Heart failure symptoms, causes, treatment and daily care

Heart failure means your heart cannot pump blood as well as it should. It does not mean that your heart has stopped or is about to stop.

The heart muscle may be too weak to squeeze well, or too stiff to fill up between beats. Either way, blood backs up and fluid collects in the lungs, legs, feet and belly. That is why it is also called congestive heart failure. It usually develops over months or years, but it can start suddenly, for example after a heart attack.

After a chest X-ray, you may hear the words "lumaki ang puso" (an enlarged heart). A big heart shadow can mean the heart has been working too hard, but it is not a diagnosis by itself. Other tests show how well the heart pumps.

Most heart failure has no cure. Still, with the right medicines and daily habits, many people keep it stable for many years.

Symptoms often start slowly. At first you may notice them only when you are active. Later they can happen at rest. The most common are:

• Shortness of breath with everyday activities, such as walking, climbing stairs or housework
• Breathlessness when lying flat, so you need extra pillows or sleep sitting up
• Waking up at night short of breath
• Swelling (manas) of the feet, ankles, legs or belly; shoes or waistbands feel tight
• Sudden weight gain over a few days, from fluid, not fat
• Tiredness, weakness, dizziness or light-headedness
• A cough that will not go away, often worse at night, sometimes with wheezing. Coughing up pink, frothy phlegm is a danger sign
• Poor appetite, urinating at night, and a fast or irregular heartbeat (palpitations)

These signs are easy to blame on old age, a cold or "hika" (asthma). If you have them, especially with high blood pressure, diabetes or a past heart attack, get checked. See when to get help now for the danger signs.

If you already have heart failure, small changes can warn you that fluid is building up:

• Weight gain of more than about 1 kilogram in a day, or 2 kilograms in a week
• More breathlessness than usual, needing more pillows, or waking up breathless
• More swelling, or a cough that sounds wet

Ask yourself: Did I eat something salty, miss a medicine or drink more than usual? Then contact your doctor or health center the same day. Do not wait until you cannot breathe. Infections such as flu or pneumonia, a new heart rhythm problem and some medicines can also make heart failure suddenly worse.

If you notice any of the danger signs, such as severe breathlessness or chest pain, call 911 or have someone bring you to the nearest emergency room right away. Do not drive yourself.

Heart failure happens when something damages or overworks the heart. The most common causes are:

• Coronary heart disease and heart attack, which starve the heart muscle of oxygen
• High blood pressure that is not controlled, which makes the heart muscle thick and stiff (see our high blood pressure guide)
• Heart valve disease, where valves are too narrow or leak
• Cardiomyopathy, a disease of the heart muscle itself
• Irregular heart rhythms, such as atrial fibrillation

Other causes include heart problems from birth, infections of the heart muscle, diabetes, kidney disease, anemia, thyroid problems and some cancer treatments.

Rheumatic heart disease starts with a strep throat or skin infection in childhood that is not treated properly. The body's reaction (rheumatic fever) can scar the heart valves for life. The WHO says it is the most common heart disease acquired by people under 25, especially where there is poverty and crowding.

Your risk is higher if you are 65 or older, have family members with heart failure, are overweight, smoke, drink a lot of alcohol, are not active, or use illegal drugs.

Your doctor will ask about your symptoms, listen to your heart and lungs, and check for swelling. You may then have:

• Blood and urine tests, including NT-proBNP or BNP. A high level suggests strain on the heart; a normal level makes heart failure less likely.
• An ECG (electrocardiogram) to check the heart's rhythm
• A chest X-ray to look for fluid in the lungs or a large heart
• An echocardiogram (2D echo), an ultrasound that shows how well the heart pumps and whether the valves work. It is often the most useful test.
• Tests for causes, such as blood sugar, cholesterol, kidney and thyroid checks

Start at your barangay health station, rural health unit (RHU) or YAKAP clinic. The doctor can refer you to an internist, a heart specialist (cardiologist) or a hospital for tests the clinic cannot do. Use Find care to look for one near you.

Treatment eases symptoms, slows the disease, keeps you out of the hospital and helps you live longer.

Many people need several medicines together. Your doctor chooses them, starts them slowly and adjusts them over time:

• Water pills (diuretics), such as furosemide, help your body pass extra fluid as urine.
• ACE inhibitors (such as enalapril), ARBs (such as losartan) or sacubitril-valsartan relax blood vessels so the heart works less.
• Beta-blockers, such as carvedilol, bisoprolol or metoprolol, slow the heart and protect it over time.
• Spironolactone helps remove salt and protects the heart.
• SGLT2 inhibitors, such as dapagliflozin or empagliflozin, first made for diabetes, also help many people with heart failure.

You will need regular blood tests to check your kidneys and potassium.

• Take your medicines every day, even when you feel well. Never stop or change them on your own.
• Ask your doctor or pharmacist before any new medicine, including medicines for erection problems. Pain relievers called NSAIDs (such as ibuprofen, naproxen and mefenamic acid) make the body hold salt and water.
• Do not replace your medicines with herbal teas or supplements. Tell your doctor about any you take.

Some people also need a procedure: opening blocked heart arteries, repairing a valve, a pacemaker, or an ICD, a device that shocks the heart out of a dangerous rhythm. Severe cases may need a heart pump or a transplant.

Cardiac rehabilitation, a program of safe exercise, education and support, is recommended for people with heart failure. Ask your hospital if one is near you. If heart failure becomes severe, palliative care can ease symptoms and support your family.

What you do every day matters as much as your medicines.

1. Weigh yourself every morning, after using the toilet and before eating, on the same scale. Write it down. A fast gain means fluid is building up.
2. Eat less salt. Salt makes the body hold water. For adults in general, the WHO advises less than 5 grams of salt a day, just under one teaspoon in total. WHO Philippines estimates that Filipino adults eat more than twice that. Ask your doctor or a dietitian how strict you need to be.
3. Watch for hidden salt in patis, toyo, bagoong, seasoning mixes, tuyo and daing, instant noodles, canned goods, hotdog, longganisa and salty snacks. Flavor food with calamansi, garlic, onion, ginger and pepper instead.
4. Avoid salt substitutes unless your doctor approves. Many contain potassium, which can be harmful with some heart medicines.
5. Follow your fluid advice. Not everyone needs to drink less. If your doctor sets a limit, it is often 1.5 to 2 liters a day, and soups count. A marked bottle helps you keep track.
6. Stay active, for example with walks, as your doctor advises. Skip exercise on days your weight has jumped or you feel unwell.
7. Stop smoking, and avoid alcohol or drink only what your doctor allows.
8. Get vaccinated: a flu shot every year, a pneumonia (pneumococcal) vaccine and COVID-19 vaccines as advised.
9. Keep your check-ups, at least every few months, and sooner after a medicine change.

Feeling worried or low is common, so tell your doctor or nurse. Our heart failure check-in assistant can help you track your weight and symptoms, and you can ask a nurse or book a call.

Heart failure is long-term, so costs add up. Use the help available:

• Hospital stays: Under PhilHealth Circular 2024-0037, the latest case-rate list we could find in November 2026, PhilHealth pays a case rate of ₱30,615 for a hospital admission for heart failure (for admissions from 1 January 2025). Members in basic or ward accommodation in accredited public and private hospitals should have no co-payment. Senior citizen and PWD discounts come off the bill first.
• Maintenance medicines: Your YAKAP clinic doctor can prescribe some medicines for free. As of January 2026, the YAKAP clinic list included enalapril, metoprolol and losartan; your doctor decides whether these are the right ones for your heart. As of mid-2026, PhilHealth GAMOT lets members registered with a YAKAP clinic get up to ₱20,000 of listed medicines a year for free, from accredited GAMOT pharmacies, using a prescription from their YAKAP doctor. Pharmacies are still being added, so ask your YAKAP clinic if one is near you. Not every heart failure medicine is on the list, so ask which of yours are.
• Check-ups and tests: YAKAP covers consultations and some lab tests your YAKAP doctor requests.
• After a heart attack: since December 2024, PhilHealth's heart attack packages also cover angioplasty with a stent (PCI) and cardiac rehabilitation after PCI in accredited hospitals.
• Remaining bills: Malasakit Centers in government hospitals help patients who cannot pay the rest. See our Malasakit Center guide.

See our PhilHealth YAKAP guide and what PhilHealth covers. Amounts change, so confirm with PhilHealth or the billing office.

Most heart failure comes from conditions you can prevent or control:

• Control your blood pressure. Have it checked, take your medicine every day if you need it, and learn to check your blood pressure at home.
• Control blood sugar and cholesterol. Read about diabetes symptoms.
• Do not smoke, limit alcohol, eat less salt, be active and keep a healthy weight.
• Get a child's sore throat with fever checked. Treating strep throat properly prevents rheumatic fever. Anyone who has had rheumatic fever may need long-term antibiotic injections, so keep every appointment.
• Get a yearly check-up, even if you feel well. See our annual check-up guide.

After a heart attack, follow your treatment and rehab plan closely to lower the chance of heart failure later.