Frequently asked questions on heart failure

For patients and their carers, it is important to know why they have Heart Failure, because it then puts the diagnosis into context. Heart Failure can be caused by current or past medical conditions, which either damage or add extra workload to the heart.

If you have (or had) more than one of these conditions, your risk of Heart Failure is substantially increased. Your doctor should be able to tell you what may have caused your Heart Failure. This section lists the different conditions that can cause or trigger Heart Failure, explaining what each condition is.

Some of the more common causes of Heart Failure include:

• Previous heart attacks
• Coronary artery disease
• High Blood Pressure
• Heart valve disease
• Heart muscle disease or inflammation of the heart
• Congenital heart defects
• Lung conditions
• Alcohol or drug abuse

In some cases, someone whose body is compensating well for his/her Heart Failure may develop symptoms if their heart is temporarily unable to keep up with their body’s needs. Conditions that can trigger this type of Heart Failure include:

• Infection
• Kidney disease or poor kidney function
• Anaemia
• Abnormal heart rhythm
• Overactive thyroid gland

If these triggers are treated, Heart Failure can often get better.Other conditions, such as diabetes, may aggravate Heart Failure.

In addition, people with Heart Failure frequently become symptomatic if they stop taking their medicines, or don’t follow their treatment plan properly.For some people, the cause of their Heart Failure is unknown, and they don’t have any of the conditions listed above. If you are unsure of the cause of your Heart Failure, you should discuss it with your doctor.

2. What are the symptoms of Heart Failure?

Heart Failure symptoms can vary widely from person to person, depending on the type of Heart Failure you have. Therefore, you may experience all the symptoms described here, or just a few of them.

In the early stages, you may not notice any symptoms, but if your Heart Failure progresses, you are likely to experience symptoms which may become more severe. The main symptoms of Heart Failure are caused by fluid accumulation, or congestion and poor blood flow to the body.

Symptoms caused by fluid accumulation or congestion:

• Shortness of breath
• Cough or wheezing
• Weight gain
• Swollen ankles, legs, or abdomen

Symptoms related to the reduced flow of blood to parts of the body:

• Tiredness or fatigue
• Dizziness
• Rapid heart rate

Other symptoms of Heart Failure:

• Loss of appetite
• Needing to urinate at night more than usual

3. How is Heart Failure diagnosed?

If you suspect that you have symptoms of Heart Failure, you should talk to your doctor. Your doctor will more than likely perform a thorough examination of your body and will ask you about your symptoms, your medical history and your lifestyle. It is important that you answer any questions as honestly and accurately as possible, so that your doctor can make an accurate diagnosis and can work with you to find the best treatment.

If your doctor suspects you have Heart Failure, he or she will probably suggest you have certain tests done. These tests will help to show whether your heart is working properly and, if not, where the problem lies.

After taking a medical history and doing a physical examination, the most common tests are:

• ECG
• Blood tests
• Chest x-ray
• Exercise testing
• Lung function test
• Echocardiogram
• Cardiac catheterisation and angiography
• Computerised tomography (CT scan), or Magnetic Resonance Imaging (MRI scan)

As the symptoms presented to the doctor may vary widely between patients, you may only be required to do a few of these tests – it is very unlikely you will have to do them all. If you have any concerns regarding your tests, you should discuss them with your doctor.

4. Can Heart Failure be cured?

Heart Failure is a serious, chronic condition that tends to gradually worsen over time. Eventually, it can shorten your life.

The progress of Heart Failure is unpredictable and different for each individual. In many cases, the symptoms remain at a stable level for quite some time (months or years) before becoming worse. In some cases, the severity and symptoms gradually worsen over time, or they may progress rapidly following, for example, a new heart attack, a heart rhythm disorder, or a lung infection. Such acute conditions usually respond to treatment.

Most importantly, you should understand that careful management of your condition can not only ease symptoms, but can also improve prognosis and prolong life. Your doctor and other members of your healthcare team will work with you to treat your condition effectively, using a combination of medical treatments and changes to your lifestyle.

5. Can a person have Heart Failure without being aware of it?

It is common for people to be in the early stages of Heart Failure and not be aware of it. Early on, there may be no symptoms because the body and heart can often compensate for any deficits. When symptoms start, they may resemble other illnesses. Early symptoms include shortness of breath, racing heartbeat, trouble sleeping, extreme fatigue and weakness. In some cases, Heart Failure can occur suddenly, and symptoms may include severe shortness of breath, irregular or fast heartbeat and a cough with foamy, pink mucus. If you experience any signs and symptoms of Heart Failure, see a doctor.

6. Will I need to take medication for the rest of my life?

You are likely to require medication for your Heart Failure for the rest of your life. There are lots of different medicines that you may be given. They can help to keep your symptoms under control and improve your quality of life. Some of them carry side effects, but the benefits usually greatly outweigh the problems. If you do find it hard to cope with one of your medicines because of the side effects, it is important to talk to your doctor who can help you. Don’t stop taking your medicines or adjust any doses. Your doctor may be able to work with you to find a dose or a version that suits you better.

However, it is important to note that the initial side effects of Heart Failure drugs are very common, but disappear after time. Therefore, it’s essential to persevere with the help of your doctor or nurse. Not all medicines are needed by every person with Heart Failure. Which medicines are right for you will depend on your symptoms, general health and lifestyle.

Your doctor will consider any other medical problems you have that may affect your treatment. It is very important to take your medicines exactly as your doctor advises, as this will ensure that the medicine works for you. In order to get the best effects, some medicines must be given at the optimal dose, which usually means that the dosage of tablets must be increased over time. This is called up-titration, which means gradually increasing the dosage of medicine.

Blood Pressure, Heart Rate and blood test results may need more careful monitoring during periods when medication is changed – your doctor or nurse will be able to advise you. You are likely to need more than one medicine at a time. Making a note or chart may help you to keep track.

7. Will natural remedies or nutritional supplements help my Heart Failure?

You may have read some encouraging claims about alternative or natural/herbal therapies. However, there is often no medical evidence that these improve Heart Failure. On the contrary, ingredients within some of these alternative therapies may interfere with the actions of some Heart Failure medicines and may have harmful effects.

Some of the more common alternatives or natural remedies that may affect certain Heart Failure medicines include:

• Ephedra
• Ephedrine metabolites
• Chinese herbs
• Hawthorn (crataegus) products
• Garlic
• Ginseng
• Ginkgo

It is strongly recommended that you talk to your doctor or pharmacist before taking any alternative/natural/herbal remedies.

8. Can I still have sex?

Many people with Heart Failure are not sure if they should have sex because of their condition and may feel embarrassed to raise this question with their doctor or nurse. The good news is that most people with Heart Failure can continue to enjoy sexual relations once their symptoms are under control.

Just as with any other activity, you shouldn’t have sex if you are feeling ill, are very short of breath, or are experiencing chest pains. You may feel more comfortable and confident when trying the following:

• Choose a time for sex when you are rested, relaxed and not pressured
• Avoid having sex immediately (approx. 1 hour) after eating a big meal, or drinking excessive amounts of alcohol
• Have sex in a comfortable, familiar room that is not too hot or too cold and where you will not be interrupted
• Use foreplay as a warm-up period to help your body get used to the increased activity level of intercourse
• Have sex in less strenuous positions, such as lying on the bottom, or with you and your partner lying side by side. If at any time, you start to feel uncomfortable, breathless, or tired during intercourse, stop and rest for a short while.

It is also important to remember that you may not feel like having sex after a diagnosis such as Heart Failure. Feelings like stress, anxiety and depression are natural after a diagnosis of this nature and can often cause a loss of interest in sex. If this is the case, you might like to find other ways of being physically close and intimate with your partner. For example, you could spend time hugging, kissing and touching instead. This may also be reassuring for your partner.

Also, bear in mind that people with Heart Failure frequently have physical problems with sex such as erectile dysfunction (impotence), problems with ejaculation, or the inability to have an orgasm or climax. In some rare cases, some of the medications prescribed for Heart Failure may also cause such problems. Don’t be shy. Most people with Heart Failure can enjoy a rewarding sex life. You should seek advice from your doctor or nurse if you have any concerns. There are very effective medical treatments available that most people with Heart Failure can use as required, and you should discuss this with your doctor or nurse. Take the time you need to accept your new situation. Your interest in sex may well return after you begin to take charge of your health and make appropriate lifestyle adjustments.

9. Is it safe for me to fly?

Air travel is not usually a problem for people with Heart Failure, even though oxygen levels are slightly lower – even in pressurised commercial aircraft cabins. However, some people may sometimes need supplemental oxygen during the flight. Generally, if your Heart Failure is well controlled and stable, you should not have any difficulties with mild reductions in oxygen levels in a plane, provided your symptoms are stable before you travel. If you have new or worsening symptoms – such as increasing shortness of breath or recent weight gain – you should discuss your travel plans with your doctor. In some rare cases, your doctor may recommend supplemental oxygen for your flight, so make sure you contact the airline you are flying with in advance of your trip, so that you can check their policy on the use of supplemental oxygen and make the appropriate arrangements.

If you have had a device (e.g., pacemaker) implanted, then it will probably be detected by the security machines. You should inform the security personnel beforehand. Security control and air travel will not interfere with the function of your device. Devices use standard technology, and you will be able to have your device checked in most parts of the world, if required. Sitting still for long periods in cramped positions in an aircraft often leads to swollen ankles and sometimes muscle cramps. Regular stretching and mobility exercises can help, as well as walking around the cabin and while waiting in airports. Try to avoid alcohol and be sure to drink enough water. In some cases, your doctor may recommend that you wear knee-high support stockings during the flight to prevent blood clots (DVT).

10. Is it safe for me to have vaccinations?

Caring for yourself when you have Heart Failure is mainly about staying as well and as healthy as possible. One way to stay well is to minimise the risk of getting respiratory infections like influenza (flu) or pneumonia, as respiratory problems can worsen Heart Failure. Safe vaccines that can provide immunity against flu and pneumonia are available. You should discuss having these vaccines with your doctor, who will be able to advise you in more detail about them. When travelling, your travel agent will advise you on the immunisations or medications needed. Discuss these immunisations and medication with your doctor (e.g., malaria tablets), that may be required for your destination.