Heart failure overview
What is heart failure?
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.
What causes heart failure?
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:
- viral infection;
- alcohol damage;
- valve problems;
- heart abnormalities present at birth (congenital heart disease);
- anaemia; and
- drug side effects.
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.
How does the heart normally function as a pump?
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.
What are the symptoms of heart failure?
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.
What treatment can I expect?
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.
- Diuretics (‘water pills’) reduce the amount of fluid the heart has to push.
- ACE inhibitors or angiotensin II receptor blockers relax blood vessels so that the heart doesn’t have to work as hard to push blood through.
- Digoxin has many actions, including helping the heart work harder.
- Beta-blockers relax blood vessels and/or slow the heart down, depending on the type used.
- Vasodilators, such as hydralazine and isosorbide dinitrate, are sometimes used to relax blood vessels.
How do I look after myself?
Monitor your symptoms
- Weigh yourself daily. If your weight increases by more than 1.5 kg in 24 hours, especially if associated with other symptoms, contact your doctor. A rapid gain in weight may indicate a fluid build-up and an increase in your diuretic tablets may be needed.
- See your doctor regularly for a review of your symptoms and medication.
If you become suddenly short of breath or have other acute symptoms, call an ambulance immediately.
Find a balance between rest and activity
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.
Watch your diet
- Reduce your salt intake because salt encourages the body to store fluid. Foods high in salt include salted nuts, dips, snacks, luncheon sausage, ham, corned beef, cheese, soy sauce, Marmite, Vegemite, canned or packaged soups, and some processed and canned foods. Use herbs, spices and other flavours to replace salt in cooking and avoid adding salt at the table.
- Eat a wide variety of foods.
- Eat foods low in fat (especially animal fats) to help keep your blood cholesterol down.
- Eat plenty of fresh fruit and vegetables to provide extra potassium for the body to balance any potential loss of potassium caused by some types of diuretics (water tablets). However, check with your doctor first, as some medications used to treat heart failure actually increase potassium levels.
Stop smoking
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.
Drink in moderation
Alcohol is acceptable in small amounts. Limit your intake to no more than 2 standard drinks a day, unless otherwise stated by your doctor.
What about returning to normal activities?
Work
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.
Driving
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.
Sexual activity
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
- 1. Austroads. Assessing fitness to drive for commercial and private vehicle drivers. Medical standards for licensing and clinical management guidelines [2003, Sep; reprinted 2006; accessed 2009, Jun 18]. Available at: http://www.austroads.com.au/aftd/index.html
2. Therapeutic Guidelines (eTG). Heart failure. In: Cardiovascular guidelines [updated 2008, Jun; accessed 2009, Jun 19]. Available from: http://www.tg.org.au
3. Cardiac Society of Australia and New Zealand. Cardiovascular disease and driving [published 2002; accessed 2009, June 19]. Available from: http://www.csanz.edu.au/
Sponsored links
Related Articles
Heart: how your heart pumps blood around your body
Related Topics
Cardiovascular conditions
Support Group Searches
Health support groups for Heart disease, disorders and surgery
Related Tools
Heart disease risk assessment Advertisement
Advertisement
Advertisement
