What is heart failure?
The heart is a muscular pump that makes sure blood gets to each part of the body that needs it. When this muscular pump is damaged by disease it no longer moves blood around efficiently. As a result, blood (and therefore oxygen and nutrients) isn’t delivered very well to the tissues and organs. Meanwhile, back pressures build up in the circulation causing fluid to accumulate in the lungs and lower limbs. This is known as heart failure.
Heart failure affects at least one in 100 people in the UK, is responsible for one in 20 admissions to hospital and is more deadly than many cancers. Research looking at people in London with heart failure found that about 40 per cent died within one year of diagnosis – a worse survival rate than for breast, prostate or bladder cancer. However, many of these had severe heart failure; the mortality for those with mild to moderate failure is only about 10 per cent.
Symptoms of heart failure
When the heart doesn’t work efficiently or is damaged, people notice they haven’t as much energy as before, that they get tired more easily and out of breath more quickly. This is because the tissues aren’t getting enough oxygen. They may also notice their ankles swelling – this is called oedema and is due to excess fluid in the tissues. They may feel short of breath when they lie down because of fluid congesting the lungs. The skin becomes spongy, so if you press on it a dent or pit is left behind.
As heart failure gets worse, so the level of oedema gets higher until the legs are completely swollen, and pitting may be noticed even in the abdomen and lower back.
These symptoms tend to develop gradually and usually go unnoticed for a long time. The heart doesn’t fail totally or suddenly stop; instead, it struggles on inefficiently, typically causing symptoms that slowly get worse and increasingly interfere with a person’s ability to do normal activities.
Often there are periods where the person’s condition is fairly stable, interspersed with episodes of acute worsening of symptoms.
An abnormal heart rhythm is a bad sign in heart failure – about half of people with heart failure die suddenly and it’s thought that many of these deaths are due to fatal arrhythmias.
Causes of heart failure
Anything that damages the heart can affect its ability to work properly. The most common cause is coronary artery disease, where the arteries supplying the muscle of the heart are narrowed by fatty plaques. The person may experience angina – pain caused by lack of oxygen to the heart muscle.
Heart failure may begin with a heart attack, where part of the heart muscle has died as a result of a persistently low oxygen levels caused by blocked coronary arteries, leaving a scar or weak area in the heart.
A third of cases are caused by high blood pressure, which causes the heart’s muscular wall to thicken, making it less flexible and unable to pump blood properly.
Other causes include damaged heart valves, too much alcohol, hypothyroidism (an underactive thyroid gland) and inherited heart conditions, such as a form of cardiomyopathy.
The heart
Diagnosing heart failure
Because the symptoms of heart failure are common to other medical problems, certain tests are needed to confirm the diagnosis. These may include a chest x-ray to show whether the heart is enlarged, an electrocardiogram to detect any abnormal heart function and, probably most importantly, an echocardiogram. This is a special type of ultrasound that shows how well the heart and its valves are working.
In addition, blood tests will be performed and blood pressure must be measured.
Treatment of heart failure
The good news is that heart failure can be treated and the above statistics don’t take into account treatments introduced in recent years such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), which are known to improve prognosis.
The goal with treatment is to control a person’s symptoms (poor energy, breathlessness and swollen ankles), prevent these problems getting worse and allow them to get on with their life.
There are some things you can do yourself to help reduce the risk of heart failure. The ancient Greeks called heart failure dropsy and treated it with white wine. This may not have been such a bad idea, as studies have shown that for people over the age of 40, a small amount of alcohol each day may help keep the heart healthy. But unfortunately, any more than a very moderate amount may do more harm than good.
It’s also vital to treat any possible causes of heart failure, such as high blood pressure. There’s little point in treating the symptoms if you don’t treat the cause.
Not smoking, taking regular exercise, drinking a sensible amount of alcohol and eating a healthy diet with plenty of fruit and vegetables are essential. Garlic and fish oils have also been found to help protect the heart from damage.
Many medicines can help people with heart failure enjoy good and fulfilling lives. Symptoms can be improved using diuretics (water tablets), while ACE inhibitors have been shown in studies to improve life expectancy.
In the past, medicines called beta blockers were never used to treat heart failure because they were believed to be dangerous. However, research has found that some beta blockers are not only safe to use but can be beneficial.
For some people, other more invasive treatments may help, such as surgery to replace damaged heart valves, coronary artery bypass surgery or even a heart transplant.