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Heart failure

This factsheet is for people who have heart failure, or who would like information about it.

Heart failure is a term used to describe the condition when the heart is not pumping blood around the body as well as it should be.

Click on the tabs below for more information about heart failure.

Published by Bupa's Health Information Team, April 2009.

How the heart works

About heart failure

About heart failure

About heart failure


Heart failure is the result of damage to your heart muscle. This damage may weaken your heart, but it does not mean that your heart is about to stop. Your heart’s pumping action may be weaker, which makes it more difficult to pump as much blood and oxygen as you need around your body. As your heart can not keep up with your body’s demand for oxygen, you develop symptoms of heart failure. You’re more likely to get heart failure the older you get.

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. When describing an illness, the term ‘chronic’ refers to how long a person has it, not to how serious a condition is.

Causes of heart failure


There are many causes of heart failure, of which some of the most common include:

  • coronary heart disease – the most common cause
  • high blood pressure (hypertension)
  • damaged heart valves
  • disease of the heart muscle as a result of genetic causes – for example, cardiomyopathy
  • drinking alcohol excessively
  • severe lung disease
  • an overactive thyroid gland (hyperthyroidism)
  • anaemia

Complications of heart failure


People with heart failure are more likely to have:

  • a poor quality of life – this is because it is harder to carry out everyday activities
  • an irregular heart beat (arrhythmia)
  • sexual problems
  • depression – up to one third of people with heart failure have depression
  • deep vein thrombosis
  • stroke

Symptoms and diagnosis

Symptoms and diagnosis

Symptoms of heart failure


Heart failure can affect the left, right or both sides of your heart and therefore causes different symptoms. Your symptoms may change depending on how far advanced your condition is. It is important to be able to recognise the symptoms of heart failure and if you feel your symptoms are getting worse, see a doctor.

Common symptoms of heart failure include:

  • extreme tiredness
  • breathlessness
  • swollen feet, ankles or abdomen (tummy
Left-sided heart failure affects your lungs and your ability to breathe. Symptoms may include breathlessness at rest or during exercise, coughing, wheezing and extreme tiredness. If you have very severe heart failure, you may cough up froth or blood and you are more likely to get chest infections.

Right-sided heart failure affects the fluid balance in your body. You might get symptoms such as swollen feet, ankles and abdomen, or extreme tiredness, feeling sick and weight gain.

These symptoms are not always caused by heart failure, but if you have them, see a doctor.

Diagnosis of heart failure


The doctor will ask you about your symptoms and examine you. He or she may also ask you about your medical history.

There are a number of tests your doctor may recommend that you have. Some examples are listed below.

  • Blood and urine tests can check your blood count, your liver and kidney function and other indicators of heart failure.
  • An electrocardiogram measures the electrical activity of the heart to see how well it is working.
  • An echocardiogram uses an ultrasound probe to check the structure of your heart and see how well it is functioning.
If your doctor thinks your symptoms could also be the result of lung problems, he or she may recommend you have:

  • a chest X-ray to confirm if you have heart failure and to rule out other conditions
  • lung function tests, such as peak flow measurements or spirometry tests, to show how well your lungs are working
Please note that availability and use of specific tests may vary from country to country.

Treatment

Treatment

Treatment of heart failure is aimed at relieving your symptoms, making your heart stronger and improving your quality of life.

Self-help


Your symptoms of heart failure can be improved by many lifestyle changes, including:

  • eating a healthy, balanced diet
  • cutting down on salt
  • stopping smoking
  • taking regular exercise
  • drinking alcohol in moderation or not at all if alcohol has caused your heart failure
  • maintaining a healthy weight
  • monitoring how much fluid you drink and weighing yourself daily
  • managing stress
  • having a flu vaccine, if available
If you need help with any of these lifestyle changes, talk to a doctor. He or she may be able to arrange for you to attend a rehabilitation programme and offer information and support.

Medicines


There is a range of medicines available that can be used to relieve the symptoms of heart failure and help you live longer. Different medicines treat different symptoms, so you may be given more than one medicine. It is important you take each one correctly so that each can do its job properly.

Always read the patient information leaflet that comes with your medicine and if you have any questions, ask a doctor or pharmacist for advice.
Angiotensin-converting enzyme inhibitors 
Angiotensin-converting enzyme (ACE) inhibitors widen your blood vessels making it easier for your heart to pump blood around the body. ACE inhibitors are given to most people with heart failure. Side-effects may include a dry cough and low blood pressure, which may make you feel dizzy. If you get a cough when taking ACE inhibitors, see a doctor.
Angiotensin II receptor antagonists 
Angiotensin II receptor antagonists (also called angiotensin receptor blockers) work in a similar way to ACE inhibitors. These medicines lower your blood pressure and stop your symptoms from getting worse. You may be given these if you can not take ACE inhibitors because of the side-effects.
Beta-blockers 
There are many different types of beta-blocker but only certain ones are used to treat heart failure. Beta-blockers cause the arteries to widen and they slow down the heart rate. This helps to lower your blood pressure and the amount of work your heart does. If you have asthma or other heart problems, you may not be given beta-blockers. Side-effects can include tiredness, cold hands and feet, disrupted sleep and impotence in men.
Diuretics 
Diuretics can help to reduce swollen feet and ankles, and prevent fluid build-up on the lungs, allowing you to be more active and breathe more easily. Diuretics cause your body to get rid of excess fluid by making you urinate more often. Your heart will not have to work as hard if there is less fluid to pump around the body. If you have gout, diuretics can make it worse. They can also lower your blood pressure, which may make you feel dizzy.
Aldosterone antagonists 
Spironolactone or eplerenone are two types of common aldosterone antagonists. They work in a similar way to diuretics by affecting the balance of water and salts going into your urine. These medicines can cause sickness and may affect how well your kidneys work. Your doctor may want to do regular blood tests to check your kidney function if you take this medicine.
Digoxin 
Digoxin helps if you have a rapid or irregular heart beat by slowing down your heart rate. Side-effects may include sickness and diarrhoea. If you get these side-effects, see a doctor.
Anticoagulants 
Anticoagulants, also known as blood thinners, reduce how well your blood can clot. They do not actually thin the blood. Anticoagulants such as warfarin are used to help prevent harmful blood clots from forming. You are more likely to get blood clots if you have heart failure because your heart’s pumping action is weaker causing the blood to pool in the body. Blood clots can block narrow blood vessels and stop blood getting to parts of your body. If blood can not get to your brain, this can cause a stroke. Your doctor will consider your risk of having a stroke before prescribing you anticoagulants.
Antiplatelets 
Antiplatelets, such as aspirin, stops blood clots from forming by preventing blood platelets sticking together. Aspirin is not usually taken with warfarin. Side-effects may include sickness and stomach pain.

Other treatments

Pacemaker 
A pacemaker is a small device that sends electrical signals to your heart to stimulate it to beat at a specific rate. There are several different types of pacemaker. A pacemaker is usually implanted under the skin of your upper chest and is fitted under local anaesthesia – this completely blocks the feeling from your chest area and you will stay awake during the operation.
Cardiac re-synchronisation therapy 
Cardiac re-synchronisation therapy restores the normal pumping action of the heart. A specific type of pacemaker is fitted under the skin of your upper chest. The device sends electrical currents to leads connected to the different parts of your heart so they contract in synchronisation with each other.
Implantable cardioverter defibrillator 
An implantable cardioverter defibrillator (ICD) is similar to a pacemaker, and is usually implanted under the skin below your collarbone. An ICD can monitor your heart rhythm and deliver a small electric shock to return your heartbeat and rhythm back to normal if it detects a problem. ICDs are usually fitted under local anaesthesia.

Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.

Surgery

Transplantation 
If you have very severe heart failure, a heart transplant may be an option. Heart transplants can be very successful but they are not suitable for everybody because of the risks of surgery. There are also a limited number of donor hearts available.
Valve replacement 
If your heart failure is caused by one or more of the valves in your heart not working properly, replacing these valves may improve your symptoms.
Coronary artery bypass surgery 
If your heart failure is caused by coronary heart disease, you may be offered a coronary artery bypass. This aims to bypass your blocked arteries to increase the blood flow to your heart. This can help to improve the pumping action of your heart.

Prevention of heart failure

Prevention of heart failure

You can reduce your chance of getting heart failure by:

  • not smoking
  • losing excess weight
  • doing regular physical activity – aim for 30 minutes on at least five days a week
  • eating a healthy, balanced diet without too much salt
  • not drinking more than the recommended amount of alcohol, if you drink
If you have a condition that can lead to heart failure, for example high blood pressure, it is important to get treatment as soon as possible to try to prevent heart failure developing.

Sources

Sources

  • About Heart failure. American Heart Association. www.heart.org, accessed 20 January 2011
  • Heart failure. British Heart Foundation. www.bhf.org.uk, accessed 17 November 2010
  • Heart failure. BMJ Clinical Evidence. www.clinicalevidence.bmj.com, published 25 February 2010
  • Chronic heart failure. National Institute for Health and Clinical Excellence (NICE), August 2010. www.nice.org.uk
  • Heart failure – chronic. Clinical Knowledge Summaries. www.cks.nhs.uk, published November 2010
  • Management of chronic heart failure. Scottish Intercollegiate Guidelines Network (SIGN), February 2007. www.sign.ac.uk
  • Faris RF, Flather M, Purcell H, et al. Diuretics for heart failure. Cochrane Database of Systematic Reviews 2006, Issue 1. doi:10.1002/14651858.CD003838.pub2
  • Simon C, Everitt H, van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press, 2010: 436
  • ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. European Society of Cardiology, 2008. www.escardio.org
  • Understanding NICE guidance, chronic heart failure. National Institute for Health and Clinical Excellence (NICE), August 2010. www.nice.org.uk
  • Understanding heart failure. heartfailurematters.org. www.heartfailurematters.org, published June 2009
  • Joint Formulary Committee. British National Formulary. 60th ed. London: British Medical Association and Royal Pharmaceutical Society; 2010
  • Treatment. British Heart Foundation. www.bhf.org.uk, accessed 22 November 2010
  • Cardiac resynchronisation therapy for the treatment of heart failure. National Institute for Health and Clinical Excellence (NICE), May 2007. www.nice.org.uk
  • Recovery. British Heart Foundation. www.bhf.org.uk, accessed 22 November 2010
  • Cardiac rehabilitation: a national clinical guideline. Scottish Intercollegiate Guidelines Network (SIGN), 2002. www.sign.ac.uk
  • Standards and core components for cardiac rehabilitation. British Association for Cardiac Rehabilitation, 2007. www.bcs.com
  • For medical practitioners: at a glance guide to the current medical standards of fitness to drive. Department for Transport. www.dft.gov.uk, published February 2011a

This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. Photos and videos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

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