Heart failure

Heart failure
Heart failure is a term used to describe the condition when the heart becomes less efficient at pumping blood and is therefore unable to meet the demands of the body.

About heart failure
Heart failure is a result of damage to your heart muscle that can’t be repaired. This damage has weakened the pumping action of your heart, which makes it difficult for other parts of your body to receive blood and oxygen. It’s important to remember that heart failure only means that your heart isn’t working as well as it used to, not that it has failed completely.

There are about 707,000 people living with heart failure in the UK. Your chance of having heart failure increases steeply with age. Only one in every 100 people under 65 have heart failure, but this figure increases to between six and seven in every 100 people between 75 and 84, and up to 22 in every 100 of those over 85. Heart failure is slightly more common in men than women.

Heart failure is usually a chronic condition. A chronic illness is one that lasts a long time, sometimes for the rest of the affected person’s life. The term chronic refers to time, not how serious a condition is. Treatment for heart failure aims to reduce symptoms and prolong life.

Symptoms of heart failure
Common symptoms of heart failure include breathlessness, tiredness, and swollen feet and ankles. Other symptoms depend on which side of your heart is most affected.

Left-sided heart failure affects your lungs and ability to breathe. Symptoms include breathlessness when exercising and/or when lying flat, extreme tiredness, wheezing and a cough with a pink froth, usually occurring at night. Right-sided heart failure affects the fluid balance in your body. You may have symptoms such as swollen ankles, feeling sick, extreme tiredness and weight gain.

Complications of heart failure
People with heart failure are at risk of having:

poor quality of life – due to difficulty in carrying out every day activities
depression – one-third of people with heart failure develop severe depression
irregular heart beat (arrhythmia) – which can be fatal
damage to the brain caused by blood clots (stroke)
blood clots in the lungs or legs
liver congestion
Causes of heart failure
There are many causes of heart failure but some of the most common include:

previous heart attack – the most common cause
high blood pressure (hypertension)
damaged heart valves
irregular heart beat
disease of the heart muscle due to genetic causes (cardiomyopathy)
inherited defects (congenital heart disease)
excessive alcohol use
viral infection
anaemia
overactive thyroid gland (hyperthyroidism)
Diagnosis of heart failure
Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history.

You may need to have additional tests, such as:

blood and urine tests to check your blood count, liver function and for markers of heart failure
an ECG (electrocardiogram) – a test that measures the electrical activity of your heart to see how well it’s working
an echocardiogram (heart ultrasound scan) to show the pumping action of your heart and valves
a chest X-ray to rule out other conditions
Treatment of heart failure
Self-help
Your symptoms of heart failure can be improved by many lifestyle changes, including:

maintaining a healthy weight
cutting down on salt
eating a healthy diet
limiting how much fluid you have each day (under your GP’s advice)
stopping smoking
taking regular exercise
drinking alcohol in moderation, or not at all if this has caused your heart failure
If you need help with making some of these changes, talk to your GP. He or she may be able to arrange for you to attend a rehabilitation programme and can offer information and other support.

Medicines
A range of medicines can be used to relieve the symptoms of heart failure and slow down any worsening of the condition. The medicine you’re given will be the one that’s most effective for your individual needs. For example, if you have high blood pressure, you will be given medicine to lower it. You may be given more than one medicine. Most medicines to treat heart conditions must be taken daily.

ACE inhibitors
Angiotensin-converting enzyme (ACE) inhibitors help your heart pump more blood and are often used to lower blood pressure. They are recommended for all patients with heart failure. ACE inhibitors improve heart failure symptoms, prolong life and reduce the likelihood that you will be sent to hospital. Side-effects can include low blood pressure, which can make you feel dizzy, and a dry cough.

Beta-blockers
Beta-blockers are commonly used for treating high blood pressure and studies have shown that specific ones can improve life expectancy in some patients with heart failure. Beta-blockers can cause a slow heart rate, tiredness, cold hands and feet, insomnia, dizziness and impotence in men.

Diuretics
Diuretics are the most commonly used medicine for heart failure. They work by helping to reduce the amount of fluid in your body, which will make you urinate more often. This should help you breathe more easily (by removing fluid in the lungs) and be more active (by reducing leg swelling). Diuretics may lower your blood pressure, which can make you feel dizzy.

Spironolactone
This is a type of diuretic that works by interfering with the action of the hormone aldosterone. It’s sometimes used in patients with moderate to severe heart failure if other medicines aren’t helping.

Digoxin
Digoxin has been used for over 200 years to treat heart problems and may be given to you if other medicines aren’t helping your heart failure, especially if you have an irregular heart beat. It works by helping your heart beat more strongly and regularly. The most common side-effect is feeling sick.

Angiotensin-II receptor antagonists
You may be given angiotensin-II receptor antagonists (also called angiotensin receptor blockers) together with ACE inhibitors. If you can’t take ACE inhibitors because of the side-effects, you may be given angiotensin-II receptor antagonists on their own.

Anticoagulants
Blood clots are more likely to form if you have heart failure. These can be carried in the circulation and may block narrow vessels, preventing blood from reaching some areas of the body. If this happens in the brain it’s called a stroke. Anticoagulants such as warfarin are used to thin the blood, making blood clots less likely. Taking warfarin requires careful monitoring with regular blood tests. If your blood becomes too thin, for example, this can cause difficulty in controlling bleeding.

Other treatments
Pacemaker
A pacemaker is a small device, usually implanted under the skin in the upper chest. Electrical signals are sent from the pacemaker to your heart to stimulate it to beat at a specific rate. Pacemakers are usually fitted under local anaesthetic; this completely blocks the feeling from your chest and you will stay awake during the operation.

If you have severe heart failure (an ECG appearance called ‘left bundle branch block’), a special type of pacemaker, called a resynchronisation (biventricular) pacemaker, can be helpful.

Implantable cardioverter defibrillator (ICD)
An ICD is similar to a pacemaker. However, an ICD can monitor your heart rhythm and deliver a small electric shock to return your heartbeat to normal if it detects a problem. ICDs are usually fitted under local anaesthetic; this completely blocks the feeling from your chest and you will stay awake during the operation.

Transplantation
For some people who have severe heart failure, a heart transplant may be an option. This can be a very successful procedure, although complications such as rejection of the donor heart can occur. Transplantation is limited by the number of donor hearts available.

Prevention of heart failure
A heart-healthy lifestyle can reduce your risk of heart failure by reducing the risk of coronary artery disease and high blood pressure. Maintaining a healthy weight, not smoking, being physically active most days and eating a balanced diet are all recommended to prevent heart conditions. It’s also sensible to stick to moderate drinking and to keep a check on your blood pressure and cholesterol level.