A few of you have been asking me to
make a video about Heart Failure.
It's actually a topic that is close to my own heart,
as I've spent much of the last decade as a Research Physician
looking after patients with Chronic Heart Failure.
My aim is to give you a broad overview
on how and why heart failure happens,
as well as some of the latest treatments.
I'll try to include some of my tips that
I've learned along the way from both clinicians
and sometimes the patients themselves.
What is Heart Failure?
As I'm sure you already know,
the heart is a pump which pushes and pulls blood
around the body.
In heart failure, the pump does not work as well as it should
and usually gives people significant symptoms.
This happens because of a number of causes,
which I'll talk about soon.
Roughly, there are two types of Heart Failure
and this matters in terms of what treatments can be used.
Firstly, there is Heart Failure with reduced ejection fraction,
which tends to affect men
who have underlying coronary artery disease.
Secondly, there is Heart Failure with preserved Ejection Fraction
which tends to affect older people, women
and those who are obese.
Ejection Fraction simply means the percentage of blood
that is pumped out of the heart with each heart-beat.
If it's less than 50%, it is reduced ejection fraction
and if its more than 50%,
it is preserved ejection fraction Heart Failure.
What are the symptoms of Heart Failure?
Breathlessness, or the more technical term 'dyspnoea'.
This is most obvious at night time, where you may notice
that you can't lie flat, or you have to sleep in a chair,
or suddenly need to sit up to get your breath.
The medical term for breathlessness when lying flat
is called 'orthopnoea'.
Also it's really common that people notice
they can't walk as far as they used to,
without feeling very breathless.
For example, they used to be able to play
a normal round of golf, but now they struggle with the first hole
or walking 10 metres.
Sometimes you'll see the acronym 'SOBOE' in
medical records which means 'shortness of breath on exertion'.
Fluid. Classically people notice fluid around
their feet/ankles and legs.
The medical term is 'pitting oedema'
which means if you push with your finger,
it leaves an indent.
It tends to build up over the day,
and is better in the morning.
For men, it;s really typical to have fluid build up
all around the tummy as well,
where you can't get your belt closed
and you can't blame it on eating too much!
Tiredness. Heart failure is exhausting,
and every activity feels like such an effort to complete, like
having a shower or making the bed.
It's common for people to lose their appetite
with more severe heart failure as well.
What causes Heart Failure?
Heart Failure can either start suddenly
(which is called acute Heart Failure),
or gradually (chronic heart failure).
In general there are 7 major culprits
that all put stress on the heart.
But I'll list other causes in the description for you as well.
1. High blood pressure.
If blood is going through the heart under very high pressure,
the heart muscle gets bigger to deal with it,
but will eventually give up the go if it's too much.
2. Coronary Artery Disease.
This affects the health of the walls of the heart.
3. Heart Valve Diseases.
Narrow or floppy heart valves put extra stress on the heart.
This can be through a restricted outlet or incompetence
of the valve so blood leaks backwards.
4. Medications and Drugs.
This is a very important cause where chemicals can damage
the heart muscle.
Especially too much alcohol, cocaine, methamphetamines,
and unfortunately some types of chemotherapy agents are very
toxic to the heart.
5. Chronic Arrythmias.
The main one is uncontrolled Atrial Fibrillation which
causes a disruption of the heart's usual pacemaking.
6. Nutritional and Hormones.
Things like anaemia, thyroid disease, obesity
and thiamine deficiency all put stress on the heart.
7. Unknown.
Sometimes the cause of Heart Failure is classified
as 'unknown' when multiple investigations fail to identify
any specific underlying factors.
How is Heart Failure diagnosed?
In my experience people with heart failure usually present
in two major ways.
Either the patient is admitted to their local hospital
because they are acutely breathless
and are then tested for Heart Failure,
or they go to their GP because their symptoms have been
getting worse, especially fluid retention, tiredness
and breathlessness.
A doctor will normally examine your heart
and listen to your lungs, do an ECG to check for heart rhythm
problems and then perform a special blood test
called BNP or ProBNP.
This is a hormone that leaks from your heart muscles when
the cells are stretched and is very specific to
heart failure.
This can also be measured over time to see how well your
heart failure is controlled.
The only way to formally diagnose the type of Heart Failure,
(reduced or preserved ejection fraction)
is to have an echo or echocardiogram,
which is an ultrasound of the heart.
It is important to have this test, because it will determine
what type of Heart Failure you have
and therefore the best treatments going forward.
What are the Treatments for Chronic Heart Failure?
Right, I will try to make this as simple as possible for you.
And remember that this is just an overview -
specific advice for individuals can be sought from a family
doctor or cardiology specialists.
As always, the idea behind any treatment
is to treat the underlying cause.
So if, for example, your heart failure was caused
by an overactive thyroid, then sorting out the thyroid
will usually settle your heart failure symptoms.
Of course your doctor will guide you on this.
There are also some really important general
lifestyle tips that I would strongly encourage you to do,
which are: Lose weight if you are overweight.
This reduces the overall strain on your heart.
If you are underweight on the other hand,
your doctor may give you nutritional supplements.
Stop smoking. This will help any underlying heart disease
and help your health in many other ways too.
Exercise. I know it may sound counterproductive
to put strain on your heart, but exercise in any small way
is really good for you. I'd suggest regular low-intensity exercise.
Avoid alcohol. I personally recommend to
completely eliminate alcohol,
but at the very least cut it right back.
Alcohol is associated with arrythmias and
has direct toxic effects on our heart muscle.
Daily weight. Another very important activity people with Heart
Failure should do is to weigh yourself every morning.
This is because you will detect changes in your fluid levels
by sudden increases in weight.
For example, if you put on 2kg or 4lbs in a day,
you have accumulated fluid and may need to adjust
your medications.
6. Control blood sugars if you have Diabetes.
Next I am going to run through the medications available and
the evidence behind them.
For reduced Ejection Fraction Heart Failure
(which used to be called Systolic Heart Failure)
there are 4 types of medicines that are normally given.
Firstly a diuretic or water tablet such as Furosemide.
This acts on the kidneys to remove excess fluid
and usually makes people feel much better in themselves.
It won't change the course of Heart Failure,
but it gives you some control over your symptoms.
Secondly, ACE inhibitors are used
(which are a type of blood pressure pill
that acts on the blood vessels and kidneys.)
For example: Enalapril.
Thirdly, beta-blockers are given which reduce the pressure
on the heart and slow the heart beat down.
For example, Metoprolol.
Both beta-blockers and ACE inhibitors have the best evidence
in prolonging life expectancy and improving illness,
but they have their drawbacks in terms of side effects
and are not suitable for all cases.
Then there is Spironolactone.
This is a type of diuretic which can help the symptoms
of Heart Failure. Again one has to be careful with
this medication because it can cause high potassium
in the blood and make people susceptible to falling over.
I've talked about this in my video on Spironolactone.
There are newer medications available
such as Sacubitril/Valsartan,
which look promising but it has its own issues with side effects
like dizziness and could possibly increase
one's risk of dementia.
Unfortunately, for preserved Ejection Fraction Heart Failure,
(which used to be called Diastolic Heart Failure)
there is limited evidence for the treatments currently available.
It's really about focusing on all the lifestyle measures I
mentioned and getting your fluid balance right
by using diuretics like Frusemide or Spironolactone.
If the symptoms are very bad, some doctors will advise to
restrict fluid intake to between 1.5 to 2 Litres a day.
Additionally your doctor will probably want to keep
a close eye on your blood pressure and pulse.
What is the outlook for Heart Failure?
This is a tricky question to answer
as everyone is very different, with different underlying medical
conditions and different causes of Heart Failure.
Overall the 5 year survival rate is about 50%,
but for those who have reversible causes of Heart Failure,
they should be able to completely recover.
Not surprisingly, severe heart failure will have a worse prognosis
while milder heart failure is compatible
with a longer life expectancy.
Although the prognosis for heart failure may be unnerving,
there are numerous lifestyle changes and medications that
can help slow down the progression of the condition
and increase your chances of survival.
I'd recommend to control the factors you can change
including monitoring your weight, exercising
and eating a healthy diet.
Please let me know in the comments
what you want to learn more about.
Thanks for stopping by.