Why People get Heart Failure?

There may be one or sometimes several factors causing heart failure.

In order to understand easily, we would like to divide the causes of heart failure into two main categories:

1. 1. Damaged or weakened heart muscle or Valves
   This is the commonest and the conditions causing this includes:
1. Heart Attack( Myocardial infarction)
2. Coronary artery disease
3. Faulty heart valves
4. Damage to the heart muscle (cardiomyopathy)
5. Myocarditis
6. Congenital heart defect
7. Heart arrhythmias
2. 2. Stiffness of the heart muscle without damage:
   In this condition, the heart doesn’t relax after each pumping action and therefore, unable to push blood effectively. The conditions causing this includes:
1. Old age
2. High Blood Pressure

Risks for Heart Failure (Chronic)?

1. The Conditions contributing to heart failure: Diabetes, HIV, Hyperthyroidism, Hypothyroidism, Hemochromatosis (deposition of excessive Iron ) and Amyloidosis (Deposition of excessive protein)
2. Medications: Some of the medications causes side effects, which can either result into heart failure of the heart failure can be worsens: Theses includes:
1. The diabetes medications: Rosiglitazone and Pioglitazone.
2. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)



3. **** Please Discuss With Your Patient If You Are Not Sure. ****

How to Diagnosis Heart Failure

1. The Diagnostic steps and treatment might be different depending on the start of your heart failure symptoms:
1. Acute heart failure (Emergency) - Click here
2. Chronic heart failure - Click here
2. Your local doctor or the cardiologist makes the diagnosis after assessing your symptoms and do an examination of your heart and body.

Symptoms of Chronic Heart Failure:

The symptoms of chronic heart failure starts slowly. The symptoms of chronic heart failure usually depends on the underlying heart problems (causes of heart failure). The symptoms include:

1. Shortness of breath (dyspnea), mostly on exertion but could be at rest in advance heart failure.
2. Swelling (edema) in your legs, ankles/ feet and in some cases abdomen (ascites)
3. Generalized weakness, tiredness and easy Fatigability
4. Reduced ability to exercise and walk
5. Weight gain from fluid retention

Investigations: Tests for Heart Failure:

The doctor will do examination of your heart and lungs, using a stethoscope. You will be checked for swelling of legs/feet and abdomen.

The investigations requested by the doctor usually depend on the cause of heart failure. These investigations includes:

1. Blood tests: Your blood count (hemoglobin), kidney tests and other relevant tests will be checked.
1. Pro-BNP or BNP: A special chemical in blood is checked to diagnose the heart failure. This is also used to help the doctor in treating heart failure and adjusting your medications.
2. Chest X-ray: This is performed, in Radiology department. This is to check for water in the lungs and any other problems with the lungs.
3. Electrocardiogram (ECG). This test records the electrical activity of your heart. This is used to look for Heart Attack (Damage to your Heart) and any heart rhythm problems (Arrhythmias)
4. Echocardiogram: This is the ultrasound scan of your heart. This is performed to look for any damage to the heart, valves (doors of heart) problems, and pressures in the heart and to assess the strength of heart (ejection fraction).
5. Stress test: You may need a Stress test, which is used to assess the health of your heart muscle and its response to exertional activity. You may need one from the list below as per your doctor advice;
1. Exercise Treadmill Test
2. Nuclear Stress Test
3. Stress Echocardiogram
4. Stress Test Cardiac MRI
6. Cardiac Computerized Tomography (CT) Scan: This is performed to look for any blockages in the arteries of your heart and any other abnormalities.
7. Magnetic Resonance Imaging (MRI): This is performed to look for any damage to the heart muscle, strength of the heart, heart muscle abnormalities (cardiomyopathy) and to do a stress test.
8. Coronary Angiogram: A coronary angiogram is a procedure that uses X-rays to check the blood vessels of your heart. In this test the cardiologist, assess any blockages or narrowing in the blood vessels of your heart. The procedure is performed in a catheterization (catheter) lab of a hospital.
   The procedure may be performed routinely or sometimes in emergency (heart attack).
9. Right Heart Catheterization:
1. A Right heart Catheterization is a procedure that uses X-rays to check the blood vessels of your Lungs and check the right side chambers of your heart.
2. This is used to assess the pressures and any Holes in the lungs & heart.
10. Myocardial biopsy: This test is usually, performed as a part of Right heart catheterization. After assessing your heart, your doctor inserts a small, flexible biopsy cord into the chamber of your heart and a small piece of the heart muscle is taken and later checked under the microscope. This test is performed, to diagnose certain types of heart muscle diseases that cause heart failure.

Treatment of Heart Failure (Chronic)

The treatment of Heart failure depends on the onset of symptoms and underlying cause.

1. Acute heart failure is an emergency and discussed separately - Click Here
2. The Treatment of Chronic Heart Failure includes Medications, surgery/Interventions and Medical Devices & Advance Heart Failure Therapies.
1. The treatment of Chronic Heart failure is lifelong and needs systematic approach.
2. The AIM of the treatment is to improve the symptoms of heart failure and make it stronger as much as possible.
3. The heart failure sometimes improve largely by treating the underlying cause. For example, treating the valve disease, heart attack and heart rhythm problems.

Medications:

Your doctor will prescribe various medications based on your individual needs and your underlying other conditions and risk factors. These are as follows:

1. Angiotensin-converting enzyme (ACE) inhibitors
1. These drugs help relax your arteries, lowers the blood pressure and decrease the workload on the heart
2. Examples include enalapril, Lisinopril, Ramipril and captopril.
2. Angiotensin II Receptor Blockers
1. These drugs help relax your arteries, lowers the blood pressure and decrease the workload on the heart similar to Angiotensin-converting enzyme (ACE) inhibitors.
2. Examples include losartan and valsartan
3. Beta-blockers
1. Beta-blockers reduces the heartbeats and reduces blood pressure.
2. Beta-blockers also help blood vessels relax and improve blood flow to heart muscle.
3. This drug may help in limiting or reverses some of the damage to your heat.
4. Examples include carvedilol, atenolol, metoprolol and bisoprolol.
4. Diuretics
1. Also called as “Water Pills”
2. It makes you pass more urine in order to remove excessive fluid from the body, particularly lungs and legs.
3. Example includes Furosemide (Lasix).
4. It may affect other minerals in the body, therefore the doctor may prescribe supplements of minerals in order to keep the normal level of potassium and magnesium
5. Aldosterone Antagonists
1. This is also a different type of water pill. This has a beneficial effect on the longevity of your heart
2. This drug has an important effect in the body by increasing Potassium levels. The doctor may request for regular blood tests.
3. Examples are spironolactone and eplerenone.
6. Digoxin
1. This drug increases the strength of your heart muscle and therefore helps in very weak heart
2. Can be used in slowing the heartbeat in patients with atrial fibrillation.
7. Ivabradine
1. This reduces the heartbeats WITHOUT reducing blood pressure.
2. It can be used as an alternative to Beta-blockers in patients who develop Sid effects such as; tiredness, fatigability, low blood pressure and sexual dysfunctions.
3. It can be used as an alternative to Beta-blockers in patients who cannot use beta-blockers like asthmatics and other lung problems.

Surgery/interventions:

1. If your heart failure is due to weakness of heart muscles, Valves (doors of your heart) or blockages in the arteries of heart, you may need
1. CABG
2. PCI
3. Heart valve repair or replacement

Medical devices and Advance Heart failure

If your heart failure gets worse and not fully responding to the medications and surgical therapies (as discussed above) . These advance therapies includes:

1. Implantable cardioverter-defibrillators (ICDs)
2. Cardiac resynchronization therapy (CRT), or biventricular pacing
3. Ventricular assist devices (VADs)
4. Heart transplant

1. Implantable Cardioverter-Defibrillators (ICDs).
1. An implantable cardioverter-defibrillator (ICD) is a small biscuit sized device which is used to help regulate very fast dangerous electrical impulses (current) which if not treated may lead to stopping of heart ( cardiac arrest). The procedure is performed in a catheterization (catheter) lab of the hospital or operation theatre.
2. Cardiac Resynchronization Therapy (CRT), or Biventricular Pacing.
1. In this treatment, A special pacemaker is implanted, which sends timed electrical impulses to both lower chambers of the heart's (the left and right ventricles) so that the heart pump in a more coordinated and efficient manner.
2. In some devices, ICD may be used and it is then called as biventricular ICD
3. Ventricular Assist Devices (VADs)
1. Also known as mechanical circulatory support device (Artificial heart).
2. This is implanted, via operation and the device is able to pump blood from the lower chambers of your heart (the ventricles) to the rest of your body.
3. Usually implanted in patients who are awaiting heart transplantation.
4. Heart Transplant
1. In some patients, despite multiple medications and devices implantations (as above), the heart failure gets worse, therefore need their diseased heart replaced with a healthy donor heart.
2. There is a long waiting list for Heart transplants (limited donors) and available in few limited countries in the world.
3. A team of doctors at a transplant center decides patient fitness for a heart transplant.

How to live with Heart Failure?

1. Diet and Life style changes
   If you had a Heart Failure, you must work on your lifestyle changes: these changes include:
1. Stop smoking and avoid exposure to passive smoking.
2. Eat a healthy diet with limited amounts of saturated fat; eat whole grains, and many fruits and vegetables and Restrict sodium in your diet
3. Treat diseases or conditions that can increase your risk of angina, such as diabetes, high blood pressure and high blood cholesterol and stress.
4. Get regular medical check-ups.
5. Limit alcohol consumption to one to two drinks or fewer a day.
6. Maintain a healthy weight and maintain weight monitoring diary
7. Get an annual flu shot to avoid heart complications from the virus
2. Exercise and sports Heart Failure
1. Regular Exercise helps improve heart muscle function after a heart attack and helps prevent a heart attack. Walking 30 minutes a day, five days a week can improve your health. (Discuss with your doctor about a safe exercise plan).
2. Your doctor may suggest a walking program.
3. For Sports, discuss with your doctor regarding each sports you are interested.
3. Cardiac Rehabilitation
1. Very important program run by doctors and medical team to help you recover from your heart failure.
2. Cardiac rehabilitation programs generally focus on four main areas — medications, lifestyle changes, emotional issues and a gradual return to your normal activities
3. The above changes will be tailored, according to your individual needs and the amount and severity of heart failure
4. Heart Failure and Driving
1. You can drive after 4 weeks following acute heart failure and recovery
2. In chronic heart failure, you must discuss with doctor.
3. You must inform your licensing authority and get advice if you drive large goods vehicles (LGV) or passenger-carrying vehicles (PCV).
5. Heart Failure and Working
1. After about 4-6 weeks, you can usually go back to your work.
2. If your job involves heavy lifting or manual labourer, discuss with your employer.
6. Heart Failure and Sexual Life
1. Most people can safely return to sexual activity after recovery but usually depends on your physical comfort, psychological readiness and previous sexual activity.
2. Some heart medications can affect sexual function. Your doctor can then prescribe alternative medications particularly beta blockers ( consider Ivabradine)
3. You should NOT use Viagra if you are on regular nitrates tablets.

Getting Support

Heart Failure and Support Services

Having a heart failure is one of the scariest experience of your life.

People may experience Fear, anger, guilt and depression after a heart failure.

Discussing them with your doctor, a family member or a friend might help. Or consider talking to a mental health provider or joining a support group.

Please refer to online support groups such as:

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