failure is progressive. Once the heart begins to remodel in response to sustained stress, those structural changes become harder to reverse. But at the earliest stages, when NT-proBNP is rising and symptoms are mild, the right treatment can halt progression, restore function, and dramatically reduce the risk of hospitalisation and death. Modern heart failure medications have transformed outcomes for people diagnosed early. Identifying cardiac stress before it becomes established heart failure is one of the most impactful things a comprehensive health check can do.

How Elfcare can help

Elfcare's blood panel includes NT-proBNP as standard, alongside a full cardiovascular risk profile covering lipids, HbA1c, thyroid function, kidney function, electrolytes, and iron. NT-proBNP is the most clinically meaningful blood marker for heart failure and is detectable before significant symptoms develop.

Our thoracic MRI images the heart directly, identifying structural changes that warrant further assessment. Our AMRA body composition analysis quantifies the metabolic risk factors most closely linked to heart failure development.

If our blood tests or MRI identify a suspicious finding, we take care of further diagnostics or refer you to the appropriate specialist.