Heart failure

Heart failure develops when the heart can no longer adequately perform its function, which is to pump blood efficiently around the body. Heart failure generally carries a poor outlook – about 25% of people younger than 75 years and 40% of those older than 75 years die within a year of diagnosis, survival rates far worse than for breast or prostate cancer.

Heart failure may develop for any number of reasons, for example, following a heart attack, in the presence of severe and uncorrected valve disease, or as a result of high blood pressure, diabetes or heart muscle disease. Increased stiffness of the heart muscle is an increasingly recognised cause of heart failure, especially in older women, and is called “heart failure with preserved ejection fraction”, since, although the heart can pump well, it cannot relax and fill effectively.

When the heart muscle is not pumping effectively, pressure can build up within the lungs and the chambers of the heart, creating the sensation of breathlessness. If the muscle impairment is mild, breathlessness is only felt with significant exercise, but increasing muscle damage causes breathlessness with even mild activity and is perhaps more noticeable when lying down in bed, such that a patient may start to sleep with more pillows than before. As the symptom progresses, fluid retention and swelling may become noticeable in the form of swollen ankles or distention of the abdomen. The development of atrial fibrillation (an irregular heart rhythm) as a consequence of the strain on the heart may well precipitate symptoms and be the first marker of an underlying problem.

There are many effective drugs to treat heart failure, not only improving or resolving symptoms but also improving outlook and prognosis. In some patients there is a role for an implantable cardioverter-defibrillator (ICD), to reduce the risk of sudden death from a life-threatening change in heart rhythm.

Others may benefit from a particular type of pacemaker called a biventricular pacemaker; this is also known as resynchronisation therapy, since it improves the pumping action of the heart by altering the pattern of electrical activation of the two main pumping chambers, the ventricles. It does this using a combination of three pacing leads, one stimulating the upper chamber, the right atrium, and the other two stimulating the two lower pumping chambers, the right and left ventricles.

Depending on the precise cause of the heart failure, some patients may benefit from surgery, such as coronary artery bypass surgery, or valve repair or replacement; minimal access techniques are also possible, including the percutaneous approaches to aortic valve replacement and mitral valve repair in selected cases.

Related links:

Symptoms - Breathlessness and fluid

retention

Breathlessness, or dyspnoea, is a common symptom of several medical disorders. Read more

Conditions - Cardiomyopathy

A cardiomyopathy is defined as a disorder in which the heart muscle is structurally and functionally abnormal. Read more

Conditions - Valve Disease

The four chambers of the heart are separated by one-way valves to ensure efficient forward flow of blood from chamber to chamber and into the main blood vessels, the aorta and pulmonary artery. Read more

Tests - Echocardiography

Echocardiography is the study of the heart using ultrasound. Similar to a scan of a baby undertaken during pregnancy, an ultrasound probe applied to the chest wall can be used to study the heart. Read more

Treatments - Heart Failure: Medical Therapy

When the heart muscle is not pumping effectively, pressure can build up within the lungs and the chambers of the heart, creating the sensation of breathlessness and sometimes leading to fluid retention and swelling. Read more

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