What is heart failure?

Heart failure is a condition in which the heart does not pump well. This causes the heart to lag behind in its job of moving blood throughout the body. As a result, fluid backs up in the body, and the organs in the body do not get as much blood as they need. This can lead to symptoms, such as swelling, trouble breathing, and feeling tired.

If you have heart failure, your heart has not actually “failed” or stopped beating. It just isn’t working as well as it should.

What are the symptoms of heart failure?

If your heart does not pump well, at first you might have no symptoms. But as the condition gets worse, it can cause:

• Tiredness or weakness, or make you feel lightheaded or dizzy
• Trouble breathing, which might lead you to be less active or to need extra pillows at night to sleep
• A racing heartbeat, even while resting
• Swelling in your feet, ankles, and legs or in your belly

Is there a test for heart failure?

Yes. If your doctor or nurse thinks you might have heart failure, he or she will do an exam, and might order some of the following tests:

• Electrocardiogram (ECG) – This test measures the electrical activity in your heart. It can show whether you have an abnormal heartbeat or had a heart attack in the past. These are some of the things that can cause heart failure.
• Chest X-ray – A chest X-ray shows if there is fluid in the lungs. It also shows the general shape of the heart and large blood vessels in the chest.
• Echocardiogram – This test uses sound waves to create a picture of your heart as it beats. It shows the size of the heart chambers, how well the heart is pumping, and how well the heart valves are working.
• Stress test – During a stress test, you might be asked to run or walk on a treadmill while you have an ECG or other heart tests. Physical activity makes the heart pump harder and increases the heart’s need for blood. This test helps doctors see if the heart is getting enough blood when it is under stress. If you cannot walk or run, you might instead get a medicine to stress your heart.
• Cardiac catheterisation (also called a coronary angiogram) – During this test, the doctor puts a thin tube into a blood vessel in your leg or arm. Then he or she moves the tube up to your heart. When the tube is in your heart or blood vessels, he or she will take measurements. The doctor might also put a dye that shows up on an X-ray into the tube. This can show if any arteries in your heart are narrowed or blocked.

How is heart failure treated?

There are many treatments for heart failure, but medicines are a key part of controlling the condition.
Take your medicines every day as directed. They can reduce the chances that you will need to go to the hospital, have a heart attack, or die. They can also reduce or get rid of your symptoms. That’s why they are so important.
Tell your doctor if your medicines cause side effects or other problems. Your doctor might be able to switch to another medicine or lower your dose so that you do not have that problem.
Other treatments for heart failure include devices to help the heart pump with more force or to beat at the right rhythm, and surgery to improve blood flow to the heart or replace the heart.

Which medicines might I need?

There are several different medicines that are used to treat heart failure. They work together to keep you as healthy as possible. Each medicine does something different and typically, people take a number of different types. However, very few people take all of the medicines available.

The doses and choices of medicines you get might change now and then. Your doctor will work with you to find the combinations and doses of medicine that work best for you. It is a good idea to keep a list of all the medicines you take, and bring it with you each time you visit any doctor.

What are the different types of medicine used to treat heart failure?

• ACE inhibitor, ARB, or ARNI: These medicines are often grouped together because they work in similar ways. Doctors usually prescribe an ACE inhibitor or an ARB as first line treatment for heart failure. The ARNI is a newer heart failure medicine that can be used instead of an ACE inhibitor or ARB. These medicines relax blood vessels and lower blood pressure, making it easier for the heart to pump. They also help prevent or reverse the enlargement of the heart that can happen in heart failure.
• Beta-blocker: A beta blocker slows the heart down and can lower blood pressure. It helps reduce the amount of work the heart has to do. Some examples of beta blockers include carvedilol, metoprolol and bisoprolol.
  Ivabradine (Coralan) is a newer type of drug to slow the heart down. Your doctor might prescribe ivabradine if your heart rate is still a little fast with a beta blocker, or if you cannot take a beta blocker.
• Diuretics: When you have heart failure, your body holds onto extra fluid. A diuretic helps the body get rid of extra salt and fluid. It is sometimes called a “water pill.” It can reduce heart failure symptoms or keep them from getting worse. For example, a diuretic can help pull fluid out of the lungs, making breathing easier or reduce leg swelling that may have built up over time. Frusemide (Lasix) is commonly used, but there are a number of other ones that may also be prescribed.
• Mineralocorticoid receptor antagonists: These medicines are also types of diuretic but have additional properties to protect the heart from unfavourable hormones effects that can happen when a person has heart failure. The commonest ones are spironolactone (Aldactone, Spiractin) and eplerenone (Inspra). They tend to cause the body to hold on to potassium and your doctor may stop potassium supplements when these medicicnes are used.
• Digoxin: Digoxin helps the heart pump with more force. This can help reduce some of the symptoms of heart failure.

What else can I do on my own to protect my heart?

If you do the following things, you will feel better and reduce the chances that you will need to go to the hospital:

• Take your medicines, even if you feel well. The medicines your doctor prescribes can help you feel better and live longer. But they will work only if you take them as your doctor tells you to.
• Watch for changes in your symptoms and follow any action plan that you may have been given in case symptoms develop or change. You must watch your symptoms closely and weigh yourself every day. If your symptoms get worse or if you gain weight suddenly, you must take action. This may include notifying your GP and/or cardiologist or discussing the issue with a cardiac nurse that has been assigned to assist with your cardiac care.
• Call your doctor or nurse if you gain weight suddenly. Weigh yourself every morning after you urinate but before you eat breakfast. Wear roughly the same amount of clothing every time and make sure to write down your weight every day on a calendar. Call your doctor or nurse if your weight goes up by 1 kilogram in 1 day, or 2 kilograms in 1 week. When you have heart failure, sudden weight gain is a sign that your body could be holding on to too much fluid. You might need a change in your medicines.
• Cut down on salt. Try not to add salt at the table or when you cook. Also, avoid foods that come in boxes and cans, unless their labels say they are low in sodium. The best choices for food are fresh or fresh frozen foods, and foods you prepare yourself. Your doctor might also tell you to limit the amount of fluids you drink.
• Lose weight if you are overweight. If you are overweight, your heart has to work extra hard to keep up with your body’s needs.
• Limit alcohol – if you are a woman, do not have more than 1 drink a day. If you are a man, do not have more than 2.
• Be active – ask your doctor what activities are safe for you. Your doctor will let you know if activities such as walking or biking on most days of the week can help reduce your symptoms. But do not exercise if your symptoms are bothering you a lot.
• Check with your doctor before taking any new medicines or supplements – Some over-the-counter and prescription medicines, “natural” remedies, and supplements are not good for people with heart failure. For example, medicines such as the non-steroidal anti-inflammatories such as ibuprofen (Nurofen), naproxen (Naprosyn) and celecoxib (Celebrex) can make heart failure worse.