It is a well-known fact that, when a car engine has trouble turning, all of its components are slowed down. The same is true for a person affected by heart failure. A great number of symptoms can be felt daily when one lives with a failing heart.

The heart and heart failure

The heart is a powerful muscle. From one heartbeat to the next, it pumps blood continuously to ensure that it circulates in the vessels which nourish all of the body’s organs and tissue. Blood circulation provides oxygen and nutrients which are essential to life. Following each contraction, the heart recovers its initial size to be refilled with new blood.

Heart failure is a chronic disease that occurs when the heart is weakened. There are two types of heart failure:

• Systolic heart failure
  
  The heart is weak. It does not contract with as much force as a healthy heart. Thus, the quantity of blood that is pumped out of the heart after each heartbeat is diminished.

• Diastolic heart failure
  
  After a heartbeat, the heart does not relax normally. Therefore, it does not adequately fill up with blood before the next heartbeat.

Heart failure diagnosis

Thanks to an ultrasound, heart activity can be viewed to determine the "ejection fraction"; in other words, the amount of blood ejected from the heart at each heartbeat. The ejection fraction is expressed as a percentage—for individuals affected by systolic heart failure, it is lower and generally below 40%; whereas, in cases of diastolic heart failure, it is normal.

In order to confirm a diagnosis, other tests may be requested:

• an electrocardiogram (ECG) to check the heart’s electrical activity
• an X-ray, to determine if there is liquid in the lungs
• a stress test to obtain an ECG during physical activity (using a treadmill)
• a coronary angiography to see any possible arterial blockages

Causes of heart failure

Heart failure does not only occur in the aging population, it affects people of all ages. The most common causes are:

• cardiac arrhythmias
• control valve issues
• myocardial infarction (heart attack)
• high blood pressure
• cardiomyopathy (heart muscle issues)

There is a common thread in all of these types of heart failure—they lead to increased heart workload or a decrease of oxygen to certain areas of the heart. Treatment prevents the progression of heart failure.

Signs and symptoms of heart failure

Most symptoms of heart failure are manifested when the disease goes untreated or is poorly controlled. Speak to your healthcare professional if the following symptoms appear of worsen despite adequate treatment:

• effort-induced breathing problems or difficulty breathing during regular physical activities
• difficulty breathing while resting
• difficulty breathing while lying down
• increased number of pillows needed during the night
• increased coughing
• oedema (water accumulation) in the feet, ankles, legs, hands, and in the abdomen
• weight gain
• feeling of fatigue or weakness
• dizziness
• increased heart rate, even while resting

Drug treatment for heart failure

Patients with heart failure must follow a drug treatment. Taking medication as prescribed offers patients several benefits:

• decreased symptoms of heart failure
• decreased number of hospitalizations
• reduced risk of heart failure-related death

The main medications used are the following:

• Angiotensin-converting enzyme inhibitor (ACE)
  These agents reduce pressure in blood vessels, allowing the heart to pump blood more easily.
• Angiotensin receptor blockers (ARB)
  If a patient is unable to tolerate ACEs because of the cough they sometimes cause, the doctor may prescribe an ARB.
• Beta blockers
  By slowing down the heart rate and decreasing blood pressure, these medications lessen the heart’s workload. Treatment is started at a low dose and is then slowly increased, as some patients’ condition may deteriorate at the beginning of treatment. However, these unwanted effects are temporary.
• Diuretics
  These medications force the kidneys to eliminate excess salt and liquid from the body.
• Aldosterone receptor antagonists
  These medications promote the elimination of liquid by the kidneys. They also block the action of aldosterone, a hormone that can have negative effects on the heart.
• Digoxin
  This medication increases the heart’s force of contraction. Blood tests are usually needed to check if the prescribed dose is appropriate.

Do not underestimate the help that your pharmacist can provide in heart failure management. Most people suffering from this disease must take more than three medications a day, even when they feel well. In addition to giving you information about the drug treatment’s potential undesirable effects, your pharmacist can give you tips on how to take your medication regularly. Don’t hesitate to speak to him/her about the aids available to take your medication, such as dosettes and the Dispill^MC medication pack. Finally, always speak to your pharmacist before using over-the-counter medication, natural health products, or supplements, as some of them may worsen heart failure.

Alternative measures

In terms of heart failure management, medication is not enough. People affected by it must make some lifestyle changes. They must also learn to recognize the signs of deterioration of the disease. Here is some advice on how to achieve this:

• Your doctor will establish the maximum quantity of liquid that you can have daily (drinks, soup, broth). Follow these recommendations very closely! Pay particular attention to your feet, legs, and hands. If your shoes feel tight or your rings are difficult to remove, fluid may have accumulated inside the body. Speak to your healthcare professional promptly.
• Weigh yourself daily when you awaken, after having urinated, and before breakfast. Write down your weight on a calendar to help detect any variations. Weight gain of more than 1 kg (2 pounds) a day, or more than 2 kg (4 pounds) a week must be reported to your healthcare professional. It may be necessary to adjust the dose of your diuretic therapy.
• Avoid adding salt to your food. Salt promotes the accumulation of fluid in the body. Choose commercially prepared foods that are low in salt. Your daily salt (sodium) consumption should not exceed 2000 mg. Read the nutrition labels of the foods you eat to know how much salt they contain.
• Lose any excess weight. Being overweight causes your heart to work harder.
• Quit smoking. Your pharmacist can help you in this process and recommend pharmacological therapies adapted to your situation.
• Limit your alcohol consumption. Women should not have more than one alcoholic beverage per day, while men should not have more than two per day. One drink is equal to 360 ml of beer or to 150 ml of wine.
• Exercise. Several heart failure treatment centres offer supervised fitness programs. Speak to your healthcare professional about it.

Heart failure management is possible when the patient and healthcare professionals work as a team. In any case, following the drug therapy and alternative measures is essential. Furthermore, it is critical that the patient be committed, as he/she is the only one that can swiftly detect any changes in his/her health status. Are you ready to take on the challenge? If so, your heart thanks you!