This week Dr Ciarán Roarty of Scally McDaid Roarty Medical Practice looks at why the heart fails, and what can be done about it.
Heart failure doesn’t mean that your heart has actually stopped, but rather that it’s not working as well as it should be.
Usually, your heart pumps a set amount of blood around your body during each heartbeat.
In heart failure, your heart cannot cope and pump the full amount that it is needs to. It can be acute (comes on suddenly) or chronic ( develops over months or years).
Our heart normally pumps a percentage of blood that comes into its bigger chambers further on.
Doctors will usually try to decide if your heart failure means that you cannot pump this percentage, or if your heart can, but is still not coping. This will determine your best treatment. Heart failure is more common in older patients and is commonly diagnosed in patients in their seventies.
These can vary but will often include breathlessness, especially on exertion, lethargy, coughing, dizziness, loss of appetite, constipation and fluid retention (often noticed as swollen ankles). There may be other symptoms depending on the cause eg chest pain or palpitations.
What causes heart failure?
Heart failure can develop as a complication of a lot of things. The most common is coronary artery disease where the actual arteries supplying blood to the muscle of the heart become narrowed or blocked.
This may cause a heart attack (an acute blockage of one or more of these arteries) and subsequent heart failure.
Other causes include problems with the muscle of the heart itself, raised blood pressure, problems with the valves in the heart, irregular rhythms in the heart as well as some drugs eg cocaine or excess alcohol. Sometimes “ non- heart” problems such as thyroid disease or anaemia may be a factor and sometimes we never really find out what the cause was.
How is it diagnosed?
Your doctor may find signs suggestive of heart failure such as an enlarged heart, fast pulse or signs of fluid retention. This may occur in other conditions so if your doctor suspects heart failure he/she will order special blood tests and an ECG –whick is a tracing of the electrical activity of the heart.
Doctors can gain a lot of information about how healthy your heart is from an ECG. If these tests point towards a diagnosis of heart failure you will be referred to hospital for further tests such as an ultrasound of your heart or “echo”, xrays and further blood tests.
How is it treated?
It will not come as a big surprise to learn that lifestyle changes that doctors commonly recommend to treat other conditions are also useful in managing heart failure. These may include trying to maintain a healthy weight, refraining from smoking, reducing alcohol intake if consumed to excess, and taking some exercise, to the best of your ability.
There are medicines that are commonly used in heart failure and these may require regular blood tests and/or adjustments. Some medicines are aimed at the underlying cause of your heart failure, for example, aspirin if you have had a heart attack. Underlying conditions such as high blood pressure and high cholesterol may also be treated.
It is important to take the medicines that have been prescribed for you exactly as advised and not to stop taking any medication without talking with your doctor. Some patients have little devices implanted under the skin over their chest to aid treatment. For example, an implantable cardioverter defibrillator (ICD) may detect an abnormal heart rhythm such as a slow heart rate and work by giving your heart extra support by working as as a normal pacemaker.
Alternatively, if your heart is beating too fast it may give you a burst of extra slightly faster beats to slow your heart down again. It can also give you a shock ( a bit like the defibrillators do when used by paramedics or trained first aiders when someone has collapsed in the community with a heart problem ) to restore a regular heartbeat.
Pacemakers may also be implanted and these work to control the heart signals within the heart so that the heart can beat more effectively.
In a certain number of cases, it may be necessary to have surgery to replace a damaged valve or even heart transplant in some cases.
What’s the prognosis?
This depends on the cause of heart failure, how many other conditions you may have, as well as the severity of heart failure. Your specialist will be able to advise better in an individual case. Often things remain stable for a number of years before deteriorating, while in other cases things progress gradually. If a reversable cause is discovered, then it may drastically improve symptoms by treating the cause.
New treatments are improving the outlook but unfortunately about half of patients who are diagnosed with heart failure will die within 5 years.
The above information is intended as advice only and should you have any concerns please contact your own Doctor.
Dr Ciarán Roarty MB, BCh BAO MICGP DRCOG Grad. Cert. Obst. Ultrasound
is a full-time GP at Scally McDaid Roarty Medical Practice, Scally Place, Letterkenny, Tel 0749164111 http://scallys.ie