Heart Failure

Heart failure means the heart is not pumping strongly enough to meet the body's needs, so fluid backs up into the lungs and legs. The name frightens families more than it should — with the right medication and fluid discipline, many patients remain active for years.

Symptoms

Not everyone gets every symptom, and the pattern can differ in older people, in people with diabetes and in children. These are the ones most often reported.

• Breathlessness on exertion, then on lying flat
• Waking at night gasping for breath, needing extra pillows
• Swelling of both feet and ankles that pits when pressed
• Abdominal fullness and loss of appetite
• Persistent tiredness and reduced capacity for daily work
• Rapid weight gain over a few days from fluid retention

When to see a doctor

• Breathlessness at rest or while speaking — attend the emergency department
• Weight gain of two to three kilograms within a week
• Increasing leg swelling despite regular medication
• Coughing pink frothy sputum, or waking repeatedly to sit up and breathe

Tests that may be advised

Your consultant will order only the investigations that change the plan. Most of the following are available on the SIMS campus, so results usually come back the same visit.

• 2D echocardiography to measure pumping function
• ECG and chest X-ray
• Blood tests including kidney function, electrolytes and haemoglobin
• Thyroid function and blood sugar
• Coronary angiogram where blocked arteries are the suspected cause

How it is treated

Treatment is decided case by case — by how advanced the problem is, what else you are being treated for, and what you can realistically sustain. Broadly, it involves the following.

• Medication to remove excess fluid and reduce strain on the heart
• Daily weight and salt-and-fluid limits agreed with the treating doctor
• Treatment of the underlying cause — coronary disease, valve disease, high blood pressure or alcohol
• Hospital admission with oxygen and monitoring during acute decompensation
• Vaccination advice, graded activity and regular follow-up to prevent readmission