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Heart failure

Published by Bupa's health information team, April 2009.

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 becomes less efficient at pumping blood and is therefore unable to meet the demands of the body.

How the heart works

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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.

Further information

Heart failure Q&As

See our answers to common questions about heart failure, including:

Related topics

Sources

  • Heart failure. British Heart Foundation. www.bhf.org.uk, accessed 5 September 2008
  • Simon C, Everitt H, Kendrick T. Oxford handbook of general practice. 2nd ed. Oxford: Oxford University Press, 2007:334-335
  • Prevalence of heart failure. Heartstats: British Heart Foundation Statistics Website. www.heartstats.org, accessed 5 September 2008
  • Chronic heart failure. National Institute for Clinical Excellence (NICE), 2003, Full Guideline no. 5. www.nice.org.uk
  • Management of heart failure. National Institute of Clinical Excellence (NICE), 2003, Information for the Public Guideline no. 5. www.nice.org.uk
  • Heart failure (view whole topic). Clinical Knowledge Summaries. http://cks.library.nhs.uk, accessed 5 September 2008
  • Medicines for the heart. British Heart Foundation. www.bhf.org.uk, accessed 9 September 2008
  • Preventing heart disease. British Heart Foundation. www.bhf.org.uk, accessed 9 September 2008
  • Joint Formulary Committee, British National Formulary. 56th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2008:105
  • Tachycardia. Arrhythmia Alliance. www.heartrhythmcharity.org.uk, accessed 30 March 2008
  • Implantable cardioverter defibrillators for arrhythmias. National Institute for Health and Clinical Excellence (NICE), 2006, Technology Appraisal 95. www.nice.org.uk

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. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: April 2009

 

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