Heart failure

What is Heart Failure?

Heart failure is a condition where the heart muscle is weakened and is not able to efficiently pump blood around the body.  Heart failure does not mean the same as “a heart attack” it simply means that the heart’s capability to pump blood around the body is compromised.

Often the “cardiac output” ie; the amount of blood that is pumped around the body in a minute is reduced and is often not enough to meet the body’s needs.  The heart itself is composed of four chambers.  The top two chambers are the atria and they pump blood into the lower chambers (the ventricles).  It is the ventricles that are responsible for the pumping of blood around the body and in particular the left ventricle which is the main “engine” that supplies oxygenated/oxygen rich blood to the body’s tissues.

What are the typical symptoms?

Often patients with mild heart failure will have little by way of symptoms.  

However heart failure is often progressive.  Commonly reported symptoms are breathlessness, reduced exercise capacity and a general lack of energy.

Patients will often complain of swollen feet and legs and difficulty breathing when they lie flat in bed at night-this is known as ‘orthopnoea’.

Often patients will get particularly breathless at night and may cough and bring up frothy sputum.

The commonest cause of heart failure in the UK is coronary artery disease. That is to say patients who have experienced a previous heart attack (myocardial infarction). The damage a heart attack leaves behind, particularly to the left ventricle (main pumping chamber of the heart) jeopardises the way the blood is pumped and then leads to heart failure. Other common causes of heart failure include long standing high blood pressure (hypertension) and leaking heart valves or narrowed heart valves (heart valve disease). Other causes of heart failure include endocarditis (an infection of the heart – in particular the valve) and long standing diabetes. A large group of patients have idiopathic dilated cardiomyopathy. This means that they have failure and heart weakness where the cause is poorly understood. Sometimes it can be a result of a viral infection that has attacked the heart.

There are several tests that we use but a good clear history obtained by a consultant cardiologist is key followed by investigations which include a 12 lead ECG (this can give us clues as to whether patients have had a heart attack in the past or high blood pressure) and heart scans (echocardiograms) will demonstrate if the heart muscle is weak and if so how weak. It will also tell us if there is any significant valve disease. Blood tests are also helpful, in particular a BNP test (B type natriuretic peptide). In patients with heart failure the BNP level is often significantly elevated. Other tests can be performed and include cardiac MRI scanning, coronary angiography and cardiac CT.

Heart failure is progressive.  The goal of treatment is to stabilise symptoms and to reduce the rate of progression.  Commonly used drugs that are ACE inhibitors (drugs such as Ramipril, lisinopril), beta-blockers (drugs such as bisoprolol, Nebivolol and metoprolol).  Other valuable drugs that we use include drugs such as Spironolactone and Eplerenone.  We also use drugs such as Frusemide and Bumetanide which are diuretics and help to reduce the swelling that can occur in association with heart failure.  If patients have concomitant conditions they may well be on drugs such as statins (to treat high cholesterol) and bloods to regulate blood pressure.  Treatment is very much individual patient centred therapy.

Patients with heart failure are also at higher than average risk of dangerous heart rhythms such as ventricular tachycardia (VT) and ventricular fibrillation (VF). These are potentially life threatening problems and therefore some patients who have heart failure are recommended to have an Implantable Cardioverter Defibrillator (ICD) implanted.

It is very important that heart failure patients are assessed thoroughly so that the right patients can be offered these cardiac ‘devices’. They are generally implanted by a cardiac electrophysiologist/cardiologist-such as Dr Fox.

What are the Procedures?

These are the procedures associated with Heart Failure

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