Heart failure

There are many causes of heart failure, of which some of the most common include:

• coronary heart disease – the most common cause
• high blood pressure (hypertension)
• damaged heart valves
• disease of the heart muscle as a result of genetic causes – for example, cardiomyopathy
• drinking alcohol excessively
• severe lung disease
• an overactive thyroid gland (hyperthyroidism)
• anaemia

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

Common symptoms of heart failure include:

• extreme tiredness
• breathlessness
• swollen feet, ankles or abdomen (tummy)

Left-sided heart failure affects your lungs and your ability to breathe. Symptoms may include breathlessness at rest or during exercise, coughing, wheezing and extreme tiredness. If you have very severe heart failure, you may cough up froth or blood and you're more likely to get chest infections.

Right-sided heart failure affects the fluid balance in your body. You might get symptoms such as swollen feet, ankles and abdomen, or extreme tiredness, feeling sick and weight gain.

These symptoms aren't always caused by heart failure, but if you have them, see your doctor.

People with heart failure are more likely to have:

• a poor quality of life – this is because it's harder to carry out everyday activities
• an irregular heart beat (arrhythmia)
• sexual problems
• depression – up to one third of people with heart failure have depression
• deep vein thrombosis
• stroke

Your doctor will ask you about your symptoms and examine you. He or she may also ask you about your medical history.

There are a number of tests your doctor may recommend that you have. Some examples are listed below.

• Blood and urine tests can check your blood count, your liver and kidney function and other indicators of heart failure.
• An ECG measures the electrical activity of the heart to see how well it's working.
• An echocardiogram uses an ultrasound probe to check the structure of your heart and see how well it's functioning.

If your doctor thinks your symptoms could also be the result of lung problems, he or she may recommend you have:

• a chest X-ray to confirm if you have heart failure and to rule out other conditions
• lung function tests, such as peak flow measurements or spirometry tests, to show how well your lungs are working

Treatment of heart failure is aimed at relieving your symptoms, making your heart stronger and improving your quality of life.

Self-help
You can improve your symptoms by making various changes to your lifestyle, including:

• eating a healthy, balanced diet
• cutting down on salt
• stopping smoking
• taking 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 and weighing yourself daily
• managing stress
• having the annual flu vaccine

If you need help with any of these lifestyle changes, talk to your doctor. 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 available that can be used to relieve the symptoms of heart failure and help you live longer. Different medicines treat different symptoms, so you may be given more than one medicine. It's important you take each one correctly so that each can do its job properly.

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 making it easier for your heart to pump blood around the 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. If you get a cough when taking ACE inhibitors, see your doctor.

Angiotensin II receptor blockers
Angiotensin II receptor blockers (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. You may be given these 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. Beta-blockers cause the arteries to widen and they slow down the heart rate. This helps to lower your blood pressure and the amount of work your heart does. If you have asthma or other heart problems, you may not be given 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 the lungs, allowing 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 the body. If you have gout, 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. Your doctor 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 by slowing down your heart rate. Side-effects may include sickness and diarrhoea. If you get these side-effects, see your doctor.

Anticoagulants
Anticoagulants, also known as blood thinners, reduce how well your blood can clot. They do not actually thin the blood. Anticoagulants such as warfarin 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 causing the blood to pool in the body. 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 doctor will consider your risk of having a stroke before prescribing you anticoagulants.

Antiplatelets
Antiplatelets, such as aspirin, stops blood clots from forming by preventing blood platelets sticking together. Aspirin is not usually taken with warfarin. Side-effects may include sickness and 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 fitted under local anaesthesia – this completely blocks the feeling 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 the heart. A specific type of pacemaker is fitted under the skin of your upper chest. The device sends electrical currents to leads connected to the different parts of your heart so they contract in synchronisation with each other.

Implantable cardioverter defibrillator
An implantable cardioverter defibrillator is similar to a pacemaker, and is usually implanted under the skin below your collarbone. They can monitor your heart rhythm and deliver a small electric shock to return your heartbeat and rhythm back to normal if it detects a problem. Implantable cardioverter defibrillators are usually fitted under local anaesthesia.

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.

Valve replacement
If your 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.

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 – aim for 30 minutes on at least five days a week
• 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.

This information was published by Bupa Group's Health Content Team and has been reviewed by appropriate medical or clinical professionals. To the best of their knowledge the information is current and based on reputable sources of medical evidence, however Bupa (Asia) Limited makes no representation or warranty as to the completeness or accuracy of the Content.

The information on this page, and any information on third party websites referred to on this page, is provided as a guide only. It should not be relied upon as a substitute for professional medical advice, nor is it intended to be used for medical diagnosis or treatment. Bupa (Asia) Limited is not liable for any loss or damage you suffer arising out of the use of, or reliance on, the information.

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