Living with
Heart Failure

What is Heart Failure?

Heart failure doesn’t mean your heart has stopped working; instead it means that your heart is too weak or stiff to pump blood like it should.
This is usually as a result of heart disease like coronary artery disease, hypertension and diabetes.

Your body depends on the heart pumping blood to deliver oxygen and nutrients to your cells for energy production. Without a steady delivery of oxygen and nutrients, your body’s cells cannot function properly. This means that you will probably feel fatigued and short of breath, particularly during times of increased physical exertion, like walking up stairs or carrying groceries, when the body has increased energy demands.

This condition is also known as chronic congestive heart failure, as fluid will back up in the lungs if the heart cannot pump blood to the rest of the body or back from the pulmonary (lung) circulation.
This may cause fluid to build up in other organs (like the lungs or liver), or, alternatively, it may cause other organs (like the kidneys) to get too little blood supply; both of which will cause organ damage.
Fluid also commonly builds up in parts of your body that are specifically under the influence of gravity, like the legs or feet, causing swelling.

What happens during heart failure?

In heart failure, your heart cannot pump enough blood to meet your body’s requirements.

In order to try and meet this demand to pump more blood, your heart stretches or enlarges, while trying to develop more muscle mass, all so it can contract with greater strength. Your heart rate will also increase to compensate for the decreased blood supply. However, these compensatory mechanisms all damage your heart even further.

Additionally, the body tries to compensate in other ways for less blood being pumped. Blood vessels constrict and blood flow is diverted away from other organs (like the kidneys) to meet the requirements of the heart and brain.
Moreover, these changes cause a resulting increase in hypertension that further damages the heart and may also result in other organ damage as well.

While originally these compensatory mechanisms might mask the signs and symptoms of heart failure, eventually the heart damage will progress and worsen, and your heart will no longer be able to compensate.

How could you know if you are in heart failure?

Heart failure is usually a progressive, ongoing or chronic condition; however, sometimes heart failure may develop suddenly or acutely.
Symptoms are usually related to the effects of congestion (fluid build-up).

Heart failure signs and symptoms may include:

• Shortness of breath (medically know as dyspnoea), particularly when you exert yourself or when you lie down on your back
• General fatigue, weakness and reduced ability to do physical activity
• Swelling (medically known as oedema) in your legs, ankles and feet
• Rapid or irregular heartbeat/palpitations
• Persistent cough or wheezing with white or pink blood-tinged phlegm
• Waking up at night struggling to breathe or with a cough
• Swelling of your abdomen (medically known as ascites)
• Very rapid weight gain (1-1.5 kg over a few days because you are retaining fluid)
• Lack of appetite and nausea.

More severe symptoms:

• Sudden, severe shortness of breath and coughing up pink, foamy mucus
• Chest pain that may indicate you are having a heart attack
• Difficulty concentrating or decreased alertness/disorientation, including fainting
• Not going to the bathroom to urinate over a 24-hour period (medically known as oliguria).

What are the different types of heart failure?

Heart failure is commonly classified according to which side of the heart is most affected, such that there are the following differentiations:

• Left-sided heart failure: This is the most common type of heart failure. This is because the main pumping chamber of the heart, the left ventricle, is usually first affected by heart disease.
  When the left ventricle cannot pump blood properly, fluid builds up in the lungs, typically causing shortness of breath. This type of heart failure is further divided into:
  • Systolic heart failure that indicates that the heart is weak; particularly, that the left ventricle is not contracting strongly enough.
  • Diastolic heart failure that indicates that the heart is stiff and that the left ventricle cannot relax enough to full with blood between heart beats, and, as such, pumps an insufficient blood supply.
• Right-sided heart failure: This type of heart failure, on the other hand, occurs when the right ventricle cannot pump blood to the lungs properly. This causes fluid to build up in the rest of the body causing swelling.
  Right-sided heart failure can occur as a result of left-sided heart failure; although chronic lung disease, especially chronic obstructive pulmonary disorder (COPD) like emphysema, can cause pulmonary hypertension that can lead to right-sided heart failure – this type of heart failure is then known as cor pulmonale.

Keep in mind that it is quite possible to have both types of heart failure at the same time, especially when the condition worsens over a long duration or is left untreated.

What are the stages of heart failure?

Depending on what symptoms you have and how you experience them, you will be classified into different classes or stages of disease progression, and this will determine what treatment your doctor may prescribe.

The stages of heart failure (New York Heart Association Classification) are:

• Class 1: During this stage of the condition, you may not yet have any symptoms of heart failure. Your doctor may decide that lifestyle changes might be sufficient to manage your condition.
• Class 2: During this stage of heart failure, you probably only experience symptoms during physical activity (usually strenuous activity) and you probably feel fine again at rest. Your doctor will need to monitor your condition and may decide that medications are needed, in addition to lifestyle changes, to manage your condition.
• Class 3: During this stage of your condition, you will probably experience symptoms even on mild exertion/physical activity; for example, shortness of breath when you walk a short distance. You may still be fine during rest. Your doctor will carefully assess what treatment you need and will probably want to check up with you regularly.
• Class 4: During this stage, you will have symptoms even during rest. Your doctor can discuss the possible treatment options with you.

What causes heart failure?

Heart failure is a common condition in the elderly that have underlying heart disease.
However, in developing countries, a significant proportion of young people also experience heart failure due to infectious causes that affect the heart muscles and valves.
A recent study published in the South African Medical Journal found that 37,7 million people worldwide are affected by heart failure.

The risk factors for developing heart failure include:

• Hypertension
• Coronary artery disease
• Diabetes
• Valvular heart disease (including rheumatic valvular heart disease)
• Overweight or obesity
• Myocarditis (inflammation of the heart muscle from infection, usually by viruses)
• Cardiomyopathy
• Over consumption of alcohol
• Use of some illicit drugs like cocaine
• Arrhythmia
• Congenital heart disease
• Age: As mentioned, you are more likely to suffer from heart disease as you get older.
• Other medical conditions like iron-deficiency anaemia, an overactive thyroid or pulmonary embolism, for example.

Living and managing

Knowing your risk factors for heart disease and reducing them can significantly decrease your risk of developing heart failure.
By working closely with your doctor, you can reduce your risk of heart disease by focusing on the following healthy lifestyle measures:

1. Manage your blood pressure
   As hypertension is the most significant cause of heart disease, keeping your blood pressure levels within healthy limits is very important in preventing and managing heart failure.
   To manage your blood pressure, limit your dietary salt intake.
   You can also access your own Cooking from the Heart Low Salt booklet, containing listed salt contents of South Africa’s most popular foods and nutrition brands. This booklet will ensure that you are never tricked by complicated, and often misleading, food labels again. Download it now for healthier cooking, shopping and snacking!
2. Eat a healthy diet low in fat and salt
   Read more about how to eat a heart-healthy, low-fat and low-salt diet.
   If your cholesterol levels are high even with a healthy diet, speak to doctor about medication to manage your cholesterol levels.
3. Exercise and try to maintain a healthy weight
   Try to keep as active as possible. You don’t have to join a gym do this; instead, just take regular walks, ride a bike or dance along to the music on your radio.
   Your goal should be 30 minutes of moderate activity (makes you sweat and your heart beat a little faster) most days of the week.
   Regular physical activity helps you manage your blood pressure and glucose levels, lose weight, and alleviate stress, thereby reducing the risk of heart disease.
   If you have advanced stage heart failure, speak to your doctor about an exercise programme you can follow – do not start a new fitness regime without talking to a healthcare provider first.
4. Manage your diabetes
   Eating a healthy low-fat and low-sugar diet, exercising regularly and maintaining a healthy weight will all help you successfully manage your blood sugar levels.
   If your blood sugar levels are still above normal even with healthy diet and exercise, then speak to your doctor as you may need to take medication to manage your glucose levels.
5. Manage stress
   When you’re stressed, your heart rate and blood pressure go up – this is not good for your heart. Furthermore, you may not manage your blood pressure or other chronic conditions and forget to exercise, eat right or take your medicines when you are anxious.
   Find ways to relieve stress, such as practising meditation, mindfulness or yoga.
6. Stop smoking
   Talk to your doctor about ways to quit smoking, as tobacco smoke significantly increases your risk of heart disease.
7. Limit your alcohol consumption
   As excess alcohol consumption damages the heart and blood vessels, you will need to speak to your doctor or healthcare provider about what amount of alcohol is appropriate for you to consume.
   Generally, to stay healthy, it is recommended that women not exceed one glass of alcohol per day, while men should have no more than two glasses per day.

What treatment is available for managing chronic congestive heart failure?

There is no cure for chronic heart failure. But, along with healthy lifestyle behaviors, certain medications can be used to help the heart pump more effectively, relieving the symptoms of heart failure.

Common medications prescribed to chronic heart failure patients include:

• ACE inhibitors: Medication in this class help to dilate blood vessels, improving blood flow.
• Anti-arrhythmia medications: For example, beta-blockers which can slow the heart rate.
• Diuretics: These medications help to eliminate excess fluid in the body, reducing congestion in the lungs and swelling in the liver or extremities.
• Digoxin: Often referred to as digitalis, digoxin is commonly used in the treatment of heart failure to increase the strength of contraction of the heart during each heartbeat. This medication is more commonly prescribed if you have underlying atrial fibrillation.

What are the complications of heart failure?

• Kidney damage or failure
• Arrhythmia
• Valvular heart disease
• Pulmonary oedema and pulmonary hypertension
• Liver damage
• Sometimes death.