Types of heart failure

Photo of a grandmother reading to her grandchild (PantherMedia / Sandra Weber)

In heart failure, the heart can no longer pump enough blood around the body. The heart muscle is either too weak or not elastic enough. Different parts of the heart may be affected too. The type of medication people use for the treatment of heart failure will depend on the type of heart failure they have.

Heart failure often only affects the left or right side of the heart, but can affect both. Doctors differentiate between three types of heart failure, accordingly:

  • Left-sided heart failure: The left ventricle of the heart no longer pumps enough blood around the body. As a result, blood builds up in the pulmonary veins (the blood vessels that carry blood away from the lungs). This causes shortness of breath, trouble breathing or coughing – especially during physical activity. Left-sided heart failure is the most common type.
  • Right-sided heart failure: Here the right ventricle of the heart is too weak to pump enough blood to the lungs. This causes blood to build up in the veins (the blood vessels that carry blood from the organs and tissue back to the heart). The increased pressure inside the veins can push fluid out of the veins into surrounding tissue. This leads to a build-up of fluid in the legs, or less commonly in the genital area, organs or the abdomen (belly).
  • Biventricular heart failure: In biventricular heart failure, both sides of the heart are affected. This can cause the same symptoms as both left-sided and right-sided heart failure, such as shortness of breath and a build-up of fluid.

Left-sided heart failure is usually caused by coronary artery disease (CAD), a heart attack or long-term high blood pressure. Right-sided heart failure generally develops as a result of advanced left-sided heart failure, and is then treated in the same way. It is sometimes caused by high blood pressure in the lungs, an embolism in the lungs (pulmonary embolism), or certain lung diseases such as COPD.

Classification based on pumping ability

Nowadays, heart failure is increasingly being classified based on the pumping ability of the heart. This is because the pumping ability plays an important role when choosing the most suitable medication. There are two types of heart failure here:

  • Heart failure with reduced pumping ability: The heart muscle has become weaker, and no longer pumps enough blood around the body when it contracts (squeezes). As a result, the organs in the body don’t get enough oxygen. The medical term for this is “heart failure with reduced ejection fraction.”
  • Heart failure with preserved pumping ability: Although the heart muscle is still strong, it can no longer relax and widen enough after it has squeezed blood out, so it doesn’t fill up with blood properly. Despite pumping strongly enough, not enough blood is pumped out into the body as a result, especially during physically strenuous activities. Doctors call this “heart failure with preserved ejection fraction.”

Heart failure with reduced pumping ability is sometimes referred to as “systolic” heart failure, and heart failure with preserved pumping ability is also known as “diastolic” heart failure. The systolic phase of the cardiac cycle is the phase when the heart contracts (squeezes), and the diastolic phase is when the heart relaxes and widens.

Classification based on course of the disease

Heart failure can develop suddenly, for instance after a heart attack or due to certain heart rhythm problems. This is known as acute heart failure.

But it usually develops gradually over time as a result of a different medical problem, such as permanently high blood pressure. This is known as chronic heart failure.