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Heart failureThis factsheet is for people who have heart failure or who want to know more about it. Heart failure occurs when your heart is unable to pump enough blood to meet the demands of the body. Typical symptoms include breathlessness, swollen ankles and feet, and extreme tiredness. The chance of having heart failure increases with age. Only one in 100 people under 65 are affected, but this figure increases to seven among people between 75 and 84. It's more common in men.
What is it?Heart failure sounds quite alarming. But it only means that the heart is not working as well as it used to, not that it has failed completely. Heart failure is usually a chronic (long-term) condition, with no complete cure. Treatment aims to reduce symptoms and prolong life. People with heart failure are more prone to potentially dangerous conditions such as:
For more information about the heart, lungs and circulation, please see the separate BUPA health factsheet, The cardiovascular system. What causes heart failure?A number of conditions can cause heart failure to develop. Some examples are listed below.
SymptomsOne of the main symptoms of heart failure is tiredness and a lack of energy. This is because of poor blood supply to the muscles. Other symptoms depend on which side of your heart is most affected. Left heart failure affects the side of your heart that pumps blood around your body. It commonly develops after a heart attack. Symptoms include breathlessness when exercising and/or when lying flat, severe breathlessness in the early hours, fatigue and a cough with frothy spit. Right heart failure affects the side of the heart that pumps blood to the lungs. It often happens as a result of left heart failure, but it can also be caused certain chronic lung problems, such as chronic bronchitis. Right heart failure results in a build up of fluid in the legs that can extend over the lower back and inside the abdomen (where it is called ascites). The liver can become enlarged and there may be nausea and swollen veins in the neck. The extra fluid may cause weight gain, although severe chronic heart failure sometimes causes wasting. DiagnosisA physical examination and a review of your medical history will help your GP diagnose heart failure. You may be asked to go for some hospital tests, such as:
Medical treatmentA range of medicines can be used to relieve the symptoms of heart failure and slow down any worsening of the condition. Any underlying cause will be treated first - for example, drug treatment given to lower blood pressure. The various types of drugs used to treat heart failure work in different ways. ACE inhibitorsThese drugs reduce the production of hormones which constrict blood vessels. This makes the walls of the blood vessels relax, which reduces pressure and makes it easier for blood to circulate. Overall, they improve the performance of the heart, reduce heart failure symptoms and prolong life. Side-effects can include a persistent dry cough, low blood pressure and faintness. Angiotensin II antagonistsThese act directly on the blood vessel wall to block the effects of the hormones which constrict them. Their action is therefore similar to those of the ACE inhibitors but they tend not to cause a dry cough. They are used if ACE inhibitors cause too many side-effects. Beta-blockersBeta-blockers are commonly used for treating high blood pressure. They also steady the heartbeat and make the heart more able to cope with exercise. In the past they were thought to be unsuitable for people with heart failure. However, studies have shown that specific beta blockers can actually help in some heart failure patients. They aren't suitable for people who have asthma. Loop diureticsThese increase the production of urine, which helps to remove excess fluid from the body. This reduces leg swelling and removes fluid from the lungs, and can improve symptoms such as breathlessness. There are some side-effects. Diuretics can upset the balance of salts in the body (especially potassium), leading to muscle weakness, fatigue and abnormal heart rhythms. Other drugs or potassium supplements may help to counter this. Talk to your GP for more advice. SpironolactoneThis is a type of diuretic which works by interfering with the action of the hormone aldosterone. It is sometimes used if other medicines aren't helping to control the heart failure. DigoxinThis works to slow the heartbeat and improve the heart muscle's pumping ability. It is used if symptoms aren't adequately controlled by ACE inhibitors and other drugs. Side-effects can include a loss of appetite and nausea. Hydralazine and nitratesACE inhibitors or angiotensin II antagonists do not always help to control heart failure symptoms and are sometimes not tolerated. In these situations, hydralazine and nitrates, which relax the walls of blood vessels, have been shown to be useful. Other treatmentsAnticoagulants, eg warfarinBlood clots are more likely to form in the heart chamber's of people with heart failure and arrhythmias. These can be carried in the circulation and may block narrow vessels, preventing blood from reaching some tissue. If this happens in the brain it's called a stroke. Anticoagulants are used to thin the blood, making blood clots less likely. Taking warfarin requires careful monitoring with regular blood tests. Thinning the blood too much, for example, can mean that an injury causes bleeding that is difficult to control. TransplantationFor some people who have severe heart failure and a life expectancy of less than six months, 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. It isn't suitable for all patients, and is limited by the amount of donor hearts available. PreventionTo prevent heart failure it is vital to tackle the underlying causes. A heart-healthy lifestyle can reduce the risk of heart failure by reducing the risk of coronary artery disease and hypertension. This means not smoking, being physically active most days and eating a balanced diet. Sticking to moderate drinking and keeping a check on your blood pressure is also sensible. The British Heart Foundation also recommends you make these changes if you already have heart failure, to help prevent it getting worse. Further informationOther BUPA health factsheets on cardiovascular health include:
Sources
Reviewed by Dr James Quekett, Bsc.MB Ch.B MRCGP DRCOG DFFP, partner/principal general practitioner at Rowcroft Medical Centre. Published by BUPA's health information team, healthinfo@bupa.com, March 2007.
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