Systolic heart failure might sound complicated, but let’s break it down into simple terms. It means your heart isn’t pumping blood as strongly as it should, which can affect how well oxygen and nutrients get around your body. Over time, this can lead to feeling tired, having trouble breathing, and other issues.
Let’s dive into what it means and how it’s treated.
What Is Systolic Heart Failure?
Your heart is a pump. It squeezes (contracts) to send blood around your body. In systolic heart failure, the left side of the heart gets weak, and it can’t squeeze enough blood out with each beat. This leads to a condition called reduced ejection fraction, meaning less blood is pumped out each time.
You might also hear it called heart failure with reduced ejection fraction (HFrEF).
What Causes It?
A few things can weaken the heart over time, including:
- Heart attacks, which damage the heart muscle
- High blood pressure, making the heart work harder
- Heart valve problems
- Long-term alcohol use
- Certain viral infections
- Genetic heart conditions
Common Symptoms
Systolic heart failure often develops slowly, and symptoms can change as the condition progresses. Some of the most common signs include:
- Shortness of breath – You might feel winded during exercise or even when lying down.
- Feeling tired or weak – You may find you’re more easily fatigued, even without much physical activity.
- Swelling in the legs, ankles, or feet – Fluid builds up in your body, causing puffiness or swelling.
- Coughing or wheezing – Especially at night, it might be harder to breathe.
- Fast or irregular heartbeat – You may feel your heart racing or skipping beats.
- Weight gain – Sudden weight increase, often due to fluid retention.
- Trouble with exercise or walking – It might get harder to keep up with normal physical activity.
These symptoms happen because your heart isn’t pumping blood as well as it should be, which puts strain on your body.
What Does a Doctor Look For?
If you visit your doctor with symptoms like these, they’ll ask about your health history and do a physical exam. Some signs they might notice include:
- An increased heart rate or low blood pressure
- Crackles in the lungs, which can happen when fluid backs up into the lungs
- Swelling in your legs and ankles, known as oedema
- Enlarged neck veins due to pressure in the chest
- An enlarged liver or cold hands and feet because of poor circulation
- A shifted heartbeat (called a displaced apex beat) if the heart has gotten bigger
How Is It Diagnosed?
To figure out if you have systolic heart failure, your doctor may recommend a few tests:
- Echocardiogram – An ultrasound of your heart to see how well it’s pumping.
- ECG (electrocardiogram) – A test to check your heart rhythm.
- Blood tests – To check for markers like BNP, which go up when the heart is under strain.
- Chest X-ray – To see if there’s any fluid in the lungs or signs that your heart is enlarged.
Treatment Options
While there’s no cure for systolic heart failure, it can be managed with treatment. The goal is to help the heart pump more effectively, reduce symptoms, and avoid emergencies like hospital stays.
1. Lifestyle Changes
A few simple habits can make a big difference in how you feel:
- Cut down on salt to help reduce swelling and fluid retention.
- Stay active with gentle, regular exercise to keep your heart healthy.
- If you smoke, quit – and limit alcohol intake.
- Weigh yourself daily to keep track of sudden changes, which could signal fluid build-up.
2. Medications
Your doctor will likely prescribe a combination of medicines to help your heart work better. Here are some of the main ones:
- ACE inhibitors – like ramipril, which help relax blood vessels and reduce strain on the heart.
- ARBs – such as losartan, which work similarly if you can’t tolerate ACE inhibitors.
- Entresto (sacubitril/valsartan) – a newer option that combines two medications to help your heart pump better. It’s been shown to reduce hospital visits and even improve survival.
- Beta blockers – like bisoprolol, which help slow your heart rate and improve heart function over time.
- Diuretics – such as furosemide, which help get rid of extra fluid and reduce swelling.
- Mineralocorticoid receptor antagonists – like spironolactone, which help control fluid build-up and protect the heart.
- SGLT2 inhibitors – like dapagliflozin, originally used for diabetes but now proven to help heart failure patients, even if you don’t have diabetes. If you get sick—especially with vomiting, diarrhoea, or a fever—you might need to stop this medication temporarily, as dehydration or a rare issue called ketoacidosis can happen. Your doctor will guide you on when to pause and restart it safely (this is called sick day rules).
These medications work together to help manage symptoms and lower the risk of complications.
3. Devices and Procedures
In some cases, devices or procedures might be needed to support the heart, such as:
- Pacemakers – to fix slow or irregular heart rhythms.
- ICDs (Implantable Cardioverter Defibrillators) – devices that prevent dangerous rhythms.
- CRT (Cardiac Resynchronisation Therapy) – a special type of pacemaker that helps the heart beat in sync.
What’s the Outlook?
With the right treatment, many people with systolic heart failure can still live a full and active life. The key is catching it early, sticking to your treatment plan, and keeping an eye out for any changes. Think of it like taking care of a car—regular maintenance keeps it running smoothly for longer.
When to See a Doctor
Don’t ignore symptoms like shortness of breath, swelling in your legs, or constant fatigue. These can be signs your heart needs some help. The sooner heart failure is detected, the better it can be managed.
Worried about your heart?
At OneMedicine, we offer same-day appointments, personalised heart assessments, and expert care designed around you. Whether you need a check-up or a second opinion, we’re here to support you.
