Heart failure

Chest X-ray and echocardiogram of a patient with heart failure- the heart is enlarged.

What is Systolic Heart Failure?

Systolic heart failure occurs when the heart is not able to pump sufficient blood around the body to maintain the metabolic needs of the body. It normally occurs when the heart muscle has been damaged. For example, by a Heart Attack or by a degenerative disease of the heart muscle called Cardiomyopathy. It can also be caused if the valves are two narrow, impeding blood flow or certain valves are leaky, meaning that when blood is pumped forward, it rapidly returns to the heart, without reaching the tissues effectively. In certain individuals, it can also be a manifestation of hardening of the heart arteries (Coronary Artery Disease) and these individuals do not necessarily feel angina pain or discomfort, but do get shortness of breath and this is known as an "angina equivalent".

What is Diastolic Heart Failure?

Diastolic heart failure refers to the inability of the heart muscle to relax and prime itself with enough blood for the next pumping cycle. The causes of diastolic heart failure are numerous, but include coronary artery disease and left ventricular hypertrophy. Both of these mean the heart muscle is stiff, does not relax easily and the heart therefore does not fill with blood. Accordingly, each heart cycle pumps less blood forward, is less efficient and the patient is aware of significant breathlessness on exertion.

What investigations should I expect?

We will arrange an Electrocardiogram (ECG) to look at any evidence of previous heart attack or increase of heart muscle mass. He will examine you carefully to look for signs of high blood pressure or heart failure. The key investigation is an Echocardiogram, which will look for evidence of previous heart attack, weakness of the heart muscle, valvular abnormalities or hypertrophy, armed with this, we will then make a decision about what further investigations are necessary, but more importantly, will almost certainly institute tablet therapy to help control the heart failure and improve your outlook. You may need an Angiogram to look at your heart further.

What other causes of breathlessness will we look for?

Very often, these things are not simply an isolated cause of breathlessness. It is not uncommon in someone who has been a cigarette smoker for many years to also have a degree of lung damage. We may refer you for a Lung Function Test. We may also wish to do blood tests, looking for presence of anaemia or abnormalities of the kidneys, such as Kidney Failure.

Treatment for Heart Failure

We will decide if you need treatment for excess fluid in your body. This is treated with water tablets (diuretics). In addition, several classes of drugs are known to increase survival in heart failure. Beta-blockers, angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARBs) will be prescribed to most patients. If symptoms are more severe, aldosterone antagonists such as spironolactone and eprelonone may be used. Finally, as special echocardiogram may be performed to se if a new type of pacemaker - a Biventricular Pacemaker - is required. Some patients may need an Automatic Implantable Defibrillator (AICD).

What can I do to help myself?

It would be great if you could stop smoking, lose some weight and try to reduce the salt in your diet. If allowed by the cardiologist, then exercise would also be helpful to build stamina. Alcohol intake needs to be reduced as it impairs the heart pump function when heart failure has occurred.