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Heart Failure

What is heart failure?

Heart or cardiac failure occurs when the heart, which is a muscular pump, fails to pump enough blood around the body. The heart becomes inefficient either because the muscle is weakened or because there is a mechanical fault in the valves controlling the flow of blood.

The mechanics of the heart

The heart is basically a series of two pumps, with the smaller right side pumping blood (returning to the heart) to the lungs to get oxygen. The left side of the heart has the big job of pumping blood rich in oxygen around the body. Heart failure may affect only one side of the heart but more usually affects both sides, in which case it is called congestive cardiac failure.

In left-sided failure, the lungs become congested with fluid, causing breathlessness; in right-sided failure, the blood pools in the veins, causing swelling in the tissues, especially of the legs and abdomen.

What are the symptoms?

1. The main symptom is breathlessness usually after exertion.
2. Other symptoms are tiredness, lethargy, nausea, and swelling of the ankles, liver and abdomen.

What causes it?

Coronary artery blockage, high blood pressure, faulty heart valves and alcohol abuse are the main causes.

What are the risks?

Despite its name, heart failure is not usually an immediately life-threatening disease; it generally responds to treatment and can be held in check for a long time. If untreated, it puts a great strain on all the body, which tends to become waterlogged. If treated successfully, the only danger comes from the underlying cause such as coronary artery disease or alcohol abuse.

What is the treatment?

Self-help

Reduce your physical activity: rest if your symptoms are severe but take exercise such as walking if your symptoms are mild or absent

• cut down your salt intake: have a salt-free diet
• Limit your fluid intake to less than 1 1/2 litres a day
• Reduce your weight if you are overweight.
• Avoid smoking
• Take no alcohol or small quantities only.

Medication

• Apart from treating the cause it is important to improve the strength of the heart muscle, and this is best done by using digoxin, a wonderful drug that has been available for over 100 years.
• Fluid tablets (diuretics) are used to remove excess fluid from the lungs and other tissues.
• Since some fluid tablets remove potassium from the body, you may be prescribed potassium tablets.
• A medication called a vasodilator is used to open up the blood vessels.
• Your doctor may prescribe other drugs to boost the action of the heart.

Copyright 1995: John Murtagh, Professor of General Practice
Monash University, Melbourne, Australia