Heart failure is best to think of as an overall failure of the heart to produce enough forward blood flow to the body to maintain normal bodily functions in all organ systems. It may be as mild as causing someone shortness of breath because the heart is not providing enough forward blood output.  More commonly people recognize it as collecting fluid around the heart or collecting fluid in the ankles with shortness of breath. There are 2 basic types of heart failure which are described as heart failure with reduced ejection fraction (HFREF) or heart failure with preserved ejection fraction (HFPEF). Ejection fraction is the amount of blood in the left ventricle side that is ejected forward, passed the aortic valve. Normal ejection fraction is generally thought of at least 55% or greater of the fractional volume of blood being ejected out from the left ventricle. This means that people can have heart failure even when the ejection fraction or forward ejection amount of blood is normal. This HFReF is often a confusing concept. It’s best to think of the heart becoming stiff like a stiff balloon and can’t relax enough even though it can eject forward the right amount of blood with its pumping function. That’s why this is called heart failure with preserved ejection fraction.  Regardless of the type of heart failure however the patient presentation can be the same and patients can have fluid collections in their ankles or around their heart and be short of breath and fatigued. Management involves helping the heart become more efficient with beta blocker medicine and reducing the fluid collection often with diuretic or water type pills.