Heart Failure
What does heart failure mean?
The heart is a muscular pump whose purpose is to provide blood for all the organs in the body to work i.e. your brain, kidneys, muscles etc. The term heart failure is used to described a heart which is not working adequately, the main consequences being accumulation of fluid in the lungs (lung congestion) causing breathlessness or leg swelling.
Is heart failure a common problem?
As our population ages heart failure is becoming more common however it still only affects 2% of the general population but is more common amongst the elderly. Improvements in treatment over the last decade now allow patients with this condition to lead active lives.
What are the symptoms of heart failure?
The most common symptoms include:
• Fatigue
• Shortness of breath, especially with activity
• Shortness of breath when lying flat
• Swollen feet and ankles
• Weight gain, over a short period of time i.e. days
• Loss of appetite and abdominal swelling
• dizziness or near fainting episodes
• Irritable cough, sometimes producing frothy sputum.
• sudden severe breathlessness waking one from sleep - this requires urgent attention
What can be done to help?
(1) Medication: The aims of which are to reduce congestion by getting rid of excess fluid and easing symptoms while improving the muscle function of the heart.
(2) Diet: Salt restriction is a critical component of treatment of heart failure. Salt consumption results in fluid retention and in the development of congestion. The salt content of foods can be highly deceptive and all food labels should be carefully checked for salt or sodium content. Salt is used for preservative purposes. Processed and convenience foods are all highly salted for preservation purposes, therefore should be avoided.
• Table salt should be avoidedbut salt added to food while cooking is reasonable
• Alternative seasonings such as pepper, lemon, onion, garlic, fresh/dried herbs can be used.
• "Salt Substitutes" are not suitable alternatives to salt
• Fresh fruit and vegetables should play a large role in the diet.
(3) Alcohol: This should be taken in moderation. In some cases where alcohol has a causative role, it is best avoided and this should be discussed with your doctor in more detail.
(4) Activity: The old saying "Rest is Best" is not really true for patients with Heart Failure. By severely restricting physical activity you can get "out of shape" and reduce your stamina, so that even a short walk may seem like a big task. You may feel your heart race and pound, as breathing becomes more difficult. Being out of condition places added stress on your heart. In short it is better to keep active. By exercising regularly and keeping your body in condition, you will feel better and be able to accomplish more. You will do routine activities more easily.
This does not mean that rest is bad. Regular periods of exercise and rest should be included in your daily activities. Resting for 30-60 minutes after meals allows the heart to use its fullest capacity for digestion. Perhaps this is what the afternoon "siesta" is all about! Extra rest also helps during periods of emotional stress or illness.
Overall you will feel better when you don’t overdo it. If you listen to your body you will know just how much you can exercise. You should start off with gentle exercise, building it up gradually. The important aspect is to exercise regularly not sporadically. Best forms of exercise include walking, swimming and gentle exercises. Using weights to exercise is not advised.
General Advice
• Take an active role in the management of your condition
• Enrol a member of your family or a friend to help you
• Learn the signs of impending problems and contact help
• Ensure accurate compliance with your medication
• Exercise wisely and take rest periods during the day.
Ask your GP about the flu injections
For more information, visit:
www.irishheart.ie - Irish Heart Foundation
How Can Med Day Help?
“Heart failure prevalence is increasing faster than any other chronic illness – due to a combination of an aging population, decreased fatality following heart attack, and longer survival in affected patients. The prevalence of heart failure has been shown to be particularly high in older populations and in lower socioeconomic urban areas, such as the immediate catchment area of St. James’s. In 2009 1,459 patients were admitted to St James’s with a primary or secondary diagnosis of heart failure.
The cardiology service came to St. James’s from the Royal City of Dublin Hospital at Baggot Street and during the last 25 years has become the country’s leading angioplasty service provider and now provides a state of the art service to patients from all over Ireland. Prof Michael Walsh, then consultant cardiologist at St. James’s, tried to establish a service to provide better support for heart failure patients but his retirement intervened and the initiative lost momentum.
To address this major issue now however, the hospital aims to follow international best practice and establish a dedicated multi-disciplinary support service to provide outpatient care for heart failure patients. Funding is now sought for the medical equipment for this unit.
Long-term support
Following agreement with the hospital, the cardiology department now aims to provide ongoing and long-term support for all heart failure patients. The Heart Support Unit will provide planned education and re-education regarding symptoms and early intervention for patients and will provide planned rehabilitation – all of which will be aimed at assisting patients to achieve an improved quality of life and reducing patients’ need where possible for re-admission to hospital. For all cardiology – as well as new patients admitted with heart failure as a secondary diagnosis – the unit will provide regular, planned clinical review following discharge. Most importantly, a single point of contact for heart failure within the hospital will be provided for patients and physicians – patients will no longer need to turn to the Emergency Department with all of the unnecessary administration that entails and treatment for patients will be streamlined through improved internal communication.
A rapid access heart failure assessment clinic will also be provided for new referrals from GPs.
The Heart Support Unit is a consultant-led initiative (led by Dr Caroline Daly, Consultant Cardiologist) and it is intended that the team will include a half-time cardiology registrar and two specialist nurses – with input and support provided from the Departments of Clinical Nutrition, Medical Social Work, Occupational Therapy, Physiotherapy and Pharmacy. One specialist nurse has been appointed and took up her post in the week of April 11th 2011.
It is in the interest of all heart failure patients and indeed of all hospital patients to have a comprehensive and effective heart failure programme. It is intended that the new service will reduce waiting times for new out patient appointments by streamlining outpatient activity and will reduce the amount of time during which patients are admitted as in-patients – through early discharge with appropriate support provided and through reduced readmissions through the Emergency Department..”
Dr. Caroline Daly
Consultant Cardiologist
