In Hong Kong, cardiovascular disease is one of the major health threats, and heart failure (commonly known as “heart weakness”) can be regarded as a late-stage clinical manifestation of various heart conditions. It does not mean the heart has stopped beating, but rather that its pumping function is impaired, making it unable to deliver sufficient blood to meet the body’s metabolic needs. Many people ask: Can heart disease be cured? This article explores the causes of heart failure, the progression from early to advanced symptoms, key diagnostic and treatment approaches, and strategies for prevention.
What is Heart Failure?
Heart failure is a chronic and progressive condition. When the heart’s systolic function (pumping blood out) or diastolic function (allowing blood to fill in) becomes impaired, the heart cannot effectively deliver blood to the body’s organs. As a result, these organs do not receive enough oxygen and nutrients to function properly.
Classification Standards for Heart Failure
Clinically, the New York Heart Association (NYHA) functional classification is commonly used to assess the severity of heart failure. This system helps distinguish between early-stage symptoms and advanced-stage manifestations, providing guidance for both diagnosis and treatment planning.
| NYHA Class | Description | Severity & Symptoms |
| Stage I (Mild) | Daily activities are not restricted, and physical exertion does not cause excessive fatigue, palpitations, or shortness of breath | Early symptoms of heart failure: Only structural or functional abnormalities of the heart are present, with no specific symptoms. |
| Stage II (Mild) | No symptoms at rest, but ordinary daily activities—such as climbing one flight of stairs or brisk walking—can cause fatigue, palpitations, or shortness of breath | Early symptoms: Fatigue and weakness, swelling of the ankles or lower legs, occasional shortness of breath (especially during activity), palpitations, rapid heartbeat, frequent urination at night, loss of appetite, and mild limitation of physical activity. |
| Stage III (Moderate) | No symptoms at rest, but activities less strenuous than ordinary daily tasks—such as washing or slow walking—can cause symptoms | Progressive symptoms: Physical activity is markedly limited. |
| Stage IV (Severe) | Symptoms are present even at rest, and any physical activity worsens discomfort. Daily living requires dependence on others for care. | End-stage symptoms of heart failure: Generalized edema, ascites, significant swelling of the lower limbs, shortness of breath even at rest or severe breathlessness, rapid weight gain (more than 2 kilograms per week), difficulty breathing, chronic cough with blood-stained sputum, inability to carry out daily self-care, severe limitation of physical activity, and poor prognosis. |
Common Symptoms of Heart Failure
The symptoms of heart failure worsen as the condition progresses, mainly reflecting the body’s attempt to compensate for the heart’s reduced pumping ability.
| Symptom Categories | Common symptoms | Reason |
| Respiratory Symptoms | Difficulty breathing (dyspnea), difficulty breathing when lying flat, sudden nighttime shortness of breath | Pulmonary congestion (pulmonary edema) |
| Fluid retention | Swelling of the feet, ankles, or lower legs (pitting edema when pressed), abdominal distension, and rapid weight gain | Blood cannot flow smoothly back to the heart and becomes congested in the veins |
| Fatigue and weakness | Even with mild activity, one feels extreme fatigue, weakness, and difficulty concentrating | Insufficient blood supply to body organs (including the brain) |
| Rapid heartbeat | Feeling that the heart is beating rapidly or irregularly (palpitations) | The heart attempts to compensate for insufficient pumping by increasing the heart rate |
| Loss of appetite | Nausea and loss of appetite | Congestion in the abdominal cavity and digestive system |
Causes of Heart Failure
Any condition that damages the heart muscle or increases the workload of the heart can lead to heart failure. The main causes include:
- Coronary artery disease (CAD): Blockage of the heart’s blood vessels leads to ischemia and damage to the heart muscle. This is the most common cause.
- Hypertension (high blood pressure): Long-term high blood pressure forces the heart to pump with greater effort, resulting in strain and thickening of the heart muscle.
- Myocardial infarction (commonly known as heart attack): Causes permanent death of part of the heart muscle, weakening its pumping ability.
- Diabetes: Can directly impair the function of the heart and blood vessels.
- Valvular heart disease: Narrowing or incomplete closure of the valves forces the heart to perform extra work.
- Cardiomyopathy: Disease of the heart muscle itself, such as dilated cardiomyopathy.
- Others: Conditions such as hyperthyroidism or hypothyroidism, and severe anemia.
Diagnosis Methods for Heart Failure
Doctors usually combine clinical evaluation and diagnostic tests to confirm heart failure.
- Electrocardiogram (ECG): Checks for abnormal heart rhythms and signs of myocardial ischemia or hypertrophy.
- Chest X-ray: Assesses heart size (enlargement) and detects pulmonary congestion or fluid in the lungs.
- Echocardiogram: The most important diagnostic tool. Used to evaluate heart structure, myocardial contractility (Ejection Fraction), and valve function.
- Blood Test: Measures levels of brain natriuretic peptide (BNP/NT-proBNP), which increase in heart failure.
- Exercise ECG or Cardiac Catheterization: Helps determine whether coronary artery disease is the primary cause.
- Magnetic Resonance Imaging (MRI): Produces detailed internal images, allowing doctors to analyze the condition of the heart.
- Coronary Angiogram: Uses X-rays to check for narrowing of the coronary arteries and assess blood supply to the heart.
Risk Factors for Heart Failure
In Hong Kong, the following factors significantly increase the risk of developing heart failure:
- Metabolic syndrome: Hypertension, hyperlipidemia, and high blood sugar (diabetes).
- Smoking and excessive alcohol consumption.
- Obesity
- Unhealthy diet: High salt, high fat, and high sugar intake.
- Lack of physical activity
- Advancing age (especially over 65).
Treatment Options for Heart Failure
The goals of heart failure treatment are to relieve symptoms, slow disease progression, prevent complications, and improve patients’ quality of life. Treatment typically involves a combination of medications, interventional procedures, and surgical options.
| Treatment Category | Treatment Method | Objective | Description |
| Medication Therapy | Angiotensin-Converting Enzyme Inhibitors (ACEIs) / Angiotensin II Receptor Blockers (ARBs) | Helps dilate blood vessels, lower blood pressure, reduce the heart’s pumping workload, and protect the myocardium | It is a fundamental drug in heart failure management |
| Beta-blockers | Helps slow the heart rate, giving the heart more time to rest and relax, and reduces myocardial oxygen consumption | Dosage must be carefully adjusted under medical supervision, as it is crucial for improving long-term outcomes | |
| Diuretics | Helps the kidneys remove excess water and sodium from the body | Quickly relieves symptoms such as edema, pulmonary congestion, and shortness of breath | |
| Novel Medications (e.g., SGLT2 Inhibitors) | Originally developed for diabetes, now proven to improve heart and kidney function. | Effectively improves the prognosis of heart failure patients, even in those without diabetes. | |
| Surgical and Interventional Treatments | Percutaneous Coronary Intervention (PCI) / Coronary Artery Bypass Grafting (CABG) | Restores blood supply to the heart and treats coronary artery disease as the underlying cause. | Indicated for myocardial ischemia caused by coronary artery disease. |
| Implantable Cardioverter-Defibrillator (ICD) | Continuously monitors heart rhythm and automatically delivers shocks when malignant arrhythmias occur. | Prevents sudden cardiac death in high-risk patients due to arrhythmias. | |
| Cardiac Resynchronization Therapy (CRT) | By implanting a specialized pacemaker, synchronizes the contractions of the left and right ventricles. | Indicated for patients with ventricular dyssynchrony to improve pumping efficiency. | |
| Valve Repair or Replacement Surgery | Repair or replace diseased heart valves. | Treats heart failure caused by valvular stenosis or regurgitation. | |
| End-stage treatment | Heart Transplant | Replace the damaged heart. | It is suitable for young patients with end-stage heart failure who have not responded to all conventional treatments and whose physical condition allows for surgery. At present, it is the best option for long-term survival, but it is limited by organ availability and strict selection criteria. |
Daily Lifestyle Tips for Heart Failure Patients
Patients with heart failure should strictly follow these self‑management principles:
- Limit fluid and salt intake: Daily fluid intake should be controlled according to medical advice; strictly avoid high‑salt foods to reduce cardiac burden and swelling.
- Take medication regularly: Never stop or adjust medication dosage without consulting your doctor.
- Monitor body weight: Weigh yourself daily. A rapid increase (e.g., 3 pounds or more within two days) may indicate fluid retention and should be reported to your doctor immediately.
- Exercise moderately: Follow medical advice to engage in appropriate cardiac rehabilitation and physical activity to improve heart and lung function.
Ways to Prevent Heart Failure
The best way to prevent heart failure is to control all underlying causes.
- Control the “Three Highs”: Keep blood pressure, blood sugar, and cholesterol within target ranges.
- Quit smoking and limit alcohol: Stop smoking completely and reduce alcohol intake.
- Healthy diet: Follow a low-sodium, high-fiber eating pattern.
- Maintain a healthy weight: Avoid obesity.
Frequently Asked Questions about Heart Failure
Can Heart Failure Be Completely Cured? Are There Ways to Improve It?
Heart failure is currently a chronic condition that cannot be completely cured. However, with early diagnosis, appropriate medication, lifestyle modifications, and necessary interventional treatments, the progression of the disease can be significantly controlled. These measures help relieve symptoms, improve quality of life, and extend survival.
How High Is the Mortality Rate for Heart Failure Patients?
The prognosis of heart failure depends on its stage, underlying causes, and response to treatment. While patients with advanced or end‑stage symptoms face a higher mortality rate, advances in modern medicine mean that many individuals can live for years with active treatment. For those diagnosed at an early or mild stage, the outlook is relatively more favorable.
Is Heart Disease the Same as Coronary Heart Disease?
Heart disease is a broad term that includes all conditions affecting the heart’s function. Coronary heart disease (coronary artery disease) refers specifically to blockages in the heart’s blood vessels. It is only one type of heart disease, but it is the most common cause of heart failure.
Can Heart Disease Patients Still Exercise?
Yes, and they should. Unless the condition is in an acute episode or a doctor has specifically prohibited it, moderate and regular exercise (such as walking or cycling) is very important for cardiac rehabilitation. Exercise helps improve cardiovascular function, control weight, and reduce stress. However, it is essential to follow a rehabilitation plan under the guidance and advice of a cardiologist.
If you suspect that you are experiencing early symptoms of heart failure, please make an appointment as soon as possible with a cardiology specialist for a thorough examination and evaluation.
