Diagnosis & managing heart failure

If you think that someone you know is experiencing symptoms of heart failure, the first step should always be for them to speak to their doctor. The doctor will perform an examination and ask a few questions to help determine a possible diagnosis. Should the doctor feel it necessary, they may recommend one or more tests, including:

Electrocardiogram (ECG) - a simple test that can be used to check your heart’s rhythm and electrical activity.

Chest X-ray - produces images of your heart, lungs, blood vessels, airways, and the bones of your chest and spine to help detect problems. Along with a careful and detailed history and clinical examination, this test may help to confirm the presence of heart failure.

Coronary angiogram - a procedure that uses X-ray imaging to see your heart’s blood vessels. The test is generally done to see if there’s a restriction in blood flow going to the heart.

Blood tests - to check whether there’s anything in your blood that might indicate heart failure or another illness.

Treatment options

Main types of medical approaches include:

Medication

There are several different medications a doctor may prescribe, depending on the individual’s condition. Some include1,3:

  • ACE inhibitors & Angiotensin receptor blockers (ARB) – lower blood pressure and prevent damage to heart and kidneys
  • Beta blockers – to slow heart rate and reduce blood pressure
  • Diuretics – to help reduce fluid retention
  • Aldosterone antagonists – potassium-sparing diuretics, mainly for those with severe systolic heart failure
  • Inotropes- for severe conditions to help heart pumping function and maintain blood pressure
  • Digoxin – increases the strength of your heart muscle contractions
  • Angiotensin receptor blockers (ARB) – lower blood pressure and prevent damage to heart and kidneys.
  • Angiotensin Receptor-Neprilysin Inhibitors (ARNI) – reduce blood pressure and improve fluid status in the body
  • Mineralocorticoid Receptor Antagonists (MRA) - decrease sodium reabsorption and increase water excretion

Device implants that control heart rhythm

Several devices can be implanted to help heart function. They include1,4:

  • CRT (biventricular pacing) – a sort of pacemaker that sends electrical impulses to both of the heart’s lower chambers to help them pump more efficiently.
  • ICDs – like a pacemaker it monitors heart rhythm and tries to speed or reduce the heartbeat if becoming too fast or slow.
  • VADs – ventricular assist devices; a mechanical pump that helps your heart pump blood from the ventricles to the rest of your body.

Surgery

This is less common and only used when necessary, such as in severe cases. Possible forms of surgery include1,4:

Coronary bypass surgery – this is when blood vessels from the legs, arms or chest bypass a blocked artery to help improve blood flow. This is usually only when arteries are severely blocked.

Heart valve repair or replacement – if heart failure is the result of a faulty valve, a doctor may suggest repairing or replacing it. Valve replacement is only performed if repair is not possible and is performed using a prosthetic valve.

Heart transplant – Usually only in such severe cases that other surgical interventions or medications can’t help. Heart transplants may improve survival rates and increase life expectancy. However, depending on where you live, some people may have to wait long periods before a suitable donor heart becomes available.

Often, a management plan may require all the above. A doctor will help plan the most suitable approach based on factors such as symptoms, age, and lifestyle.

Tips for caregivers

Caring for someone with Heart Failure

Heart Failure is for life and is not curable. However, helping someone with heart failure manage their condition can lead to a much better prognosis and help maintain a good lifestyle going forward. Heart failure, when well managed, does not have to usher the end of your social and personal life.

Here are some tips for caring for someone with Heart Failure:

  • Make sure they have a strong support network around them
  • Encourage them to track and manage symptoms regularly
  • Make sure they keep an honest, open dialogue with their doctor around disease progression
  • Encourage them to keep doing the ‘normal’ things as best they can: hobbies, hikes, etc.)
  • Make sure there is always an ear to listen – heart failure can have many ups and downs.

Maintaining a healthy lifestyle

Lifestyle and advice tips for HF

Most people will have to make lifestyle changes in order to manage their heart failure6,7. This means a low-impact, regular exercise regime, healthier eating and more sensible lifestyle choices – all aimed at keeping the heart functioning as well as possible8.

Any changes to your diet or exercise regime should be made under the guidance of your doctor.

Keeping Fit

People with heart failure need to maintain a good level of physical activity9. This helps not only the body, but also the mind10. It is important to build an exercise program slowly but regularly7. This can be a mix of cardio and light weight-training.

Here are some useful tips to follow:

It is important to encourage those with heart failure to take exercise regularly. Scheduling exercise at the same time every day can help make it a regular part of their life8. This should be built up over time so encourage them to start off slow and not overdo it7,8.

Low-impact aerobic exercise combined with some light strength training is usually best11. Swimming and walking are great low-impact forms of exercise. They should aim to reach 30-40 mins of exercise at a comfortable level9. Their healthcare team can help define the best regime.

Things to avoid/be conscious of7:
• Any sort of high-intensity activities.
• Reduce activity when tired.
• Make sure they take adequate rest periods.

Eating Well

Keeping a heart working well also means paying close attention to what a person is eating. A good diet can lower cholesterol, sodium levels and reduce weight, which takes pressure off the heart12.


Don’t try crash-dieting or fads, balance is key. Try to have them eat12:
• Five portions of fruit and vegetables a day.
• Wholegrain bread, rice and pasta.
• A small number of dairy products.
• Protein rich foods like eggs, fish, meat and beans – in moderation.
• Very little high-fat or sugary foods.
• Sodium intake should be discussed and managed with your treating physician. Excess sodium is best avoided where possible and only taken very minimally. Sodium can raise blood pressure and have negative effects on the heart.

Alcohol should also be limited. Talk to a doctor about alcohol consumption guidelines and stick to them..

Supporting a loved one with Heart failure

Illnesses like heart failure often come suddenly and can cause a shock. And, the realisation that you will become that person’s carer is both shocking and daunting, too. The first step in supporting your loved one is simply being there for them. Then learning about and supporting them on their journey13. Of course, you must never forget to take care of yourself, also.

Here are some tips to managing your role as a caregiver:

Understand the support needed – Heart failure can affect people differently, depending on the severity and associated comorbidities. It is important to listen to their doctor and understand their needs and the level of support required. Educating yourself on the required lifestyle changes, medications and other needs can make it easier for you to help them manage their condition.

Be there for them – emotional support is paramount in the management of any illness. Try to talk to them regularly about their condition, what they’re going through and how it’s affecting them. It can also be beneficial to suggest they talk to a therapist or support group in your area.

Be there for you - It is important to keep a close eye on your own emotions, too. This is also your struggle and you may benefit from talking to other carers or people living with heart failure. Keep your health as a priority and if you begin to feel stressed, overwhelmed or depressed, talk to someone.

Use support networks– most places will have one, if not many, different types of support groups and networks you can benefit from. Most of them are free of charge and can really act as a space to reduce stress and anxiety. Ask your healthcare team and they can recommend some for you.

Emotional Support for Caregivers

It is important to remember that supporting a loved one with a serious disease can be a heavy burden on both of you. Always remember to keep an eye on your own mental wellbeing and ensure that you, too, have a support network around you that can help you during difficult times. If you cannot reach out to friends or family, ask your healthcare team about support groups in your area.

Take a look at our Living with heart failure page for more information on heart failure management.

Learn to live with HF

References

  1. Heart failure treatment. Available at: https://www.nhs.uk/conditions/heart-failure/treatment/. Accessed 2 September 2020.
  2. American Heart Association. Treatment Options for Heart Failure. Available from: https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure. Accessed 2 September 2020.
  3. American Heart Association. Medications Used to Treat Heart Failure. Available from: https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/medications-used-to-treat-heart-failure. Accessed 3 September 2020.
  4. American Heart Association. Devices and Surgical Procedures to Treat Heart Failure. Available from: https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/devices-and-surgical-procedures-to-treat-heart-failure. Last accessed 2 September 2020.
  5. American Heart Association. Living with Heart Failure and Managing Advanced heart failure. Available from: https://www.heart.org/en/health-topics/heart-failure/living-with-heart-failure-and-managing-advanced-hf. Last accessed: 2 September 2020.
  6. Living with heart failure. Available from: https://www.nhs.uk/conditions/heart-failure/living-with/. Last accessed 16 September 2020.
  7. Living with heart failure. Available from: https://www.bhf.org.uk/informationsupport/support/practical-support/living-with-heart-failure. Last accessed 16 September 2020.
  8. American Heart Association. Lifestyle Changes for Heart Failure. Available from: https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/lifestyle-changes-for-heart-failure. Last accessed 16 September 2020.
  9. Exercise training as therapy for chronic heart failure. Available from: https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-14/Exercise-training-as-therapy-for-chronic-heart-failure. Last accessed 16 September 2020.
  10. American Heart Association. Why is physical activity so important. Available from: https://www.heart.org/en/healthy-living/fitness/fitness-basics/why-is-physical-activity-so-important-for-health-and-wellbeing. Last accessed 16 September 2020.
  11. Hopkins Medicine. 7 Heart Benefits of Exercise. Available online at: https://www.hopkinsmedicine.org/health/wellness-and-prevention/7-heart-benefits-of-exercise. Last accessed 16 September 2020.
  12. Healthy eating. Available from: https://www.bhf.org.uk/informationsupport/support/healthy-living/healthy-eating. Last accessed 16 September 2020.
  13. Healthline. Tips for caring for someone with heart failure. Available from: https://www.healthline.com/health/heart-failure/caregiving-tips. Last accessed 16 September 2020.
11 February 2021

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