Heart failure is common but not inevitable in old age

By June Shannon Heart News   |   18th Apr 2019

The number of people affected by heart failure is set to increase significantly however, there are a lot of things you can do to reduce your risk of developing the condition.

Heart failure currently affects 90,000 people in Ireland, and this is set to increase significantly thanks to the fact that we are living longer and getting better at treating heart disease.

According to Dr Angie Brown, Medical Director of the Irish Heart Foundation, “Heart Failure can affect people of any age, but it is more common in older people. However, in cases where heart failure is not caused by an inherited condition such as a cardiomyopathy, it is important to note that heart failure can be prevented and in other cases well treated, improving the quality of life and allowing people to live longer.”

“Although it gets more likely as we age, by making sure you have a healthy diet, don’t smoke or drink too much alcohol, ensure your blood pressure is under control, maintain a healthy weight and take moderate regular exercise, you can reduce the risk of developing heart failure,” Dr Brown added.

“Heart Failure can affect people of any age, but it is more common in older people,"

Dr Angie Brown, Medical Director , Irish Heart Foundation

Lack of understanding

Almost half of Irish adults surveyed recently for the Irish Heart Foundation’s new heart failure awareness campaign ‘Don’t Ignore the Signs of Heart Failure’, mistakenly believed that heart failure means that the heart stops beating, confusing the condition with a cardiac arrest.

However, Dr Brown explained that unless you have an underlying problem with the rhythm of your heart, such as heart block, it is very unlikely that your heart will suddenly stop beating.

“However, a very slow heart rate is one cause of breathlessness, fatigue and dizziness and the heart could potentially stop in this case – the treatment for this is a pacemaker. If the underlying cause of heart failure is due to blocked arteries and there is further ischaemia (reduction of the blood supply to the heart), then a serious arrhythmia could occur, this could lead to collapse and a cardiac arrest. The treatment for this is to open the blockage if possible, reducing the risk of ischaemia, medication, and in some cases an ICD,” she explained.

An Implantable Cardioversion Defibrillator (ICD) is a small electrical device placed under the skin that monitors the rhythm of your heartbeat. When it detects an abnormal rhythm (arrhythmia) it works to restore a normal rhythm.

Although rare, children and young adults can get heart failure usually as a result of a congenital heart conditions and other causes such as valve disease or viral infections.

While some heart failure is hereditary such as a genetically inherited cardiomyopathy, a lot is secondary due to ischaemic heart disease, high blood pressure or excessive alcohol intake.

Almost half of Irish adults surveyed recently for the Irish Heart Foundation’s heart failure awareness campaign mistakenly believed that heart failure means that the heart stops beating.

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Here comes the science bit

The signs and symptoms of heart failure include, shortness of breath, swollen ankles and fatigue. This is because in heart failure, the heart does not pump oxygenated blood around the body as well as it should, leading to fluid build-up in the lungs and the legs.

Dr Brown explained that factors such as high blood pressure or obesity puts the heart under increased pressure, forcing it to work harder, resulting in what is known as hypertrophy- where the muscle gets thicker from over use.

As the heart muscle thickens it becomes stiff and can no longer fill with blood in the same way. This leads to what is called heart failure with preserved ejection fraction (HFpEF). Over time this can progress causing the heart to enlarge and the EF to go down, which is known as Heart Failure with reduced (HFrEF).

A normal ejection fraction (EF) is more than 55 per cent. The lower the EF the higher the risk of developing a life-threatening arrhythmia or rhythm disturbances, if the EF is very low some patients may be advised to have an ICD.

According to Dr Brown, “Heart failure affects people in different ways but 80 per cent of people will have symptoms such as breathless and this limits their daily actives. Some people can’t work, often there is profound fatigue, sometimes dizziness and palpitations. For some patients the worst thing is swelling of the feet and ankles which means they can’t wear their regular shoes. Some heart failure patients also suffer from depression.”

“Many people are unaware of the signs and symptoms of heart failure, so it’s important if they have any of the symptoms listed on knowourheart.ie that they discuss them with their GP,"

Dr Angie Brown, Medical Director, Irish Heart Foundation

Diagnosis and treatment

Dr Brown explained that diagnosing heart failure involved taking a patient’s history, a physical exam, blood tests, Chest X-ray, an ECG and an Echocardiogram.

“Depending on those results, the patient may be referred for a coronary angiogram and, in some cases, a Cardiac MRI she added.

Treatments for heart failure include medication such as diuretics, ACE inhibitors and betablockers. The Irish Heart Foundation’s leaflet on medications has more information on these treatments.

Asked what advice she would give to someone who has recently been diagnosed with heart failure Dr Brown said, “I would explain the cause of the heart failure and the treatment and I would then advise that it’s very important for them to take their medication regularly. I would also advise them to weigh themselves at the same time every day to monitor for weight gain. In heart failure rapid weight gain can be a sign of water retention which may indicate a worsening of the condition.”

In conclusion Dr Brown said that the good news was that some heart failure was preventable therefore, early diagnosis and treatment was important.

“Many people are unaware of the signs and symptoms of heart failure, so it’s important if they have any of the symptoms listed on knowourheart.ie that they discuss them with their GP,” she said.

The Irish Heart Foundation campaign, which is supported by Novartis, aims to educate the public about the warning signs of heart failure. The good news is that people with heart failure can live a full and active life if the condition is detected and treated early.

As part of the campaign, the Irish Heart Foundation has developed a free online symptom checker to help people identify if they are experiencing heart failure symptoms. The heart failure symptom checker is available on the campaign website, KnowYourHeart.ie; people can use the checker and download their findings to help them discuss any concerns they may have with their GP.

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