Heart Failure

The common symptoms to look out for that might indicate heart failure are:

• Breathlessness – shortness of breath can have a number of possible causes, not all of them serious. Common causes include chest infection or being overweight. However, it can also be a symptom of heart failure, as well as chronic obstructive pulmonary disease and lung cancer. For this reason, it is important to have it checked if it has lasted for longer than a month, or if it gets worse when you’ve been active or when you’re lying down, or if you also have swollen ankles. Breathlessness associated with heart failure tends to be worse when you are lying down and may wake you up at night.
• Oedema/swollen ankles/legs – a build-up of fluid can occur when the heart is not functioning properly, particularly in the ankles or legs. It may be better in the morning and worse later in the day.
• Fatigue/weakness – Feeling tired most of the time and finding exercise exhausting may be a sign of heart failure, although there can be many other reasons for fatigue so it is important to have a proper diagnosis.

There are other, less common symptoms that might indicate heart failure, including:

• A persistent cough (lasting more than three weeks), which may be worse at night
• Wheezing
• Bloating and/or loss of appetite
• Unexplained weight gain or weight loss
• Dizziness and fainting
• Confusion
• A fast heart rate or palpitations
• Sudden onset of depression of anxiety with no obvious cause

Arrhythmia is a problem with the heart rhythm. Your heartbeat is controlled by electrical impulses. If these malfunction the heart can begin to beat in an abnormal way; too quickly, too slowly or with an irregular rhythm.

More than two million people in the UK are believed to have some kind of arrhythmia. Most are able to lead a normal life, providing they have a proper diagnosis. However, atrial fibrillation makes you five times more likely to have a stroke. And. certain types of arrhythmia in people with severe heart conditions can lead sudden cardiac death.

For this reason, if you have any of the symptoms associated with possible arrhythmia you should see your doctor to have a proper diagnosis. If it is confirmed that you have arrhythmia, there are many different treatments available.

There are a number of conditions that can cause heart failure:

• Coronary artery disease causes decreased blood flow to the heart muscle. If the arteries become blocked or narrowed, the heart is starved of oxygen and nutrients.
• Heart attacks damage the heart muscle, resulting in scarring. The scarred area does not function properly.
• Cardiomyopathy causes damage to the heart muscle as a result of infection or alcohol/drug abuse.
• Conditions that overwork the heart – such as high blood pressure, valve disease, diabetes or kidney disease – can cause heart failure.

There are a number of different tests to diagnose heart failure, including:

• Blood test
• Electrocardiogram (ECG)– this records the electrical activity of your heart and can help to determine if it is functioning correctly. Sensors are attached to your skin which detect and records the electrical signals that your heart produces every time it beats
• Echocardiography/heart scan – this is a type of ultrasound scan that checks the structure of the heart and surrounding blood vessels, checking how the blood flows through them and how well the pumping chambers of the heart are working. It uses a small probe which sends out sound waves at too high a frequency for us to hear. These sound waves create echoes as they bounce off different parts of the body. These are turned into a moving image that is displayed on a monitor.
• Breathing tests – these may be used to rule out lung problems which may be contributing to your breathlessness.
• Chest X-ray – this may be used to check whether your heart is bigger than it should be or if there is fluid in your lungs.

Treatment will vary depending on the stage of heart failure you are experiencing and whether you have acute or chronic heart failure. The main treatments are:

• Lifestyle changes – You may be given the chance to attend a heart failure rehabilitation programme, which will advise you on areas such as education, exercise, emotional support and relaxation. You may be advised to:
  • quit smoking
  • improve your diet
  • reduce alcohol consumption
  • cut down on salt
  • take regular exercise
• Medication – You may be prescribed medication for heart failure, including:
  • ACE inhibitors – open up your blood vessels making it easier for your heart to pump blood around your body.
  • Beta-blockers – slow your heart down and protect it from the body’s natural “fight or flight” chemicals.
  • Angiotensin receptor blockers (ARBs) – work in a similar way to ACE inhibitors, but possibly less effective. Often prescribed if ACE inhibitors produce coughing as a side-effect.
  • Hydralazine with nitrate – often prescribed for people who can’t take ACE inhibitors or ARBs.
  • Diuretics – make you wee more, helping to combat fluid retention and breathlessness.
  • Aldosterone antagonists – similar to diuretics but without reducing potassium levels.
  • Sacubitril valsartan – recommended for people with severe heart failure.
  • Ivabradine – used as an alternative to beta-blockers if the side-effects are problematic.
  • Digoxin – usually only used for people who continue to have symptoms despite treatment with ACE inhibitors, ARBs, beta-blockers and diuretics.

• Pacemaker – may be recommended if your heart beats too slowly. It continuously monitors the heart rate and sends electrical pulses to keep it beating regularly.
• Cardiac resynchronisation therapy – a special type of pacemaker that makes the walls of the left ventricle all contract at the same time, making the heart pump more effectively.
• Implantable cardioverter defibrillators – monitor the heart rhythm. If it starts beating dangerously fast, they deliver small, controlled electrical shocks to bring it back to normal.
• CRT-Ds – combine cardiac resynchronisation and defibrillation.
• Surgical procedures – these might include: heart valve surgery; a coronary angioplasty or bypass; left ventricular assist devices; or total heart transplant.
• Self-monitoring – once you have been diagnosed with heart failure, it is important to keep an eye on your own symptoms. If anything worsens or changes, you should visit your doctor immediately for further tests.