What is heart failure?

Heart failure happens when the heart loses its ability to pump enough blood, leaving the organs and tissues with insufficient oxygen and nutrients to function properly. In congestive heart failure, there is a build-up of fluid in the tissues (an oedema).

How is heart failure diagnosed?

“Doctors diagnose heart failure by looking at a patient’s symptoms and medical history, doing a physical examination and conducting tests,” explained Adjunct Associate Professor Lim Chong Hee, Senior Consultant, Department of Cardiothoracic Surgery, and Director, Heart and Lung Transplant Programme, National Heart Centre Singapore (NHCS), a member of the SingHealth group.

These tests include a chest radiograph, electrocardiogram (ECG; also called EKG), other imaging tests and cardiac catheterisation.

Symptoms of heart failure

  • Shortness of breath at rest or on exertion
  • Frequent coughing, especially when lying down
  • Swollen feet, ankles, and legs
  • Abdominal swelling and pain
  • Fatigue
  • Dizziness or fainting
  • Sudden death

What causes heart failure?

  • Coronary heart disease and heart attack (which may be “silent”): The arteries supplying blood to the heart become narrowed or blocked. A heart attack happens when blood flow to an area of the heart is completely blocked. The heart muscle suffers damage when its blood supply is reduced or blocked. If the damage affects the heart’s ability to pump blood, heart failure develops.
  • Cardiomyopathy (disease of the heart muscles): It may be caused by coronary artery disease and various other heart problems. It can weaken the heart muscle, leading to heart failure.
  • High blood pressure (hypertension): A common cause, hypertension makes the heart work harder to pump blood. When it cannot keep up, heart failure symptoms develop.
  • Other causes: heart valve disease and postchemotherapy complications

Treatment of heart failure

Medicine and lifestyle changes

For most patients, heart failure is a chronic disease with no cure, but it can be managed and treated with medicines and lifestyle changes. It helps to reduce salt intake to lessen swelling in the legs, feet and abdomen and have a healthy diet to maintain a proper body weight. Quitting smoking and giving up or cutting down on alcohol also help. Low-impact aerobic exercises, walking, cycling or swimming may be recommended, but patients must only start on an exercise programme with the advice of their doctors.

Heart surgery

Sometimes, surgery is needed. Congenital heart defects and abnormal heart valves can be repaired with surgery. Blocked coronary arteries can usually be treated with angioplasty or coronary artery bypass surgery.

Heart devices or transplants

With severe or endstage heart failure, the heart muscles may become so damaged that available treatments will not help. When all other treatments do not work, patients are usually considered for mechanical heart devices and heart transplantation.

See previous page to learn about the new advancements in heart implants.

Ref: Q15