Restore Medical
Two people exercising on a beach. UPright by Restore Medical. The right direction.

What is heart failure?

Heart failure does not mean the heart has stopped working. It means the heart cannot pump enough blood to meet the body's needs, or can only do so when pressure inside the heart and lungs rises.

It is a long-term condition that affects an estimated 60 to 65 million people worldwide.

Lungs Left sideof the heart Body Right sideof the heart
The right side of the heart pumps blood to the lungs. The left side pumps oxygen-rich blood to the body.

What does "reduced ejection fraction" mean?

Ejection fraction (EF) is the percentage of blood the left ventricle (the heart's main pumping chamber) pushes out with each beat. When it is 40% or below, doctors call it heart failure with reduced ejection fraction (HFrEF). Up to half of all people with heart failure have this type.

Ejection fraction, percent of blood pumped out with each beat

40%50%70%
  • 40% or below
    Reduced ejection fraction (HFrEF)
  • 50 to 70%
    Normal

Why symptoms appear during activity

Many people with HFrEF feel well at rest. During activity, the heart cannot keep up, and pressure builds in the left side of the heart and backs up into the lungs. This is what causes shortness of breath and tiredness.

At rest

Pressure in the left side of the heart and the lungs stays low.

During activity

Pressure rises and backs up into the lungs.

Common symptoms

Shortness of breath during activity or when lying down
Tiredness
Swelling in the legs, ankles or abdomen
Rapid weight gain from fluid build-up
Reduced ability to exercise

How heart failure is diagnosed

Your doctor may use several steps.

1Conversation and examinationYour symptoms and a physical examination
2Blood testsIncluding a marker called BNP or NT-proBNP
3Electrocardiogram (ECG)Records the heart's rhythm and electrical activity
4EchocardiogramAn ultrasound of the heart that measures the ejection fraction
5Other tests, if neededDetailed imaging, an exercise test, or a catheterization that measures pressures inside the heart
Severity

How doctors describe heart failure

Two scales are used. Classes describe how you feel today and can change with treatment. Stages, used mostly in the United States, describe how the condition has developed.

Classes I to IV (NYHA)

How much your symptoms limit daily activity
  • I
    Class INo limitation in ordinary activity
  • II
    Class IISlight limitation
  • III
    Class IIIMarked limitation, comfortable only at rest
  • IV
    Class IVSymptoms even at rest

Stages A to D (ACC/AHA)

How the condition develops over time
  • A
    Stage A: at riskRisk factors such as high blood pressure or diabetes, with no symptoms or changes in the heart's structure or function
  • B
    Stage B: pre-heart failureChanges in the heart's structure or function, with no symptoms
  • C
    Stage C: symptomatic heart failureChanges in the heart's structure or function, with current or past symptoms
  • D
    Stage D: advanced heart failureSymptoms that interfere with daily life despite treatment

How heart failure is treated today

Lifestyle

Diet and fluid management, activity, and weight monitoring.

Medications

Several groups of medicines, often taken together, are the foundation of treatment.

Implanted devices

Some patients receive a defibrillator (ICD) or a pacing device (CRT).

Advanced therapies

For the most severe cases, heart pumps or transplantation.

Even with the best available treatment, many people still have symptoms during activity.

Investigational device

The UPright™ System

The UPright™ System is an investigational device being studied in people with HFrEF who still have symptoms despite treatment. It does not require open-heart surgery: the implants are placed through a vein in the leg into the two arteries that carry blood from the heart to the lungs. It is designed to reduce the pressure build-up during activity.

It is being studied in clinical trials and is not approved for sale.

The UPright™ System for patientsAbout our clinical studies
A couple carrying exercise mats on a beach. UPright by Restore Medical.

Always talk to your own doctor about your condition and treatment options.