Heart failure

About heart failure

Heart failure is a condition where the heart muscle becomes weak and can’t pump blood and oxygen around the body as well as it usually does.

In people with heart failure, the heart muscle tries to adapt by increasing in size and thickness. But over time the heart isn’t able to contract or relax properly. When this happens, fluid can build up in other parts of the body, including the lungs, tummy, legs and ankles. This causes many of the symptoms of heart failure.

Although heart failure is a lifelong condition, there are many things you can do to help you feel better and stay out of hospital.

Causes of heart failure

Coronary heart disease is the major cause of heart attacks. A heart attack can cause scarring of the heart muscle, which means the muscle isn’t able to pump blood and oxygen around the body properly. Risk factors for coronary heart disease include:

• high blood pressure
• high cholesterol
• diabetes
• tobacco smoking
• physical inactivity
• not following a heart-healthy eating pattern
• overweight or obesity
• excess alcohol intake
• depression, anxiety and social isolation.

Heart failure can also develop due to other conditions which damage, weaken or stiffen your heart, including:

• chronic conditions like diabetes, HIV and thyroid conditions
• heart valve disease – if the heart valves are damaged, blood cannot flow through the heart as normal. This puts extra strain on the heart
• congenital heart disease – heart abnormalities may be present from birth that can affect the normal flow of blood through the heart
• cardiomyopathy – a disease of the heart muscle affecting its function, size or shape. This can affect the heart’s pumping ability
• myocarditis (inflammation of the heart muscle) – viruses or other infections can damage the heart muscle
• abnormal heart rhythms – a fault in the heart’s electrical system can cause it to beat rapidly or in an irregular way. Over a long period of time, this can lead to heart failure
• toxins – alcohol and illicit drugs

Other less common conditions can cause heart failure including amyloidosis, sarcoidosis, and some nutritional deficiencies.

Symptoms of heart failure

Heart failure causes symptoms because of the reduced supply of blood and oxygen to muscles and organs, and the build-up of fluid in your body.

Symptoms of heart failure can include:

• new or worsening shortness of breath or trouble breathing (particularly during physical activity or at night when lying flat)
• coughing and wheezing
• fainting or dizziness
• weight gain
• fatigue, tiredness, weakness
• ankle or leg swelling
• tummy swelling or bloating
• heart palpitations (feeling of a fluttering, racing, thumping or pounding in your chest)
• chest pain or discomfort in parts of the upper body
• loss of appetite or nausea
• constipation.

Factors that can worsen symptoms of heart failure

Several factors can make heart failure symptoms worse, including:

• anaemia (a condition where the blood doesn’t have enough healthy red blood cells)
• too much salt, fluid, or alcohol in your diet
• pregnancy
• some viral and bacterial infections
• kidney diseases
• lung diseases
• not taking prescribed heart failure medicines.

Diagnosis of heart failure

Ways of diagnosing heart failure include:

• An echocardiogram (ultrasound scan of the heart) is a very important test to assess how the heart is pumping if you doctor suspects, you have heart failure.

Other tests may include:

• physical examination including listening to the heart with a stethoscope
• blood tests
• chest X-ray
• electrocardiogram (ECG), to monitor the heart rate and pick up any unusual heart rhythms. An ECG can also help assess if the left ventricle is enlarged
• exercise tests or ‘stress tests’, to monitor how your heart works when you’re physically active. These tests usually involve either walking on a treadmill or riding a stationary bike while connected to a heart monitor
• lung function tests, to assess how the lungs are working

Treatment for heart failure

Treatment for heart failure includes attending a heart failure management program and cardiac rehabilitation, taking medicines and devices or surgery.

Heart failure management programs (chronic disease management programs)

Attending a specialised program for people with heart failure can reduce the risk of complications and having to go to hospital. Going to a program can also help you live longer and improve your quality of life.

Heart failure programs, sometimes called chronic disease management programs, are run by health professionals who work as a team to help you manage your condition. The team can include a heart failure nurse, a cardiologist, pharmacist, physiotherapist, dietitian or a psychologist.

When you attend a heart failure management program, you’ll get information to help you manage your condition. This can include:

• how to manage your heart failure medicines
• when to act if your symptoms get worse
• how to monitor your fluid levels and salt intake

If you have heart failure and haven’t been referred to a heart failure management program, ask your doctor to help you enrol. Some services are now available from your own home using telephone and internet services.

Cardiac rehabilitation and physical activity

Attending a cardiac rehabilitation program is one of the best things you can do for heart failure. Many people can benefit from cardiac rehabilitation - it can improve your quality of life, keep you out of hospital and have a positive impact on your mental health and wellbeing.

Cardiac rehabilitation combines exercise and education sessions to help you make healthy changes. This includes exercise to help increase your strength, fitness and confidence levels. Exercise includes activities that make you slightly out of breath, while still being able to hold a conversation. For example, walking or riding a stationary bike. It might also include exercises that use light weights or other equipment. You’ll get a tailored exercise program to suit you and you will be able to go at your own pace. Many cardiac rehabilitation service now offer home-based services via telephone and/or over the internet.

Visit the Heart Foundation’s cardiac services directory to find a cardiac rehabilitation program near you.

Walking for heart health

Walking is a great activity for heart health and managing blood pressure. Getting involved with a Heart Foundation Walking group is a fun and social way to be active. You can also register for a free Personal Walking Plan. Visit Heart Foundation Walking for more information.

Medicines

Heart failure medicines usually need to be taken long-term. Your doctor may increase the dose of your medicines even if you feel well. It’s important you do not stop taking your heart failure medicines without speaking to your doctor or pharmacist first.

Below are some common types of heart failure medicines. Your doctor will prescribe certain medicines depending on the type of heart failure you have. Many people with heart failure need to take a combination of medicines.

• Angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs). These medicines help your blood vessels to relax, putting less strain on your heart and making it easier to pump blood around your body.
• Angiotensin receptor-neprilysin inhibitors (ARNIs). These medicines help by managing your blood pressure and also get rid of extra fluid.
• Beta blockers. These medicines slow your heart rate which allows it to pump more efficiently.
• Mineralocorticoid receptor antagonists (MRAs). These medicines help prevent or reduce damage and changes to the heart muscle.They also help to manage blood pressure.
• Sodium-glucose cotransporter 2 (SGLT2) inhibitors. These medicines can improve symptoms of heart failure by reducing extra fluid in the body. SGLT2 inhibitors also help manage blood sugar levels in people with heart failure and diabetes.
• Diuretics. Diuretics help get rid of extra fluid from your body, including your lungs, abdomen (tummy), legs, ankles and feet. They do this by increasing the amount of urine (pee) you make. Diuretics help you feel better by reducing swelling and making it easier to breathe.

Find more information about taking your heart medicines.

Pacemakers and other devices

The heart has its own electrical system that regulates the heartbeat. With every heartbeat, there's an electrical signal that travels through your heart, causing it to contract and pump blood around the body.

For some people with heart failure, the electrical system doesn’t work properly. People with heart failure have an increased risk of abnormal heart rhythms (arrythmias), like atrial fibrillation. If you have an abnormal heart rhythm, you may need a pacemaker or device to regulate the heart rate and rhythm.

Pacemaker

A pacemaker is a small implantable device that electrically stimulates the heart to maintain a regular heart rhythm. It is inserted under the skin on your chest (or tummy) and has one or more wires that connect to your heart. The pacemaker produces small electrical currents that stimulate the heart to pump regularly.

Pacemakers are sometimes used in people with heart failure to help reduce symptoms when the left and the right side of the heart don’t beat together. This is a special type of pacemaker, also sometimes called a ‘cardiac resynchronisation therapy (CRT) device’ or a ‘biventricular pacemaker’. This type of pacemaker is often combined with an implantable cardioverter defibrillator (CRT-D).

A pacemaker shouldn’t affect your day-to-day life. You may need to make a few small changes for a short time. People who have pacemakers and devices need to have regular follow-up appointments to make sure the device is working well. A pacemaker battery usually lasts between five to 15 years. Your doctor will check the battery regularly. When the battery is running low, you will need to go back into hospital to get it replaced.

Implantable cardioverter defibrillator (ICD)

An ICD is a small battery-powered box (smaller than a matchbox) that is inserted under the skin, usually in the space just below the collar bone (clavicle). Thin wires connect the ICD to the heart. The ICD continuously monitors your heart and can correct dangerous abnormal heart rhythms by delivering controlled electric ‘shocks’. There are different types of ICDs and your doctor will talk to you about which option is right for you.

Surgery and procedures

Some people with heart failure may need other surgeries and procedures to improve symptoms and quality of life. The type of surgery depends on the cause of your heart failure, how severe your symptoms are and any other medical conditions you might have.

Types of surgery and procedures include:

• Catheter ablation to help regulate the heartbeat in people with abnormal heart rhythms. Ablation removes the small cells in the heart where the abnormal electrical signals are coming from.
• Heart valve surgery to repair or replace damaged heart valves.
• Coronary artery bypass graft surgery (or ‘heart bypass surgery’) for people with coronary heart disease.
• Heart transplant. Only a very small number of heart transplants are performed each year in Australia.

Living well with heart failure

The Heart Foundation has developed a range of resources for people living with heart failure, and their families and carers.

• Living well with heart failure booklet, which includes information about what to do when you feel sick, managing symptoms, and monitoring your fluid and salt intake.
• Living well with heart failure video series, which includes seven videos covering topics to help you manage your condition. The series is available in a range of languages.
• Heart failure fact sheet, which includes questions to ask your health professional and what changes you might need to make to your daily life.
• Heart failure action plan, which helps you to identify the most important parts of your heart failure management to focus on right now.

Access these resources on the Heart Foundation website.

Where to get help

• In an emergency, always call Triple Zero (000)
• Your GP (doctor)
• Cardiologist
• Heart Foundation
• Emergency department of your nearest hospital
• NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice 24 hours a day, 7 days a week