Download THE BHI HEART FAILURE SERVICE – A GUIDE FOR PATIENTS

THE BHI HEART FAILURE SERVICE – A GUIDE FOR PATIENTS
Aims of the Heart Failure Service
Heart failure is often a chronic condition that at times may make you feel very unwell. The
aim of the heart failure service is to ensure that you receive the best treatment possible,
that is based on the most up-to-date medical research, and provide monitoring and support
to improve how you feel. We will provide information about your diagnosis and treatment
to you and your relatives.
We also aim to prevent you from being admitted to hospital unnecessarily. Many patients
will need to come into hospital occasionally for review and possible changes to treatment.
We aim to ensure that your admission to hospital is appropriate and timely rather than an
as an unplanned emergency.
What is Heart Failure?
Heart failure is a term to describe the signs and symptoms that occur when the heart is not
able to pump effectively.
There are a number of types of heart failure, including:
Heart failure due to left ventricular systolic dysfunction: The left side of the heart is weak
and the heart’s ability to pump blood around the body is reduced.
Heart failure with preserved ejection fraction (diastolic dysfunction): A type of heart failure
when the walls of the heart become stiff and the heart may not be able to fill with blood
effectively.
Cardiomyopathy: Disease of the heart muscle which can have a number of different causes
including genetic, alcohol and viral infection.
Right Heart Failure: The right side of the heart is unable to adequately pump blood to the
lungs.
How is Heart Failure diagnosed?
Diagnosis is confirmed by echocardiogram, a painless ultrasound test that uses sound waves
to examine heart function. You will also have blood tests. You will be seen by a heart
failure nurse who will carry out a full assessment and discuss all aspects of your heart
failure with you. You will be given relevant literature that includes the number of the heart
failure helpline service. There will be time for you to ask questions and make sure that you
have a good understanding of how to manage your condition.
Follow-up can occur at a number of clinics in north or south Bristol. When you have an
appointment with the heart failure specialist nurse, cardiologist or GP, please bring a list of
all your tablets and your ‘patient-held record folder’ if you receive community heart failure
visits.
Self Assessment – Is my Heart Failure Worsening?
Over time, people with heart failure usually learn to recognise the signs and symptoms if
their condition is worsening. This checklist may help if you are unsure what to look for:

Weight increase or decrease suddenly (by 1kg or 2.2lb) per day over two or three
consecutive days. We suggest that you weigh yourself every day at the same time.

Breathlessness worse than usual

Waking up at night due to breathlessness

Needing more pillows than usual, or needing to sleep ‘propped up’

Increase in feet and leg swelling

Shoes and clothes feeling tighter than usual

Feeling more tired than usual

Tolerance of physical activity reducing

Feeling dizzy, faint or having blackouts

Heart racing, slow heart, missed beats or palpitations

New chest discomfort or pain or angina is worse than usual
When to call for help or advice
One of the main aims of the heart failure service is to prevent you from needing to be
admitted to hospital unnecessarily. It is important that you are aware of these signs that
may indicate that your heart failure is worsening so that you know when to call for help or
advice. It is important that you do not delay making contact with either your heart failure
nurse or GP if you feel that things are getting worse, regardless of whether you have an
appointment booked for the near future.
The Treatment of Heart Failure
Medicines are the usual treatment for heart failure. The medicines that you will be
prescribed will depend on the type of heart failure that you have and your symptoms.
Taking your tablets properly is vital for treating the causes and symptoms of heart failure,
with the aim of making you feel better and live longer. Your doctor or heart failure nurse
will discuss the treatments you are taking and how they work. Take all of your medications
as prescribed, unless you are concerned about them, in which case you should contact your
GP or heart failure nurse before making any changes. These are the most commonly used
medicines for heart failure:
Diuretics ( also known as water tablets):
Names: Furosemide, Bumetanide, Bendroflumethiazide, Metolazone.
Action: Help your kidneys get rid of excess fluid by making you pass more urine. This will
reduce breathlessness and swelling to legs and other parts of the body.
Side effects: Passing urine more often , dizziness, light-headedness and gout. Watch for any
difficulties passing urine
Diuretics are usually taken in the morning to avoid you having to get up frequently in the
night, but you may choose to take your diuretic in the afternoon if you have a morning
appointment.
ACE-inhibitors/Angiotensin II Receptor Blockers
Names: Ramipril, Lisinopril, Perindopril, Enalapril, Candesartan, Losartan, Valsartan.
Action: Improve life expectancy and heart failure symptoms. They make it easier for your
heart to pump blood around your body by reducing the heart’s workload. You will be
offered a low dose at first and it may be gradually increased. Before and after each dose
increase you will have a blood test to check how effectively your kidneys are working, and
have your blood pressure measured.
Side effects: dry irritating cough, dizziness, itchy rash, swelling of lips or mouth
Beta-Blockers
Names: Bisoprolol, Carvedilol, Metoprolol, Nebivolol
Action: they help to slow down your heart rate and stop it beating too forcefully. This helps
your heart to pump more blood around your body. You will be offered a low dose at first
and it may be gradually increased.
Side effects: tiredness, cold fingers and goes, dizziness, vivid dreams, nightmares, skin rash,
nausea and diarrhoea and impotence.
Aldosterone Antagonists
Names: Spironolactone, Eplerenone
Action: improve life expectancy, they have a mild diuretic effect which can reduce
ankle/leg swelling and improve breathlessness. You will have regular blood tests to check
kidney function and potassium levels.
Side effects: breast enlargement and tenderness in some men who are taking
Spironolactone. It can affect kidney function so report it if you start to pass less urine than
usual.
Ivabradine
Action: works in a different way to Beta-blockers to reduce the heart rate.
Side effects: blurred vision, dizziness, nausea, diarrhoea, vomiting.
Digoxin
Action: Slows down your heart rate and strengthens the heart to allow it to pump more
efficiently. In heart failure it can reduce symptoms if you are already taking a Beta blocker,
ACE inhibitor and a diuretic.
Side effects: nausea and vomiting, diarrhoea, rash, dizziness, disturbed vision, low heart
rate.
Sick Day Rules
If you are unwell with significant or prolonged diarrhoea or vomiting which lasts more than
12-24 hours, or are unable to drink fluids, you may need to stop some of your heart failure
tablets for the period of your illness. These are the tablets you should stop if you become
unwell:
ACE inhibitors – Ramipril, Lisinopril, Captopril, Perindopril.
Angiotensin II Receptor Blockers – Candesartan, Losartan, Irbesartan, Telmistartan or
Valsartan.
Aldosterone Antagonists – Spironolactone and Eplerenone
Diuretics – Furosemide, Bumetanide, Metolazone, Bendroflumethiazide
It is important to seek medical advice in these circumstances, especially if you are becoming
dehydrated. As soon as you have recovered, it is important to start taking your tablets
again.
Devices
For some people with heart failure that is not responding well to the usual medications, we
can sometimes consider implanting a pacemaker device to help improve the heart’s
pumping function. Your cardiologist or heart failure nurse will discuss this with you if
appropriate.
Lifestyle
Making changes to your lifestyle can improve symptoms, improve your quality of life and
slow disease progression.
Stop Smoking. Smokers who stop smoking are more likely to see their heart failure
symptoms improve. Long-term smokers may need help to stop smoking. The contact
details for the smoking cessation service is at the back of this leaflet.
Cut Down on Salt A high salt diet can lead to fluid retention. To pump this extra fluid, the
heart has to work even harder and this extra work can cause or worsen breathlessness.
Never add salt at the table, try cooking with less salt. ‘Lo-Salt’ substitutes are not
recommended as they still contain salt and are higher in potassium. Avoid high salt foods, eg
ham, sausages, bacon, salted nuts, Bovril, crisps, tinned soups, ready-meals, fast food etc.
Alcohol It is usually okay for patients with heart failure to consume a modest amount of
alcohol. You should following the recommended levels for safe alcohol consumption of 14
units a week, and should drink no more than 2 units in one day.
1 unit = One half of beer or cider, one small glass of wine or one pub measure (25ml) of
spirits.
2 units = One pint of beer or cider.
10 units = 1 bottle of 13.5% wine.
Your heart failure nurse will advise you if you should avoid alcohol completely.
Watch Your Fluid Intake:
Fluid management is important in managing heart failure. You may be prescribed diuretics
(water tablets) to get rid of extra water. Water tablets may make you feel thirsty, so in
order to make sure that you do not drink too much fluid it is important to monitor your fluid
intake. You should aim to drink not more than 1.5-2 litres (2.5-3.5 pints) per day. This
includes tea, coffee, water and any other drinks.
To help keep to this limit, find out how much water your mug, glass or bowl takes so that
you can add up your total amount of fluid. Or use a 2 litre bottle of water and use for all
your fluid intake that day.
Maintaining an Ideal Weight
Being overweight puts extra strain on your heart as it has to work harder to deliver oxygen
to the body tissues. If you are overweight, losing weight can help reduce the strain on your
heart. The British Heart Foundation has published two leaflets that give advice on healthy
eating, ‘Eat Well, Shop Smart, Save Money’, and ’10 Minutes to Change Your Life – Time to
Eat Well’. Both can be ordered via phone or email, contact details are at the end of this
leaflet.
Exercise
Regular exercise is important, including for heart failure patients. Exercise may help regulate
your blood pressure, improve circulation and help with weight loss. Try and have a regular
routine so that exercise becomes part of your lifestyle. Don’t exercise if you are unwell,
have chest pain, are very short of breath or have been having dizziness or palpitations.
‘Flu and Pneumonia Vaccination
Ensure that you are protected by an annual ‘flu, and one-off pneumonia vaccines as getting
the ‘flu or a chest infection can make heart failure symptoms worse and sometimes causes
people to be admitted to hospital.
Sex
It is fine to engage in sexual activity as long as it does not cause you to be more than mildly
breathless or cause chest pain.
Driving
Most people with heart failure are able to drive a car. If you need a licence to drive a heavy
goods or passenger vehicle, please ask your doctor or heart failure nurse to check the
latest guidelines from the DVLA.
Travel
Usually if you are not too troubled by heart failure symptoms, you should be able to travel
safely, including by ‘plane. If you have worsening symptoms, seek advice before you travel.
It is highly advisable to have adequate travel insurance in place, and ensure you have
sufficient tablets for the duration of your trip.
Contacting the Heart Failure Team:
The hours of service are Monday to Friday 09.00am to 5.00pm.
Telephone no: 0117 342 660 or 0117 342 6696. – an answerphone is available on these
numbers, so please leave a message, stating your full name, and your BRI hospital number,
or your NHS number. One of the heart failure nurses will call you back as soon as possible.
If your call is urgent and the heart failure nurse does not answer when you call, please ring
the BRI main switchboard who will contact the nurse via a pager.
Bristol Royal Infirmary Switchboard: 0117 923 0000. Pager number 3687 or 3503.
More information can be found at:
Stop Smoking Bristol – www.smokefreebristol.com. Tel 0117 922 2255
British Heart Foundation – www.bhf.org.uk. Tel 0300 330 3322
Pumping Marvellous. – www.pumpingmarvellous.org- Tel 0800 978 8133
Cardiomyopathy UK – www.cardiomyopathy.org. Tel 01494 791224