Chest pain, tightness in the chest: is it heart disease or acid reflux?

What is frightening about this condition is that patients may have symptoms that accumulate over a long period without realizing it, until a triggering factor such as myocardial ischemia causes sudden damage to the heart muscle, leading toacute heart failure - a critical period that can be life-threatening. Understanding the differences in symptoms and recognizing warning signs can help us protect ourselves and our loved ones in time.

What is heart failure?

Heart failure (Heart Failure) is a syndrome caused by abnormalities in the structure or function of the heart, resulting in the heart being unable to pump enough blood to supply various organs to meet the body’s needs, or requiring abnormally high pressure within the heart to maintain adequate blood circulation.

This condition may occur because the heart contracts poorly, or because the heart becomes abnormally stiff and cannot relax to fill fully with blood, causing blood to back up in the heart and blood vessels. This leads to symptoms such as easy fatigue, shortness of breath, inability to lie flat, and swelling in the legs, ankles, or abdomen.

Although heart failure is a common chronic disease, there are now medications and treatment technologies that help control symptoms, reduce hospitalizations, and significantly improve patients’ quality of life and longevity—if properly diagnosed and treated from an early stage.

How many types of heart failure are there?

Heart failure can be classified in several ways—by the course of the disease, the side of the heart affected, and the heart’s pumping efficiency.

Classification by disease course

- Chronic heart failure (Chronic Heart Failure)
Symptoms develop gradually and accumulate over a long time, such as easy fatigue, shortness of breath, or leg swelling; in the early stage, symptoms may not be obvious.

- Acute heart failure (Acute Heart Failure)
Symptoms occur rapidly and severely, such as sudden severe shortness of breath, pulmonary edema, or low blood pressure. It is often found in patients with acute myocardial ischemia, severe arrhythmias, or an exacerbation of chronic heart disease.

Classification by the side of the heart affected

- Left-sided heart failure (Left-sided Heart Failure)
The left ventricle pumps poorly, causing blood to back up into the lungs, resulting in shortness of breath, inability to lie flat, and possibly pulmonary edema.

- Right-sided heart failure (Right-sided Heart Failure)
The right ventricle cannot adequately receive and pump blood returning from the body, causing venous congestion and resulting in swelling of the legs, feet, abdomen, or an enlarged liver.

Classification by cardiac pumping efficiency (Ejection Fraction: EF)

- HFrEF: Heart failure with reduced ejection fraction
The heart’s pumping ability is clearly reduced; EF is often below 40%. This group has clear treatment approaches and responds well to several classes of medications.

- HFpEF: Heart failure with preserved or near-normal EF
The heart relaxes and fills poorly even though EF remains within the normal range. It is commonly found in older adults, women, and patients with hypertension, diabetes, and obesity.

- HFmrEF: Heart failure with mildly reduced EF
This group has EF between HFrEF and HFpEF and shows mixed features of both groups.

Note: Some patients may have more than one pattern of heart failure at the same time, such as both chronic heart failure and left-sided heart failure. Therefore, diagnosis by a specialist physician is important for appropriate treatment planning.

Check warning signs: Which symptoms are concerning and require vigilance for an acute episode?

Symptoms vary by stage and severity. Abnormalities can be observed as follows:

Symptoms of heart failure (chronic, gradually progressive)

- Easy fatigue, weakness, or more shortness of breath than usual during activities that used to be comfortable

- Difficulty breathing when lying flat, needing multiple pillows, or waking up in the middle of the night because of a feeling of not getting enough air

- Swelling in the feet, ankles, shins, or abdomen

- Rapid weight gain over a few days, e.g., more than 2 kg within 3 days, or more than 2–3 kg within 1 week, due to fluid retention

- Frequent urination at night

- Loss of appetite, early satiety, nausea, or abdominal fullness

Danger signs ofacute heart failure symptoms 

If these symptoms are present, the patient should be taken to the emergency department immediately, or call 1669 right away, as they are signsof a severe heart failure exacerbation or a cardiovascular emergency.

- Severe shortness of breath even while resting seated, or a feeling of being unable to breathe

- Unable to lie flat, needing to sit up to breathe, or waking up at night due to severe shortness of breath

- Chest tightness/pain, especially if myocardial ischemia is suspected

- Lightheadedness, dizziness, or fainting

- Abnormally fast heart rate, severe palpitations, or irregular heartbeat

- Severe cough with pink or frothy sputum, which may be a sign of pulmonary edema

Causes and risk factors for heart failure

Heart failure usually does not occur suddenly. In most cases, it results from diseases or conditions that damage the heart or make it work harder continuously over a long period. Common causes and risk factors include:

- Coronary artery disease and myocardial ischemia
A major cause of heart failure, because heart muscle that receives insufficient blood flow or has had a heart attack loses pumping efficiency.

- Hypertension
Long-standing high blood pressure forces the heart to work harder, causing the heart muscle to thicken and stiffen and increasing the risk of heart failure in the future.

- Diabetes, obesity, and chronic kidney disease
These three groups are now recognized as important factors in Cardiovascular-Kidney-Metabolic Syndrome (CKM Syndrome), significantly increasing the risk of heart failure.

- Valvular heart disease
Valve stenosis or regurgitation causes abnormal blood flow and increases the heart’s workload over the long term.

- Cardiomyopathy
May be due to genetics, infection, inflammation, or other causes, leading to weakened or abnormally stiff heart muscle.

- Arrhythmias
Especially atrial fibrillation or sustained tachycardia, which can reduce the heart’s performance.

- Obstructive sleep apnea (Obstructive Sleep Apnea)
A common but often overlooked risk factor that can raise blood pressure and increase the heart’s workload.

- Behaviors and lifestyle factors
Smoking, excessive alcohol consumption, lack of exercise, and improper weight control all increase the risk of heart failure.

Assessment of disease severity

Heart failure severity differs among individuals. Physicians often use the NYHA (New York Heart Association Classification) to measure the impact on daily life and plan treatment.

- NYHA Class I: There is heart disease or heart failure, but the patient can perform daily activities normally without fatigue, shortness of breath, or weakness.

- NYHA Class II: Able to perform general activities, but begins to experience fatigue, shortness of breath, or weakness with exertion beyond usual.

- NYHA Class III: Marked limitation of activity; even light activities such as walking a short distance or doing housework may cause fatigue or shortness of breath.

- NYHA Class IV: Symptoms of fatigue, shortness of breath, or weakness even at rest, and the patient is often unable to perform physical activity without symptoms.

In addition to symptom assessment, physicians now also use the ACC/AHA staging system (Stages A–D), which helps identify individuals at risk for heart failure even before symptoms occur, enabling prevention and early treatment as follows:

• Stage A: Has risk factors such as diabetes, hypertension, or obesity, but no heart disease yet
• Stage B:Has structural heart abnormalities, but no symptoms yet
• Stage C:Has structural heart abnormalities and begins to have heart failure symptoms
• Stage D:Advanced heart failure requiring specialized/advanced therapies

How is heart failure diagnosed?

When a patient visits a physician with suspicious symptoms, the physician will take a history and perform an initial physical examination, along with additional laboratory tests to confirm the diagnosis, identify the cause, and assess disease severity, as follows:

- Blood tests:  Help assess the function of organs that may affect the heart, such as the kidneys, liver, blood cells, and thyroid, including measuring NT-proBNP, a substance released by the heart when workload increases; higher-than-normal levels may indicate heart failure.

- Electrocardiogram (Electrocardiogram): Used to evaluate heart rhythm, detect arrhythmias, or identify signs of coronary artery disease and cardiomyopathy.

- Chest X-ray: Helps assess heart size and detect pulmonary congestion or pleural effusion.

- Echocardiogram (Echocardiogram): A key test for diagnosing heart failure, helping evaluate heart contraction and relaxation, Ejection Fraction (EF), chamber size, and valvular abnormalities 

- Coronary artery evaluation: In patients suspected of coronary artery disease, physicians may consider additional tests such as CT Coronary Angiography or Coronary Angiography.

How is heart failure treated?

The goals of treatment are to relieve symptoms, reduce the heart’s workload, and prevent complications, with the following approaches:

1. Lifestyle modification and medications

Self-care is an important part of treatment. Patients should control sodium intake, exercise as recommended by their physician, manage weight, stop smoking, and limit alcohol intake.

Regarding medications, there are now several classes that help reduce symptoms, decrease hospitalizations, and increase survival, such as SGLT2 inhibitors, ACE inhibitors, ARBs or ARNI, beta-blockers, mineralocorticoid receptor antagonists (MRAs), and diuretics to reduce edema and fluid retention.

The physician will select and adjust medication types and doses appropriately for each patient. Patients should not stop medications on their own without medical advice.

2. Treatment with medical devices

In some patients with electrical conduction abnormalities or those at risk of severe arrhythmias, treatment with specialized devices may be used, such as:

- Implantable Cardioverter-Defibrillator (Implantable Cardioverter-Defibrillator): Helps monitor and deliver an electric shock when a severe arrhythmia is detected to prevent death.

- Cardiac resynchronization therapy device  (Cardiac Resynchronization Therapy): Helps send electrical signals so the left and right ventricles contract in a coordinated and effective mannerto improve the heart’s pumping efficiency.

3. Cardiac surgery and other procedures

If heart failure is caused by a treatable heart condition, physicians may consider addressing the root cause, such as:

- Balloon angioplasty or Coronary Artery Bypass Grafting (Coronary Artery Bypass Grafting; CABG) : To correct coronary artery narrowing

- Heart valve repair or replacement : To correct abnormal valve function

- Cardiac ablation (Ablation) : To treat arrhythmias

For patients with advanced heart failure who do not respond to standard treatment, advanced therapies may be considered, such as:

 - Left Ventricular Assist Device (Left Ventricular Assist Device; LVAD) : To help the heart pump blood in patients awaiting surgery

- Heart transplantation (Heart Transplantation): An option for patients with severe symptoms unresponsive to other treatments, requiring a donor heart

How can heart failure be prevented and how should patients take care of themselves?

Although heart failure is a chronic disease, appropriate self-care can help reduce symptoms, decrease hospitalizations, and slow disease progression. Key recommendations include:

      Take medications consistently as prescribed by the physician
Do not stop, adjust, or self-medicate without consulting a physician.

      Monitor body weight and abnormal symptoms
Weigh yourself daily at the same time. If weight increases by more than 2 kg within 3 days, or if swelling and shortness of breath worsen, consult a physician promptly.

      Control diet and reduce sodium
Avoid very salty foods, processed foods, and high-sodium foods to reduce fluid retention.

      Continuously manage underlying conditions
Keep blood pressure, blood sugar, blood lipids, and kidney disease under appropriate control.

      Exercise appropriately
Regular light-to-moderate aerobic exercise such as walking, cycling, or similar activities can improve physical capacity and quality of life. Consult a physician before starting an exercise program.

      Stop smoking and avoid excessive alcohol consumption
These factors can accelerate cardiac deterioration and increase the risk of complications.

      Get enough sleep and address sleep apnea
If you snore loudly, feel unusually sleepy during the day, or suspect sleep apnea, consult a physician for further evaluation.

      Receive vaccinations as recommended
Especially influenza and respiratory infection vaccines, which may help reduce the risk of heart failure exacerbations.

Monitoring your symptoms, attending regular follow-up visits, and continuously treating the underlying causes are key to living well with heart failure.

Physicians specializing in heart failure treatment

Dr. Kriengkrai Hengrussamee, Director of Bangkok Heart Hospital

You canclick hereto make an appointment yourself.

Dr. Wasupol Manomaiphan, Internist, Bangkok Heart Hospital

You canclick hereto make an appointment yourself. 

Hospitals specializing in heart failure treatment

Heart disease cannot wait - especially when abnormalities become life-threatening. Choosing a healthcare facility with adequate readiness can reduce the risk of loss. At the Cardiology Internal Medicine Clinic, Bangkok Heart Hospital, we have a team of heart disease specialists led by Dr. Kriengkrai Hengrussamee, Director of Bangkok Heart Hospital, together with advanced medical technology.

We focus on diagnostic evaluation to find the true cause and create an individualized treatment plan, including medications, procedures, and surgery, to provide timely help for patients in critical conditions, along with ongoing care to restore quality of life and help patients regain strong heart health.

Article summary

Heart failure is not a condition in which the heart stops working, but a warning sign that the heart is fatigued and needs urgent care - especially for those with risk factors related to myocardial ischemia. Closely observing bodily abnormalities is important. Ifacute heart failure symptoms occur, such as severe shortness of breath, inability to lie flat, or lightheadedness, you should see a specialist physician immediately. Early detection and treatment, together with lifestyle modification, can help prolong heart function and provide better long-term quality of life for patients.

Frequently Asked Questions (FAQ) about heart failure

1. Can heart failure be completely cured? 

Most cases of heart failure are chronic and cannot be cured 100%. However, taking medications continuously as prescribed, treating the underlying cause, and practicing proper self-care can help control symptoms, prevent worsening, and allow patients to carry out daily life as usual.

2. How are acute heart failure symptoms different from a heart attack? 

A heart attack (Heart Attack or acute myocardial infarction) occurs when a coronary artery suddenly becomes blocked, preventing blood from reaching the heart muscle. Patients often have severe chest tightness/pain.

In contrast,acute heart failure symptoms refer to a condition in which the heart cannot pump blood adequately, leading to pulmonary edema and severe shortness of breath. A heart attack is often a main cause that leads to acute heart failure symptoms.

3. Can patients with heart failure exercise? 

Yes, and it is beneficial, but it should be light-to-moderate exercise such as walking with arm swinging or stationary cycling, and avoiding resistance activities or competitive sports that make the heart rate too fast. Consult a physician to assess heart function before starting exercise every time.

4. Why do patients with heart failure often have swollen legs or feet? 

This occurs because the right ventricle cannot pump blood back to the heart efficiently, causing blood to pool and back up into the veins of the lower body such as the legs, ankles, and soles of the feet, resulting in fluid swelling.

5. How much water should patients drink per day to avoid pulmonary edema? 

Patients with heart failure may need to limit daily fluid intake, including other liquids such as soup and milk, to avoid overloading the heart’s pumping work and to reduce the risk of pulmonary edema. The appropriate amount varies by individual as assessed by the physician, so patients should strictly follow their physician’s recommendations.

 

 

Reference :

Bangkok Hospital Get to Know Heart Failure: The Cause of Acute Heart Failure Symptoms

ArokaGO Providers Bangkok Hospital