What Is Heart Failure and Is It the Same as a Heart Attack?
No, heart failure is not the same as a heart attack. A heart attack is a sudden emergency where blood flow to part of the heart muscle is blocked, usually by a clot in a coronary artery. Heart failure is a long-term condition where the heart cannot pump blood around the body as well as it should. The two are linked, because a heart attack is one of the main causes of heart failure, but many people with heart failure have never had a heart attack.
The name causes a lot of unnecessary fear. Heart failure does not mean the heart has stopped or is about to stop. It means the heart needs support, and with the right treatment many people live with it for years. This guide explains how the two conditions differ, how they are connected, the symptoms of each and how heart failure is diagnosed.
Heart failure vs heart attack at a glance
Heart attack | Heart failure | |
What it is | A sudden blockage of blood flow to the heart muscle | An ongoing problem with how well the heart pumps |
How it starts | Suddenly, often within minutes | Usually gradually, sometimes suddenly after illness or damage |
Main symptoms | Chest pain or pressure, often spreading to the arm, neck or jaw | Breathlessness, tiredness and swollen ankles or legs |
Urgency | Always an emergency. Call 999 | Needs prompt assessment, and an emergency if breathing becomes severely difficult |
Treatment | Emergency treatment to restore blood flow, such as a stent | Long-term medicines, lifestyle changes and sometimes devices |
What is a heart attack?
A heart attack, or myocardial infarction, happens when blood flow to part of the heart muscle is suddenly cut off. This is usually caused by a blood clot forming where a fatty plaque in a coronary artery has broken open. Without blood and oxygen, the affected muscle starts to be damaged within a short time, which is why speed of treatment matters so much.
According to the British Heart Foundation, there are around 100,000 hospital admissions in the UK each year due to heart attacks, roughly one every five minutes.
Typical symptoms include chest pain that feels tight, heavy or crushing, pain spreading to the arms, neck, jaw or back, breathlessness, sweating, nausea and feeling light-headed. Symptoms can be milder or less typical in some people, particularly women, older adults and people with diabetes, and can feel more like indigestion.
If you think someone is having a heart attack, the NHS advises calling 999 straight away. While waiting, the person should sit and rest, and take a 300mg aspirin if one is available and they are not allergic to it.
What is heart failure?
Heart failure means the heart muscle is not pumping or filling as effectively as it should. Blood moves around the body less efficiently, and fluid can build up in the lungs, legs and abdomen. The British Heart Foundation estimates that more than a million people in the UK are living with heart failure.
Doctors often describe heart failure by the ejection fraction, which is the percentage of blood the main pumping chamber pushes out with each beat. The British Heart Foundation groups it into three types.
Heart failure with reduced ejection fraction, where the ejection fraction is 40% or less and the heart muscle is weakened.
Heart failure with mildly reduced ejection fraction, between 41% and 49%.
Heart failure with preserved ejection fraction, 50% or more, where the heart pumps normally but is stiff and does not fill properly.
That last group is important, because it means a normal pumping figure on a scan does not rule heart failure out on its own.
How a heart attack can lead to heart failure
When a heart attack damages part of the heart muscle, that section may heal with scar tissue that no longer contracts. The rest of the heart has to work harder to make up for it. Over weeks, months or years, that extra strain can weaken the heart and lead to heart failure.
This is why treatment after a heart attack focuses on protecting the heart as well as clearing the blocked artery. Medicines such as beta blockers and ACE inhibitors, cardiac rehabilitation and control of blood pressure and cholesterol all help reduce the risk of heart failure developing later.
A heart attack is not the only route, though. The NHS lists long-term high blood pressure, coronary heart disease, heart valve disease, cardiomyopathy, heart rhythm problems such as atrial fibrillation, and heavy alcohol use among the causes. Kidney disease, anaemia and thyroid problems can also contribute.
Where cardiac arrest fits in
A third term is often confused with both. A cardiac arrest is when the heart suddenly stops pumping blood around the body, usually because of a dangerous heart rhythm. The person collapses, is unresponsive and is not breathing normally. A heart attack can trigger a cardiac arrest, but most heart attacks do not. If someone has a cardiac arrest, call 999, start CPR immediately and use a defibrillator if one is nearby.
Symptoms of heart failure
Heart failure symptoms tend to build up gradually, which is why they are easy to put down to age, weight or being unfit. The most common are these.
Breathlessness during everyday activity, or when lying flat.
Waking up short of breath at night, or needing extra pillows to sleep.
Unusual tiredness and weakness.
Swollen ankles and legs, sometimes spreading to the abdomen.
Rapid weight gain over a few days from fluid build-up.
A persistent cough, especially at night.
Feeling light-headed or dizzy.
Call 999 if breathlessness becomes severe, if lips or skin turn pale, blue or grey, or if someone passes out and does not respond normally.
How heart failure is diagnosed
Diagnosis usually starts with a blood test. NICE guidance (NG106) recommends measuring a natriuretic peptide, a hormone the heart releases when it is under strain. For NT-proBNP, a level above 2,000 ng/litre should lead to specialist assessment and an echocardiogram within two weeks, and a level between 400 and 2,000 ng/litre within six weeks.
An echocardiogram is the key scan. It is an ultrasound of the heart that shows the size of the chambers, how the valves are working and the ejection fraction. An ECG, chest X-ray and further blood tests check for causes and related problems such as kidney function, anaemia and thyroid disease.
In our experience, combining a BNP blood test with an echocardiogram works better than relying on an ECG alone when heart failure is suspected because an ECG mainly shows the heart's rhythm and electrical activity, whereas the blood test shows whether the heart is under strain and the echocardiogram shows how well it is pumping and filling. This is also the approach NICE recommends.
At Heartsure, BNP is part of the on-site blood test panel, and a transthoracic echocardiogram usually takes 30 to 45 minutes with no special preparation. The scan is reported by a specialist sonographer and then reviewed by your consultant, who explains the result and the next steps.
How each condition is treated
A heart attack is treated as an emergency. The aim is to restore blood flow as quickly as possible, most often with coronary angioplasty and a stent, sometimes with clot-busting medicine and occasionally with bypass surgery. Afterwards, patients are usually prescribed medicines to protect the heart and are offered cardiac rehabilitation.
Heart failure is managed over the long term. There is no cure, but treatment can control symptoms and keep the condition stable for many years. According to the NHS, this usually involves a combination of the following.
Diuretics to reduce fluid build-up.
Medicines such as ACE inhibitors or angiotensin receptor blockers to relax the blood vessels.
Beta blockers to slow the heart and reduce strain.
Treating the underlying cause, such as a narrowed artery or faulty valve.
Devices such as a pacemaker or implantable defibrillator for some patients.
Cardiac rehabilitation, combining exercise, education and support.
Lifestyle changes make a real difference too. Stopping smoking, cutting down on alcohol and salt, staying active within your limits and weighing yourself regularly to spot fluid build-up are all part of good heart failure care.
Recovery after a heart attack
Heartsure was founded in 2012 as a rehabilitation and prevention service, and from working with patients since then, we've kept cardiac rehabilitation one to one. The programme usually begins two to four weeks after a heart attack. Each programme starts with a two-hour assessment covering medication, ECG, blood pressure and a walking test, followed by weekly supervised 75-minute sessions. Rebuilding fitness safely and keeping risk factors under control are among the best ways to protect the heart from further damage.
Speak to a cardiologist
A heart attack is a sudden blockage that needs emergency treatment. Heart failure is a long-term pumping problem that is managed with medicines and lifestyle changes. A heart attack is one of the most common causes of heart failure, but not the only one, so anyone with ongoing breathlessness, tiredness or ankle swelling should have their heart checked.
At Heartsure in Kingston upon Thames, our consultant cardiologists can assess your symptoms, with BNP blood tests, ECGs and echocardiograms available on site, often in a single visit. Contact us to book a consultation or a heart test.
