Heart
Heart Failure
A chronic condition where the heart doesn't pump blood as well as it should, leading to fatigue and breathlessness.
Heart failure occurs when the heart cannot pump effectively — causing breathlessness, leg swelling, and fatigue. It affects approximately 1–2% of Singapore's adult population and represents a leading cause of hospitalisation and cardiovascular mortality.
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Heart failure occurs when the heart muscle is weakened or stiff, reducing its ability to supply adequate blood to the body.
Types of Heart Failure
- HFrEF (Reduced Ejection Fraction) — ejection fraction below 40%; weakened heart muscle, commonly caused by coronary artery disease or prior heart attack
- HFpEF (Preserved Ejection Fraction) — ejection fraction 50% or above; stiff heart cannot relax adequately; more prevalent in older patients, women, and those with hypertension
- HFmrEF (Mildly Reduced) — ejection fraction 40–49%; intermediate features
Symptoms
- Breathlessness on exertion or at rest
- Orthopnoea (breathlessness when lying flat)
- Paroxysmal nocturnal dyspnoea
- Ankle and leg swelling
- Fatigue and reduced exercise tolerance
- Persistent cough
Treatment for HFrEF
- ACE inhibitors or ARNIs (sacubitril/valsartan)
- Beta-blockers
- Mineralocorticoid receptor antagonists (spironolactone/eplerenone)
- SGLT2 inhibitors (dapagliflozin/empagliflozin)
Treatment for HFpEF
- SGLT2 inhibitors
- Aggressive management of hypertension and diabetes
Device & Advanced Therapy
- Cardiac resynchronisation therapy (CRT)
- Implantable cardioverter-defibrillators (ICD)
- Ventricular assist devices and cardiac transplantation for end-stage disease
Concerned About Heart Failure?
Dr. Peter Chang offers specialist assessment and personalised management at Paragon Medical Centre, Singapore.