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OXFORD ICD GROUP
COPING WITH HEART FAILURE …
Patient Perspective Paper 12
These notes are a patient’s view on the subject following a talk given to the Oxford ICD Group by Helen Jackson,
heart failure nurse specialist from John Radcliffe Hospital. You might like to refer to the various booklets on the
subject and these are amongst the stock of information, which I hold and are listed on our website.
I must emphasise once again that notes such as these are very much my personal interpretation and I apologise but
take no responsibility for any inaccuracy. If you are worried in any way concerning your own position, please
consult your own doctor or consultant.
What is heart failure ?
The heart is a hollow muscular pump with four chambers. It pumps blood
containing oxygen and nutrients around the body. Heart failure is a medical term to describe a weakness of the heart
muscle leading to it having less ability to push blood forward. The term “heart failure” is unfortunate, because it
implies that the heart has actually failed! It is a very common problem in the population and there is an increased risk
with age.
Heart failure leads to back pressure in the system. If the pressure becomes particularly high, water in the blood
moves across the blood vessel and into the tissues of the body – this often shows itself by swelling in the feet, legs
and abdomen. This might eventually lead to the heart becoming bigger and it therefore has to work harder.
The causes of heart failure.
The heart may have coped with conditions that put an extra workload on the heart
before heart failure shows itself. Some of these might be high blood pressure, abnormalities in the heart valves,
thyroid gland disease, abnormal heart rates or anaemia.
On the other hand a patient might have a cardiac arrest (heart attack) or prolonged high blood pressure: these are
found to be the more common ones. Others might be heart valve disease, infection of the heart muscle a viral
infection, abnormal heart rhythms or excessive alcohol consumption.
Symptoms of heart failure.
Shortness of breath on exertion or when lying flat or in bed. Feeling tired or
lethargic, swollen legs, feet or abdomen, weight gain due to accumulation of fluid are the main obvious symptoms.
However please note that smoking does cause breathlessness and ankle swelling is often caused by varicose veins.
Diagnosis of heart failure.
Tests will include an electrocardiogram (ECG), chest x-rays and blood tests.
Treatment. Some will be chosen for you but there are also ways that you can help yourself. Weigh yourself
regularly and check for excessive swelling, particularly in the legs or stomach. Seek advice before you become
breathless. If you do feel breathless, go to your GP. Reduce your weight if you are obese in any way. Above all stay
positive, reduce stress and accept advice from professionals and support groups like ourselves.
Drugs.
o Diuretics (water tablets) increase the amount of water and salt passed from the kidneys into the urine.
o Ace inhibitors have a relaxing effect on the arteries and reduce the amount of work the heart has to do.
o Digoxin treats atrial fibrillation and will usually slow the heart rate.
o Anticoagulants reduce the risk of the formation of blood clots.
o Antiplatelet drugs stop the blood platelets from sticking together to form clots.
Have the annual flu vaccination and the one-off pneumonia vaccination. Check any over the counter medicines with
your pharmacist. Avoid non-steroidal antiflammatories such as ibuprofen. See Perspective on Drugs no 2.
Physical activity. – Pace your daily/weekly activities sensibly. Take regular exercise within your limitations.
Consumption of water. About 3 pints a day is about right for the average adult. If it is hot or if you have a vomiting
sickness, you obviously need to drink more. If the latter persists, stop taking diuretics and seek medical advice
immediately.
Reduce salt intake to 3 grams a day (about teaspoon). Remember salt is hidden in food, particularly if it is processed
in any way. Look at the packages before you buy. Do not use “Lo-salt”, as this is rich in Potassium.
Smoking.
Give it up. Seek advice to do this.
Alcohol consumption. Reduce it.
Surgery or the implantation of an ICD, LVAD or pacemaker. Consider this positively if advised about this.
References.
BHF booklets: Heart attack (No 7), Living with heart failure (No 8).
GCS/05.01.10
Geoff Shaw