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  Heart Failure

What is Heart Failure?

This is a condition based on a deterioration in the ability of the heart to pump blood around the body. It is a progressive disorder affecting many organs and systems in the body. A syndrome, arising from the inability of the heart to maintain an output to meet the needs of an individual, at rest or at exercise. It is characterised by a limitation in exercise capacity with symptoms of breathlessness and fatigue.

It is a common problem affecting 1.5-2.0% of the population and increases with age, such that it affects 6-10% of those aged 65-74 years. It can shorten life and places limitations on physical activity and quality of life. It is responsible for up to 5% of all hospital admissions in the over 65 age group. It is an increasing problem in the Western world as more people survive heart attacks and the population ages.

Causes

In the developed world the majority of patients with heart failure have problems with the blood supply to the heart or coronary artery disease. They have often lost the function of segments of the heart due to heart attacks or myocardial infarcts and hence affect its ability to pump. Other causes include:

  1. High Blood Pressure
  2. Valvular Heart Disease
  3. Toxins like alcohol
  4. Virus infections
  5. Metabolic diseases like thyroid disease
  6. Inherited or Congenital
  7. Idiopathic (no cause found)

The final common pathway is the same with impaired pump function of the heart and is normally due to impaired contraction (systolic function) of the heart although, problems with relaxation (diastolic function) are also recognised.

Signs and Symptoms

Breathlessness

This is one of the main symptoms with shortness of breath on exertion and a decreased exercise capacity. This usually represents fluid on the lungs (pulmonary oedema). It can also occur when lying flat (orthopnoea) or you can be woken from sleep with breathlessness (paroxysmal nocturnal dyspnoea)

Fatigue

General tiredness or sluggishness is a common feature and represents various organs and tissues like the skeletal muscle not getting enough oxygen due to the heart’s failure to pump blood around the body adequately.

Ankle or leg swelling

This represents fluid retention as a compensatory mechanism by the body to try and improve the pumping function of the heart. It is normally treated with water tablets or diuretics.

Weight gain or weight loss

With ankle swelling there is normally a gain in weight as the body retains fluid and regular weighing is a good way of monitoring fluid status. In the absence of fluid retention patients can lose weight and in particular muscle mass. This is due to the chronic poor blood supply to the body musculature from the failing heart but tends to be a late feature of heart failure.

Loss of appetite

Swelling of the gut due to fluid retention can cause bloating and a loss of appetite but can also be related to medication.

Chest pain or angina

A tight heavy feeling in the centre of the chest radiating to the neck and jaw and down the left arm, particularly if it occurs with exercise can represent narrowing in the coronary arteries. This is the commonest cause of heart failure particularly if there has been a heart attack in the past.

Palpitations

Patients often experience palpitations or an awareness of an abnormal heart beat. About a third of patients will develop an irregular heart rhythm or atrial fibrillation (see atrial fibrillation link)

How is Heart Failure diagnosed?

Initial assessment is based on symptoms of breathlessness particularly if ankle swelling is present.

Investigations include:

  1. ECG – This looks at the electrical activity of the heart and may show evidence of previous heart attacks or an abnormal heart rhythm

  2. CHEST X-RAY – This would show if the heart was enlarged and if there is any fluid in the lungs

  3. ECHOCARDIOGRAM – This is an ultrasound scan of the heart that involves bouncing high frequency sounds waves off the heart to create an image. This is the main test for diagnosing heart failure. It looks at the size of the heart as well as wall motion and the function of the heart valves.

  4. AMBULATORY ECG MONITOR – This may be required investigate palpitations and look for abnormal heart rhythms. It is also used to look for the more dangerous ventricular arrhythmias which may require assessment for ICD (link) insertion.

  5. CARDIAC CATHETERISATION – This is an invasive test used to assess the state of the coronary arteries and also the significance of heart valve problems.

  6. CARDIAC MAGNETIC RESONANCE IMAGING (MRI) – This non-invasive test uses strong magnetic fields to obtain a detailed image of the heart It is useful when good images can not be obtained by echocardiography.

 

Useful Links

  1. http://www.bhf.org.uk/hearthealth/index.asp?secID=1&secondlevel=77&thirdlevel=352
  2. http://www.nice.org.uk/page.aspx?o=79729
  3. http://www.nice.org.uk/page.aspx?o=79725
  4. http://www.patient.co.uk/showdoc/23068755/
  5. http://www.londonbridgehospital.com/LBH/services-det/cardiology/

 


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