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Heart failure

Key points

  • If you have heart failure, your heart doesn’t pump blood around your body as well as it should.
  • You’re more likely to get heart failure the older you get.
  • There are many causes of heart failure but the most common is coronary heart disease.
  • You’re less likely to get heart failure if you take steps to follow a healthy lifestyle.
  • The most common symptoms of heart failure are breathlessness, tiredness and swollen ankles.

Video: how the heart works

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

Animation - how the heart works

About heart failure

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.

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.

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)

Causes of heart failure

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

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 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.

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.

 

Produced by Rachael Mayfield-Blake, Bupa Heath Information Team, February 2013.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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