What is Heart Failure?
Heart failure (HF), often called congestive heart failure (CHF) is generally defined as the inability of the heart to supply sufficient blood flow to meet the needs of the body.
Heart failure can cause a number of symptoms, including shortness of breath, leg swelling, and exercise intolerance. Incidence increases with age and it is commonest in older people, but can occur in the young.
Types of Heart Failure
Systolic Heart Failure
This 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 disease of the heart muscle called a cardiomyopathy. It can also be caused if the valves are too narrow or leaking.
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 related to blood pressure.
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.
Diagnosis of Heart Failure
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 fluid overload. The key investigation is an Echocardiogram, which will look for evidence of previous heart attack, weakness of the heart muscle, valvular abnormalities or hypertrophy. A chest X-ray may show an enlarged heart, but can be normal. You may need an Angiogram to look at your heart further.
Treatment of Heart failure
Drug treatments target fluid overload and may also allow you to live longer. Excess body fluid 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 epleronone may be used. Finally, if your ECG is abnormal, or a special echocardiogram suggests benefit, a special type of pacemaker – a Biventricular Pacemaker – may be required. Some patients may need an Automatic Implantable Defibrillator (AICD).