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Heart failure

Heart failure is when your heart doesn’t pump blood around your body as well as it should.

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

Around 900,000 people are living with heart failure in the UK. You’re more likely to get heart failure the older you get. In the UK, about one in every 100 people under 65 has heart failure, but this figure increases to between seven in every 100 people between 75 and 84, and up to 20 in every 100 people over 85.

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.

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Details

  • Symptoms Symptoms of heart failure

    Your symptoms will depend on whether the left, right or both sides of your heart are affected. Your symptoms may change depending on how advanced your condition is. It’s important to recognise the symptoms of heart failure and if you feel your symptoms are getting worse, see your GP.

    Symptoms of heart failure include:

    • breathlessness – you may feel breathless when you’re resting or during exercise
    • swollen feet, ankles or abdomen (tummy)
    • coughing
    • wheezing
    • feeling sick
    • extreme tiredness
    • losing or gaining weight

    If you have any of these symptoms, see your GP.

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  • Diagnosis 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. Your GP may refer you to a cardiologist (a doctor who specialises in identifying and treating conditions of the heart and blood vessels).

    Your GP or cardiologist may recommend a number of tests. Some examples are listed below.

    • Blood and urine tests. These check your blood count, liver and kidney function and other signs of heart failure.
    • An ECG. This measures the electrical activity of your heart to see how well it’s working.
    • An echocardiogram. This uses an ultrasound probe to check the structure of your heart and to see how well it’s working.
    • A chest X-ray. This can check if you have any congestion in your lungs and also rule out other conditions.
    • Lung function tests, such as peak flow measurements or spirometry tests. These can show how well your lungs are working.
  • Treatment Treatment of heart failure

    Treatment for heart failure aims to relieve your symptoms and make your heart stronger to improve your quality of life.

    Self-help

    You can improve your symptoms by making various changes to your lifestyle. These include the following:

    • eating a healthy, balanced diet
    • cutting down on salt
    • stopping smoking
    • doing 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
    • managing stress
    • having an annual flu vaccine

    If you need help with any of these lifestyle changes, talk to your GP. 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 that can relieve the symptoms of heart failure and help you live longer. Different medicines treat different symptoms, so you may need to take more than one. It’s important you take each one correctly. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your doctor or pharmacist for advice.

    Angiotensin-converting enzyme (ACE) inhibitors

    ACE inhibitors widen your blood vessels and make it easier for your heart to pump blood around your 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.

    Angiotensin II receptor blockers

    Angiotensin II receptor blockers (ARBs), also called angiotensin receptor antagonists, work in a similar way to ACE inhibitors. These medicines lower your blood pressure and stop your symptoms from getting worse. Your doctor may prescribe this medicine if you can’t 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. They slow down your heart rate, which helps to lower your blood pressure and the amount of work your heart does. They also make your heart more sensitive to hormones, which circulate in your blood, and changes in your nervous system that help your heart to function more efficiently. If you have asthma or other heart problems, you may not be able to take 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 your lungs, which will allow 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 won’t have to work as hard if there’s less fluid to pump around your body. Tell your doctor if you have gout, as 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. In men, they can cause painful breasts (gynaecomastia). Your GP 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 as it slows down your heart rate. Side-effects may include sickness and diarrhoea. If you get these side-effects, see your GP.

    Anticoagulants

    Anticoagulants, also known as blood thinners, reduce how well your blood can clot. They don’t actually thin your blood but are used to help prevent harmful blood clots from forming. You’re more likely to get blood clots if you have heart failure because your heart’s pumping action is weaker, which can cause blood to pool in your body. This risk is even greater if you have atrial fibrillation.

    Antiplatelets

    Antiplatelets, such as aspirin, stop blood clots from forming by preventing blood platelets sticking together. Blood clots can block narrow blood vessels and stop blood getting to parts of your body. If blood can’t get to your brain, this can cause a stroke. Your GP will consider your risk of having a stroke before prescribing these medicines. Side-effects may include 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 usually fitted under local anaesthesia – this completely blocks pain 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 your heart. A specific type of pacemaker is fitted under the skin of your upper chest. The device sends electrical currents to leads that are 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 an electric shock to return your heartbeat and rhythm back to normal if it detects a serious problem with the rhythm of your heart. Implantable cardioverter defibrillators are usually fitted under local anaesthesia in the same way as pacemakers.

    Surgery

    Transplantation

    If you have very severe heart failure, a heart transplant may be an option. Heart transplants can be very successful but they aren’t suitable for everybody because of the risks of surgery. There are also a limited number of donor hearts available. Ask your doctor if a heart transplant is a suitable option for you.

    Valve replacement

    If 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 graft

    If your heart failure is caused by coronary heart disease, you may be offered a coronary artery bypass graft. 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.

  • Heart treatment on demand

    You can access a range of our health and wellbeing services on a pay-as-you-go basis, including heart treatment.

  • Causes Causes of heart failure

    There are many causes of heart failure. Some of the most common include:

    • coronary heart disease – which accounts for seven out of 10 patients with heart failure
    • high blood pressure (hypertension)
    • atrial fibrillation (when your heart beats too fast in an irregular rhythm)
    • damaged heart valves
    • an inherited heart muscle disease, such as cardiomyopathy
    • drinking too much alcohol
    • severe lung disease
    • overactive thyroid gland (hyperthyroidism)
    • diabetes
    • anaemia
  • Complications Complications of heart failure

    People with heart failure are more likely to have:

    • a poor quality of life, since it’s harder to carry out everyday activities
    • sexual problems
    • depression – up to one third of people with heart failure have depression
    • weight and muscle loss (cachexia)
  • Prevention Prevention of heart failure

    You’re less likely to get heart failure if you take steps to follow a healthy lifestyle. You can reduce your chance of getting heart failure by:

    • not smoking
    • losing excess weight
    • doing regular physical activity if you’re able to
    • eating a healthy, balanced diet without too much salt
    • not drinking more than four units of alcohol a day for men or three units for women

    If you have a condition that can lead to heart failure, for example high blood pressure, it’s important to get treatment as soon as possible to try to prevent heart failure developing.

  • FAQs FAQs

    Can I drive my car or travel with heart failure?

    Answer

    You may be able to carry on driving depending on how serious your heart failure is. Speak to your GP and contact your motor insurer so that you’re aware of their recommendations. You may need to inform the Driver and Vehicle Licensing Agency (DVLA) about your condition. 

    If your heart failure is under control, you can probably travel safely by air.

    Explanation

    You can drive your car as long as you have no symptoms that could distract you. If you drive lorries or buses, you may need regular exercise tests to make sure you’re well enough to continue. If your symptoms are more serious, you may not be able to carry on driving. If you feel unwell, dizzy or your symptoms get worse, don’t drive.

    Most people with heart failure can travel by air, but tell the airline that you’re travelling with beforehand. During the flight, your legs and ankles may swell and breathing may get more difficult if you have severe heart failure. Try to do some stretches and walk around the cabin regularly. It’s also important to be aware that places you travel to at high altitude and places that are hot or humid may make your symptoms worse.

    When travelling, it’s important to take your medicines as you usually would. If you’re flying, ask your airline if you have any questions about how to take your medicines on your flight.

    Do I have to stop exercising if I have heart failure?

    Answer

    Most people with heart failure can still do regular exercise. In fact, exercise can improve your symptoms. Speak to your GP before you start an exercise programme.

    Explanation

    Exercise guidelines differ depending on how serious your heart failure is and what treatment you’re having. Studies have shown that if you have heart failure, keeping active may improve your quality of life because it enables you to do everyday activities more easily.

    It’s a good idea to exercise as part of a rehabilitation programme. These are designed to be specific to your needs. A cardiac rehabilitation programme will consist of a number of sessions (the number will depend on your individual needs). They usually involve group-based education and exercise sessions. The education sessions will provide you with advice and support on many lifestyle areas including managing your weight, help giving up smoking and relaxation techniques. The exercise sessions are likely to involve a gentle warm-up followed by a range of exercises designed specifically for you to improve your fitness, and then end with a cool-down period.

    Speak to your GP if you would like more information about cardiac rehabilitation programmes.

    What can I do to help ease my symptoms of heart failure?

    Answer

    Although medicines can help, there are many things you can do yourself to try to manage your symptoms.

    Explanation

    The most common symptoms people get with heart failure are breathlessness, tiredness and swollen feet and ankles. Below are some practical tips on how to cope with your symptoms.

    You may have difficulty breathing while lying on your back, or sleeping because of the fluid that can build up in your lungs. Keep yourself propped up with pillows as this may help you breathe more easily and stop breathlessness disturbing your sleep. You may also get some wheezing and coughing as a result of the build-up of fluid in your lungs. Try not to have too much salt in your diet. Too much salt makes your body hold on to more fluid than usual, which can cause congestion in your lungs and make you short of breath. Contact your GP if you get severe or persistent breathlessness.

    You may feel tired all the time and find it difficult to carry out everyday activities like shopping, walking or climbing stairs. This happens because your heart can’t pump enough blood around your body and the blood that it does pump goes to your vital organs, for example your heart and brain, instead of to your exercising muscles. It’s important to pace yourself and give yourself plenty of time to do daily activities. Try breaking up big tasks into small parts and ask for help from your friends and family. Keep a diary to monitor your levels of tiredness so you can notice any changes.

    Swollen feet and ankles are caused by your body holding on to water and salt. This causes the excess fluid to leak out of your blood vessels and into surrounding areas of your body. You may get swelling of your feet, ankles and lower legs, but it can also spread much further to include the whole of your leg, groin and the lower part of your abdomen.

    Try not to sit or stand for long periods of time and keep your feet raised when you rest – use a stool or chair to rest your feet on. You may also find it easier to wear comfortable shoes and socks that aren’t too tight. It’s also important to keep active by walking and regularly moving your legs.

    Will I need to take medicines for the rest of my life for my heart failure?

    Answer

    Yes, it’s likely that you will need to take one or more medicines for the rest of your life. Don’t stop taking your medicines or change how much or how often you take them without speaking to your GP first.

    Explanation

    Medicines are likely to help ease your symptoms of heart failure, although there is no cure for the condition. Finding the right combination of medicines to suit you may take some time depending on your symptoms, how severe your heart failure is and if you have other medical conditions.

    Most medicines can cause side-effects and your GP will monitor you closely. It’s important to see your GP or pharmacist if you have any questions or worries about your medicines.

  • Resources Resources

    Further information

    Sources

    • European Society of Cardiology. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Eur Heart J 2012; 33:1787–847. doi:10.1093/eurheartj/ehs104
    • About heart failure. American Heart Association. www.heart.org, published 20 August 2012
    • Heart failure – suspected. Map of Medicine. www.mapofmedicine.com, published 2 October 2012
    • Davies EJ, Moxham T, Rees K, et al. Exercise based rehabilitation for heart failure. Cochrane Database of Systematic Reviews 2010, Issue 4. doi:10.1002/14651858.CD003331.pub3
    • Quick facts and questions about heart failure. Heart Failure Society of America. www.hfsa.org, accessed 13 February 2013
    • Heart failure – chronic. NICE Clinical Knowledge Summaries. www.cks.nice.org.uk, published November 2010
    • Heart failure. eMedicine. www.emedicine.medscape.com, published 25 January 2013
    • Warning signs of heart failure. American Heart Association. www.heart.org, published 20 September 2012
    • Chronic heart failure quality standard. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, published June 2011
    • Chronic heart failure: national clinical guideline for diagnosis and management in primary and secondary care. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, published 25 August 2010
    • Common tests for heart failure. American Heart Association. www.heart.org, accessed 2 January 2013
    • Heart failure. British Heart Foundation. www.bhf.org.uk, accessed 13 February 2013
    • Lifestyle changes for heart failure. American Heart Association. www.heart.org, published 20 August 2012
    • Symptomatic left ventricular systolic dysfunction (LVSD) – management. Map of Medicine. www.mapofmedicine.com, published 2 October 2012
    • Heart failure medications. American Heart Association. www.heart.org, published 2 October 2012
    • Heart failure. eMedicine. www.emedicine.medscape.com, published 25 January 2013
    • Start active, stay active: a report on physical activity from the four home countries’ chief medical officers. Department of Health. www.dh.gov.uk, published July 2011
    • How much alcohol is too much? Drinkaware. www.drinkaware.co.uk, accessed February 2013
    • Living with heart failure. British Heart Foundation. www.bhf.org.uk, published 9 January 2011
    • What is cardiac rehabilitation? American Heart Association. www.heart.org, published 14 August 2012
    • British Cardiovascular Society. Fitness to fly for passengers with cardiovascular disease. Heart 2010; 96:ii1-ii16. doi:10.1136/hrt.2010.203091
    • Heart failure. Driver and Vehicle Licensing Agency. www.dft.gov.uk, accessed 13 February 2013
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    Produced by Rachael Mayfield-Blake, Bupa Heath Information Team, February 2013.

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