The term "heart failure" always seems to me to be a bit inaccurate and probably quite alarming for patients to hear.
For me, it conjures up images of either a heart that has somehow failed something (similar to a car with a WOF), or a heart that is at imminent risk of ceasing to function.
Luckily neither of these are true, but nonetheless heart failure is a serious and frequently under-diagnosed condition, and is a warning sign that the heart is under strain. Detecting and treating it early can make a huge difference to quality and length of life.
Heart failure is when your heart, for a variety of reasons, can't pump blood (and therefore oxygen and other essentials) around the body as effectively as it used to.
Although the heart is still functioning, it is under considerable strain and if not detected, this will inevitably get worse. Acute heart failure is the term used to describe heart failure of sudden onset, whereas chronic heart failure is of a longer duration, and often has a more insidious presentation.
Lots of conditions can lead to heart failure, but the most common ones include:
Heart attack – during a heart attack some of your heart muscle is deprived of oxygen. Depending on the degree of muscle damage, heart failure can result as the muscles can no longer work as effectively.
High blood pressure or hypertension – consistently high blood pressure (ie blood pressure that either isn't treated at all or is inadequately treated) will put a constant strain on the heart, leading to heart failure.
Diseases of the heart valves – if our heart valves are damaged (either due to infection such as rheumatic fever or endocarditis, secondary to a congenital or birth defect, or just due to ageing) they can't effectively open or close, making it really hard for the heart muscle to pump properly. This will in time lead to heart failure.
Diseases or infections of the heart muscle known as cardiomyopathy can be a cause of heart failure.
Some medications or drugs including excessive alcohol, cocaine use, and certain types of chemotherapy.
Chronic or severe anaemia
Either an underactive or overactive thyroid, especially if undetected and untreated for a long period of time
Other rare causes exist, and sometimes there is no obvious cause found at all to explain why someone has developed heart failure.
As mentioned, sometimes heart failure is pretty silent, and can be really hard to pick up. It can mimic other things, and are often symptoms are just put down to "being tired" or "getting old".
I'd really encourage anyone who identifies with the list below, and doesn't have an obvious explanation, to talk to their GP – there are some pretty easy tests that can tell how your heart is functioning and getting this treated early is the key to minimising really serious issues later on:
Feeling tired – if your energy levels have changed significantly, don't just put it down to being too busy, or getting older, as there could be something else going on – heart failure wouldn't be top of the list, but it is common, especially in older people, affecting around 10% of those over 70.
Shortness of breath – in heart failure, it is typical to feel breathless with exertion (eg when going out for a walk, or going up stairs), or when lying flat; it can be so severe that people wake from sleep gasping for air, and have to sit upright to feel better.
Fluid retention – as the heart isn't effectively pumping blood around the body, fluid tends to "pool" in other places, including ankles and legs (causing swelling), lungs (causing shortness of breath) and abdomen.
Dizziness or fainting
Lack of appetite, despite sometimes gaining weight due to the fluid retention
Your GP will be able to examine your heart and lungs to see if heart failure is likely, and will then organise some basic tests including bloods, a chest xray looking for fluid on the lungs and an enlarged heart, and an ECG to check the rhythm of your heart is normal.
They may also refer you for a test known as an echocardiogram – this is basically a scan of the heart, which shows how effectively your heart is working, and whether the heart muscle and valves are performing as they should be. You may need to see a cardiologist (a heart specialist) depending how severe your symptoms are.
If you or a loved one are diagnosed with heart failure, please don't despair. Although it isn't "curable" and won't ever go away completely, there are lots of different treatments available now that will enable your heart to function better and will reduce the risk of things getting worse with time.
Medications include ace inhibitors, beta blockers and diuretics (water tablets) – often a combination of these will be required to get symptoms under control.
As well as reliably taking any prescribed medication, you can make a huge difference to your heart's function by adapting your lifestyle as well – minimising alcohol, stopping smoking, losing weight, reducing the salt in your diet and doing some regular enjoyable exercise are all helpful, and will have positive impacts on many other aspects of your health and well-being as well as your heart!
For support and advice, visit the Heart Foundation at www.heartfoundation.org.nz