Heart failure refers to the reduced ability of the heart to pump blood efficiently around the body. It is a poorly chosen term because it suggests the heart is about to stop or fail completely. This is not the case. The term congestive heart failure is also used and refers to the typical symptoms that occur in heart failure from excess fluid accumulation in the body.
Heart failure affects approximately 4 per cent of Australian adults aged over 45 years. Angina and heart failure can occur together because they are both often caused by coronary heart disease.
The most common cause of heart failure is damage to the heart muscle, often due to coronary heart disease or long-term high blood pressure. Other causes of heart failure include:
If the heart can no longer pump efficiently, it compensates by beating faster, eventually resulting in enlargement of the heart (hypertrophy) to cope with the extra workload. The body also tries to increase the volume of blood in the circulation by retaining water and it also gets the kidneys to retain salt (sodium). Because of the fluid retention, the heart muscle becomes stretched (dilated) and eventually loses its ability to contract efficiently, so the amount of blood pumped to the body is reduced.
The heart is a muscular organ, which pumps blood around the body. It is divided into 4 chambers, 2 thin-walled atria (receiving chambers) and 2 larger, thicker-walled ventricles (pumping chambers).
Blood that is low in oxygen returns from the body to the right side of the heart. It flows through the right atrium into the right ventricle, which pumps the blood into the lungs. Here oxygen is picked up before the blood flows back to the heart into the left atrium and then into the left ventricle, which pumps it to the body.
One of the most common symptoms is shortness of breath, which may be caused by fluid gathering in the lungs. Fluid can also gather in the ankles and legs, causing swelling. Some people feel weak and tired, and have a poor appetite. A dry cough can also indicate fluid on the lungs. Shortness of breath may be more obvious on physical exertion, such as climbing stairs. It can also occur when lying flat or several hours after lying down, causing you to wake up breathless or coughing. Sleeping well-supported with pillows may help relieve shortness of breath. The fluid retention that occurs with heart failure can cause unusual weight gain.
Cyanosis (a blue tinge to the lips, nails or skin), dizziness and palpitations are other symptoms.
You may experience feelings of helplessness, depression, anger and loss of confidence because of changes in your lifestyle. These feelings are very real and it's important to discuss them with your family, friends, your doctor, and if necessary, a counsellor.
The most commonly used medications are diuretics, angiotensin converting enzyme (ACE) inhibitors, digoxin and beta-blockers, and most people need treatment with two or more different types of drugs.
If you become suddenly short of breath or have other acute symptoms, call an ambulance immediately.
Although rest may be a part of the initial treatment, staying active is very important. You will be the best judge of how much you can do. There are no strict rules about physical activity, however, regular walking within the limits of your comfort and symptoms is strongly encouraged. You should be able to carry out a normal conversation when you exercise. Do not work beyond this point. Try to accumulate 30 minutes of physical activity most days.
While exercise is beneficial when symptoms are mild, bed rest is necessary when symptoms are severe.
If you are a smoker, quit. Smoking causes continuing damage to your lungs, heart and blood vessels. It's never too late to give up and there is help available. Phone the Quitline on 131 848 or see your GP.
Alcohol is acceptable in small amounts. Limit your intake to no more than 2 standard drinks a day, unless otherwise stated by your doctor.
Heart failure can usually be adequately treated and controlled, allowing you to continue normal daily activities. You may need to adjust your working hours or drop off some strenuous activities if you tire more easily. If this is happening to you, discuss it with your doctor in case a change of medication is necessary, or with your employer to see if other work can be arranged.
Austroads, the association of Australian and New Zealand road transport and traffic authorities, publishes Assessing Fitness to Drive, the latest national guidelines and standards for assessing a person’s fitness to drive.
The aim of the guidelines is to assist health professionals in assessing the fitness to drive of any patient who holds a licence for a light motor vehicle including a car or motorcycle.
Austroads’ guideline for heart failure advises that you may drive if asymptomatic (without obvious signs or symptoms of disease) on moderate exertion. However, if you have severe symptoms, consult your doctor. There are more stringent criteria for drivers of commercial vehicles.
The Cardiac Society of Australia and New Zealand has guidelines (2002) for doctors assessing the fitness of individuals with heart and vascular disease to drive. These state that people with heart failure or cardiomyopathy may be fit to drive if they don't get short of breath on mild exertion and there are no other conditions, such as abnormal heart rhythms or poorly controlled anticoagulant therapy (e.g. warfarin), present which would preclude the person from driving.
As with other activities, it should be within the limits of your symptoms. Sexual intercourse should be OK if you can climb 2 flights of stairs without stopping due to angina, dizziness or shortness of breath. Less strenuous positions, for example, side-by-side or having the healthier person on top, may be best.
Last Reviewed: 05 June 2009