HEART FAIIURE:

What is heart failure?Heart failure is when the heart loses its ability to pump blood efficiently through your body. Oxygen and nutrients in blood provide your body with the energy it needs to operate normally.Heart failure may affect the left, right or both sides of the heart.
If the left half of the heart fails (left ventricular failure), fluid will build up in the lungs due to congestion of the veins in the lungs.
If the right half of the heart fails (right ventricular failure), general body vein pressure will increase and fluid will accumulate in the body, especially in the legs and in the abdominal organs, with the liver most likely to be affected. Often left heart failure leads to right heart failure, causing biventricular failure (failure on both sides). What causes heart failure? Heart failure can be caused by many different diseases. Some of which happen as an acute, sudden effect, while others are chronic, long-term conditions.
High blood pressure
Diseases of the heart valves.
Ischaemic heart disease - a blood clot in one of the coronary arteries can cause injury and irreversible damage to the heart muscle.
Cardiomyopathy (chronic heart muscle disease).
Congenital heart diseases.
Endocrine disorders, including decreased metabolism due to abnormal thyroid function (rare) and also increased metabolism due to abnormal thyroid function (rare).
Severe anaemia (rare).What are the symptoms of heart failure?
Left-sided heart failure
Shortness of breath together with a reduction in mobility.
In less severe cases, breathing problems only start upon exertion.
A dry cough may develop that doesn't go away.
Fatigue.
Right-sided heart failure and biventricular failure
Swelling in the legs (oedema).
Oedema may lead to dry skin on the lower part of the legs because of pressure from inside the tissue.
There may be an eczema-type rash on legs, which can be complicated by ulcers that do not heal (venous leg ulcers).
Possible accumulation of fluid in the abdominal cavity and organs, especially the liver. The organs swell and the abdominal wall might expand.How does the doctor diagnose heart failure?
The diagnosis is usually based on medical history combined with an examination that will look for an increased heart rate, abnormal heart sounds, the presence of heart murmurs, swollen legs, fluid in the lungs, swollen neck veins and liver enlargement.
To determine the extent of the heart failure, a chest X-ray is done.
To establish whether a previous heart attack may be associated with the development of heart failure, an electrocardiogram (ECG) will be taken.



Blood samples are usually taken to check for metabolic upset and kidney function.To find out what caused the heart failure, further investigations are required. These can include:
additional blood tests to check for recent viral infections and for rare metabolic causes of heart failure
an ultrasound examination of the heart (echocardiograph)
an exercise test using a treadmill
an examination of the coronary arteries by injecting a dye into the left and right coronary arteries so any blockages show up on an X-ray
measurement of pressure and valve function in between both the chambers of the heart and the great blood vessels (cardiac catheterisation)
taking a small sample of heart muscle (biopsy) if heart muscle disease (cardiomyopathy) is suspected at the time of catheterisation
additional non-invasive imaging to look at the heart muscle using magnetic resonance imaging (MRI).In the long termHeart failure is a progressive disease, with the potential for gradual deterioration. Treatment can often slow the progression of the illness and substantially increase your quality of life.
What are the signs of deterioration?
Left-sided heart failure
Increasing difficulty in moving around.
Breathlessness at rest or when lying flat (orthopnoea).
Waking up at night with breathlessness (paroxysmal nocturnal dyspnoea).
A cough with frothy sputum (lung oedema).
Right-sided heart failure
Venous leg ulcers.
General swelling of the legs, abdomen and, in men, the scrotum.
Possible liver enlargement if severe.What can the doctor do?
Investigate with a view to coronary artery widening (revascularisation) and valve replacement if necessary.



Treat any obvious causes of heart failure.
Give advice regarding risk factors such as smoking, excessive weight and high blood pressure.
Refer you for further investigation to identify the cause of the heart failure.
Prescribe medication.
Monitor your health on a regular basis.Which medication is used afterwards?
AspirinAspirin (eg Nu-seals 75mg) is always prescribed unless it can't be tolerated. It has a mildly blood-thinning effect and goes some way to prevent further cardiac events. Aspirin must be taken for the rest of your life.Clopidogrel (Plavix) can be given instead of aspirin.
Agents for increasing cardiac function Digoxin (eg Lanoxin) helps the heart contract more vigorously.
Nitroglycerin and other nitrates Nitrates such as glyceryl trinitrate or isosorbide mononitrate (eg Imdur) make the veins and arteries relax and widen (dilate). When the blood vessels dilate in this way there is more space inside them and so less resistance. This makes it easier for the heart to pump blood around the body.
Beta blockers Beta blockers block the action of adrenaline hormones on the heart. They reduce the energy used by the heart to pump blood around the body, so it doesn't have to work so hard.
ACE inhibitors ACE inhibitors prevent the formation of a hormone that makes the blood vessels contract. This means that less effort is needed by the heart to pump blood.
Diuretics Diuretics help the body excrete excessive fluid and salts, reducing the strain on the heart and blood vessels. If you take diuretics, you may need to take a potassium supplement because some diuretics cause a loss of potassium.What can be done to avoid heart failure?
Stop smoking.
Avoid overeating.
Exercise regularly.
Eat a healthy, low-fat diet.
If you are suffering from a disease that can cause heart failure, such as high blood pressure, it is important to have it treated as soon as possible. The risk of developing heart failure will then be greatly reduced.