Heart failure and stroke are the leading causes of death in adult South Africans; more than four times the number of people murdered. They are the leading cause of hospitalisation in people over 65.
Heart disease, a noncommunicable disease, is one of the most serious threats to our health and it’s mainly due to the Western lifestyle. With South Africa’s current crime statistics, it’s interesting to note that while 49 people are murdered every day, 210 die of heart disease every single day.
Heart failure doesn’t mean the heart has stopped working. Rather, it means the heart’s pumping power is weaker than normal. With heart failure, blood moves through the heart and body at a slower rate, and pressure increases. As a result, the heart can’t pump enough oxygen and nutrients to meet the body’s needs.
The chambers of the heart may respond by stretching to hold more blood to pump through the body or by becoming stiff and thickened. This helps to keep the blood moving, but the heart muscle walls may eventually weaken and become unable to pump as efficiently. As a result, the kidneys may respond by causing the body to retain fluid (water) and salt.
If fluid builds up in the arms, legs, ankles, feet, lungs, or other organs, the body becomes congested. Congestive heart failure is the term used to describe the condition.
The diagnosis is mainly made by history and examination. The doctor will ask you about any conditions you have that may cause heart failure (such as coronary artery disease, angina, diabetes, heart valve disease, and high blood pressure). You will be asked if you smoke, take drugs, drink alcohol (and how much you drink), and about what drugs you take.
The doctor may also order other tests to determine the cause and severity of your heart failure. These include blood tests. Blood tests are used to evaluate kidney and thyroid function as well as to check cholesterol levels and the presence of anaemia.
B-type natriuretic peptide (BNP) blood test. BNP is a substance secreted from the heart in response to changes in blood pressure that occur when heart failure develops or worsens. BNP blood levels increase when heart failure symptoms worsen, and decrease when the heart failure condition is stable.
Chest X-ray. A chest X-ray shows the size of your heart and whether there is fluid build-up around the heart and lungs.
Echocardiogram. This test is an ultrasound which shows the heart’s movement, structure, and function.
The ejection fraction. It is used to measure how well your heart pumps with each beat to determine if systolic dysfunction or heart failure with preserved left ventricular function is present.
Electrocardiogram (ECG). An ECG records the electrical impulses travelling through the heart.
Cardiac catheterisation. This invasive procedure helps determine whether coronary artery disease is a cause of congestive heart failure.
Stress test. Noninvasive stress tests provide information about the likelihood of coronary artery disease.
Heart failure is caused by many conditions that damage the heart muscle, including:
Coronary artery disease (CAD). CAD, a disease of the arteries that supply blood and oxygen to the heart, causes decreased blood flow to the heart muscle. If the arteries become blocked or severely narrowed, the heart becomes starved for oxygen and nutrients.
Heart attack. A heart attack occurs when a coronary artery becomes suddenly blocked, stopping the flow of blood to the heart muscle. A heart attack damages the heart muscle, resulting in a scarred area that doesn’t function properly.
Cardiomyopathy. Damage to the heart muscle from causes other than artery or blood flow problems, such as from infections or alcohol or drug abuse.
Conditions that overwork the heart. Conditions including high blood pressure, valve disease, thyroid disease, kidney disease, diabetes or heart defects present at birth can all cause heart failure. In addition, heart failure can occur when several diseases or conditions are present at once.
If you have heart failure, you may have one or all of these symptoms or you may have none of them. They may or may not indicate a weakened heart. The symptoms can include:
Congested lungs. Fluid backup in the lungs can cause shortness of breath with exercise or difficulty breathing at rest or when lying flat in bed. Lung congestion can also cause a dry, hacking cough or wheezing.
Fluid and water retention. Less blood to your kidneys causes fluid and water retention, resulting in swollen ankles, legs, abdomen (called oedema), and weight gain. Symptoms may cause an increased need to urinate during the night. Bloating in your stom ach may cause a loss of appetite or nausea.
Dizziness, fatigue, and weakness. Less blood to your major organs and muscles makes you feel tired and weak. Less blood to the brain can cause dizziness or confusion.
Rapid or irregular heartbeats. The heart beats faster to pump enough blood to the body. This can cause a rapid or irregular heartbeat.
Keep your blood pressure low. It is important to keep your blood pressure controlled so that your heart can pump more effectively without extra stress.
Monitor your own symptoms. Check for changes in your fluid status by weighing yourself daily and checking for swelling. Call your doctor if you have unexplained weight gain (1.4kg in one day or 2.3kg in a week) or if you have increased swelling.
Maintain fluid balance. Your doctor may ask you to keep a record of the amount of fluids you drink or eat and how often you go to the bathroom. Remember, the more fluid you carry in your blood vessels, the harder your heart must work to pump excess fluid through your body. Limiting your fluid intake to less than two liters per day will help decrease the workload of your heart and prevent symptoms from recurring.
Limit how much salt (sodium) you eat. If you follow a low-sodium diet, you should have less fluid retention, less swelling, and breathe easier.
Monitor your weight and lose weight if needed. Learn what your “dry” weight is. Dry weight is your weight without extra water (fluid). The goal is to keep your weight within 1.8kg of your dry weight. Record your weight in a diary or calendar. If you gain 1.4kg in a day or 2.3kg in a week, call your doctor. Your doctor may want to adjust your medications.
Take your medications as prescribed. Medications are used to improve your heart’s ability to pump blood, decrease stress on your heart, decrease the progression of heart failure, and prevent fluid retention. Many heart failure drugs are used to decrease the release of harmful hormones. These drugs will cause your blood vessels to dilate or relax, thereby lowering your blood pressure.
Schedule regular doctor appointments. Keep good records and show the doctor.
Avoid these medications:
- Nonsteroidal anti-inflammatory medications such as Brufen;
- Some antiarrhythmic drugs;
- Most calcium channel blockers (ask your doctor about these if you are hypertensive);
- Some nutritional supplements such as salt substitutes and growth hormone therapies;
- Antacids that contain sodium (salt); and
- Decongestants such as most flu tablets.
It is important to know the names of your medications, what they are used for, and how often and at what times you take them. Keep a list of your medications and bring them with you to each of your doctor’s visits.
Never stop taking your medications without discussing that with your doctor. Even if you have no symptoms, your medications decrease the work of your heart so that it can pump more effectively.
- Stop smoking or chewing tobacco;
- Reach and maintain your healthy weight;
- Control high blood pressure, cholesterol levels, and diabetes;
- Exercise regularly;
- Do not drink alcohol;
- Eat a healthy diet. Limit foods high in trans fat, salt, cholesterol, and sugar;
- Don’t overdo it. Plan your activities and include rest periods during the day;
- Prevent respiratory infections. Ask your doctor about flu and pneumonia vaccines;
- Take your medications as prescribed. Do not stop taking them without first consulting your doctor;
- Get emotional or psychological support if needed. Heart failure can be difficult for your entire family. If you have questions, ask your doctor or nurse.
If you need emotional support, social workers, psychologists, the clergy, and heart failure support groups are a phone call away. Ask your doctor or nurse to point you in the right direction.