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Heart Failure Q&A

Although it's a quite common condition, there is still confusion surrounding heart failure. Consultant Cardiologist Steven Shaw from BMI The Alexandra Hospital, helps us better understand what is heart failure, what are its signs and symptoms and how the condition is treated.

What is considered heart failure?

"Heart failure" is the name of a medical condition where the pumping function of the heart fails to meet the demands of the body. It is an epidemic in the UK and over half a million people here are already diagnosed with it

What are the symptoms of heart failure?

The main symptoms are reduced exercise capacity and shortness of breath, tiredness / fatigue, and sometimes fluid retention.

What causes heart failure?

There are many causes. Coronary artery disease is the common heart condition in the UK, followed by high blood pressure. Other causes include faulty heart valves, viral infections, abnormal heart rhythms, drugs (e.g. amphetamines, chemotherapy), pregnancy and gene malfunctions to name just a few.

How is heart failure diagnosed?

The diagnosis is made through a detailed medical history, physical examination, 12 lead ECG, blood tests and a scan of your heart.

What are the stages of heart failure?

Most commonly, the severity of heart failure is described by “NYHA class”. This stands for "New York Heart Association"(the organisation who devised it).

  • Class 1 means a patient has structural or functional heart disease on a scan but with no symptoms.
  • Class 2 means patients have generally mild symptoms of heart failure and modest limitations of physical activity.
  • Class 3 means there is significant limitation of physical activity although comfortable at rest.
  • Class 4 means there are symptoms of heart failure at rest or very minor physical activity such as getting dressed.

The higher the NYHA class, the worse the prognosis. ALL classes of heart failure need assessment and treatment.

What is the difference between heart failure and heart attack?

A heart attack means that there is a sudden blockage of blood flow to the heart muscle, usually because of a blood clot in a coronary artery. The blockage of blood flow means that the heart muscle doesn’t receive oxygen, and therefore starts to die – causing central chest pain and often irreparable damage to the heart muscle. It is a medical emergency.

Heart failure is the condition that occurs when the heart muscle is not pumping properly. Therefore, a heart attack is one of the most common causes of heart failure.

How can heart failure be prevented?

It is all about trying to prevent heart damage being done in the first place. Risk factors for a heart attack should be addressed and modified where necessary.

Blood pressure should be controlled adequately, a good diet and regular exercise is important, avoiding stress, moderating alcohol intake, avoiding illicit drugs etc are all important.

Unfortunately, sometimes heart failure is unavoidable through no fault of your own (eg viral illnesses, pregnancy or genetic inheritance).

How can heart failure be managed?

Heart failure is a serious condition. Management should start with an assessment by a consultant cardiologist who is a dedicated heart failure specialist (which is recommended in national guidelines). This will ensure that the correct investigations and treatment options are implemented.

Are there any self-help ways to manage heart failure? E.g. diet, cutting down on alcohol, exercise etc

Absolutely. I educate patients about lifestyle changes, in particular exercise, diet and fluid intake principles.

Reducing weight if your body mass is high can certainly have a beneficial effect. Graduated exercise therapy through rehabilitation programs have been shown to reduce the burden of heart failure.

I must stress however, that self-help management is an addition to medical therapies, not a replacement. The latter remain crucial to the wellbeing of patients.

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