Acute and chronic heart failure explained

Heart failure does not mean that the heart has stopped. It means the heart cannot meet the body's needs as effectively as it should. Chronic symptoms may remain fairly steady with treatment; acute symptoms can develop quickly because fluid backs up into the lungs or circulation.

Chronic heart failure can present with breathlessness during activity or when lying flat, fatigue, swollen ankles, reduced exercise tolerance, cough or rapid weight gain from retained fluid. Acute heart failure may be a person's first episode or a sudden deterioration of established disease, often with marked breathlessness, chest discomfort, clammy skin or confusion.

High blood pressure, abnormal heart rhythms, damaged heart muscle and valve disease can contribute. A new rhythm disturbance, infection, missed medicine or excess fluid can also destabilise someone whose condition had been controlled.

Take prescribed medicines consistently and do not stop or change them because symptoms improve. Follow the personalised advice given about salt, fluids and activity, because these recommendations depend on kidney function, blood pressure and the type of heart failure. Keep scheduled checks for blood tests, heart rhythm, blood pressure and medicine adjustment.

Notice changes from your usual baseline, such as tighter shoes, increasing ankle swelling, needing more pillows, waking breathless or becoming exhausted by familiar tasks. Record symptoms and weight as your care team recommends, then contact the clinic promptly when the agreed warning threshold is reached.

Call emergency services for severe breathlessness at rest, gasping, blue or grey lips, fainting, new confusion, chest pressure, or coughing up pink frothy fluid. These signs may reflect dangerously reduced oxygen or circulation and should not be managed by taking extra medicine unless an emergency clinician directs it.

Seek same-day clinical advice for clearly increasing swelling, rapid fluid-related weight gain, worsening breathlessness, persistent palpitations or a major drop in urine output. Early assessment may identify fluid overload, kidney strain, infection or an abnormal rhythm before symptoms become critical.

Ask which type of heart failure you have, what your medicines each do and which changes should trigger a call. Clarify your personal advice on fluids, salt, exercise and weight monitoring. It is also useful to know whom to contact after hours and whether an irregular pulse or palpitations need separate rhythm assessment.