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What is heart failure?
The term ‘heart failure’ is used to describe the signs and symptoms which can arise when the heart muscle is unable to pump as efficiently as normal. A common consequence is a build up of fluid in the body.
Heart failure is very common and although it is not a curable condition there are very effective treatments 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
- poor blood supply to the heart (coronary heart, or artery, 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?
If you have 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. The tiredness and lack of alertness is surprisingly variable and you may have good days and bad days.
- 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 in England and Wales, and the Scottish Intercollegiate Guidelines Network (SIGN) guidelines in Scotland, recommend that heart failure patients should be considered for the following medications.
In general, you will be asked to start all the drugs at low doses to start with, but with the aim of gradually increasing the doses of medication over a period of months. The aim is to reach the 'target dose' of the medications shown be to beneficial in clinical trials. You will need frequent blood tests to make sure that there are no harmful side-effects whilst starting medications or changing the doses.