Understanding Heart Failure

Other causes of heart failure include:

• Cardiomyopathy (heart muscle disease)
• Heart valves that either leak or are too narrow
• Congenital heart disease may lead to heart failure at younger age .
• Heart rate that is much too fast, or too slow, or irregular (arrhythmias)

What are the symptoms of heart failure ?

Mild heart failure can remain undetected as some people suffer few symptoms. This does not mean however that mild heart failure requires no medical attention – it does, because the progression of the disease needs to be halted.

The symptoms of heart failure include severe tiredness, breathlessness, or swelling of the ankles, legs and feet.   If you have any of these symptoms, it does not automatically mean that you have heart failure, but you should visit your doctor to discuss these problems.

• Severe tiredness : Loss of energy and tiredness can occur even when you are at rest or following only a small amount of activity.  It is due to the body’s organs receiving insufficient oxygen.  As the heart’s pumping capacity decreases, muscles and other tissues receive less oxygen and nutrition from the circulating blood.
• Shortness of breath: Breathlessness is caused by blood not pumped through adequately in the lungs (pulmonary oedema).  Breathing difficulties may occur at rest or during exercise.  You may also experience coughing.  Shortness of breath can be severe enough to prevent or interrupt your sleep, and you may need to sit up, or go to the window for some fresh air
• Swollen ankles: Swollen ankles, legs or feet (peripheral oedema) occur as the body is less efficient at pumping fluid (water and salt) around the body.  Fluid backs up in the veins, leaks out, and accumulates in the tissues.  Also, a decrease in blood flow to the kidneys can lead to an increase in fluid retention.

Additional signs and symptoms may include:

• Weight gain (due to fluid build-up in the tissues)
• Weight loss, due to wasting if heart failure is at an advanced stage
• Palpitations, high heart rate
• Confusion (due to a lack of oxygen being circulated to the brain)
• Failure of vital organs due to reduced blood supply
• Low blood pressure (if heart failure is at an advanced stage)
• Loss of appetite

If you think you may have heart failure, consult your doctor as soon as possible.

 

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How many people have heart failure?

Heart failure is a relatively common chronic disorder and it is rising as the population gets older.  In Europe, around 14 million people suffer from heart failure, and this number is forecast to rise to 30 million by 2020.

How can heart failure be treated?

Heart failure can be managed in several ways: drug treatment, device therapy, surgery and lifestyle changes. The aims of treatment are to reduce the progression of the disease, reduce hospitalisation, reduce mortality and extend and improve quality of life.

Medicines to treat heart failure

• Angiotensin converting enzyme (ACE) inhibitors which help dilate the arteries, lower high blood pressure and improve heart muscle function. They improve survival and reduce hospitalisation rate.
• Angiotensin receptor blockers (ARBs), which have a similar mode of action to ACE inhibitors, are used as an alternative where people are intolerant to ACE inhibitors. They too improve survival and reduce hospitalisation rate.
• Beta blockers which slow down the heart rate and improve heart muscle function. They also improve survival and reduce hospitalisation rate.
• Aldosterone blockers which reduce build-up of fibrous tissue and help control heart rhythm. Again, they improve survival and reduce hospitalisation rate.
• Diuretics (water tablets) which help prevent fluid build up in the lungs, aiding breathing but not improving heart muscle function or survival. Diuretics also help relieve swelling in the ankles and legs.
• Digitalis which is still used occasionally to control over-stimulation of the heart.

Detailed guidelines exist which advise doctors which sort of drug is most appropriate for use with specific types of heart failure.

 

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Device therapy

Heart failure cannot always be controlled by medication

Cardiac Resynchronisation Therapy (CRT) is a new type of device therapy which delivers electrical stimulation to both sides of the heart, re-synchronising and therefore strengthening its pumping action. A conventional pacemaker only stimulates the right side of the heart, affecting just heart rate. 
A recent study (COMPANION) showed that applying CRT to people with advanced heart failure already receiving optimal drug therapy significantly decreased the risk of death and hospitalisation.  

Surgery

Patients with serious heart failure may benefit from a surgical technique which can repair the valve that controls the flow of blood between two of the damaged heart’s chambers.

Heart transplantation is a ‘last resort’ treatment for advanced heart failure. In carefully selected people it has been shown to increase survival, exercise capacity, return to work and quality of life compared to conventional treatment.

Healthy lifestyle
A healthy lifestyle is also important to maintain heart function and to minimise the effects of heart failure. Adopting a healthy lifestyle includes the following steps: 

• Stop smoking
• Reduce alcohol intake
• Maintain a healthy weight and diet.  For those with advanced heart failure, a healthy diet includes a low salt (sodium) intake. A high sodium intake can cause fluid retention and therefore contribute to oedema
• Be physically active, within the limits advised by your doctor

How can I prevent heart failure?

As coronary heart disease (CHD) and hypertension are common causes of heart failure, it is important that these disorders are quickly and effectively treated with appropriate medication.  Lifestyle changes that can help the prevention of heart failure include:

• Maintaining a sensible weight and eating a healthy diet.  A healthy weight and diet are important, as obesity is a risk factor for heart failure, hypertension, stroke, heart disease, and diabetes. Excess weight puts additional strain on the heart making it difficult to fulfill the demand for oxygen to tissues of the body.
• Stopping smoking.  Smoking is a risk factor for CHD and heart failure. Cigarette smoke contains carbon monoxide, which interferes with the body's ability to transport oxygen.
• Reduce cholesterol level. High cholesterol levels have been linked to coronary heart disease, therefore eating a diet high in fruits and vegetables and low in saturated fats will reduce the risk.
• Reduce alcohol intake.  Long term excessive intake of alcohol can depress the contraction function of the heart.
• Exercising (within limits advised by your doctor).  Moderate aerobic exercise is an integral part of improving stamina and quality of life for patients with heart failure. Activities such as walking or cycling and swimming can strengthen muscles, heart, and the cardiovascular system. And, contrary to popular misconceptions, heart failure patients should not rest but be physically active.

I have been diagnosed as having heart failure. Should I reduce all physical exertion?

Absolutely not!  You should try and be physically active, but within the limits advised by your doctor.  The type of activity that is recommended for the heart is moderate, rhythmic (aerobic) exercise such as brisk walking, cycling or swimming. 

I feel tired and breathless, what should I do?

Tiredness, breathlessness and swollen ankles are not always caused by heartfailure, but you should consult your doctor as soon as possible. If you are diagnosed as having heart failure, it is important that you are treated promptly.

How is heart failure diagnosed?

In some cases, your doctor will suspect heart failure after a careful physical examination.  Your doctor will ask you questions about your energy levels and your breathing, take your heart rate and rhythm, measure your blood pressure, check whether you have fluid in your lungs, legs and other parts of your body and listen to sounds made by the heart valves. Suspected heart failure needs then to be confirmed by additional tests including:

• An echocardiogram – this can provide a picture of the heart’s pumping action and is an obligatory test to confirm heart failure
• ECG – this measures the heart’s electrical impulses
• Chest X-ray
• Blood tests

Is heart failure just part of growing old?

While it is true that the majority of people with heart failure are elderly, heart failure is not simply part of the aging process.  It is a serious, chronic cardiovascular disease that can be greatly helped by correct treatment with modern medicine

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