Chronic Heart Failure

Acute heart failure is when symptoms come on suddenly – over hours and days – and requires urgent medical attention. In chronic heart failure, by contrast, symptoms gradually get worse over several months – you may not notice at first, but gradually you find you are short of breath doing the things you used to easily do, such as exercise or a walk to the shops. You may find breathing more difficult or that you’re coughing at night, as lying down causes excess fluid on the lungs to irritate. You may get swelling in your ankles and lower legs, especially towards the end of the day, or if you’ve been on your feet for a long period. The excess fluid may cause you to feel heavier and the scales may show weight gain.

Symptoms range from mild to severe and can fluctuate over time. More severe symptoms include waking suddenly at night, gasping for air, or requiring multiple pillows to allow you to sleep upright, and being breathless at rest, not just with exercise.

Chronic heart failure can be exhausting – you may feel tired and weak. You may suffer palpitations, dizziness, confusion and a cough with pink frothy sputum.

Heart failure can occur as a result of a number of conditions, mainly ones affecting the heart such as a previous heart attack, or irregularities of the heartbeat such as atrial fibrillation; infections of the heart and coronary artery disease may also contribute.

You may have a problem with one of the valves in your heart – if this is leaking, blood can't effectively build up in one chamber of the heart to be pushed to the next and then around the body, or one of your coronary arteries could be blocked, therefore the supply of blood to the heart is restricted. Sometimes the symptoms of chronic heart failure can suddenly get worse, causing acute-on-chronic heart failure, and this require urgent medical attention.

Conditions in other organs can put a strain on the heart, such as a blood clot in the lungs, stroke, diabetes and severe kidney disease.

It’s mostly a condition affecting older people, although those born with heart problems – congenital heart disease – may develop heart failure earlier in life.

If your breathing has suddenly got faster, more laboured or you are coughing and gasping for breath, especially if this occurs at rest, you should book an on-the-day appointment with your doctor or attend the local Emergency Department for assessment. This may be acute heart failure or another condition, but either way, this requires urgent assessment and treatment.

If symptoms are milder or have crept up on you over a few weeks or months – perhaps you’ve noticed some coughing or breathlessness at night, or that you’re getting out of breath with exercise that used to feel comfortable, or that your ankles are swollen – then you should book an appointment with your doctor and consider if this could be heart failure. They will ask about symptoms and examine your heart, lungs and lower legs.

Blood tests are done to confirm heart failure as well as to identify the possible underlying causes. A specific blood test, BNP (N-terminal pro-B-type natriuretic peptide), is a hormone tested in the blood to give a number that can add to the diagnosis of heart failure. Your doctor will request investigations such as an ECG to look at the electrical activity of your heart, a chest X-ray and an echocardiogram, an ultrasound scan of the heart to have a closer look at the movement and blood flow.

You may be referred to a cardiology clinic, where the specialist will look at your results and determine the severity of your condition, and advise on any changes to your medications. They may consider specific investigations to look at any blockages in the blood vessels leading to your heart that could cause heart failure, and they have surgical techniques to treat this.

If there is a treatable cause for heart failure, then it may be curable. For most, the symptoms of chronic heart failure are managed lifelong, with regular reviews with your doctor, and you may have a heart failure nurse allocated to you, or be under the care of a cardiologist.

You can take steps yourself to reduce any stress or strain on the heart. This includes keeping your weight within a healthy range – or losing weight as needed. This can be done through diet, healthy eating and gentle exercise. If you smoke, the best thing you can do is to give up – cigarettes cause particular damage to both the heart and lungs – and drinking alcohol should be kept to a minimum.

A doctor will recommend starting a combination of medications. These medications will open narrowed blood vessels to increase the blood flow, and diuretics will remove excess fluid from the body and reduce the load on the heart. There are other medications that lower the blood pressure and strengthen the contractions of the heart to help pump blood around the body.

If things are getting a little worse, they may suggest increasing certain medications such as diuretics and restricting your daily fluid intake to shed excess fluid from the body via the kidneys and out in the urine. This is usually just a short-term measure.

If a leaky heart valve or obstructed coronary blood vessel is thought to be causing the heart failure, you may be referred for surgery to repair or replace the leaky valve or bypass surgery to open up any blocked vessels. Devices such as pacemakers or implantable defibrillators may also be appropriate to help fix any heart rate or rhythm irregularities. In severe cases, a heart transplant may be suggested.