Heart failure: Making a success of a serious situation

Heart failure may sound like an urgent condition that requires immediate treatment, but that isn’t necessarily the case. While it can come about suddenly and is a serious complaint where medical attention is needed, heart failure can also be a long-term chronic condition.

Top Doctors speaks to esteemed consultant cardiologist Dr Kaushik Guha, who has particular expertise in heart failure, about this condition. He answers some of the most asked questions about heart failure in this comprehensive article, providing reassurance as to how it can be treated and managed in the long run.

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What are the most common causes of heart failure?

Heart failure is a commonly encountered cardiac condition. It’s a chronic disease and may be lethal which means that the patient requires a timely, rapid diagnosis, full access to appropriate assessment and timely intervention with specialist medicines, access to specialists and their multidisciplinary teams and the need to consider more advanced treatment options which include:

• Surgical procedures;
• Specialist defibrillators;
• Pacemakers;
• And where relevant, consideration of referral for heart transplantation.

The term means that there is an issue which is affecting the heart to pump or fill with blood properly. This is diagnosed via specialist assessment and reviewing the patient's electrocardiogram (ECG) - heart tracing and echocardiogram (heart scan). Patients are then categorised into different groups on the basis of these tests and then are given appropriate treatment on the basis of these results.

What are the main symptoms?

Heart failure is characterised by a collection of symptoms. These are things that the patient and family notice and report to healthcare professionals. This includes:

• Worsening shortness of breath;
• A difficulty to exert oneself;
• Swelling of the ankles, legs and abdomen;
• The need to prop yourself to breathe properly at night time;
• And waking up at night time with increased breathlessness.

The patient may also experience:

• Chest pain and an awareness of heart rhythm (palpitations);
• Blackouts or loss of consciousness;
• And recurrent dizzy or giddy episodes.

None of these symptoms in isolation represent potential heart failure, but when grouped together mean that the patient is at risk of this condition. What are the main urgent warning signs that might indicate heart failure?

A patient who develops new onset breathlessness, worsening exercise capacity (an inability to do normal activity as compared to previous) and or new onset leg swelling is at risk of the condition and needs urgent specialist assessment.

When consulting with their General Practitioner or other primary care community-based healthcare practitioner, the patient should have a blood test called a BNP or nt-pro BNP in association with other basic blood tests to check for anaemia and kidney and liver function. If this blood test is abnormal and above certain levels, it does not mean that the patient has heart failure, but indicates that the patient is a t-risk of this condition. The higher the value of the BNP/nt-pro BNP blood test, the sicker the patient is, and the worse the prognosis for the patient.

When is emergency treatment required?

Emergency treatment and hospitalisation is required when the patient has overwhelming fluid overload in their bodies and particularly their lungs. Profound leg swelling and abdominal swelling also indicates fluid overload. This is treated with intravenous diuretics (water tablets) and will lead to fluid removal and stabilisation.

Additionally, patents may experience abnormal heart rhythms which mean that the patient is at risk of dizzy or giddy episodes, blackouts or even cardiac arrest - this requires emergency medication and urgent attention to all forms of pacemakers and defibrillators which need to be considered and fitted by a specialist.

The goal of outpatient treatment is to try and identify patients early at the time of their initial diagnosis and to follow the patient up to ensure that they are not at risk of life-threatening complications. The chances of life-threatening problems are reduced by a rapid diagnosis and for those patients where the heart pump is weaker than it should be on the left-hand side of the heart (left ventricle) specialist medication.

There are clear evidence-based guidelines as to what medication the patient should be on, and this has been shown through large robust clinical studies to potentially improve the patient’s condition, making them live longer, prevent emergency hospitalisation and potentially strengthen the heart. This process has to be supervised by a heart failure specialist and may involve the heart failure specialist nurse team as well.

How is heart failure diagnosed?

Heart failure according to previous studies is due to in many patients high blood pressure (hypertension) and coronary artery disease (heart attacks, bypass surgery and previous coronary artery stents or angioplasty).

However, beyond these causes there are many other potential causes which require consideration. Some of these include:

• Genetic;
• Other medication such as chemotherapy for previous cancer treatment;
• Heart valve problems;
• Heart rhythm problems;
• And excessive alcohol to name but a few.

Beyond making a correct diagnosis, the specialist should focus on the cause and tailor treatment accordingly.

When is surgery required?

Surgery and procedures are indicated for select groups of patients with heart failure. Surgery which involves open heart surgery and keyhole techniques (percutaneous) is for those patients with heart failure and heart valve disease.

These procedures are carried out by either heart surgeons or specialist cardiologists who have dedicated expertise within this field. Other potential procedures for some patients include pacemakers and defibrillators. These are not surgical procedures and are normally day-case procedures performed by a trained cardiologist.

If you’re looking for leading treatment for heart failure or other cardiology conditions, arrange a consultation with Dr Guha via his Top Doctors profile.