What is heart failure?
Heart failure is a term used to describe a number of conditions that affect the heart's ability to pump blood to the lungs and the rest of the body. Although it sounds like a life-threatening illness, there are effective drug treatments that your doctor can prescribe to manage the condition. If you suffer from heart failure you may experience tiredness, swelling of the ankles and legs and shortness of breath when lying down. Breathing may be easier when you are propped up on a bed.
What causes heart failure?
Causes can include high blood pressure, a previous heart attack, diseased heart muscle or faulty heart valves. Lung diseases such as chronic bronchitis may also contribute to heart failure. The heart is forced to work harder to pump blood around the body and eventually weakens. As a result, the lungs become fluid-filled, making breathing more difficult. Fluid retention (oedema) in other parts of the body causes swelling, particularly in the ankles and legs.
Who is at risk for heart failure?
According to statistics published by the British Heart Foundation in 2014 there are over 750,000 people living with heart failure in the UK. The incidence of heart failure increases steeply with age and it is more common in men than in women. The number of people with heart failure is thought to be rising - this is partly because people are living longer nowadays, and because more people survive a heart attack.
What treatments are available for heart failure?
Treatment depends partly on the cause of the heart failure. Various tests are used to make an accurate diagnosis. These include a chest x-ray, which will show whether the heart is enlarged and an electrocardiogram (ECG) which can detect any abnormal heart function. A special ultrasound device (echocardiograph), gives an image of the heart on a screen and shows damage to the structure of the heart. None of these tests cause any discomfort.
Drug treatments for heart failure include digoxin, which strengthens the heart's contractions, and diuretics (water tablets), which help the body to get rid of excess fluid and reduce swelling. There are many different diuretics available and some preparations contain a combination of two different types of diuretic.
A class of drugs called ACE inhibitors bring considerable improvement in many cases of heart failure. They improve the flow of blood by reducing constriction in the blood vessels and can stop the disease progressing. Examples of ACE inhibitors include captopril, cilazapril, enalapril, fosinopril, lisinopril, perindopril, quinapril and ramipril. Several combined preparations containing an ACE inhibitor and a diuretic are also available.
Nitrates help reduce the load on the heart in acute heart failure. Nitrate preparations include glyceryl trinitrate (GTN) and isosorbide mononitrate .
Other drugs which may be prescribed for heart failure include aminophylline (eg, Phyllocontin®) and theophylline (eg, Uniphyllin Continus®), hydralazine, ivabradine (Procoralan®) and prazosin (eg, Hypovase®). Three drugs from a class called the beta-blockers can now be prescribed for heart failure in certain circumstances. These are bisoprolol (eg, Cardicor®), carvedilol and nebivolol (eg, Nebilet®).
Candesartan (eg, Amias®), losartan (eg, Cozaar®) and valsartan (eg, Diovan®) belong to another class of drugs, known as angiotensin II antagonists, that can also be used to treat some people with heart failure.
Valsartan is available in combination with another drug called sacubitril, which is a type of treatment known as a neprilysin inhibitor. Sacubitril reduces the strain on the heart, lowers blood pressure and protects the heart from developing scar tissue. The sacubitril/valsartan tablet (Entresto®) can be used to treat people with heart failure when their heart pumps out less blood than it should.
In addition, eplerenone (eg, Inspra®), a type of drug known as an aldosterone antagonist, may be used together with standard therapy in some people with heart failure.
Your GP will usually prescribe a combination of two or more drugs. It is important that high blood pressure is controlled.
There are steps you can take to help treat your heart failure (see below), but seek advice from your doctor. Regular exercise is beneficial in nearly all cases, but check with your doctor first. If you smoke, try to stop - your doctor or practice nurse can help you with this. Smoking increases the heart's need for oxygen and causes constriction of the blood vessels. This means that your heart will have to work harder to pump the blood around your body.
- If you smoke, try to stop
- Try to maintain a healthy weight - being overweight can add to the strain on the heart, especially during exercise
- Eat sensibly, avoiding high-fat foods. Don't add salt to your cooking or to your food at the table
- Limit how much alcohol you drink. The recommended limit is 14 units per week (spread over three or more days) with two or more drink-free days each week. One unit = 1/2 pint of average-strength beer (approximately 250mL); 1/2 glass of wine (76mL); 1 standard pub measure of spirits (25mL).
- Ask your doctor's advice about exercise. In most cases, regular gentle exercise, such as walking will be encouraged
- Make sure you take your medication as prescribed. It will help stabilise your heart failure and improve your symptoms
Further information available from:
British Heart Foundation
Greater London House
180 Hampstead Road
London NW1 7AW
Tel: 020 7554 0000
Heart Help Line: 0300 330 3311 (Monday to Friday, 9am-5pm)
Fact sheet provided by MIMS
Date last reviewed: May 2014