A Patients Guide to Heart Failure Exceptional healthcare, personally delivered
Heart Failure The term heart failure means that your heart is weakened and is having difficulty in pumping as hard as it would like to do to keep up with the needs of the other organs in your body. Your heart is working less efficiently than before. Common symptoms Shortness of breath on exertion or at rest. Breathlessness or coughing when laid flat. Waking up breathless at night. Tiredness and fatigue. Swelling of the ankles and feet. Loss of appetite or constipation. The stomach feeling swollen or bloated. Sputum production (which can be bloodstained). How your heart works Your heart and all the blood vessels around the body form the cardiovascular system. The tissues themselves get their supplies of nutrients from the blood, which flows around the body within a closed network of blood vessels. Your heart is the body s pump and is made from a special type of muscle that is not found anywhere else in the body. Every time your heart beats it pumps blood to the organs and tissues in your body. The problem To enable the heart to do this job well the heart muscle must be working normally. It will not pump normally if it has been damaged. Any condition that forces the heart to work harder than it needs to over the years can increase the chance of it weakening and of heart failure developing. For some people, damage to the heart can occur more suddenly, for example, after a large heart attack. 2 A Patients Guide to Heart Failure
Doctors believe that heart failure is becoming more common. This has occurred because people are living longer, also because doctors are getting better at treating other problems such as heart attacks, which can lead to heart damage. This may cause problems months to years after the heart attack. The commonest cause of heart failure in the Western World occurs from muscle damage that is caused by heart attacks. It may also result from conditions that make the heart work harder such as: High blood pressure. Leaking or narrowed heart valves. Slow or fast heart rhythms, which affect the filling and pumping action of the heart. Congenital heart defects. Obesity. Diabetes. Other causes such as Cardiomyopathy, rheumatic fever, overactive thyroid, viral infection and excessive alcohol intake. Effects on the body from heart failure As the blood flow leaving the heart is slowed, this builds up backpressure through the lungs and veins, causing congestion in the tissues. Most commonly, this fluid accumulates in the lungs and the legs. The site of fluid accumulation depends upon which chambers of the heart have been affected. Fluid in the lungs interferes with breathing and fluid in the legs causes swelling known as oedema. Heart failure also affects the kidneys ability to get rid of salt and water. This retention makes the congestion and oedema worse. A Patients Guide to Heart Failure 3
Spotting the signs and symptoms Breathlessness This is a common symptom. You may feel breathless when you do physical activity, exert yourself or even when at rest. One of the symptoms of severe heart failure is needing to sleep propped up in bed, and if you were to slip down in the bed you may wake feeling very short of breath. If you were to sit up again, symptoms do ease after a short while. If your condition does get worse, you should notify your doctor or nurse. You may need some adjustment to your treatment that can help alleviate your symptoms. Fatigue In the early stages of heart failure, you are most likely to feel tired and breathless when you do physical activity because your muscles are not getting an adequate amount of blood. Fatigue may persist. It is important to be aware of these symptoms, and pace yourself during your activities. It is also important to have sufficient rest. Swollen ankles It is not uncommon for people without heart failure to suffer with swollen ankles. However, when it is a symptom of heart failure it is likely to affect both legs equally. Much in the same way that fluid collects in the lungs and can make you short of breath, fluid can also leak out of the blood vessels and collect in the tissues, especially in the legs. How is heart failure confirmed? It is usually difficult to diagnose heart failure without further tests. These usually include: A physical examination which will include taking your pulse and blood pressure, listening to your heart, checking the veins in your neck, and looking for oedema (swelling) of your legs. 4 A Patients Guide to Heart Failure
Blood tests, to rule out anaemia, and check the function of your kidneys. A chest X-ray. An ECG. An echocardiogram which reviews the function of the heart, how effectively it is pumping and also how well the heart valves are working. This is a good way to detect any damage to the heart muscle. Some people may require further investigations. Treatment for heart failure The aim of treatment is to control your symptoms and treat the underlying cause of heart failure. Recently there have been significant advances in the treatment of heart failure, especially in relation to drug therapy. These have been shown to prolong life and improve the quality of life for people with heart failure. Symptoms can be improved by Lifestyle modification such as: Diet. Monitoring your weight. Regular exercise. Stopping smoking. Rest and relaxation. Avoiding excess alcohol. Avoiding infections. Taking your tablets regularly. A Patients Guide to Heart Failure 5
Diet It is essential that you cut down on your salt intake. Salt causes the body to retain fluid. Salt also interferes with the effectiveness of diuretics. Areas you can cut down on your salt intake are: Not adding salt to your food when cooking or at the table. Avoiding salty snacks such as peanuts, crisps and soy sauce. Cutting down on processed foods such as salami, and ready made convenience meals. Avoid salt substitutes such as low salt as these replace salt with potassium which is not recommended in large amounts. Try to follow a healthy low fat diet, eating foods such as lean meat, fish or poultry and drinking skimmed milk. Also include foods high in fibre such as wholemeal bread, pasta, fruit and vegetables. To stop your body retaining too much fluid, your doctor may ask you to limit the amount of fluid you drink each day to 2 litres (2-3 pints). This will include drinks such as tea and coffee. Monitoring your weight It is important to weigh yourself everyday. This is an excellent way to check if your body is retaining excess fluid. It is best to weigh yourself at the same time every morning. It is important to inform your nurse or doctor if you gain 3-5 pounds in a week. This may mean your body is holding too much fluid. The dose of your drugs may need to be adjusted to help with the problem. Regular exercise Gentle physical activity is good for the heart, the circulation and your muscles. It is important not to over do it, aim to exercise until you are mildly out of breath. 6 A Patients Guide to Heart Failure
Stop smoking Smoking is harmful to the heart. It increases the amount of oxygen the heart needs, raises blood pressure and your heart rate. Stopping smoking will help stop these effects. To help you give up, many GP surgeries provide smoking cessation clinics. Your GP may be able to assist by prescribing nicotine patches. Your family could also help you stop smoking by stopping smoking or not smoking in front of you. Also avoid situations in which you would normally smoke or smoky places. Rest and relaxation Yes, you do need remain active; this is good for the heart. However, there will be times when you need to rest. For example, if your breathlessness becomes worse. You also need to pace your activities throughout the day and rest in between activities. This will help prevent you becoming too fatigued. Alcohol There is some evidence to suggest that alcohol in small doses is good for the heart. It is sensible to restrict your intake to 1-2 units per day. It is important to remember that alcohol is high in calories if you are trying to lose weight. It is also part of your fluid allowance, so it may be better to stick to smaller measures e.g. wine or spirits rather than big glasses of beer. It is important to note that alcohol can be very harmful for some patients with heart failure. If your heart failure was brought on by alcohol then you will be advised to avoid alcohol completely. Avoid infections It is important to be immunised for flu each year and to have a one off injection of the pneumoccal vaccination. A Patients Guide to Heart Failure 7
Can I still have sex? There is no reason why you should not still enjoy an active sex life. If you have any worries, please discuss them with your doctor or nurse. Some drugs used in treating heart failure can cause impotence, if this is a problem, please discuss it with your doctor or nurse. Taking your tablets regularly It is important to remember to take your tablets regularly. This will help keep your symptoms under control. Some drugs may make your heart failure worse. It is important to avoid over the counter medications such as non-steroidal antiinflammatory drugs. Ask your pharmacist for advice before buying any tablets over the counter. Drugs that you have been prescribed for your heart failure will now be discussed. A page per group of drugs is used. A space is left for your own notes and questions. 8 A Patients Guide to Heart Failure
Ace Inhibitors Such as Ramipril, Captopril, Lisinopril and Perindopril. Ace inhibitors are a group of drugs that act on the heart and blood vessels. They have been shown to prevent worsening heart failure, improve symptoms and prolong life. ACE stands for Angiotensin Converting Enzyme. This blocks the body s production of angiotensin; a chemical that causes blood vessels to narrow and the kidneys to retain salt and water. Ace inhibitors make the blood vessels relax. This makes it easier for the heart to pump. As with some drugs, some people may experience side effects. Ace inhibitors can rarely cause kidney problems. Occasionally, dizziness may be experienced. A more common side effect is a cough, if you develop a problematic cough, please advise your doctor. A different drug may be prescribed. Any Questions? A Patients Guide to Heart Failure 9
Beta Blockers Such as Bisoprolol / Cavedilol and Nibivolel Beta blockers are often given to patients with angina and high blood pressure. It has also been shown to benefit patients with heart failure. Beta blockers slow the heart rate and lower blood pressure. This helps the heart work more effectively. Beta blockers are started at low doses and the dose is increased gradually. You may feel slightly worse when first starting to take this drug, but this should only last a short while. Some side effects include tiredness, cold hands and feet and in some cases impotence. Certain beta blockers can cause the airways to narrow and so will be avoided in patients with lung problems. If any side effects occur do not stop taking these tablets, speak to your doctor. Any Questions? 10 A Patients Guide to Heart Failure
Diuretics Such as Frusemide, Bendrofluazide, and Bumetinide. Diuretics force the kidneys to produce more urine therefore removing sodium (salt) and water from the body. This reduces the amount of fluid circulating in your body, which reduces the amount of work the heart has to do. Diuretics should help reduce breathlessness and swollen ankles, which are common in heart failure. Diuretics have a significant impact on your weight. As previously discussed, an increase in weight may indicate extra fluid. Use the record at the back of this book to record your weight on a daily basis. Any Questions? A Patients Guide to Heart Failure 11
Spironolactone This is another type of diuretic. It blocks the effect of a hormone named aldosterone that causes the kidneys to reabsorb salt and make less urine. By blocking the effects of aldosterone, spironolcatone stimulates the kidneys to pass more urine and so remove excess salt and water. Any Questions? 12 A Patients Guide to Heart Failure
Digoxin Digoxin slows and helps control the heart rate. It is mainly used for patients with an irregular heart rhythm called atrial fibrillation. Side effects can include nausea and vomiting. These should be reported to your doctor. Any Questions? A Patients Guide to Heart Failure 13
Things to remember To keep your symptoms under control and stay out of hospital, it is important to keep taking your tablets everyday. Always have a good supply of tablets so you don t run out. If any side effects develop, don t stop taking your tablets, talk to your doctor first. If you are taking any medicines for any other conditions other than heart failure, for example cold remedies or anti-inflammatory drugs, please inform your doctor. Weight Diary A weight diary is included at the end of this book. The importance of daily recording has been discussed. You can use the following pages to record your weight and any symptoms or problems you have experienced throughout the day. NHS Constitution. Information on your rights and responsibilities. Available at www.nhs.uk/aboutnhs/constitution [Last Accessed March 2010] 14 A Patients Guide to Heart Failure
Weight Adverse symptoms experienced A Patients Guide to Heart Failure 15
Weight Adverse symptoms experienced 16 A Patients Guide to Heart Failure
Weight Adverse symptoms experienced A Patients Guide to Heart Failure 17
Weight Adverse symptoms experienced 18 A Patients Guide to Heart Failure
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How to contact us: H North Bristol NHS Trust, Frenchay Hospital Bristol BS16 1LE See your appointment letter for the number to phone with any queries you may have www.nbt.nhs.uk If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice. North Bristol NHS Trust. First Published February 2005. This second edition July 2010. NBT002238