Heart failure

Your symptoms will depend on whether the left, right or both sides of your heart are affected. Your symptoms may change depending on how far advanced your condition is. It's important to be able to recognise the symptoms of heart failure and if you feel your symptoms are getting worse, see your GP.

Common symptoms of heart failure include:

• extreme tiredness
• breathlessness
• swollen feet, ankles or abdomen (tummy)

Left-sided heart failure affects your lungs and your ability to breathe. Symptoms may include breathlessness at rest or during exercise, coughing, wheezing and extreme tiredness. If you have very severe heart failure, you may cough up froth or blood and you're more likely to get chest infections.

Right-sided heart failure affects the fluid balance in your body. You might get symptoms such as swollen feet, ankles and abdomen, or extreme tiredness, feeling sick and weight gain.

These symptoms aren't always caused by heart failure, but if you have them, see your GP.

Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history.

There are a number of tests your GP may recommend that you have. Some examples are listed below.

• Blood and urine tests can check your blood count, your liver and kidney function and other indicators of heart failure.
• An ECG measures the electrical activity of the heart to see how well it's working.
• An echocardiogram uses an ultrasound probe to check the structure of your heart and see how well it's functioning.

If your GP thinks your symptoms could also be the result of lung problems, he or she may recommend you have:

• a chest X-ray to confirm if you have heart failure and to rule out other conditions
• lung function tests, such as peak flow measurements or spirometry tests, to show how well your lungs are working

There are many causes of heart failure, of which some of the most common include:

• coronary heart disease – the most common cause
• high blood pressure (hypertension)
• damaged heart valves
• disease of the heart muscle as a result of genetic causes – for example, cardiomyopathy
• drinking alcohol excessively
• severe lung disease
• an overactive thyroid gland (hyperthyroidism)
• anaemia

Treatment of heart failure is aimed at relieving your symptoms, making your heart stronger and improving your quality of life.

Self-help

You can improve your symptoms by making various changes to your lifestyle, including:

• eating a healthy, balanced diet
• cutting down on salt
• stopping smoking
• taking regular exercise
• drinking alcohol in moderation or not at all if alcohol has caused your heart failure
• maintaining a healthy weight
• monitoring how much fluid you drink and weighing yourself daily
• managing stress
• having the annual flu vaccine

If you need help with any of these lifestyle changes, talk to your GP. He or she may be able to arrange for you to attend a rehabilitation programme and offer information and support.

Medicines

There is a range of medicines available that can be used to relieve the symptoms of heart failure and help you live longer. Different medicines treat different symptoms, so you may be given more than one medicine. It’s important you take each one correctly so that each can do its job properly.

Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your GP or pharmacist for advice.

Angiotensin-converting enzyme (ACE) inhibitors

ACE inhibitors widen your blood vessels making it easier for your heart to pump blood around the body. ACE inhibitors are given to most people with heart failure. Side-effects may include a dry cough and low blood pressure, which may make you feel dizzy. If you get a cough when taking ACE inhibitors, see your GP.

Angiotensin II receptor blockers

Angiotensin II receptor blockers (also called angiotensin receptor antagonists) work in a similar way to ACE inhibitors. These medicines lower your blood pressure and stop your symptoms from getting worse. You may be given these if you can't take ACE inhibitors because of the side-effects.

Beta-blockers

There are many different types of >beta-blocker but only certain ones are used to treat heart failure. Beta-blockers cause the arteries to widen and they slow down the heart rate. This helps to lower your blood pressure and the amount of work your heart does. If you have asthma or other heart problems, you may not be given beta-blockers. Side-effects can include tiredness, cold hands and feet, disrupted sleep and impotence in men.

Diuretics

Diuretics can help to reduce swollen feet and ankles, and prevent fluid build-up on the lungs, allowing you to be more active and breathe more easily. Diuretics cause your body to get rid of excess fluid by making you urinate more often. Your heart won't have to work as hard if there's less fluid to pump around the body. If you have gout, diuretics can make it worse. They can also lower your blood pressure, which may make you feel dizzy.

Aldosterone antagonists

Spironolactone or eplerenone are two types of common aldosterone antagonists. They work in a similar way to diuretics by affecting the balance of water and salts going into your urine. These medicines can cause sickness and may affect how well your kidneys work. Your GP may want to do regular blood tests to check your kidney function if you take this medicine.

Digoxin

Digoxin helps if you have a rapid or irregular heart beat by slowing down your heart rate. Side-effects may include sickness and diarrhoea. If you get these side-effects, see your GP.

Anticoagulants

Anticoagulants, also known as blood thinners, reduce how well your blood can clot. They do not actually thin the blood. Anticoagulants such as warfarin are used to help prevent harmful blood clots from forming. You're more likely to get blood clots if you have heart failure because your heart's pumping action is weaker causing the blood to pool in the body. Blood clots can block narrow blood vessels and stop blood getting to parts of your body. If blood can't get to your brain, this can cause a stroke. Your GP will consider your risk of having a stroke before prescribing you anticoagulants.

Antiplatelets

Antiplatelets, such as aspirin, stops blood clots from forming by preventing blood platelets sticking together. Aspirin is not usually taken with warfarin. Side-effects may include sickness and stomach pain.

Other treatments

Pacemaker

A pacemaker is a small device that sends electrical signals to your heart to stimulate it to beat at a specific rate. There are several different types of pacemaker. A pacemaker is usually implanted under the skin of your upper chest and is fitted under local anaesthesia – this completely blocks the feeling from your chest area and you will stay awake during the operation.

Cardiac re-synchronisation therapy

Cardiac re-synchronisation therapy restores the normal pumping action of the heart. A specific type of pacemaker is fitted under the skin of your upper chest. The device sends electrical currents to leads connected to the different parts of your heart so they contract in synchronisation with each other.

Implantable cardioverter defibrillator

An implantable cardioverter defibrillator is similar to a pacemaker, and is usually implanted under the skin below your collarbone. They can monitor your heart rhythm and deliver a small electric shock to return your heartbeat and rhythm back to normal if it detects a problem. Implantable cardioverter defibrillators are usually fitted under local anaesthesia.

Surgery

Transplantation

If you have very severe heart failure, a heart transplant may be an option. Heart transplants can be very successful but they aren't suitable for everybody because of the risks of surgery. There are also a limited number of donor hearts available.

Valve replacement

If your heart failure is caused by one or more of the valves in your heart not working properly, replacing these valves may improve your symptoms.

Coronary artery bypass graft

If your heart failure is caused by coronary heart disease, you may be offered a coronary artery bypass graft. This aims to bypass your blocked arteries to increase the blood flow to your heart. This can help to improve the pumping action of your heart.

People with heart failure are more likely to have:

• a poor quality of life – this is because it's harder to carry out everyday activities
• an irregular heart beat (arrhythmia)
• sexual problems
• depression – up to one third of people with heart failure have depression
• deep vein thrombosis
• stroke

• 1. What can I do to help ease my symptoms?

Although medicines can help, there are many things you can do yourself to try to manage your symptoms.

The most common symptoms people with heart failure get are breathlessness, tiredness and swollen feet and ankles. Below are some practical tips on how to cope with your symptoms.

You may have difficulty breathing while lying on your back or sleeping because of the fluid that builds up in your lungs. Keeping yourself propped up with pillows may help you breathe more easily and stop the breathlessness disturbing your sleep. You may also get some wheezing and coughing as a result of the build-up of fluid in your lungs. Try not to have too much salt in your diet. Too much salt makes the body hold on to more fluid than usual, causing congestion of your lungs and making you short of breath. Contact your GP if you get severe or persistent breathlessness.

You may feel tired all the time and find it difficult to carry out everyday activities like shopping, walking or climbing a flight of stairs. This happens because your heart can't pump enough blood around your body and the blood that it does pump goes to your vital organs, for example your heart and brain, instead of to your exercising muscles. It's important to pace yourself and give yourself plenty of time to do daily activities. Try breaking up big tasks into small parts and ask for help from your friends and family. Keep a diary to monitor your levels of tiredness so you can notice any changes.

Swollen feet and ankles are caused by your body holding on to water and salt. This causes the excess fluid to leak out of your blood vessels and into surrounding areas of your body. You may get swelling of your feet, ankles and lower legs, but it can also spread much further to include the whole of your leg, groin and the lower part of your abdomen.

Try not to sit or stand for long periods of time and keep your feet raised when resting – use a stool or chair to rest your feet on. You may also find it easier to wear comfortable shoes and socks that aren't too tight. It's also important to keep active by walking and regularly moving your calves and feet.

2. Do I have to stop exercising if I have heart failure?

Most people with heart failure can still do regular exercise. In fact, exercise can improve your symptoms. Speak to your GP before starting an exercise programme.

Exercise guidelines differ depending on how serious your heart failure is and what treatment you're having. Studies have shown that if you have heart failure, keeping active may improve your quality of life because it enables you to do everyday activities more easily.

Exercise should be done as part of a rehabilitation programme. Rehabilitation programmes are designed to be specific to your needs. You can expect a cardiac rehabilitation programme to usually last between 11 and 16 sessions. They usually involve group-based education and exercise sessions. The education sessions will provide you with advice and support on many lifestyle areas including managing your weight, help giving up smoking and relaxation techniques. The exercise sessions are likely to involve a gentle warm-up followed by a range of exercises designed specifically for you to improve your fitness, and then end with a cool-down period.

Speak to your GP if you would like more information about cardiac rehabilitation programmes.

3. Will I need to take medicines for the rest of my life?

Yes, it's likely that you will need to take one or more medicines for the rest of your life. Don't stop taking your medication or change how much or how often you take it without speaking to your GP first.

Medicines are likely to help ease your symptoms of heart failure, although there is no cure for the condition. Finding the right combination of medicines to suit you may take some time depending on your symptoms, how severe your heart failure is and if you have other medical conditions.

Most medicines can cause side-effects and your GP will monitor you closely. It's important to see your GP or pharmacist if you have any questions or worries about your medicines.

4. Can I travel with heart failure?  

You may be able to carry on driving depending on how serious your heart failure is. Speak to your GP and contact your motor insurer so that you're aware of their recommendations. If your heart failure is under control, you can probably travel safely by air.

You can drive your car as long as you have no symptoms that could distract you. If you drive lorries or buses, you may need regular exercise tests to make sure you're well enough to continue doing so. If your symptoms are more serious, you may not be able to carry on driving. If you feel unwell, dizzy or your symptoms get worse, don't drive.

Most people with heart failure can travel by air, but you should tell the airline you're travelling with beforehand.

During the flight, your legs and ankles may swell and breathing may get more difficult if you have severe heart failure. Try to do some stretches and walk around the cabin regularly. It's important to be aware that places at high altitude and places that are hot or humid may make your symptoms worse.

When travelling, it's important to take your medication as you usually would.

This information was published by Bupa Group's Health Content Team and has been reviewed by appropriate medical or clinical professionals. To the best of their knowledge the information is current and based on reputable sources of medical evidence, however Bupa (Asia) Limited makes no representation or warranty as to the completeness or accuracy of the Content.

The information on this page, and any information on third party websites referred to on this page, is provided as a guide only.  It should not be relied upon as a substitute for professional medical advice, nor is it intended to be used for medical diagnosis or treatment. Bupa (Asia) Limited is not liable for any loss or damage you suffer arising out of the use of, or reliance on, the information.

Third party websites are not owned or controlled by Bupa and any individual may be able to access and post messages on them. Bupa is not responsible for the content or availability of these third party websites. Last updated August 2017.

• About heart failure. American Heart Association.www.heart.org, accessed 20 January 2011
• Heart failure. British Heart Foundation.www.bhf.org.uk, accessed 17 November 2010
• Heart failure. BMJ Clinical Evidence.www.clinicalevidence.bmj.com, published 25 February 2010
• Chronic heart failure. National Institute for Health and Clinical Excellence (NICE), August 2010.www.nice.org.uk
• Heart failure – chronic. Clinical Knowledge Summaries.www.cks.nhs.uk, published November 2010
• Prevalence of heart failure. British Heart Foundation Statistics Website.www.heartstats.org, published 18 October 2010
• Management of chronic heart failure. Scottish Intercollegiate Guidelines Network (SIGN), February 2007.www.sign.ac.uk
• Faris RF, Flather M, Purcell H, et al. Diuretics for heart failure. Cochrane Database of Systematic Reviews 2006, Issue 1. doi:10.1002/14651858.CD003838.pub2
• Simon C, Everitt H, van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press, 2010: 436
• ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. European Society of Cardiology, 2008.www.escardio.org
• Understanding NICE guidance, chronic heart failure. National Institute for Health and Clinical Excellence (NICE), August 2010.www.nice.org.uk
• Understanding heart failure.www.heartfailurematters.org, published June 2009
• Joint Formulary Committee. British National Formulary. 60th ed. London: British Medical Association and Royal Pharmaceutical Society; 2010
• Treatment. British Heart Foundation.www.bhf.org.uk, accessed 22 November 2010
• Cardiac resynchronisation therapy for the treatment of heart failure. National Institute for Health and Clinical Excellence (NICE), May 2007.www.nice.org.uk
• Recovery. British Heart Foundation.www.bhf.org.uk, accessed 22 November 2010
• Cardiac rehabilitation: a national clinical guideline. Scottish Intercollegiate Guidelines Network (SIGN), 2002.www.sign.ac.uk
• Standards and core components for cardiac rehabilitation. British Association for Cardiac Rehabilitation, 2007.www.bcs.com
• For medical practitioners: at a glance guide to the current medical standards of fitness to drive. Department for Transport.www.dft.gov.uk, published February 2011