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It is important to note that no book, website or organisation can be a substitute for personal medical advice however these resources can be useful to supplement that advice.
What is heart failure?
The term ‘heart failure’ is used to describe the signs and symptoms which can happen when the heart muscle is unable to pump as efficiently as normal. This can lead to a build up of fluid in the body.
Heart failure is very common and although it is not a curable condition there is medical evidence for the very effective treatments that are available to improve symptoms, improve quality of life and help people live longer.
What causes heart failure?
There are many causes of heart failure. Some of these causes are:
- previous history of heart attacks
- coronary heart disease
- high blood pressure
- narrow or leaking heart valves
- a very fast or slow heart rate
- infection or disease of the heart muscle
- excessive alcohol intake
What are the main signs and symptoms of heart failure?
You may have some, none or all of these symptoms.
- Shortness of breath
This is more common when you are taking physical exercise such as climbing the stairs or walking up a slope. Some people are breathless when lying flat in bed. Some people wake in the middle of the night feeling breathless. You may find that sleeping propped up by extra pillows will help.
- Swollen feet, ankles, legs or abdomen
This is called oedema and is due to a build up of fluid. You may find that sitting with your feet up when possible will help reduce ankle swelling.
- Severe tiredness, weakness and fatigue
Feeling less mentally alert.
- Frequent dry ‘hacking’ cough, particularly when lying down.
Some of these symptoms may appear very quickly or may develop over a period of weeks or months.
How is heart failure diagnosed
You will have some tests to diagnose your heart failure. These may include an electrocardiogram (ECG), a chest X-ray and a scan of your heart called an echocardiogram.
- An ECG is a test which looks at the electrical activity in your heart. It can detect changes in the rate and rhythm of your heart as well as detecting heart attacks (old and new) and signs that your heart may be enlarged. It may be necessary to take a repeat ECG in the future.
- A chest X-ray will look at the size of your heart and also show if there is any fluid in your lungs.
- An echocardiogram is an ultrasound scan of your heart which will show how well your heart is pumping and whether the valves in your heart are opening and closing effectively.
What is the treatment for heart failure?
There has been lots of research into which medications will help heart failure patients stay well and help to keep symptoms under control. The National Institute of Clinical Excellence (NICE) guidelines recommend that heart failure patients should be considered for the following medications.
These tablets help to relax your blood vessels, making it easier for your heart to pump blood around the circulation. ACE Inhibitors may slow down the disease progression.
ACE Inhibitors need to be started at a low dose and increased slowly. You will require regular blood tests whilst your ACE Inhibitor is being commenced or increased. Your nurse will assess your response and adjust the dose accordingly.
Occasional side effects may include a troublesome cough or dizziness. You should report any of these symptoms to your heart failure nurse or GP.
Diuretics increase the amount of water and salt passed from the kidneys into the urine and therefore can help to get rid of any build-up of fluid. They are very effective in reducing your heart failure symptoms.
Diuretics are best taken in the morning on an empty stomach. If you take an afternoon diuretic try to take it no later than 4pm to avoid having to get up often in the night to pass urine.
These tablets work by slowing down your heart beat and reducing the work that your heart has to do. Some relax your blood vessels, making it easier to pump blood through them.
You may feel tired or a bit more short of breath in the early days, as your body adjusts to taking these tablets. These tablets will be started at a low dose and increased slowly.
Research has shown that people with heart failure benefit from taking these tablets. People who have asthma may not be able to take a beta blocker.
If you still have symptoms despite taking ACE inhibitors, beta blockers and diuretics or if your heart failure is graded as moderate-severe you may be asked to take Spironolactone as well.
This tablet blocks the action of a hormone called aldosterone which can cause problems for people with heart failure. Research studies have found it to be very useful in helping to control your symptoms and help you to live longer.
You will need regular blood tests at 10, 20 and 30 days after commencing Spironolactone. Spironolactone is started at 12.5mg and if this suits you the aim will be to increase it to 25mg after approximately one month.
You will need regular blood tests at your doctors surgery both whilst your medication is being maximised and as routine once you are on the best combination of medication for you.
You may be asked to take Digoxin if you have a rapid or irregular heart beat or if you still have symptoms once you are on all of the other medication.
Digoxin slows, steadies and strengthens your heart beat and helps the heart to pump more efficiently. The dose of Digoxin will depend on how fast or slow your heart rate is. The dose may be reduced if you are started on a beta blocker.