Heart Failure

The function of the heart is to pump blood around the body. When it is unable to perform this function heart failure develops. Heart failure may have a poor outlook with survival rates worse than many types of common cancers. However, modern treatment has improved the outlook substantially. Heart failure is an increasing problem and becomes more common with age There are several different causes of heart failure and some require specific treatment.

Symptoms of Heart Failure

There are several symptoms that occur in heart failure. These all relate to the inability of the heart to pump effectively. When the heart cannot pump properly fluid accumulates in the tissues. This can lead to ankle swelling (or oedema) in the legs. If the heart failure is only mild then you might only notice breathlessness during exercise. As the heart failure becomes more severe then this breathlessness will become present during even mild exercise. Also people tend to notice that they are sleeping with more pillows at night. Heart failure can also make you feel weak and tired and nauseous. You may also develop a dry cough. These symptoms can be bought under control with treatment.

Causes of Heart Failure

There are many causes of heart failure but they all result in reducing the ability of he heart to pump properly. The commonest cause in the UK is after a heart attack. After a heart attack part of the heart muscle dies and turns into scar tissue and this scar tissue is unable to contract. This then reduces the ability of the heart to pump. There are many other causes including:

• Severe heart valve disease (narrowing or leakage of the heart valves)

• Cardiomyopathy, where there is a problem with or disease of the heart muscle itself

• Previous infection or inflammation of the heart (called myocarditis)

• Long standing raised blood pressure which has not been adequately treated

• Poorly control heart rhythm problems such as atrial fibrillation (AF). It is also worth noting that AF when present tends to make the heart failure worse as the heart cannot pump as effectively

• Certain heart defects that are present from birth (congenital heart disease)

• High alcohol intake over a long period of time

• Other disease such as an overactive thyroid, anaemia and disease of iron storage in the body can lead to heart failure

Diagnosis of Heart Failure

If your symptoms suggest that you may have a diagnosis of heart failure there are several tests that are performed for two reasons. Firstly the diagnosis of heart failure needs to be confirmed and then secondly the cause of heart failure needs to be found.

Tests that are used to confirm heart failure include an ECG, blood tests and an echocardiogram. An ECG is performed as this if this is normal then it makes a diagnosis of heart failure less likely and other causes for symptoms should be investigated. Routine blood tests are performed as they might lead to a cause for the heart failure being found. A special blood test called serum BNP is often performed. This blood test is often abnormal in heart failure and a normal serum BNP level, much like the ECG, makes the diagnosis of heart failure much less likely. An echocardiogram is often performed. This uses an ultrasound probe placed on the chest to visualise the heart chambers and valves (transthoracic echocardiogram). Moving images of the heart can then assess the how well the heart is pumping and to determine if the heart is not pumping properly. As well as finding out if the heart is not pumping properly an echocardiogram can often determine the cause of the heart failure such as problems with the heart valves or a previous heart attack. Sometimes a chest X-Ray is also performed to see if there is any fluid in the lungs.

There are many tests that are used to find the cause of the heart failure once the diagnosis has been established. These can include MRI scans of the heart, a coronary angiogram and a transoesophageal echocardiogram (where the ultrasound probe is passed down your oesophagus or gullet under sedation rather than placed on your chest). Specialised blood tests to look for certain conditions may be undertaken. MRI of the heart can identify many causes of heart failure and increasingly this test is being performed on everyone with a diagnosis of heart failure to make sure that the correct cause for heart failure is found

Treatment of Heart Failure

Apart from specific treatment for the cause of the heart failure there are certain medications and treatments that are used to treat all forms of heart failure. These help the heart muscle to pump more effectively. Most patients will be started on an ACE inhibitor (eg Ramipril or Lisinopril) and a beta blocker (eg Bisoprolol or Carvedilol). These drugs have also been shown to reduce admissions to hospital with deteriorating heart failure and they help people to live longer.  Other treatments are aimed at removing the excess fluid around the body (diuretics). There are several types of diuretics but the most commonly used ones to remove fluid are called loop diuretics (eg Furosemide and Bumetanide). Other types of diuretics can also be used in certain situations. In some cases a special type of pacemaker (called a biventricular pacemaker) can be inserted to help the heart to function more effectively.