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Heart failure


Expert reviewer, Dr Tim Cripps, Consultant Cardiologist
Next review due May 2021

Heart failure is when your heart doesn’t pump blood around your body as well as it should. This can make it difficult for your body to get as much blood and oxygen as it needs. This then causes the symptoms of heart failure, such as having trouble breathing, especially after being active.

The term ‘heart failure’ can seem worrying. But although this is a serious medical condition, it doesn’t mean that your heart is going to stop working. It just needs some support to help it work better.

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

About heart failure

Heart failure can happen if the structure of your heart or the way it works isn’t as it should be. There are many different reasons for this, but common causes include coronary heart disease, heart valve disease and high blood pressure. Many people with heart failure have had a heart attack in the past. See our Causes of heart failure section for more information.

You’re more likely to get heart failure as you get older. The average age for someone finding out they have heart failure is 76.

You’ll usually have heart failure for a long time, sometimes for the rest of your life. But with treatment, you can keep the symptoms of heart failure under good control for years.

Symptoms of heart failure

Your symptoms will depend on which part (or parts) of your heart are damaged, and how severely. Symptoms of heart failure include:

  • trouble breathing – you may feel breathless when you’re exercising or even when you’re resting, particularly when you’re lying flat
  • sudden breathlessness in the night
  • persistent swelling of your feet, ankles or abdomen (tummy)
  • feeling extremely tired
  • a cough (often at night) and wheezing

If these symptoms start, contact your GP. If you know you have heart failure, contact your GP if you feel your symptoms are getting worse.

Diagnosis of heart failure

Your GP will ask you about your symptoms and medical history, and examine you. They may refer you to see a cardiologist – a doctor who specialises in conditions that affect the heart and blood vessels.

Your doctor may recommend various tests to find out if you have heart failure or not and, if so, what’s causing it. Tests for heart failure include those listed below.

  • Blood and urine tests. These check your blood cell count and how well your kidneys are working, as well as other signs of heart failure.
  • An electrocardiogram (ECG). This measures the electrical activity of your heart. It can tell your doctor if you’ve had a heart attack, if your heart rhythm is normal and whether part of your heart is thickened.
  • An echocardiogram. This uses ultrasound to check the structure of your heart and how well it’s working.
  • A chest X-ray. This can check if you have any congestion in your lungs and whether your heart is enlarged.

If your doctor asks you to have a test, they’ll explain what it’s for and what’s involved. It’s OK to ask questions if you have any concerns or want to know more.

Self-help for heart failure

If you have heart failure, there’s a lot you can do yourself to improve your symptoms and keep yourself as healthy as possible. These may include:


The links above will take you to lots more information, help and advice about making lifestyle changes. You may also find it helpful to visit our health blog, and the organisations listed below in our ‘other helpful websites’ section.

You may have a specialist heart failure nurse who can help you manage your symptoms and make changes to your lifestyle. Your GP may also be able to arrange for you to attend a local rehabilitation programme which offers information and support.

Treatments for heart failure

Medicines

If you have heart failure, your doctor is likely to prescribe one or more medicines for you. These aim to improve your symptoms, keep you as well as possible and prolong your life. At first, your doctor may need to change the dose or even the medicine a few times to get the best result for you. They’ll monitor how you’re doing and talk to you about any side-effects which may happen.

Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist or doctor for advice.

Here we list the most commonly used medicines for heart failure.

Angiotensin-converting enzyme (ACE) inhibitors

ACE inhibitors widen your blood vessels and make it easier for your heart to pump blood around your body. Possible side-effects include a dry cough and low blood pressure, which can 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. They 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

Beta-blockers slow down your heart rate, which helps to lower your blood pressure and the amount of work your heart does. It can take a few weeks or months for beta-blockers to work. You might think your symptoms are getting worse to begin with but try and stick with them. Possible side-effects include tiredness, cold hands and feet and trouble sleeping.

Diuretics

Diuretics make you pass more urine – you may hear them called ‘water tablets’. They can treat swollen feet and ankles, and prevent fluid build-up on your lungs, which will allow you to be more active and to breathe better. They can also lower your blood pressure, which may make you feel dizzy.

Aldosterone antagonists

Spironolactone and eplerenone are two types of medicines called aldosterone antagonists that may be used to treat the symptoms of heart failure. They may also be called potassium-sparing diuretics . They work in a similar way to diuretics and are often given together with other medicines. These medicines may affect how well your kidneys work. In men, they can cause swelling and discomfort of the breasts.

Digoxin

Digoxin strengthens your heartbeat and slows down your heart rate. It may be added to other medicines to treat heart failure, or used if other medicines haven’t worked well enough. Side-effects can include feeling sick and diarrhoea.

Anticoagulants and antiplatelets

If you have heart failure, you’re more likely to get blood clots especially if you have atrial fibrillation. So, your doctor may recommend you take anticoagulant and antiplatelet medicines, which help prevent clots forming. Blood clots can cause a stroke if they block narrow blood vessels and stop blood getting to your brain.

Implanted devices for heart failure

Cardiac re-synchronisation therapy

Some people with heart failure have problems with the way electrical signals pass through the heart, which then affects how well the heart pumps. If so, cardiac re-synchronisation therapy may help. A pacemaker device is fitted under your skin at the top of your chest or in your abdomen (tummy). This sends electrical currents to leads that are connected to the different parts of your heart so they contract together in the correct way.

Implantable cardioverter defibrillator

In some cases heart failure can cause a sudden, unexpected change in your heart rhythm which is very serious and may be fatal. If your doctor thinks you are at risk of this, they may offer you an implantable cardioverter defibrillator (ICD). This is a device that’s usually implanted under your skin below your collarbone. An ICD can monitor your heart rhythm. If it detects a serious problem with this, it will deliver an electric shock to return your heartbeat and rhythm back to normal.

Surgery for heart failure

Transplant

If you have very severe heart failure, you might be able to have a heart transplant. Heart transplants can be very successful but they aren’t suitable for everybody. There’s also a limited number of donor hearts available. Ask your doctor if a heart transplant is an option for you.

Valve replacement

If one or more of the valves in your heart aren’t working properly (heart valve disease), it can cause heart failure. You might be able to have an operation to replace them, which should improve your symptoms. For more information about what the operation involves, see our information on heart valve surgery.

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 muscle. For more information about this procedure, see our information on coronary artery bypass graft (CABG).

Living with heart failure

If you have heart failure, it’s only natural to feel concerned about how it’s going to affect your day-to-day life or worry about your future. It’s a complicated condition which affects people differently. You may find that the best way to cope is to find out lots about the condition and learn what you can do to help yourself. This should make you feel more in control and lessen any anxiety or stress you feel.

Changing your lifestyle

Having heart failure may mean you have to make some changes to your life. You may need to take things more slowly and to rest more, even if you’re not feeling particularly tired or unwell. If you have a particularly busy day coming up, try to rest the day before and after. Think about taking up offers of help from friends and family.

Taking medicines

You’ll probably be taking a number of medicines. It’s important to take these as your doctor prescribes, so you might find it helpful to use a pill box organiser. Keeping track of your symptoms and other experiences with your condition might also be helpful. You can then discuss these with your doctor when you see them. This can all help you to feel more in control of your condition.

Work

If you work, you may need to make some adjustments, such as reducing your hours because of your symptoms. Most people with heart failure can keep working if they wish to. If you have a very physical job this may be more difficult. If your work involves driving, see our FAQ – Can I still drive if I have heart failure? Talk to your doctor or nurse if you need advice.

Depression

It’s normal to feel low or sad from time to time, but if this feeling persists you may be developing depression. Doctors know this can happen if you have a long-term condition like heart failure. See our information on depression to find out more about the symptoms. If you think you may be becoming depressed, contact your GP.

Sex life

Having heart failure can affect your desire or ability to enjoy sex. This may be because of the disease itself, the medicines you take or because you’re tired, anxious or depressed. Don’t feel embarrassed to talk to your nurse or GP about this if you’re concerned.

Everyone has their own way of coping with a long-term condition like heart failure. It can help to know you’re not alone. For further support and advice you may find it helpful to know about the organisations we list below in our section ‘other helpful websites’. Some have a telephone helpline you can ring, or an online forum you can join for a chat with others in your position. There may also be local groups where you can meet other people with similar medical issues, or other carers. Your heart failure nurse may know of some.

Causes of heart failure

Heart failure is when your heart can no longer pump blood as well as your body needs it to. This is usually because there is:

  • damage to your heart muscle
  • a problem with a valve in your heart
  • an irregular heartbeat, which is called an arrhythmia

Lots of things can cause these problems, which include:


There are many other medical conditions that can cause heart failure. If you have heart failure and want to know more about what might have caused it, ask your doctor.

Complications of heart failure

Complications of heart failure include:

  • losing weight, and muscle loss
  • kidney disease
  • an irregular heartbeat (arrhythmia)
  • sudden death caused by a problem with your heart – but the number of people dying from heart failure is falling

If you have heart failure you may have a higher chance of becoming depressed, and you may have problems with your sex life. For more information about these, see our section on living with heart failure.

Every person is different – your doctor can discuss with you how likely these complications are in your particular circumstances.

Prevention of heart failure

You’re less likely to get heart failure if you have a healthy lifestyle. This includes:


If you have a health condition that might cause heart failure in the future, such as high blood pressure, it’s important to get treatment. And if you’ve been prescribed treatment, it’s important to keep taking it as recommended. You might be able to prevent heart failure developing.

You can find lots of useful tips and hints on how to life a healthier lifestyle from our health blog.

Frequently asked questions

  • You may be able to carry on driving but this will depend on your symptoms. You may need to tell the Driver and Vehicle Licensing Agency (DVLA) about your condition. The rules are different depending on what type of licence you have. See our section below, other helpful websites, for contact details.

    If you drive a car or motorcycle, you need to tell the DVLA if you have symptoms and they:

    • affect your ability to drive safely
    • distract you when driving
    • happen when you’re not doing any activity (when you’re ‘at rest’)

    If you’re not sure about whether it’s safe to drive, ask your doctor for advice. Remember, you should never drive if you feel it’s not safe.

    If you drive a bus, lorry or coach and you have heart failure, you must stop driving and tell the DVLA. They may ask you to have some tests to see if you can continue to drive.

    You should tell your motor insurer if you have heart failure, and about any treatment you have. This is because it may affect your cover.

  • If your heart failure is under control and your symptoms aren’t too severe, you can probably still fly.

    If you’re treated for breathlessness from heart failure which has come on suddenly, you shouldn’t fly for six weeks. If treatment has controlled your symptoms by then, you’re probably OK to fly – but check with your doctor.

    If you’re living with heart failure as a long-term condition, then you’ll probably still be able to fly. But it’s best to avoid flying if your symptoms become worse in the six weeks before your flight. Check with your doctor if you’re unsure. You may need to arrange to have oxygen on board the flight, depending on how severe your symptoms are. Ask your doctor about this, and let the airline know well in advance. You should also let the airline know if you’re going to need help at the airport.

    During the flight, your legs and ankles may swell and you might find it more difficult to breathe if you have severe heart failure. Try to do some stretches and walk around the cabin regularly. Places at high altitude and places that are hot or humid may make your symptoms worse.

    It’s important to take your medicines as you usually would when you travel. If you’re flying, check with your airline about taking medicines on your flight. Make sure your travel insurance covers you too.

  • Most people with heart failure can still exercise. In fact, exercise can improve your symptoms.

    How much you can exercise will depend on how serious your heart failure is and what treatment you’re having. If you have heart failure, keeping active may improve your quality of life because it helps you to do everyday activities more easily.

    Find something you enjoy – it doesn’t have to be a sport. Even just getting out and walking regularly is good. It’s best not to take part in very exhausting activities, or doing heavy lifting. If you’re uncertain about a particular activity or sport, ask your nurse or doctor for advice. And it’s probably best to talk to your nurse or GP before you start anything new.

    It’s a good idea to exercise as part of a rehabilitation programme. This involves going to a number of sessions that are designed to be specific to your needs. They usually involve group-based education and exercise sessions. The education sessions will give you advice and support in many lifestyle areas including managing your weight, giving up smoking, and relaxation techniques.

    Speak to your nurse or GP if you’d like more information about cardiac rehabilitation programmes.

  • Medicines can help but there are lots of things you can do yourself to try to manage your symptoms.

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

    • If you have difficulty breathing and sleeping while lying on your back, keep yourself propped up with pillows. This should help you to breathe more easily and stop breathlessness disturbing your sleep. If you’re wheezing and coughing, cut back on 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.
    • If you feel tired all the time, pace yourself and give yourself plenty of time to do everyday activities. Try breaking up big tasks into small parts and ask for help from your friends and family.
    • If you have swollen feet and ankles, don’t sit or stand for a long time. And raise your feet when you rest – use a stool or chair to rest your feet on. Wear comfortable shoes and socks that aren’t too tight. It’s also important to keep active by walking and regularly moving your legs.

  • Yes, you’ll probably need to take one or more medicines for the rest of your life. They’ll help to ease the symptoms of heart failure but won’t cure your condition.

    Most medicines can cause side-effects so your doctor will monitor you closely. Not everyone gets side-effects, but if you notice something new, tell your doctor. Don’t stop taking your medicines or change how much or how often you take them without speaking to your doctor first.


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Related information

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  • Reviewed by Dr Kristina Routh, Freelance Health Editor, Bupa Health Content Team, May 2018.
    Expert reviewer, Dr Tim Cripps, Consultant Cardiologist
    Next review due May 2021



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