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Congestive heart failure

Heart failure is a serious condition caused by the heart failing to pump enough blood around the body at the right pressure.

Heart failure is a serious condition caused by the heart failing to pump enough blood around the body at the right pressure.

It usually occurs because the heart muscle has become too weak or stiff to work properly.

If you have heart failure it does not mean that your heart is about to stop working. It means that your heart needs some support to do its job, usually in the form of medicines.

Breathlessness, feeling very tired and ankle swelling are the main symptoms of heart failure. However, all of these symptoms can have other causes, only some of which are serious.

The symptoms of heart failure usually develop quickly (acute heart failure), but they can also develop gradually (chronic heart failure).

Read more about the symptoms of heart failure.

Types of heart failure

There are three main types of heart failure. They are:

  • heart failure due to left ventricular systolic dysfunction (LVSD) – due to the part of the heart that pumps blood around your body (the left ventricle) becoming weak 
  • heart failure with preserved ejection fraction (HFPEF) – usually due to the left ventricle become stiff, causing difficulty in filling with blood
  • heart failure due to valve disease

It is important that the type of heart failure you have is identified because it will affect the type of treatment you will be offered.

A number of tests can be used to help diagnose heart failure.

You should also have blood tests, an electrocardiogram (ECG) and/or an echocardiogram. These are used to investigate your heart and check how well it is functioning. If you have not had these tests, you should ask your doctor for an explanation.

Read more about how heart failure is diagnosed.

What causes heart failure?

Heart failure does not often have a single cause. A number of problems usually 'gang up' on the heart, causing it to fail.

There are a number of health conditions that increase your chances of developing heart failure including:

  • high blood pressure (hypertension) – can put extra strain on the heart which over time can lead to heart failure
  • coronary heart disease (CHD) – where the arteries that supply blood to the heart become clogged up by fatty substances (atherosclerosis); this may cause angina or a heart attack
  • heart muscle weakness (cardiomyopathy) – can cause heart failure; the reasons for this are often unclear but it may be genetic in origin, due to an infection (usually viral), alcohol misuse, or medication that is used to treat cancer
  • heart rhythm disturbance (atrial fibrillation)
  • heart valve disease, damage or problems with the heart's valves

Sometimes, anaemia, an overactive thyroid gland (hyperthyroidism), or high pressure in the lungs (pulmonary hypertension), can also lead to heart failure.

Read more about the causes of heart failure.

Treating heart failure

In most cases, heart failure is a lifelong condition that cannot be cured. Therefore, treatment aims to find a combination of measures, including lifestyle changes, medicines, devices, or surgery that will improve heart function or help the body get rid of excess water.

In cases where heart failure has a specific cause, a cure may be possible. For example, if your heart valves are damaged, it may be possible to replace them, which can cure heart failure.

As treatment will usually be lifelong, you and your doctor will need to find a balance of effective treatments that you can manage in the long-term so that you have the best symptom control and quality of life possible.

Effective treatment for heart failure can have the following benefits:

  • it helps make the heart stronger
  • it improves your symptoms
  • it reduces the risk of a flare-up
  • it allows people with the condition to live longer and fuller lives

Read more about how heart failure is treated.

Preventing heart failure

Many of the factors that increase your risk of developing heart failure can be managed either by making lifestyle changes or by taking medicines.

For example, in terms of lifestyle factors, you should:

Read more about preventing heart failure.

Living with heart failure

Being diagnosed with heart failure may come as a shock. While the outlook is related to age, the severity of the heart condition, and any other health problems that may exist, such as lung or kidney diseaseanaemia and diabetes, it also depends on what you do to reduce your risk.

Self care means taking responsibility for your own health and wellbeing, with support from the people who are involved in your care.

It is very important that you take any prescribed medication, even after you feel better. Some medicines are designed to protect or heal your heart. If you do not take them, they cannot help and the underlying problem will get worse. The medicines can prevent or delay your heart problem and symptoms from getting worse.

Speak to your healthcare team if you have any questions or concerns about the medication you are taking or any side effects.

As heart failure is a long-term condition, you will have regular contact with your healthcare team. Developing a good relationship with the members of your team will enable you to discuss your symptoms and any concerns that you have. The more the team knows about you, the more they can help you.

Read more about living with heart failure.



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Congestive heart failure

In most cases, heart failure does not have a single cause. There are a number of other conditions that increase your chances of developing heart failure.

In most cases, heart failure does not have a single cause.

There are a number of other conditions that increase your chances of developing heart failure. These include:

There are also a number of other conditions that can increase your risk of developing heart failure. Some of these are discussed below.

Heart rhythm abnormalities (arrhythmias)

If your heart beats too fast, it may not have enough time to fill and empty properly. This will cause the heart muscle to weaken.

A very slow heartbeat (less than 40 beats a minute) may reduce the output of your heart, leading to the symptoms of heart failure. However, some people who are very fit can have a pulse of less than 40 beats a minute.

An irregular heart rhythm (atrial fibrillation is the most common irregularity) increases your risk of developing a blood clot (thrombosis), which may cause a stroke. In some people, it may also cause heart failure, particularly if the heart rate is too fast.

Damaged heart valves

The heart contains four one-way valves that ensure the blood flows in the right direction. A leaking valve means that your heart has to work harder and will stretch to deal with the extra volume of blood.

A narrowed valve can obstruct blood flow and reduce the amount of blood that your heart can pump and increase the stress on the heart muscle.

Some children are born with faulty valves (congenital heart disease). Heart valves can also be damaged during a heart attack, or sometimes they can just wear out. The average heart beats about 75 times a minute, which is 4,500 beats an hour or more than 100,000 heart beats a day.

Some damaged heart valves can be repaired but others have to be replaced. This usually requires an open heart operation, although less invasive alternatives are now becoming available and can be used in certain situations.

Myocarditis

Myocarditis is inflammation of the heart muscle. It is usually caused by a viral infection and can sometimes lead to heart failure. However, myocarditis is rarely recognised as a cause of heart failure in the UK.

Other congenital heart conditions

Some babies are born with a 'hole in the heart', which is an abnormal connection between the left and right sides of the heart. This allows blood to flow from one side of the heart to the other (usually left to right), putting a strain on the right side and sometimes causing heart failure.

In some cases, a hole in the heart may not be detected until adult life. Holes can often be plugged using devices that are mounted on a heart catheter, though sometimes an operation is required.



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Congestive heart failure

If you have symptoms of heart failure, your GP will ask you to describe them in detail, and you will also have a physical examination.

If you have symptoms of heart failure, your GP will ask you to describe them in detail, and you will also have a physical examination.

If heart failure is suspected, a number of tests may be recommended to find out more. Some of the tests that you may have include:

  • blood tests – to check whether there is anything in your blood that might indicate heart failure or some other illness
  • breathing test – you may be asked to blow into a tube to check whether a lung problem is contributing to breathlessness 
  • an electrocardiogram – which records the electrical activity of your heart 
  • an echocardiogram – where ultrasound waves are used to examine your heart and check how well it is pumping and whether there are valve problems (the procedure is similar to the one used to look inside the womb during pregnancy)

You should ask your doctor whether you should have these tests if you are not offered them but you are receiving treatment for heart failure.

Blood tests

Blood tests can help identify whether another condition is causing your symptoms, such as anaemia, diabetes, thyroid problems, kidney disease, or liver disease. A high blood cholesterol level is often associated with coronary heart disease, which may lead to heart failure.

Natriuretic peptide test

Your blood will be tested for a substance called natriuretic peptide (also called BNP or NTproBNP). If your heart is under high levels of stress, it will secrete BNP into your blood. The test is able to detect these increased levels.

A natriuretic peptide test can also indicate the severity of your heart failure. Higher levels of BNP/NTproBNP in your blood may indicate that you have more severe heart disease, while lower levels may indicate a milder form.

You can read more about the BNP test on the Lab Tests Online UK website. 

Echocardiogram (echo)

An echocardiogram, or echo, is a procedure that can be used to look at the structure of your heart in detail.

A pulse of harmless, high-frequency sound waves is passed through the chest wall and produces a picture by ‘bouncing back’ from the heart's structures (it is similar to an ultrasound scan used during pregnancy).

During the test, you will be asked to lie on your left side with your left arm behind your head. A gel will be put on your chest and an ultrasound probe (recorder) will be placed at various points on your chest between your ribs.

The probe will pick up echoes from your heart and show them on a screen as a detailed image of the structures of your heart. The image is known as an echocardiogram.

An echocardiogram provides a lot of useful information about the heart, including:

  • how well your heart valves are working and whether any are damaged
  • how well your heart is working as a pump (when your heart contracts it forces blood to circulate around your body; this is known as the systolic function)
  • how well your heart relaxes after pumping (when the heart relaxes after each contraction it fills with blood; this is known as the diastolic function)
  • whether there are holes in the walls between the chambers of your heart that allow blood to flow from one side to the other (intracardiac shunts)

The most important finding from an echocardiogram is usually a measurement of how well one of the heart's chambers – the left ventricle – is pumping. The left ventricle pumps the blood around the body.

A measurement called the left ventricular ejection fraction (LVEF) is an estimate of how much of the blood that enters the left ventricle is pumped out when the heart muscle contracts.

In a healthy heart, about 60% of the blood entering the left ventricle is pumped out when the heart muscle contracts. A value of less than 40% indicates that your heart is definitely not pumping normally.

Sometimes, different types of echocardiogram are carried out. These are outlined below.

Stress echocardiogram

A stress echocardiogram is carried out to see how well your heart functions when it has to work hard. During the test, your heart rate will be increased, either by exercising on a treadmill or exercise bike, or by using injected medication.

Trans-oesophageal echocardiography

Ultrasound does not travel well through lungs, which can make imaging the heart through the chest wall difficult.

However, the heart lies right in front of the oesophagus (the tube connecting your mouth to your stomach). This makes it possible for a thin, flexible tube with a small ultrasound probe at the end to be inserted into your oesophagus to examine the structures of your heart in much greater detail. There is no lung in the way and the probe can get very close to your heart.

Before the procedure, you may be given a mild sedative to help you relax, and an anaesthetic will be sprayed onto the back of your throat.

You can read more about echocardiograms on the British Heart Foundation website.

Chest X-ray

A chest X-ray may sometimes be used to check whether your heart is bigger than it should be and whether there is fluid in your lungs, which might indicate heart failure. It can also pick up lung conditions that may be causing breathlessness.

Read more about tests for heart conditions on the British Heart Foundation website.



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Congestive heart failure

There are many ways of reducing your chances of developing heart failure, including maintaining a healthy weight, eating healthily and exercising regularly.

Many of the factors that increase your risk of developing heart failure can be managed either by making lifestyle changes or by taking medicines.

In particular, high blood pressure (hypertension) and smoking are risks for heart health, and tackling them could help reduce symptoms and improve quality of life.

Stop smoking

Giving up smoking (if you smoke) is likely to be the single biggest way to cut your risk of developing coronary heart disease and heart failure. Tobacco smoke can damage your heart in a number of ways, forcing it to work harder.

Smoking also tends to make the blood thicker and slows down blood flow, increasing the risk of blood clots (thrombosis). It damages the linings of the arteries, causing them to fur up. This furring up of the arteries (atherosclerosis) is a main cause of coronary heart disease, stroke and some forms of dementia.

Research has shown that you are up to four times more likely to give up smoking successfully if you use NHS support, together with stop-smoking medicines. Ask your GP about this or visit the NHS Smokefree website for more information.

Reduce your blood pressure

If your blood pressure is too high, your heart has to work harder to pump blood around your body. To cope with the extra effort, the heart muscle thickens over time, and will eventually become too stiff or weak to work properly.

Keeping your blood pressure at a healthy level can stop or delay this happening so it may be useful to have your blood pressure checked regularly.

It may be necessary to take blood pressure medicines (usually more than one) to get your blood pressure down to a healthy level. It is important you and your doctor choose the medicine or combination of medicines that will suit you.

Reduce your cholesterol level

High levels of cholesterol (fat) in your blood can cause furring and narrowing of the arteries (atherosclerosis), heart attacks and strokes.

The risk of coronary heart disease – and therefore heart failure – increases as the level of cholesterol in your blood increases. If you have other risk factors, such as high blood pressure or you smoke, the risk is even higher.

If your cholesterol level is too high, your doctor will usually first advise you to make some changes to your diet (switching to a low-fat diet) and to take plenty of regular exercise.

If, after a few months, your cholesterol level has not decreased, you will usually need to take cholesterol-lowering medicines called statins.

Lose weight

If you are overweight, added pressure will be placed on your heart, increasing your risk of coronary heart disease and heart attack. Both of these make heart failure more likely.

Following the advice below will help you lose weight, as well as lowering your risk of developing heart failure.

Eat a healthy diet

A healthy diet can help reduce your risk of developing coronary heart disease and therefore heart failure.

If you already have heart problems, eating healthily can help protect your heart from getting worse, as well as protecting you from other diseases, such as diabetes and some types of cancer.

Keep active

Regular physical activity can keep your heart healthy and help you maintain a healthy weight.

You do not need to join a gym or start running marathons, but including exercise in your daily routine will help. If you do not have a good level of mobility, you may be able to do arm or wheechair-based exercises.

Drink within safe limits

Drinking more than the recommended amount of alcohol can increase your blood pressure, which can lead to heart failure.

Heavy drinking over a number of years can damage your heart muscle and lead directly to heart failure, as well as having many other harmful effects on your health.

Men who regularly drink more than three to four units of alcohol a day, and women who regularly drink more than two to three units a day are likely to be damaging their health.

Read more about cutting down your alcohol consumption.

Cut your salt intake

Too much salt can raise your blood pressure, so reducing the amount you eat will help keep your blood pressure down and reduce your risk of developing heart failure.

People of African-Caribbean descent appear to be more at risk of the harmful effects of salt compared with people from other ethnic groups.

However, it is rarely helpful or necessary to have a diet that is very low in salt. Avoiding adding salt to food at the table or during cooking and not eating too much obvious salty foods, such as curry, salted snacks and pizza, is a good start.


 

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Congestive heart failure

For heart failure, self care is an integral part of daily life. It means taking responsibility for your health and wellbeing with the support of those involved in your care.

Cardiac rehabilitation

Taking regular exercise will improve the overall health of your heart. However, an exercise programme that is led by a health professional can help people with heart failure to breathe more easily and improve their quality of life.

If these programmes are available in your area, they are likely to be part of a service called cardiac rehabilitation.

Most people on cardiac rehabilitation programmes will either have had heart surgery or a heart attack, but the programmes are also useful for people with heart failure.

They are usually run in hospitals by cardiac rehabilitation teams, which include various healthcare professionals, such as nurses, physiotherapists, occupational therapists and exercise specialists.

The exercise programmes vary widely across the country, but most cover one or more of the following:

  • exercise
  • education
  • relaxation and emotional support

Before you start, you will have an assessment to find out how much exercise you can safely do. The programme worker will tailor a programme of exercises specifically for you. You will be encouraged to start slowly and gently and to gradually increase the amount of exercise you do over the week. You should work within your limits and follow the advice you are given.

The sessions will begin with warm-up exercises. The main part of the session will be aerobic exercises that help your heart and circulation. Some programmes use special equipment, such as exercise bikes, and others will include exercises you can do in a chair.

You may be asked to monitor your heart rate while you exercise by using a small machine called a heart rate monitor that you can hold or strap to your wrist. This is to ensure your heart does not work too hard.

At the end of each session, there will be a cool-down phase that will involve stretching your muscles to help stop them aching the next day.

The education part of the programme will give you information on healthy eating, recognising and avoiding stress, and practical ways to reduce your risk of further damage to your heart. Many programmes also focus on different ways to relax and finding a technique that suits you.

The British Heart Foundation website has a postcode search facility that you can use to find a cardiac rehabilitation programme in your area. You can also read more about recovering from a heart condition.

Feelings and relationships

Being diagnosed with heart failure can be a shock. Some people feel scared, anxious, depressed or angry. They may feel unable to enjoy the things they used to, or to cope with everyday life. It is estimated that around one in five people with heart failure have depression.

You should seek help if you think that you are depressed. Not only does depression reduce your ability to enjoy life, but it can make your heart failure symptoms worse.

Understandably, heart failure can make you worry about your health and how it affects your family. Many people also find that their physical relationship with their partner changes after they have been diagnosed, due to worries about having a heart attack, or losing interest in sex, or being unable to get an erection (which can sometimes be caused by your medication).

It is important that you discuss any worries or problems you have with your doctor or nurse if you feel unable to talk to your family. Many people do not want to burden those closest to them with their worries.

Your doctor or nurse will be able to advise you and arrange support. You may also find it helpful to join a heart support group where you can talk to other people with heart conditions whose circumstances are similar to yours.

You can call the British Heart Foundation's heart helpline on 0300 330 3311 to find out about support groups in your area.

Travelling

Being diagnosed with heart failure should not prevent you from travelling or going on holiday, as long as you feel well enough and your condition is well controlled. If you have heart failure, check with your doctor before you travel.

Ensure that you inform the airline, who may provide a wheelchair or electric car so that you can avoid having to walk long distances in the airport.

Anyone travelling and sitting still for a long time, either in a car, coach or on a plane, should do simple exercises to reduce the risk of deep vein thrombosis (DVT). When flying, you should wear flight socks or compression stockings to keep blood flowing through your legs and reduce the risk of DVT.

You should also be aware that your legs and ankles may swell when flying and breathing may become more difficult if you have severe heart failure.

It may be a good idea to take two sets of medication with you when you travel. Carry them in different places in case you lose one, and make a list of the medication you take and what it is for.

Having heart failure should not stop you from getting travel insurance, but you may have to find a specialist company that will insure you.

You can read more about holidays and travel on the British Heart Foundation's website.

Work and financial help

Can I continue working?

If you are well enough, it is important to keep working for as long as you feel able. With the right support, staying in work can make you feel better and give you financial security. 

Talk to your employer as soon as you feel that your heart failure is affecting your ability to do your job so that you can find a solution that suits both of you. For example, it may be possible for you to work part-time.

The Disability Discrimination Act (DDA) requires employers to make reasonable adjustments to working practices or premises to help a person with a disability. This might, where possible, include changing or modifying tasks, altering work patterns, installing special equipment, allowing time off to attend appointments or helping with travel to work.

What happens if I can no longer work?

If you cannot continue working due to heart failure, you may be able to claim disability and incapacity benefits.

People over 65 years of age who are severely disabled may qualify for a type of disability benefit called Attendance Allowance.

Find out more about money issues on the British Heart Foundation's website.

Help for carers

Carers may also be entitled to some benefits, depending on their involvement with the person with heart failure. You should find out whether you are getting all the benefits you are entitled to.

Read more about benefits for carers and benefits for the person you care for.

Caring for someone with heart failure

Looking after someone with heart failure can mean anything from helping with visits to their GP or hospital clinic to collecting prescriptions or full-time caring for someone with more severe heart failure.

There are many ways you can support someone with heart failure. Heart failure can be disabling and distressing, and many people with the condition find it a huge relief to share their concerns and fears with someone who cares.

As a carer, if you can attend GP and hospital appointments with the person with heart failure, you can encourage them to ask the right questions while you note down the answers. You could also provide the doctor with additional information or insights into the person’s condition, which can be helpful for planning the right treatment.

Another way that you can help is by watching for warning signs that the person’s heart failure is getting worse, or if they are not responding to treatment. Contact the person's doctor if you notice a new symptom, or if their current symptoms are getting worse.

Signs to look out for include:

  • shortness of breath that is not related to usual exercise or activity
  • increased swelling of the legs or ankles
  • weight gain of more than 1.8-2.3kg (4-5lb) over a few days 
  • swelling or pain in the abdomen (tummy) 
  • trouble sleeping, or waking up short of breath
  • a dry, hacking cough
  • increasing tiredness, or feeling tired all the time

Read more about all aspects of caring for someone with a long-term health problem

What will happen towards the end?

When heart failure gets more severe, a person may become more and more immobile.

Breathlessness can get worse and can become distressing. Increased intensity of treatment, sometimes including morphine (opioids), may be required to control breathlessness.

Some people also find that grumbling, low-level aches and pains become more of a problem as their heart failure gets worse. Opioids can also help relieve pain.

What is palliative care?

Palliative care is the support and care of a person's symptoms when there is no cure for their condition. Your doctor or nurse may suggest that you see a specialist or nurse in palliative care or a counsellor.

A palliative care team will focus on controlling your symptoms, keeping you as comfortable and as pain-free as possible, as well as offering physical, psychological, spiritual and social support for both you and your family.

What decisions do I need to make?

The things that you will need to consider are listed below.

  • Making a will if you have not made one already.
  • An advance statement lets those close to you know about the type of care you would like and where you want it – for example, at home, at hospital, or in a hospice – if you are not able to decide for yourself. While you can write down your wishes about what sort of future treatment you do and do not want, doctors can override your decision if they think it is in your best interests.
  • Whether you want to make a living will (this is called an advance decision). This allows mentally competent people to refuse some or all forms of medical care in the future when they are unable to make their own decisions or tell doctors what they want (for example, if they are in a coma). This is legally binding, so doctors must comply with your wishes.
  • Whether you want to be resuscitated if your heart stops.  
  • Whether you would want your defibrillator turned off (if you have one).

Read more about end of life care and making advance decisions.










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