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         Heart failure

What is heart failure?

Heart failure is the term used when the heart becomes less efficient at pumping blood round the body, either while you are resting or active. The term ‘heart failure’ is unfortunate because it implies that the heart has actually failed. However, most people can have some control over their condition by making changes to their lifestyle and by taking their prescribed medication. And for some people, surgery or other types of treatment can help.

How a normal heart works
Circulation of the blood around the body is essential as the blood takes nourishment to all your tissues and organs. It also transports waste materials to the lungs and kidneys, which then get rid of them from the body.

The heart is a muscular pump that pumps blood around your body. The two sides of the heart – the right side and the left side – work together. Blood from your muscles and organs enters the right side of your heart. The heart pumps the blood to the lungs where it takes up oxygen and removes the carbon dioxide it has been carrying. This oxygen-rich blood then enters the left side of the heart. From here it is pumped through the arteries to all parts of your body including to the heart muscle itself.

The movement of the blood through the heart is regulated by a system of valves. These make sure that the blood flows in the correct direction. There are four valves – one at the entrance and one at the exit of each of the two pumping chambers.

What causes heart failure?
Heart failure may result from damage to the heart muscle. The damage is most commonly caused by a heart attack, but sometimes it may be caused by drinking too much alcohol, or by a viral infection, or by a disease of the heart muscle called cardiomyopathy. In some people the cause of the damage is unknown.

Heart failure can also result from conditions which put an extra workload on the heart. The heart may have coped with this increased workload for many years before heart failure occurs.

Problems which can cause an increased workload include:
high blood pressure (hypertension)
heart valves that either leak or are too narrow
thyroid gland disease
a heart rate that is much too fast, or too slow,
or irregular, or
anaemia.

Causes of heart failure of the left side of the heart
The most common causes of heart failure of the left side of the heart are: damage to the muscular pump of the left ventricle caused by a heart attack, prolonged high blood pressure, and diseases of the mitral valve and aortic valve. The main symptoms of left heart failure are tiredness and breathlessness.

Causes of heart failure of the right side of the heart
The most common cause of heart failure to the right side of the heart is left heart failure (see above). Right heart failure can also be caused by lung diseases, as these can result in the right ventricle not pumping efficiently, causing the heart to become enlarged and producing symptoms of right heart failure. The most common sign of right heart failure is swollen ankles and feet. Symptoms include extreme tiredness and breathlessness following physical activity.

 What are the signs and symptoms of heart failure?
The main symptoms of heart failure are severe tiredness and breathlessness. You may also get swollen ankles and feet. These signs and symptoms may come on suddenly, may happen after a heart attack, or may develop slowly over weeks or even months.

Severe tiredness
A common problem with heart failure is loss of energy, and tiredness either while you are resting or after you’ve done only a small amount of activity. The tiredness can be quite overwhelming, making it difficult or impossible for you to carry on as normal. The tiredness is due, at least in part, to reduced blood flow to the exercising muscles and may be an early symptom of heart failure. How tired and lacking in energy you feel will depend on how severe your heart failure is and how well your symptoms are controlled.

Breathlessness
Breathlessness is a common symptom of heart failure. Failure of the left side of the heart to pump blood into the arteries efficiently enough results in ‘back pressure’ in the circulation. This can cause fluid to build up in the air spaces of the lungs. The breathlessness is most likely to happen when you are active or when you are lying flat in bed. You may get a cough, too. Breathlessness may actually wake you up at night, and you may need to sit up, with pillows to support you, or even go to the window for some fresh air.

Swelling of the ankles and feet
People with heart failure often have swelling (oedema) of the ankles and feet. This may extend to their legs, thighs and groin, and there may be swelling of the abdomen too. The swelling is due to the body holding salt and water – something which happens in people with heart failure.

Other symptoms of heart failure
Other symptoms of heart failure may include loss of appetite, feeling sick, constipation, coughing, poor memory, dizziness and a disrupted sleep pattern.

How is heart failure diagnosed?
If you have the symptoms described above your doctor may suspect that you have heart failure. In some cases doctors can make a diagnosis after doing a careful physical examination. During a physical examination.

Your doctor will examine your heart rate and rhythm, take your blood pressure, check whether you have fluid in your lungs, legs and in other parts of your body, listen to sounds made by the heart valves, and check if the blood pressure in your neck is high. (High blood pressure here can be caused by too much fluid.) A blood test will show whether you have anaemia, kidney damage, diabetes or thyroid disease.

You will probably need to have some further tests done. This will include an electrocardiogram (ECG) and a chest X-ray. However, the most useful and widely used test to check the pumping action of the heart is an echocardiogram. This is a type of ultrasound scan. This painless test provides pictures of the heart in action, and allows doctors to check how well the heart is pumping. It often gives important clues about the cause of the condition.

Another useful test to help diagnose heart failure is a BNP test (a brain natriuretic peptide test). This is a blood test which measures the levels of certain hormones related to heart failure.

What can be done for heart failure?
It may be possible to put right some of the conditions which can lead to heart failure – for example, severe anaemia, or some heart rhythm disorders caused by overactivity of the thyroid gland. Sometimes doctors identify the cause of heart failure as valve disease or a congenital heart abnormality (a heart condition you are born with, and which can sometimes remain undiscovered until adult life). In these cases it may be possible to correct the problem with surgery.

In most patients, heart failure is the result of damage to the heart muscle – damage which reduces the pumping function of the heart. At the moment, there is no cure for this. However, advances in treatment mean that the outlook for many people with heart failure has improved
substantially in recent years.

What you can do to help yourself
Symptoms can often be treated effectively – and your outlook improved – by a combination of making changes to your lifestyle and getting the right treatment from your doctors and nurses. It makes good sense to do everything you can to stop or slow down any progression of your
heart failure. This includes the following.

Weigh yourself regularly
If you have heart failure, it is important to keep an eye on your weight. This is because, if your weight goes up, it might be because your body is building up too much fluid. Weigh yourself every morning and tell your doctor or heart-failure nurse about any sudden weight change – for example, if your weight goes up or down by about 6 pounds (about 2.5 kilos) over three days – or if you start getting more breathless, or have more ankle swelling.

Watch the amount of fluid you have each day
Keep a record of your fluid intake and try to have the same amount of fluid every day. If you’re not sure how much fluid you should be having, or whether you need to restrict your fluid, talk to your doctor or nurse.

Cut down on salt
Too much salt could increase your blood pressure and could also upset the balance of salt and water in the body. Salt also makes you retain water. Don’t add salt to your food at the table, and avoid cooking with it. You can use herbs and spices to add flavour instead.

Other ways to eat a healthy balanced diet
• Reduce the total amount of fat in your diet, and eat starchy foods instead – for example, bread, pasta, rice, cereals and potatoes.

• Cut down on saturated fats and substitute them with small amounts of polyunsaturates and
monounsaturates. Saturated fats are found in butter, cheese, lard, dripping, coconut oil and palm oil.
Polyunsaturated fats are found in, sunflower oil, soya oil, cornflower oil and fish oil. Some margarines and spreads are made from polyunsaturated fats. Monounsaturated fats are found in olive oil and rapeseed oil, and in some margarines and spreads.
• Aim to eat at least five portions of fruit and vegetables a day

Work towards a sensible body weight
If you are overweight, you need to lose some weight. Don’t try to lose the extra weight too quickly. Losing weight slowly and steadily (half a kilo, a week) is more healthy, and you’re more likely to keep the weight off for good.

If you smoke, stop smoking
Stopping smoking is the single most important thing a smoker can do to live longer. If you have tried to quit and have gone back to smoking again, there are things that can help. These include products to help you stop smoking, joining a stop-smoking group, or alternative therapies such as hypnotherapy or acupuncture.

Be physically active, within the limits advised by your doctor
The type of activity that is recommended for the heart is moderate, rhythmic (aerobic) exercise such as brisk walking or cycling. Walking is particularly good as you can often build it into your daily routine. If you want to go swimming, ask your doctor or nurse first whether it’s the right exercise for you to do.
Try to work some regular activity into your daily routine. But don’t overdo the amount of activity you do on one day just because you feel a bit more energetic than usual. Overdoing things will leave you tired and exhausted the following day. So, however energetic you feel, try to keep
to the same amount of activity each day. It is important to keep as active as possible, but build up
your activities slowly and do only as much as you feel comfortable doing. If you get very breathless during exercise, you should slow down or stop.

Heart failure and your quality of life
Symptoms
Tiredness, breathlessness, swelling and fatigue are common symptoms of heart failure, which can make it difficult for some people to live their lives normally. Some people also find that their mood is affected and may feel more anxious and depressed than is usual for them, or lose their confidence. Some have pain. Do tell your doctors about how you feel, and about the
ways that heart failure is affecting your everyday life. They may be able to adjust your treatment to help improve the quality of your life.

Anxiety
Many people with heart failure worry about their condition and the effect it has on their own life and on their families. It is important to discuss this with your family and close friends. You can also discuss with your doctor any worries or problems related to your heart failure.

Stress
Stress generally happens when we feel unable to cope when there are high demands on us. It affects different people in different ways. Stress can affect the heart by releasing certain hormones that can increase blood pressure and encourage the blood to clot in the arteries.
Not managing stress can also make us turn to bad habits such as smoking, drinking alcohol, or snacking on unhealthy foods. Finding healthy ways of coping with stress can help you handle your heart failure.

Lack of control over the future
People with heart failure can become tired and depressed about their limitations, and worried about their future. Understanding what heart failure is and the drugs used to treat it and being involved in making decisions about your treatment, will all help you to have more control over
your condition. Talk to your heart-failure nurse or doctor about your concerns and fears. They will be able to help by explaining what services are offered locally, especially social care services, voluntary services or palliative care.

 
      Doctor Tips
Angina is an uncomfortable feeling or pain in the chest.
   
It usually feels like a heaviness or tightness.
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