A B C D E F G H I J K L M N O P R S T U V W

HEART FAILURE

What is Heart Failure ?

Damage to the heart in a number of ways may affect its pumping performance. If the damage is severe, blood pressure may fall. To correct for this, the blood vessels narrow and the kidneys automatically retain water in the body. This is an attempt to keep up the blood pressure. However, the kidneys may over-correct: too much water is then retained by the body. It leaks out of the blood vessels and causes swelling of the feet, ankles, and sometimes the abdomen. Extra fluid build-up in the lungs makes breathing more difficult. At first this breathlessness happens only with exercise. If it gets worse, it may happen at rest and even in bed. The whole process can occur suddenly or gradually develop over a period of weeks or months. In response to the falling blood pressure, small blood vessels in the body constrict. This is another compensation but may also be overdone. Blood flow to vital organs such as the kidney may then actually get less and affect their function.

Why does Heart Failure occur ?

Heart failure may be caused by many diseases. The commonest is narrowing of the coronary arteries which supply oxygen and other nutritious chemicals to the heart muscle. This leads to a heart attack (myocardial infarction). The damage to the heart from such an attack affects its pumping only if the damage is severe. Fortunately the heart has an amazing reserve of strength. The normal heart pumps 4-5 litres (1 gallon) of blood into the circulation each minute at rest. With exercise it can increase to 20-25 litres (5 gallons) per minute. When damage occurs, the heart uses up some of this reserve, normally used only on exercise. Sometimes the heart's reserves are gradually whittled away by advancing coronary artery disease over several years rather than by a single heart attack. Heart failure then comes on gradually. A slow start to the problem also occurs in disease such as heart muscle disease (cardiomyopathy), high blood pressure, or heart valve disease.

Treatment Involved for Heart Failure

DIAGNOSIS Apart from standard blood tests and chest X-rays, your doctor will arrange an electrocardiogram (ECG) which gives information about the condition of the heart and its rhythm. You may also have an echocardiogram done. This investigation is rather like a radar plot. It tells the doctor about the efficiency of the heart’s action and much more besides. It is important for your doctor to know exactly why the heart is not beating effectively. TREATMENT The best way to treat heart failure is to remove the cause. If it is due to a valve problem, valve surgery should improve it. Treatment of high blood pressure will actually avoid heart failure. This is a good example of prevention being better than cure. In some instances, prevention is not possible. If the cause is not known (as in many forms of heart muscle disease), it cannot be prevented. Although coronary disease may be reduced by certain measures, it cannot be completely prevented. Once heart failure occurs, treating the coronary arteries does not usually help. There are not very many medications which work directly on the heart. A few can be given through a vein as an emergency in hospital. These are called inotropes and work by increasing the strength of the heart's contraction. One treatment of this type, called digoxin, can be taken by mouth but it is not very powerful. The most commonly used treatments, taken by mouth, are called diuretics (water tablets). These work on the kidneys to get rid of the excess water (and salt). As a result, more urine is passed. They come in various strengths and are very effective. Drugs which reduce the undesirable narrowing of the small blood vessels are also used. These are called vasodilators and there are different types. The most effective are called ACE (angiotensin-converting enzyme) inhibitors. They not only improve the symptoms of heart failure but also increase life expectancy. Another similar group of drugs called A2 (angiotensin 2) inhibitors are also very effective; their ability to increase life expectancy has not yet been proven. Finally, beta-blockers, usually in small dose can be very useful.

During Treatment for Heart Failure

Apart from getting rid of excess water kidneys, many types of water tablets may upset blood chemicals and kidney function. Potassium loss may occur. This causes tiredness and your heartbeat may become irregular. This problem can be avoided in one of three ways: by taking potassium tablets; by taking an additional water tablet which counteracts by causing potassium retention and finally by taking a different type of medication which also causes the body to retain potassium (spironolactone is such a drug which causes potassium retention and is also known to improve life expectancy). ACE inhibitors and A2 inhibitors are the alternative medications which cause potassium retention. Because of the effect on blood chemistry and kidney function, blood tests need to be checked regularly. Too much digoxin may cause nausea and a slow pulse. This is not usually a problem but if there is any doubt about the dose, the blood level can be measured in a blood sample. Vasodilator drugs may cause you to feel dizzy if the blood pressure is allowed to fall too much. For this reason, it is a good idea to take them just before you go to bed. Some of them may occasionally cause slight ankle swelling. Never stop any course of tablets, except on the advice of the doctor.

After Treatment for Heart Failure

Too little treatment may cause symptoms to come back, fluid retention and breathlessness especially. Over-treatment with diuretics may cause dehydration, making one feel generally unwell. All the treatment must be taken regularly, not just when you are feeling poorly. It should be carefully monitored by your doctor. There should be little disturbance of everyday life. However, because your heart is using some of its reserve, you may have to come to terms with some reduction of physical activity. Most people find that they are able to do the things they wish, perhaps at a slightly slower pace.

If Heart Failure is Left Untreated

Heart failure rarely gets better by itself. All the symptoms would probably get worse and the condition could become fatal. Sometimes the swelling and the breathlessness becomes very severe and causes great distress. It can then become very difficult to treat successfully. It is usually much better to treat the problem earlier prevention is better than cure.

Effects on Family of Heart Failure

It may be necessary for your family to recognise that there is some restriction of your activities, depending upon how much heart failure you suffer from.