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HEART FAILURE
The information in this booklet is not a substitute for the advice your doctor may give you based on his or her knowledge of your condition. This booklet is available in Bengali, Gujarati, Hindi, Punjabi and Urdu. This English version has been produced to help relatives, carers and health professionals who do not read these languages.
Acknowledgements
The British Heart Foundation would like to thank: Haslemere Allotments Gordon House Surgery, and Professor Jaspal S Kooner, Dr Nabeel Ahmed and Ealing Hospital for their continued support.
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Contents
What is heart failure? What are the symptoms of heart failure, and how is it diagnosed? What can be done for heart failure? Medicines to treat heart failure What you can do to help yourself Other treatments that can help some people with heart failure Heart failure and your quality of life If you look after someone with heart failure For more information Technical terms Index 5 8 15 16 24 38 39 42 44 46 47
arteries
the heart
arteries
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A heart attack causes damage to the heart muscle. This happens when the heart muscle is deprived of oxygen and blood because the arteries have become blocked, as in coronary heart disease. (For more information on coronary heart disease, see our booklet Living with angina and heart disease. See page 44.) High blood pressure is when the pressure of the blood in the arteries is too high. People with high blood pressure rarely have symptoms, but if the high blood pressure is not treated, it can lead to heart failure. Knowing what causes high blood pressure can help to reduce your risk of this happening to you. We explain more about high blood pressure on page 26.
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Other possible causes of heart failure are: a viral infection a disease of the heart muscle called cardiomyopathy heart valves that either leak or are too narrow an abnormal heart rhythm (an arrhythmia) drinking too much alcohol thyroid gland disease, or anaemia (a lack of iron in the blood).
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breathlessness swelling of the ankles and feet, and tiredness, which can be mild or severe.
Symptoms may come on suddenly, or they may develop slowly over weeks or even months. They may also happen after a heart attack. However, these symptoms can also be caused by other medical conditions, so it is important to talk to your doctor to get an accurate diagnosis.
Breathlessness
If you have heart failure, breathlessness is most likely to happen when you are active or when you are lying flat in bed. It may even wake you up at night, and you may need to sit up, with pillows to support you, or go to the window for some fresh air. The breathlessness is caused by a build-up of fluid in the lungs, which can make you wheeze or cough. Being breathless can be very frightening, which can make the breathlessness worse.
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Tiredness
The tiredness can be mild or severe. For some people, it can be quite overwhelming, making it difficult to carry on as normal. The tiredness is caused by your muscles not getting enough oxygen, or because you are not sleeping properly. We explain how to help control these symptoms of heart failure on page 15. If you have these symptoms and they are getting worse, you should speak to your doctor or nurse immediately. If the symptoms are very bad, you should call 999 for an ambulance.
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examine your heart rate and rhythm take your blood pressure check whether you have fluid in your lungs, legs and in other parts of your body listen to sounds made by your heart valves, and check if the blood pressure in your neck is high.
Your doctor will also do blood tests to find out if you have early signs of anaemia, kidney damage or thyroid disease. The other tests you will have are an electrocardiogram (ECG), an echocardiogram (see photo opposite) and a chest X-ray.
An electrocardiogram (ECG)
An ECG is a test that records the rhythm and electrical activity of your heart. Several small sticky patches are put onto your arms, legs and chest. The patches are connected to wires which lead to the ECG recording machine. This recording machine picks up the electrical signals produced by each heartbeat and records several beats onto paper. The ECG machine only records signals from your heart. It does not affect your heart in any way. The whole test takes about five minutes and is not uncomfortable at all.
An echocardiogram
An echocardiogram is a test to check the pumping action of your heart. A recorder (probe) is placed on your chest and a pulse of high-frequency
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sound is passed through the skin of your chest. Lubricating jelly is rubbed on your chest first, to help make a good contact with the probe. The probe then picks up the echoes reflected from various parts of the heart and shows them as a picture on a screen. The test can take up to an hour. It doesnt hurt at all.
Class 1 Very few or no obvious symptoms In people with Class 1 heart failure, the heart is not working as well as it should be, but they should be able to do everything that they normally do. Class 2 Mild heart failure People with Class 2 heart failure may get breathless when they do everyday activities. Class 3 Moderate heart failure People with Class 3 heart failure are quite limited in what they do, and find that they are breathless and become exhausted easily. They are usually comfortable when they are resting. Class 4 Severe heart failure People with Class 4 heart failure are breathless even when they are not very active for example, when walking around the house or even while resting. They may be unable to sleep lying down because they get breathless or because it makes them cough.
Your doctor will classify your heart failure into one of these groups by examining you, doing some of the tests described on page 10 and talking to you about your symptoms.
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Breathlessness
It is normal to become breathless when you are physically active. Breathlessness is only a problem if you find that you are becoming increasingly breathless doing activities that you could previously do easily such as walking, climbing stairs, shopping or hoovering. Breathlessness is also common in smokers. And people who are very overweight may get very out of breath when they are physically active.
Swelling
Ankle-swelling can be caused by varicose veins, especially in women. It can also be a side effect of some medicines. People who are overweight may get swollen ankles even if they do not have heart failure.
Tiredness
Tiredness can be a result of a number of conditions, such as anaemia or an underactive thyroid gland. It can also be a side effect of some medicines.
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Your doctor may prescribe one or more of these medicines for you: diuretics ACE inhibitors beta-blockers anti-platelet drugs digoxin anticoagulants.
You may also be given nitrates. And you may be given statins, to lower your cholesterol level. (For more information on nitrates and statins, see our booklet Taking medicines for your heart. See page 44.)
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On the following pages we explain what the medicines do to help your heart failure. For information on the side effects of these medicines, see our booklet Taking medicines for your heart. (See page 44.) Serious side effects are rare. If you do get any side effects, tell your doctor so that he or she can change your dose, or perhaps give you a different medicine instead. Most people with heart failure will have regular blood tests to make sure that the levels of important substances in the blood such as potassium and sodium remain within the normal limits. People who have heart failure may need to have these blood tests more frequently than people who are taking the same drugs but who do not have heart failure.
Dont stop taking your medication without speaking to your doctor first, as it can make your symptoms worse.
Complementary medicines
Some homeopathic or herbal remedies, and food supplements such as vitamins and minerals, may interact with your medicines. Before taking any of these you should discuss them with your doctor, nurse or pharmacist.
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Diuretics
Diuretics are also called water tablets.
Other information
You should tell your doctor or nurse if you: have difficulty passing urine pass less urine than normal are constipated begin to feel dizzy or faint (if this is a new symptom for you, or if it becomes worse). You will need to have a blood test about every six months to make sure that your kidneys are working properly. Some people may have a test more frequently, depending on their condition. If you have heart failure, you should avoid eating salt and salty food (see page 34). Salt can also counteract the effect of the diuretics. So, if you are taking these medicines, avoid salty foods, and dont add any salt or salt substitute to food, either during cooking or at the table.
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ACE inhibitors
How does this medicine help people with heart failure?
ACE inhibitors relax the blood vessels, and help improve the flow of blood to the heart muscle, making it easier for the heart to pump blood around your body. They also reduce the risk of having a heart attack or of dying from heart failure. ACE inhibitors can lower your blood pressure dramatically so, when you start taking these medicines, you will have your blood pressure checked regularly. ACE inhibitors are not suitable for everyone with heart failure.
Other information
If you have heart failure and are taking ACE inhibitors, you should avoid drinking alcohol as it can lead to dizziness. You should avoid salt substitutes as they contain potassium. And dont take potassium supplements or other supplements that contain potassium. ACE inhibitors can sometimes cause a dry, irritating cough. If this happens to you, you should tell your doctor about it. He or she may be able to prescribe another medicine instead.
Beta-blockers
How does this medicine help people with heart failure?
Beta-blockers prevent the heart from beating as quickly and forcefully as usual. They also increase the amount of blood that your heart can pump with each beat, and reduce the risk of dying from heart failure. Beta-blockers are usually given to people with mild to moderate heart failure. When you first start taking them, your symptoms may seem worse for a while. It can take a couple of months before you feel the benefits.
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If you have asthma or suffer from wheezing, your doctor will need to choose your beta-blocker carefully, as some types tend to narrow the air passages.
Other information
Dont stop taking beta-blockers suddenly without medical advice as this can make your symptoms much worse.
Anti-platelet drugs
How does this medicine help people with heart failure?
Anti-platelet drugs such as aspirin help to reduce blood clotting, by stopping blood platelets (cells in the blood) from sticking together. They also reduce the risk of having a heart attack.
Other information
If you cannot take aspirin, your doctor may prescribe another drug, called clopidogrel, for you. This has the same effect as aspirin. You normally have to take aspirin for the rest of your life. Some people may need to take other anti-platelets for different lengths of time, depending on their condition. You should not take any remedies that contain aspirin such as medicines for muscle and joint pains, and some remedies that people take for colds and flu as they can reduce the effect of the aspirin you are taking to protect your heart. And you should avoid all other medicines that contain aspirin. If you need to take something for a temperature or to relieve pain, ask your pharmacist or doctor which type of medicines is suitable for you. Always try and take your aspirin with or after food.
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Digoxin
How does this medicine help people with heart failure?
Digoxin slows the heart rate and strengthens the force of the heartbeat. It can help your heart to pump blood around the body more efficiently and help to control irregular heart rhythms.
Other information
Digoxin may not be suitable for people who already have a slow heartbeat or for people with certain heart conditions such as some abnormal slow heart rhythms.
Anticoagulants
How does this medicine help people with heart failure?
Anticoagulants make your blood thinner, so they help to stop clots in the blood from forming. This means that they can help to prevent a heart attack or stroke.
Other information
If you are taking anticoagulants, you should always carry with you an Anticoagulant record card that has details of the anticoagulant medicines you are taking. Your doctor will give you this card. Also, if you are having any tests or treatment, tell any doctors or nurses that you are taking anticoagulants. You will need to have regular blood tests to check that you have the right dose of anticoagulant. These tests are usually done at your doctors or at an anticoagulant clinic at the hospital. Some anticoagulants interact with other medicines. So, check with your doctor or pharmacist before you take any other medicines. You should not drink cranberry juice if you are taking anticoagulants.
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Eat a healthy diet avoiding salt or salt substitutes and making sure your diet is high in fruit and vegetables. Manage how much fluid you have. Limit how much alcohol you have. Keep as active as your symptoms allow.
We explain more about all these things on the next pages. For more information on blood pressure, see our booklet Blood pressure and how to control it. (See page 44.)
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feel more alert increase your energy levels and fitness sleep better improve your circulation and oxygen levels improve your symptoms, and reduce your risk of having a heart attack or stroke.
If you have tried to stop smoking and have gone back to smoking again, there are things that can help you. Ask your doctor about products to help you stop smoking. If you need extra help with stopping smoking, you can call Quitline or the NHS Smoking Helpline. Quitline English: 0800 00 22 00 Bengali: 0800 00 22 44 Mondays 1pm to 9pm Gujarati: 0800 00 22 55 Tuesdays 1pm to 9pm Hindi: 0800 00 22 66 Wednesdays 1pm to 9pm Punjabi: 0800 00 22 77 Thursdays 1pm to 9pm Urdu: 0800 00 22 88 Sundays 1pm to 9pm NHS Smoking Helpline English: 0800 169 0 169 Bengali: 0800 169 0885 Tuesdays 1pm to 9pm Gujarati: 0800 169 0884 Tuesdays 1pm to 9pm Hindi: 0800 169 0883 Tuesdays 1pm to 9pm Punjabi: 0800 169 0882 Tuesdays 1pm to 9pm Urdu: 0800 169 0881 Tuesdays 1pm to 9pm
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raise your energy levels and make you feel less tired improve your breathing improve your blood pressure lower your cholesterol improve your weight, and make you feel better mentally and physically.
If you have heart failure, you will have good and bad days. On the good days, you will feel that you can do lots of things. But you need to find a balance between doing too much and doing too little. Plan what you know you can do in a day. Then, each day, do what you planned to do, not what you feel you can do. This is because, if you do too much, youll feel tired the next day and you wont be able to do what you had planned for that day.
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We explain all these things on the next pages. You can still eat your favourite dishes. You just need to make small and gradual changes in what you eat. For more information, see our booklet Looking after your heart, and the healthy recipes in our Asian cookbook Healthy meals, healthy heart. (See page 44.)
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Avoid salt
Most of the salt we eat is hidden in processed foods and in pre-cooked or pre-prepared meals, which are sometimes very salty. When choosing these foods, choose ones that are labelled low salt or reduced salt. But you should still check the labels to see whether they are actually low in salt. See the box below.
Avoid adding salt when cooking or at the table. Use spices, herbs or lemon juice for flavour instead. Dont use any salt substitutes as these may contain large amounts of potassium, which is not recommended if you have heart failure. It is better to try to get used to food without salt.
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1 unit of alcohol =
a small glass (100ml) of wine (10% ABV [alcohol by volume]) or half a pint (300ml) of normal strength lager, cider or beer (3% to 5% ABV) or a pub measure (25ml) of spirits
Avoid binge drinking. If you have a problem with retaining too much fluid, check with your doctor how much you can drink, especially beer. If your heart has already been damaged by alcohol, your doctor has probably already told you that it would be better for you to give up alcohol altogether.
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Other treatments that can help some people with heart failure
Pacemaker
A small number of people with heart failure may benefit from having a special type of pacemaker, called a bi-ventricular pacemaker, fitted. This device may help to synchronise the heart rhythm and control the heart rate. It is not suitable for everyone. It is generally used in people with moderate to severe heart failure who are not responding to their medication.
Heart transplant
In a very small number of people with severe heart failure, a heart transplant may be an option. This form of treatment is for patients who have been carefully chosen, but it is not suitable for everyone. If your cardiologist (a doctor who specialises in the heart) thinks that you may be suitable for a heart transplant, he or she will ask you to go to a transplant centre for an assessment.
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A counsellor may be able to help you cope with your heart failure. Your GP may be able to refer you to one, or it might be possible to get a referral through the hospital. Counselling can be particularly useful for people who feel depressed. Your doctor may also be able to prescribe medication to help with depression. Talking to others can also be very helpful. You may find it helpful to join a heart support group. A heart support group gives you, your partner and family the chance to meet and talk to people who are going through a similar experience. Groups vary. They may meet every week, every fortnight or every month. The British Heart Foundation keeps an up-to-date list of all heart support groups in England and Wales which are linked to the British Heart Foundation. To find out about the nearest one to you, call 0300 330 3311. People with heart failure can become tired and depressed about their limitations, and worried about their future. Understanding what heart failure is and the medicines used to treat it, and being involved in making decisions about your treatment, will all help you to have more control over your condition.
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Heart HeLPLine
0300 330 3311 A local rate number. For information and support on anything relating to heart health. This service is available in English only.
Booklets
The following booklets are available in Bengali, Gujarati, Hindi, Punjabi and Urdu: Blood pressure and how to control it Cholesterol and what you can do about it Diabetes and how it affects your heart Heart failure Living with angina and heart disease Looking after your heart Taking medicines for your heart
The following booklets are available in English only: The heart failure plan Eating for your heart Healthy meals, healthy heart Physical activity and your heart Smoking and your heart So you want to lose weight for good
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DVDS
The following DVDs are available in Urdu, Hindi, Gujarati, Punjabi and Bengali. They are free, but a donation of 5 per DVD would be welcome. Living to prevent heart disease Get fit, keep fit prevent heart disease Cardiac surgery Cardiac rehabilitation Affairs of the heart
How to Order
The British Heart Foundation also produces other educational materials that may be of interest. To find out about these, to order a Heart health catalogue, or to order publications, please call the BHF Orderline on 0870 600 6566, go to bhf.org.uk/publications or email orderline@bhf.org.uk. You can download many of our publications from bhf.org.uk/publications Our publications are free of charge, but we would welcome a donation.
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technical terms
ACE inhibitor A medicine used to treat heart failure. It relaxes the blood vessels and helps to improve the flow of blood to the heart muscle. anticoagulant A medicine used to help stop clots in the blood from forming. anti-platelet drug A medicine used to help stop clots in the blood from forming. arteries Vessels which carry blood from the heart to other parts of the body. beta-blocker A medicine used to treat heart failure. It prevents the heart from beating as quickly as usual. blood pressure The pressure of the blood in the arteries. cardiomyopathy A disease of the heart muscle. digoxin A medicine used to treat heart failure. It slows the heart rate. diuretic Also known as water tablets. Diuretics increase the output of water and salt in the urine. ECG See electrocardiogram. echocardiogram An ultrasound picture of the heart which shows the structure of the heart and how it is working. electrocardiogram A test to record the rhythm and electrical activity of the heart. Also called an ECG.
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INDEX
ACE inhibitors activity alcohol ankle-swelling anticoagulants anti-platelet drugs aspirin beta-blockers blood pressure breathlessness cardiomyopathy carer causes of heart failure depression diagnosis diet digoxin diuretics drugs eating ECG echocardiogram electrocardiogram exercise 19 29 37 9, 13 21 20 20 19 6, 26 8, 13 7 42 6 39, 40 10 31 21 18 16 31 10 10 10 29 fat in the diet fluid healthy eating heart attack high blood pressure medicines nitrates nurses pacemaker quality of life rehabilitation salt smoking sodium statins support groups swelling symptoms of heart failure tests tiredness transplant treatment water tablets weight 33 9, 36 31 6 6, 26 16 16 39 38 39 39 34 27 34 16 40 9, 13 8 10 9, 13 38 15 18 9, 31
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The British Heart Foundation is the nations heart charity, saving lives through pioneering research, patient care and information. We rely on donations to continue our vital work. If you would like to make a donation to the British Heart Foundation, please ring our donation hotline on 0300 330 3322 or contact us through our website at bhf.org.uk/donate or send it to us at the address below. This booklet is available in Bengali, Gujarati, Hindi, Punjabi and Urdu. This English version has been produced to help relatives, carers and health professionals who do not read these languages. To order further copies, please call the BHF Orderline on 0870 600 6566.
British Heart Foundation Greater London House 180 Hampstead Road London NW1 7AW Phone: 020 7554 0000 Fax: 020 7554 0100 Website: bhf.org.uk
British Heart Foundation 2009, a registered charity in England and Wales (225971) and Scotland (SC039426)
G316 1109