Heart failure treatment

Heart failure has multiple causes, and is usually the result of a number of problems happening at the same time.

Some of these problems can cause heart failure to develop slowly over months or years, while others, such as a heart attack or infection, causes heart failure to happen suddenly.

Some causes of heart failure include:

• Heart attack: A heart attack or myocardial infarction (MI) occurs when blood flow to the heart is suddenly blocked leading to damage to the heart muscle
• Coronary artery disease
• Cardiomyopathy – A disease of the heart muscle that can have several causes
• Cardiac arrhythmia
• Anaemia: a lack of red blood cells that carry oxygen in the blood
• Congenital heart conditions: A heart condition you are born with
• Heart valve disease: A disease where the heart valves don't function properly disrupting blood flow through the heart and putting strain on the heart muscle
• Cardiac amyloidosis: A condition where abnormally shaped proteins build up around your heart muscle affecting its ability to pump effectively
• Endocarditis: A viral infection that affects the heart muscle
• Pulmonary hypertension: Increased pressure in the blood vessels that supply your lungs
• Some chronic conditions such as high blood pressure, thyroid disease, diabetes, and kidney disease can overwork the heart and lead to heart failure
• Chemotherapy

Some people are at a higher risk of developing heart failure due to factors such as their age, lifestyle and medical and family history.

Risk factors for heart failure include:

• Age: Heart failure is more common in people over 65
• A family history of heart disease
• Smoking
• Excessive alcohol consumption
• Some recreational drugs such as cocaine
• A sedentary lifestyle
• Overweight and obesity
• Having a heart attack
• Having a chronic health condition such as high blood pressure, coronary artery disease, diabetes, thyroid disease or kidney disease
• Eating a lot of foods high in salt and fat

The symptoms of heart failure vary from person to person. They may be mild, moderate or severe and can start suddenly or come on slowly over weeks, months or even years.

Common symptoms of heart failure include:

• Shortness of breath
• A persistent cough, which may be worse at night
• Wheezing (noisy breathing)
• Fatigue
• Swollen feet, ankles and legs (oedema)

Less common symptoms of heart failure include:

• Abdominal bloating
• Loss of appetite
• Nausea
• Needing to pee more often, especially at night
• Dizziness
• Weakness
• Weight changes
• Confusion
• Rapid or irregular heartbeat

Your heart is a muscular pump that takes blood containing oxygen from your lungs and delivers it around your body to your cells, tissues and organs, before returning deoxygenated blood to your lungs.

The left side of your heart receives oxygen-rich blood from your lungs, which it delivers to the rest of your body, while the right side of your heart receives oxygen-poor blood from your body, and delivers it to your lungs where it gets more oxygen.

The type of heart failure you have depends on which side of your heart is affected.

Left-sided heart failure (left ventricular heart failure)

Left-sided heart failure is the most common type of heart failure and occurs when the left side of your heart – your left ventricle – can't pump enough blood around your body.

There are two types of left-sided heart failure:

Systolic heart failure

Systolic heart failure occurs when your left ventricle can no longer contract normally, making it too weak to pump enough blood into circulation.

When this happens, the ejection fraction (EF) – the percentage of blood your heart can pump with each beat – drops from 60% EF to 40% EF, causing what's known as heart failure with reduced ejection, or HFrEF.

Diastolic heart failure

Diastolic heart failure occurs when your left ventricle stiffens, preventing it from relaxing. As a result, your heart can’t properly fill with blood in the resting period between each beat, causing heart failure with preserved ejection, or HFpEF.

Right-sided heart failure

Right-sided heart failure usually occurs as a result of left-sided heart failure. When your left ventricle can't push blood out to the rest of the body, it places extra pressure on your right ventricle and the blood vessels carrying blood from your heart to your lungs.

This extra pressure is called pulmonary hypertension, and makes the right side of your heart work harder to push blood to the lungs. Overtime, the right side of your heart loses power, causing blood to back up into your veins.

Heart failure is a condition that gets progressively worse over time. The stage of your heart failure is determined by how effectively your heart can still pump blood. Stages are categorised on a scale of one to four, with one being the mildest (earliest) stage and four being the most severe (latest) stage of the condition.

• Stage 1: No symptoms during everyday activity
• Stage 2: No symptoms when resting, but symptoms occur during normal activity
• Stage 3: No symptoms when resting, but symptoms occur during minor activity
• Stage 4: Any physical activity causes symptoms and you may have symptoms while resting

The cost of heart failure treatment depends on your individual circumstances. At the time of your appointment your consultant will discuss all options with you and ensure all your questions are answered.

Our fixed-price packages include the cost of your surgery and all appropriate aftercare appointments. However, any pre-surgery diagnostic tests and your consultant's outpatient appointment consultation fee are charged separately.

Our flexible payment options help you spread the cost of your payment across a time period that suits you.

At your first consultation, you'll be seen by a consultant cardiologist, a doctor specialising in conditions affecting the heart. 

Your consultant will ask you about your symptoms, general health, medical and family history. They may also ask you some questions about your diet and exercise regime, and about your lifestyle, such as whether you smoke, drink alcohol or take recreational drugs. They will perform a physical examination to assess you for signs of heart failure such as swollen feet, legs and ankles and shortness of breath.

Your first appointment is important as it's where you'll meet your consultant, the doctor responsible for your care. Your consultant will take time to get to know you, discuss your expectations for treatment and encourage you to ask any questions you may have.

At Circle Health Group, we want you to be as well-informed and comfortable as possible during your treatment, so please discuss any questions or concerns with your consultant during your appointment.

How is heart failure diagnosed?

If heart failure is suspected, your consultant may order one or more of the following tests to confirm your diagnosis:

• Blood tests: To assess your general health and check for any underlying medical conditions
• Electrocardiogram (ECG)
• Echocardiogram
• Cardiac stress test
• Chest X-ray
• Lung function tests

While there is currently no cure for heart failure, there are treatments that can improve your symptoms and help slow the progression of the disease.

Your consultant will create a tailor-made treatment plan for you depending on your symptoms, general health and the type and stage of your heart failure.

Treatments for heart failure include:

• Lifestyle changes
• Medication
• Implanted devices
• Surgery

Lifestyle changes

You can make the following lifestyle changes to slow the progression of heart failure, reduce your symptoms and improve your quality of life:

• Stop smoking
• Lose weight
• Follow a healthy diet
• Take regular exercise

Your consultant may refer you to a cardiac rehabilitation programme which focuses on education and support in living with heart-related conditions such as heart failure.

Medications

There are several medications used to treat heart failure including:

• Angiotensin-converting enzyme (ACE) inhibitors: Relax and dilate (open) your blood vessels, lower blood pressure and make it easier for your heart to pump blood
• Angiotensin-2 receptor blockers (ARBs or AIIRAs): Work in a similar way to ACE inhibitors by relaxing and dilating your blood vessels
• Beta-blockers: Slow your heart down and reduce the force at which blood is pumped around your body
• Digoxin: Slows your heart rate and strengthens the contractions of your heart muscle
• Diuretics (water tablets): Make you pass more urine and relieve symptoms of heart failure such as swollen ankles and shortness of breath
• Mineralocorticoid receptor antagonists: Reduce blood pressure by making you pass more urine. Unlike diuretics, they don't lower potassium levels.
• Hydralazine with nitrate: Works by relaxing and dilating your blood vessels
• Ivabradine: Slows your heart rate and may be prescribed as an alternative to beta blockers
• Sacubitril valsartan: This is a combination of two medications, sacubitril and valsartan, which work together to strengthen your heart's pumping ability and prevent fluid buildup.
• SGLT2 inhibitors: Work by lowering blood sugar and blood pressure and can be used to treat chronic heart failure with reduced ejection fraction (EF)

Implantable devices

In some cases, if lifestyle changes and medication haven't worked to improve your symptoms, your consultant may recommend implanting a small device in your chest to control your heart's rate and rhythm.

Implantable devices used to treat heart failure include:

• Pacemaker
• Cardiac resynchronisation therapy (CRT): A type of pacemaker that synchronises the walls of the left ventricle, so they contract at the same time and make your heart beat more efficiently
• CRT-D: A device that combines a cardiac resynchronisation device and an implantable defibrillator
• Implantable cardioverter defibrillator (ICD)
• Pulmonary artery pressure sensor: A device that is implanted into an artery and sends blood pressure readings to a monitor

Surgery

If your heart failure is severe and hasn't responded to other treatments, you may be suitable for surgery.

The type of surgery your consultant recommends will depend on the type, stage and cause of your heart failure as well as your symptoms, age and general health.

To treat heart failure, you may have one of the following surgeries:

• Heart valve surgery, where your surgeon replaces your diseased heart valves with artificial valves
• Coronary angioplasty bypass graft (CABG), where your surgeon diverts blood flow from clogged arteries into new blood vessels, known as grafts
• Coronary angioplasty, where a small balloon opens your narrowed artery and a stent is put in to hold your artery in place
• Left ventricular assist device (LVAD), a type of artificial heart pump that helps the heart pump more effectively. It can be used as a temporary measure for patients awaiting a heart transplant, or as a permanent treatment.
• Heart transplant, where your diseased heart is replaced with a healthy one from a donor

The side effects and possible complications you could face as a result of your heart failure treatment depends on the type of treatment you have. Whether it's getting a pacemaker or undergoing a heart transplant, your consultant will discuss any potential side effects and complications with you before you start your treatment.

It's important that you are fully aware of all the possible side effects and complications before you start your treatment as this will allow you to make an informed decision.

Always follow your consultant's instructions carefully before starting any treatment and please discuss any questions or concerns you may have with your consultant.

At Circle Health Group, we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about heart failure treatment, book your appointment online or call a member of our team today.

1. Chronic heart failure National Institute for Health and Care Excellence
2. Treatment. Heart failure NHS
3. Heart Failure Treatment National Heart, Lung and Blood Institute
4. Heart failure British Heart Foundation