Tirohanga whānui ki te hinganga manawa Heart failure
Heart failure happens when your heart cannot pump blood around your body as well as it should. It does not mean your heart is about to stop — just that is not working as well as it used to.
Causes of heart failure
The problem with your heart may be that:
- your heart muscle is weaker and cannot produce enough force when pumping
- the pumping chamber of your heart (ventricle) is not able to fill with as much blood.
The most common cause of a weak heart is damage from a heart attack.
Having untreated high blood pressure for a long time is the commonest cause of a heart that cannot fill properly.
Other conditions that can lead to heart failure include:
- problems with heart valves
- disease of the heart muscle (cardiomyopathy)
- heart rhythm problems including atrial fibrillation
- viral infections
- drinking too much alcohol.
Symptoms of heart failure
Symptoms of heart failure develop slowly and can vary from person to person. They include:
- getting short of breath with physical activity or when lying flat
- swelling (oedema) of your feet, legs or stomach
- being less able to do physical activity — climbing stairs or walking may leave you tired, weak and short of breath
- a rapid heartbeat
- tiredness or fatigue
- weight gain due to fluid build up
- a cough that is worse when lying down
- a loss of appetite or feeling sick (nausea)
- dizziness.
What is heart failure? (video) — Heart Foundation (external link)
Diagnosing heart failure
If you are getting symptoms of heart failure, your healthcare provider will need to examine you to check for fluid build up. They may also arrange some tests such as an electrocardiogram (ECG), echocardiogram and blood tests.
Treating heart failure
Heart failure cannot be cured but it can be controlled through medicines, healthy lifestyle measures and caring for yourself.
Medicines for heart failure
Your healthcare provider or heart specialist (cardiologist) will advise you on the medicines options for heart failure and start you on the appropriate treatment.
The type of medicines you will need depends on the type of heart failure you have and how severe it is.
Medicines called diuretics can treat your symptoms by helping your body get rid of the extra fluid. Other medicines can help your heart pump better and may help you live longer.
You may need one or more medicines. You may also need to be prepared to adjust their doses and add medicines until you and your healthcare provider find what works best for you.
Information on individual medicines used in Aotearoa New Zealand is at My Medicines.
My Medicines A-Z — My Medicines (external link)
There are different types of medicines for treating heart failure.
Diuretics help your body get rid of extra fluid. These medicines include furosemide and bendroflumethiazide.
ACE inhibitors and ARBs help your heart pump blood through your blood vessels. These medicines include enalapril and candesartan.
Beta blockers make your heart beat slower and reduce your blood pressure. These medicines include atenolol and carvedilol.
SGLT2 inhibitors improve heart pumping and work as a diuretic. These medicines include empagliflozin and dapagliflozin.
Aldosterone antagonists are another type of diuretic. These medicines include spironolactone and eplerenone.
ARNIs are used instead of ACE inhibitors or ARBs if these are not controlling your heart failure. These medicines include sacubitril with valsartan.
Digoxin is used to help your heart beat strongly and to help control your heartbeat.
Blood thinners help stop blood clots forming. These medicines include warfarin and dabigatran.
Other treatments for heart failure
Some people need a medical device fitted to help manage their heart failure. These include a:
- pacemaker
- cardiac resynchronisation therapy pacemaker (CRT-P)
- implantable cardioverter defibrillator (ICD).
Heart surgery is sometimes needed, depending on the cause of the heart failure. For example, a faulty heart valve may need replacing.
Heart treatments and procedures (internal link)
In advanced heart failure, when usual treatments are no longer working, other options to manage symptoms may be needed.
Self care for heart failure
There are lots of ways that you can look after yourself if you have heart failure.
By doing daily checks, making healthy choices and taking medication, you can help manage your heart failure.
This normally includes:
- checking your weight
- checking for swelling
- watching for changes in your breathing.
Weighing yourself is one way of knowing if you are storing excess fluid. If your weight increases over just a few days, this will be from extra water not fat.
It is best to weigh yourself every morning at the same time (after you have been to the toilet, before you eat or drink anything and before you get dressed). Use digital scales and use them on a firm surface, such as lino or tiles.
Your healthcare provider will help you work out a target weight. This is the weight at which you have no extra fluid and your heart can work the best.
Ask your healthcare provider for a Heart Failure Action Plan to record your daily checks and as a source of advice on what to do if there are changes.
Heart failure resources — Heart Foundation (external link)
Heart failure is a long-term condition, so you will need to keep taking medicines even when you are feeling better. This can be a nuisance, particularly taking diuretics which can make you need to wee (pass urine) more often.
If you have problems taking your medicine, talk to your healthcare provider about ways of making it easier for you. For instance, you may be able to take your pills later in the day if you have to go to a morning event.
Your Heart Failure Action Plan can tell you how to change your medicines depending on the amount of fluid your body is storing.
- Eat well and lower your salt intake by choosing whole foods rather than processed foods.
- Avoid drinking large amounts of fluid — more than 8 cups (2 litres) a day.
- If you smoke, quit.
- If you drink alcohol, keep your daily alcohol intake to no more than one standard drink per day — give it up completely if you can.
- Lose weight if you need to.
- Keep as physically active as possible. Even gentle activity can help your heart work better. Ask your healthcare provider about support for getting active.
- Manage stress by using relaxation techniques such as calming breathing.
- Have an annual flu vaccine. Flu vaccines are free for people with serious medical conditions or who are aged 65 or over.
- Keep up to date with COVID-19 booster vaccinations.
Activity and diet (internal link)
Flu (influenza) vaccine (internal link)
COVID-19 vaccines (internal link)
Preventing heart failure
The advice to reduce your chance of getting heart failure is the same as for preventing angina and heart attacks.
It is also important to have your blood pressure checked and treated if needed.