Heart failure doesn’t mean the heart has stopped working. 

Rather, heart failure is a condition where the heart becomes is too weak or stiff to pump blood effectively.

Heart failure is a serious but manageable condition. With proper treatment, medications, and lifestyle adjustments, patients can continue to live full and active lives. Early diagnosis and consistent care are key to preventing complications. 

A variety of treatment methods are available to manage and prevent one’s condition from progressing.

Heart failure is usually treated with lifestyle changes, medicines and procedures or surgeries.

Severe or end-stage heart failure patients whose heart muscles cannot be treated with conventional medication and procedures are usually also considered for mechanical assist devices.

Related articles:
Heart Failure Programme

Living Well With Heart Failure

Advances In Heart Failure

Dr Jeremy Chai is an Associate Consultant with the Department of Cardiology at National Heart Centre Singapore.

He attained his Bachelor of Medicine and Bachelor of Surgery (MBBS) from the National University of Singapore (NUS) and later, obtained his Membership of the Royal Colleges of Physicians of the United Kingdom (MRCP, UK) as well as Master of Medicine (MMed), NUS.

Dr Chai received the SingHealth Associate in Education Award from SingHealth Academy in 2022. Dr Chai's clinical interests are in echocardiography, heart failure and cardiac rehabilitation.

1. Question by Saw ZY

Hi Dr Chai,

I am 36 and have high blood pressure due to genetic issue and on diovarn 40mg every night. I have:

• No diabetes
• No high cholesterol
• BMI at healthy range
• No smoke and no drink of alcohol
• Moderate exercise like jogging for 25mins 3 times a week

Am I at risk of heart failure and what are the symptoms of early onset for heart failure

Can heart failure lead to cardiac arrest? I saw that cardiac arrest cases are rising.

Thank you for your advice.

Answer by Dr Jeremy Chai

Dear Saw ZY,

Thank you for your question.

Uncontrolled hypertension is a risk factor for heart failure. However, this risk is mitigated through good control of our blood pressure, which is done through taking your medications regularly and following up regularly with your physician to make sure it remains well-controlled.

In addition, you are keeping your BMI at a healthy range, exercising regularly, and avoiding unhealthy habits like smoking. These are all good ways of reducing your risk of heart failure and heart disease in general.

The symptoms of heart failure include breathlessness, leg swelling, chest discomfort, fainting spells, low blood pressure, or lethargy. However, many other conditions could have similar symptoms, hence if you have these symptoms, we recommend you see a doctor, who will be able to help you narrow down the cause of the symptoms and discern whether it is due to heart failure or some other condition.

Heart failure, if untreated, can in some cases lead to cardiac arrest. However, cardiac arrest simply refers to the heart stopping from any cause, and can be caused by other cardiac conditions (such as myocardial infarctions) or non-cardiac conditions as well, and are more likely to occur as our population becomes older.

2. Question by Chloe

Dear Dr,

Thank you for giving me the opportunity to submit my question.

By way of introduction, I have been having heart palpitations for many years.

I’ve seen a cardiologists. I’ve done ECG, Holter & Echocardiogram and the doctors diagnosed me with Ectopic heartbeat, PVC.

They told me that there’s nothing they can do for me as my condition is not serious enough to go for operation but to just live with it.

Recently the palpitations got more frequent. I used to only get it when I’m resting but now it happens every day & anytime of the day.

It happens more frequently if I had too much to eat, hungry, ate food that’s oily or not easy to digest. I brought up my stomach issues to the doctors but they told me it has nothing to do with the palpitations.

I have read an article about Roemheld syndrome and it seems like my symptoms matches.

I’m curious if my symptoms have anything to do with the gastrocardic syndrome or sinus node? I would like to hear from you. Thank you for your advice!

Answer by Dr Jeremy Chai

Dear Chloe,

Thank you for sharing your experience. Your symptoms do sound complex and concerning, and I imagine the lack of clear explanation has been frustrating.

Roemheld or gastrocardiac syndrome is not a single disease but just an umbrella term for situations where a gastrointestinal condition causes sensations and symptoms that mimic heart conditions, while sinus node dysfunction typically causes giddiness or fainting spells, rather than palpitations.

Some individuals do experience symptoms that are difficult to nail down, and some may even need to be referred to other specialties to consider and evaluate other potential causes. Even after all that, there is a small minority of patients who are unable to find a diagnosis for their symptoms despite everybody’s best efforts.

It may be helpful to stick with a doctor or a few doctors whom you trust and try to explore these symptoms further. In the meantime, keep track of when the episodes occur and any potential triggers you notice, as these could be useful information for future consultations.

3. Question by Jeffrey

Dear Dr Jeremy Chai,

In the past decades, there were several cases of sudden heart failures while victims went jogging. Victims of some of these cases were certified with a clean bill of health before they met with such sudden fatalities and it included an MP who was certified fit to do such exercise but later he died from sudden heart attack.

I have the following questions to ask:

a)  What is the best & the most reliable medical checkup to do before a person goes for jogging?

The above narratives proved that the standard checkup is just not reliable at all.  My age is now nearly 70 & I wish very much to pick up jogging again. 

My last jogging was about 10 years ago & I am not sure at all can I go for jogging again?

b)  Is a CT Scan the right type of checkup to pinpoint any blockages that may be present in the arteries or other blood vessels to & from the heart, and if so, why doctors usually do not recommend unless there is symptom in the body?

c)  If I decide to pick up jogging again after such a long absence, what specific precautions or actions must I take to prevent heart failure from setting in?

d) If there is an onset of heart attack, what fast counter actions must be taken to prevent fatality from setting in?

e)  For CT precaution scan, does government subsidise?

f)  What more do you recommend Singapore Government to do to cut down on such fatal cases?

Thank you for your advice.

Answer by Dr Jeremy Chai

Dear Jeffrey,

Thank you for your questions!

International guidelines across the world recommend against routine cardiac testing in individuals who are asymptomatic and at low risk of heart disease. This is because it has a low yield and may cause harm due to unnecessary follow-up procedures, without reducing the risk of cardiac events. In a select group of individuals who have an intermediate risk of cardiovascular disease, CT coronary artery calcium scoring may help to better narrow their risk profile and guide a doctor’s decision to recommend the initiation of cholesterol-lowering medications, but beyond that, other heart-specific tests are not typically required for the average person.

What we do recommend is to go for your regular health screening such as through the Healthier SG programme to screen for risk factors that are common and treatable, such as high blood pressure, high cholesterol, and diabetes, and to treat them if present. This can be done in consultation with your general practitioner or polyclinic physician.

When picking up exercise after a long period of inactivity, we recommend you “start low and go slow” – start with low intensity exercise, do it regularly, and slowly increase your intensity and duration of exercise as you are able to tolerate.

If you experience unusual discomfort when exerting yourself, such as chest pain, breathlessness or giddiness, you should also consult a doctor to evaluate if there may be something wrong before continuing with exercise. Furthermore, if you do develop symptoms which you suspect may be a heart attack, such as sudden onset severe chest pain or breathlessness, it is recommended to seek immediate medical attention at an accident and emergency department to better confirm if these symptoms represent a heart attack or some other cause, and treatment can be started accordingly.

4. Question by KH Chew

Dear Dr Jeremy,

Does woman experience the same symptoms as men? If not, for woman, how do we determine that it is an heart attack? Thank you.

Answer by Dr Jeremy Chai

Dear KH Chew,

Thank you for your question.

The most common symptom of heart attack in both men and women is chest pain. However, some men and women who have heart attack may not experience chest pain but only experience other ‘atypical’ symptoms, which could come in the form of breathlessness, extreme lethargy, cold sweats, fainting, or pain in other regions such as the upper gastric area, shoulder, or jaw. Women have a greater tendency to experience heart attack in this way, though the majority of women with heart attack still experience chest pain.

It may be difficult for the average person to know if they are experiencing a heart attack based on symptoms alone. Doctors would need to take a history of our symptoms, a physical examination, laboratory tests and an electrocardiography (ECG) to confirm the presence of a heart attack. In certain cases, further testing and scans of the heart may also be necessary. Hence, if you experience symptoms that you worry might be a heart attack, especially for women who are experiencing these ‘atypical’ symptoms, it is recommended to seek immediate medical attention to confirm or rule out the presence of a heart attack, and the doctors will advise and provide their recommendations accordingly.

5. Question by Steve

Dear Dr Chai,

I am confused about these three heart conditions:

• Heart failure
• Heart attack
• Cardiac arrest

a) Are their causes the same, like clogged arteries?

b) How do we tell if we are suffering from one or the other?

c) Do treatment for these conditions differ? If yes, how?

Thank you for helping to clarify.

Answer by Dr Jeremy Chai

Dear Steve,

Thank you for asking this question! This is a common point of confusion.

Heart failure refers to a condition where the heart is too weak or too stiff to pump blood effectively. It can occur acutely (very quickly) or chronically (over a period of time). Patients typically experience breathlessness or leg swelling, but may also present as generalised lethargy or low blood pressure. It can be caused by clogged arteries damaging the heart muscle and causing it to become weak, but it can also be caused by the heart muscles becoming weak from other causes such as genetic conditions. The treatment of heart failure typically involves lifestyle changes, medications to support the heart’s function, and also the underlying cause of heart failure, if treatable. In certain advanced cases, mechanical assist devices or a heart transplant may be needed.

Heart attack is not a scientific term but is generally understood to refer to myocardial infarction, a condition where there is damage and death of the heart muscle usually because of a sudden blockage of the coronary arteries of the heart. It typically presents with sudden onset chest pain, but can also sometimes present with breathlessness, pain in the upper stomach, jaw or neck, cold sweats, or other symptoms. Treatment of this will involve blood thinners, statins, and angiography and angioplasty to relieve the blockages of the coronary arteries.

Cardiac arrest refers to the heart stopping. A victim of cardiac arrest will immediately become unconscious and lose their pulse and breathing, and cardiopulmonary resuscitation (CPR) should be attempted as soon as possible to try and save the victim’s life. This can be caused by both heart conditions (such as a heart attack or heart failure) or non-cardiac conditions (such as a severe lung infection) that are severe enough to affect the heart and cause it to stop beating.

While these three terms refer to three different conditions, some patients may experience and receive treatment for a combination of any two or all three of the above at the same time. This is sometimes why some people may easily confuse these three terms.

6. Question by Seah HL

Dear Dr,

There were 2 separate incidents when I had chest pain (I can't really pinpoint to the exact place) and I broke out in cold sweat.

Problem is I do have acid reflux, and I can't tell whether the chest pain is a result of heartburn or heart attack. What's the difference in the symptoms and what tests should I take and where?

Thank you for your advice.

Answer by Dr Jeremy Chai

Dear Seah HL,

Thank you for your question!

First of all, I recommend you consult your doctor, who would take a history and perform a physical examination to better identify the cause of your symptoms and your pre-test probability for coronary artery disease, and may recommend further tests or referrals as necessary depending on your specific situation.

Typically, chest pain from heartburn tends to be associated with meals and is associated with such symptoms like a sensation of reflux or a sour taste in the mouth, whereas chest pain from heart attack tends to be worse on exertion. However, these are not the same in every person, so it is recommended to consult a doctor as they would be better able help narrow down the possibilities in your specific situation.

7. Question by Mr Sim

Dear Dr,

I am a Male aged 62, non-smoker, without elevated blood pressure and without high cholesterol (on Aspirin, Atorvastatin and Ezetimibe) with some arteries blockage. I exercise 5 times a week for at least an hr.

My cardiologist prescribed above medication and advised that I should not eat egg yolk.

May I check if I can eat egg yolk as many food comes with egg yolk like fried rice, ban mian etc?

Recently, I saw a YouTube video that Atorvastatin helped when a patient had a heart attack, other than that is only 1% help for those who had not had a heart attack before.

Would like to hear your views. Thank you.

Answer by Dr Jeremy Chai

Dear Mr Sim,

Dietary advice on limiting the intake of eggs varies depending on each patient’s unique situation.

While healthy individuals may not find their cholesterol levels significantly affected, patients who already have high cholesterol or are on cholesterol treatment may be more sensitive to this. I strongly recommend that you have this conversation with your cardiologist to further explore this.

Atorvastatin and other statin therapies are useful in reducing the risk of relapse in people who are already suffering from heart disease; this is known as secondary prevention.

These medications are also useful for reducing the risk of heart disease in certain groups of people who are at risk of heart disease before they develop heart disease; this is known as primary prevention. Both types of prevention are important in reducing one’s risk of heart disease.

8. Question by Lok YT

Hi Doctor,

My sleeping heart rate is always below 50 when asleep at night. Sometimes it was as low as 42 but never below 40.

Recently I noticed it has increased to between 48 to 53 and my oura ring always tell me to keep below 50 to be in the optimal state.

What is the implication is this change of rhythm? Any cause for concern? My daytime heart rate is always between 60 to 98 and 110 to 135 when I am doing brisk walking in the morning.

Appreciate your advice. Thanks and best regards.

Answer by Dr Jeremy Chai

Dear Lok YT,

It is common for people’s heartbeat to slow down as part of the normal body’s physiology while they are sleeping at night. After all, our body’s activity decreases while we are asleep and our heart does not need to beat as frequently to maintain the body’s function.

Conversely, our heartbeat also quickens when we are active and exercising because our body requires more blood flow. As such, if one is healthy, able to exercise, and has no symptoms such as giddiness or fainting spells, it is unlikely that a borderline low heart rate at night indicates a problem.

That being said, it is difficult to comment on your exact situation. If you are concerned, you may consider consulting a doctor to confirm that you have no symptoms or signs suggestive of underlying heart disease or conditions that require further evaluation.

Ref: G25