Heart failure

Doctor’s Corner


FOR the past three weeks we have been looking at breast issues. In the last installation we particularly explored breast cancer as a topic, specifically looking at the risk factors.

This week we look at another burning issue in the community: heart failure.

Heart failure is a scary subject for all of us because it is a life-threatening condition in which the heart can no longer pump enough blood to the rest of the body. It is usually a chronic (long-term) condition, although it can sometimes develop suddenly.

As the heart can no longer pump enough blood to the rest of the body, many organs do not receive enough oxygen and nutrients, which damages them and reduces their ability to function properly. Every part of the body is affected when the heart fails.

The most common causes of heart failure are hypertension (high blood pressure), anaemia (insufficient amount of blood in the body), diabetes (high blood sugar), kidney disease, HIV and Aids and disease of the blood vessels that supply the heart (coronary heart disease).

The risk is even more increased if you have other heart problems that are pre-existent.

Heart failure becomes more common with advancing age.

You are also at increased risk for developing heart failure if you are overweight, you smoke cigarettes, abuse alcohol, or use cocaine and other narcotic drugs.

Some of the common complaints (symptoms) that people who are going into heart failure may have are: weight gain, swelling of the feet and ankles and swelling of the abdomen. Many people may notice that their veins in the neck are becoming more and more engorged/swollen.

Heart failure patients may have a poor appetite like most sick people and may suffer from indigestion as well as feel nausea or they may be vomiting.

A very important feature is that most patients with heart disease especially those with heart failure complain that they feel easily breathless, even after walking for just a few steps.

Very importantly, they complain of becoming breathless when lying flat on their back, and usually end up sleeping with several pillows so that they are somewhat upright and this relieves the breathlessness.

The reason for this is that the lungs in these patients with heart failure become “wet” — ie the lungs become full of water and the patient “drowns” when they lie flat because of the entire chest becoming flooded due to gravity.

One also finds it difficult to sleep, mostly because of the same reasons, and many patients going into or already experiencing heart failure will complain to their doctor that they sometimes wake up suddenly at night breathless.

Fatigue, weakness, faintness, sensation of feeling the heart beat faster and harder are all important symptoms.

Another thing that may disturb sleep is that heart failure patients may have an increased urine production, and may feel the urge to pass urine at night many times.

The cough that is typical of these patients is also quite a source of discomfort.

Because in heart failure there is inadequate supply of oxygen to organs, and this includes the brain as well, many people in heart failure may have reduced ability to concentrate or decreased alertness.

Babies, infants and children also have heart problems that may make their hearts to fail, and you may suspect it in the infant when they sweat during feeding (or other exertion).

Some patients with heart failure have no symptoms.

When you visit your doctor, they may notice that your heart is “swollen” and that there is fluid in your chest.

Several investigations may be ordered including including a chest X-ray, electro-cardiogram (ECG), chest CT scan, heart MRI (magnetic resonance imaging) and, in advanced settings, a nuclear heart scan. Other blood tests can also be done.

If you have heart failure, your doctor will monitor you closely. This means having follow-up appointments at least every three to six months, figuring out any underlying cause and treating it, and periodic testing of your heart function.

For example, an ultrasound of your heart, called an echocardiogram, will be done once in a while to give an estimate of how well your heart is pumping blood with each stroke or beat.

It is also your responsibility to carefully monitor yourself and help manage your condition. One important way to do this is to track your weight on a daily basis.

Weight gain can be a sign that you are retaining fluid and that the pump function of your heart is worsening. Make sure you weigh yourself at the same time each day and on the same scale, with little to no clothes on.

Other important measures include:

l Take your medications as directed. Carry a list of medications with you wherever you go.

l Limit salt and sodium intake.

l Don’t smoke.

l Stay active. For example, walk or ride a stationary bicycle. Your doctor can provide a safe and effective exercise plan based on your degree of heart failure and how well you do on tests that check the strength and function of your heart. DO NOT exercise on days that your weight has gone up from fluid retention or you are not feeling well.

l Lose weight if you are overweight.

l Get enough rest, including after exercise, eating, or other activities. This allows your heart to rest as well. Keep your feet elevated to decrease swelling.

Here are some tips to lower your salt and sodium intake:

l Look for foods that are labelled “low-sodium”, “sodium-free”, “no salt added”, or “unsalted”. Check the total sodium content on food labels. Be especially careful of canned, packaged, and frozen foods. A nutritionist can teach you how to understand these labels.

l Don’t cook with salt or add salt to what you are eating. Try pepper, garlic, lemon, or other spices for flavour instead. Be careful of packaged spice blends as these often contain salt or salt products.

l Avoid foods that are naturally high in sodium, like anchovies, meats (particularly cured meats, bacon, hot dogs, sausage, bologna, ham and salami), nuts, olives, pickles, sauerkraut, soy and Worcestershire sauces, tomato and other vegetable juices and cheese.

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