From Dr Andrew To, Consultant Cardiologist, Waitemata DHB.
Heart failure is a clinical syndrome, associated with some underlying abnormality of heart structure and/or function. This results in a combination of symptoms and signs of systemic and pulmonary fluid retention.
Heart failure is not a final diagnosis, as it is always caused by other conditions.
A healthy heart pumps blood to all parts of the body. Heart failure means that the heart cannot pump blood as well as it should. It does not mean that the heart has stopped pumping, just not as strongly as it used to.
Causes of heart failure (心臟衰竭成因)
Heart failure is caused when the heart has been damaged in some way. Most often, this is caused by heart attack or high blood pressure. In others, we may not know what has caused the heart failure.
The list of causes include
– heart attack or angina / ischaemic heart disease
– high blood pressure
– cardiomyopathy (heart muscle disease)
– heart valve problems
– myocarditis (virus infection of the heart)
– thyroid disease
Symptoms of heart failure (心臟衰竭的症狀)
The most common symptoms of heart failure are
– shortness of breath when moving around
– shortness of breath when lying flat, especially at night
– swelling of feet
– swelling of abdomen
– getting tired easily
– unusual weight gain
– loss of appetite
The reasons for these symptoms are due mainly to fluid build up.
When the heart does not pump normally, blood flow becomes impeded and there is a build up of behind the pump, resulting in fluid leaking out of blood vessels.
The left side of the heart pumps blood from the lungs to the rest of the body. Fluid in the lungs cause shortness of breath when moving round, waking up in the middle of the night feeling short of breath, and sometimes cough or wheeze.
The right side of the heart pumps returning blood from the body to the lungs. If the right-sided heart chamber fails, fluid accumulates in the legs and abdomen, causing ankle and feet swelling, swelling of the abdomen, weight gain and loss of appetite.
When the heart does not pump normally, blood may not flow well enough around the body. Sometimes this can cause weakness.
Investigations for heart failure (心臟衰竭的測試)
Investigations for patients with heart failure are important to
– assist the management of heart failure symptoms
– understand the underlying cause for heart failure
These investigations may include
– Chest X-ray – to look for signs of pulmonary congestion or oedema
– ECG – to look for potential cause of the heart failure, such as myocardial infarction or thickening of the heart muscle
– Echocardiogram – key test to document left and right ventricular size and function, as well as concomitant valve disease
– Cardiac MRI – specific test for some situations to look at heart muscle properties, in order to understand the underlying cause for heart failure
– 胸X光 –尋找肺水腫的跡象
– 心電圖 – 可能顯示心臟衰竭的潛在原因，如心肌梗死或心肌增厚
– 超聲心動圖– 顯示左，右心室的功能，以及心瓣膜功能
– 心臟MRI – 在一些特殊情況，尋找心臟肌肉的屬性，了解心臟衰竭的根本原因
Can heart failure be cured? (心臟衰竭能可治好嗎？)
Heart failure is serious and cannot usually be cured. The exceptions include those with reversible causes, such as virus infection of the heart, alcoholic cardiomyopathy or heart arrhythmia.
However, the good news is that it can be controlled. With the right treatment and lifestyle changes, one can feel better and lead a more normal life.
Treatment for heart failure (心臟衰竭的治療)
Therapy for heart failure depends on the severity and acuity of the heart failure. Most people with acute heart failure require hospitalization, where they are closely monitored, with medications given to reduce the fluid retention. Correctable causes are treated. Inotropic therapy may be used to augment cardiac output.
Chronic heart failure is often managed in the community. The cornerstone of successful long-term management is patient understanding of the condition. Heart failure clinical nurse specialists run dedicated heart failure clinic to aid management.
Treatment for chronic heart failure mainly involves taking the right pills, eating less salt, keeping active, and in some situations device therapy.
Daily monitoring (日常監測)
Daily checks are important for patients with chronic heart failure. Action plans aim to detect fluid build up early and control these symptoms before they get worse.
The three important things to monitor are
– feet swelling
– be aware of changes in breathing
Often fluid accumulation can be controlled by restricting salt and fluid, as well as extra Frusemide (diuretics).
Salt restriction (限制鹽)
Salt, or sodium, makes it hard for the body to get rid of fluid. Too much salt in the diet will make heart failure symptoms difficult to control.
A low salt diet is an important part of controlling heart failure symptoms, maintain at a healthy weight, as well as controlling high blood pressure.
– eating fresh fruit, vegetables, fish, meat and chicken
– avoiding processed foods and tinned foods
– avoiding stock cubes, powders, or instant soups
– trying not to add salt while cooking, or at the table
– choosing foods that are low in salt by reading food labels
Many heart failure patients also need to limit the amount of fluid they drink each day to help control their symptoms.
Keeping active (保持活躍)
Exercise or physical activity is one of the best ways of controlling heart failure. Exercise is not only safe but healthy for most people with heart failure. Patients may need to be eased into exercise because of the weakened heart pump. Taking small steps with doing more exercise may be important in the start of an exercise program.
Drug therapy (藥物治療)
Diuretics (water pills)
– Common diuretics include Frusemide. It helps the body get rid of excess fluid.
– ACE inhibitors block the production of a chemical in the body called angiotensin. Angiotensin makes blood vessel contract and so less angiotension relaxes the arteries. This in turn makes it easier for the heart to pump blood through.
– Common ACE inhibitors include Cilazapril, Lisinopril, and Quinapril.
– beta-blockers limit the effect of stress hormones that worsen heart failure. It slows down the heart rate and may also lower blood pressure. Overall, it again makes it easier for the heart to pump.
– Common beta-blockers include Metoprolol, and Carvedilol.
– Spironolactone is a mild diuretic (water pill), but also blocks the harmful effect of the stress hormone aldosterone.
– Digoxin helps control fast heart rate in cases of atrial fibrillation. It also helps to make the heart beat stronger.
Device therapy (儀器裝置治療)
In some cases, device therapy may be used in selected patients. An advanced biventricular pacemaker (cardiac resynchronization therapy) may be implanted for difficult to control heart failure. Implantable cardiac defibrillator (ICD) may be used in patients at risk of sudden death from the heart failure.
Additional information (Heart Failure) in PDF – kindly reproduced with the permission of the Department of Cardiology, Waitemata DHB; and Asian Health Services, Waitemata DHB.