Heart failure - what does it mean?
Heart failure - what does it mean?
Dr Duncan Dymond, consultant cardiologist, explains what heart failure is. Find out what the causes and symptoms are, and how the condition can be treated.
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Content
7.34 -> It's a clinical diagnosis and it's a
10.41 -> syndrome i.e. a collection of symptoms and
14.849 -> signs, but the standard textbook
17.7 -> definition is that it's a situation
20.34 -> where the heart cannot meet the demands
23.1 -> of the circulation.
24.97 -> It's not the same as
26.939 -> a heart attack, you can have a heart
28.38 -> attack without having heart failure, it's
30.66 -> not the same as a cardiac arrest, which
32.82 -> is a rhythm disorder, but it's a specific
35.64 -> condition which doctors recognise where
38.73 -> congestion occurs in the lungs and in
42.57 -> the tissues because the heart cannot
44.879 -> pump properly.
45.914 -> So the most common cause is
47.91 -> where the heart muscle actually fails to
50.579 -> contract properly, there are several
52.379 -> clinical and medical reasons why that
54.149 -> can happen.
55.46 -> When the heart fails to contract
56.67 -> it's just pumping weakly, but nowadays
59.309 -> we see a different sort of heart
61.079 -> failure where the heart can contract
63 -> properly but doesn't actually relax
64.85 -> and this relaxation abnormality is often
68.22 -> called diastolic heart failure, which is
70.9 -> really only recently being increasingly recognised.
76.8 -> Well, the symptoms of heart failure
78.24 -> relate to the fact that looking
80.18 -> at it simplistically there's back
81.72 -> pressure because the pump isn't working.
84.75 -> If we take the lungs, if the lungs which are
86.7 -> normally like two dry sponges.
88.86 -> If they become congested with fluid
91.36 -> they become like wet sponges, which are more
93.6 -> difficult to move, so the first symptom
96.24 -> is breathlessness, and this can be
98.13 -> breathlessness initially on climbing
100.5 -> stairs or walking up an incline but it
102.96 -> gets worse it can become breathlessness
104.79 -> on walking on the flat on doing things
108.42 -> like bed making or housework or pushing
110.52 -> a shopping trolley, and then when the
113.159 -> lungs become really congested the
114.78 -> patient will notice as they lie flat in
116.85 -> bed at night their lungs fill up with
118.409 -> fluid and they can't lie flat, they have
120.57 -> to sleep sitting up.
122.74 -> That's the left side
123.39 -> of the heart when the right side of the
125.49 -> heart fails it's the peripheral tissues
127.68 -> that get congested, the commonest thing
130.2 -> that happens is that the ankles swell it
132.88 -> abdomen may swell because the liver
134.56 -> enlarges they may be fluid at the base
137.26 -> of the spine and the patient may get
139.09 -> very very fatigued and lethargic.
144.58 -> Well, any condition that damages the heart muscle
147.3 -> can lead to heart failure and
149.35 -> this can be due to blocked arteries, the
151.81 -> coronary arteries which supply the heart
153.43 -> with blood, if the heart becomes short of
155.17 -> blood and has lots of heart attacks the
157.42 -> heart will stop beating.
159.08 -> Then there are diseases of the valves that open and
162.34 -> shut and if they're left too long
164.02 -> without treatment, that can put a strain
166.21 -> on the heart that can damage it and
168.43 -> there are conditions that can primarily
170.59 -> affect the heart muscle which we call
172.98 -> cardiomyopathies which is specifically
174.96 -> abnormalities of heart muscle for example
177.73 -> such as drinking too much alcohol,
180.44 -> such as certain drugs, such as even viruses
182.86 -> that can damage the heart muscle.
185.26 -> It may well be underlying causes as well such
188.41 -> as anaemia, where the heart is asked to do
190.63 -> more work, or even a change in the heart rhythm
193.5 -> There's a very common arrhythmia called
195.16 -> atrial fibrillation, where the upper
197.53 -> chambers of the heart go out of rhythm
199.27 -> and a patient may have no symptoms until
201.91 -> they develop this arrhythmia and then
204.01 -> the heart can fail.
205.5 -> Now there are other
206.29 -> less common causes such as some
208.87 -> infiltrative diseases which can particularly
211.39 -> affect the relaxation, and one of the most
213.97 -> common of those is long-standing,
215.91 -> untreated high blood pressure which can
218.83 -> commonly cause heart failure if it's not
220.81 -> treated properly.
224.78 -> So, obviously prevention
225.88 -> is better than cure, but if someone has
228.19 -> heart failure there are several
230.29 -> treatments available.
231.46 -> First of all let's
232.66 -> correct the underlying cause so treat
234.85 -> the anaemia, treat the rhythm disorder,
236.89 -> reduce salt intake, treat the high blood pressure.
241.02 -> But then there are drugs known
242.709 -> as diuretics, which are commonly known as
244.87 -> water tablets, which can be given by
246.73 -> mouth or intravenously, which make the
249.1 -> kidneys get rid of the excess fluid and
251.5 -> clear the congestion.
253.54 -> There are other
254.32 -> drugs we use to take the strain off the
257.1 -> heart several groups of drugs:
259.18 -> Ace inhibitors, beta blockers, and nitrates
262.12 -> all of which have beneficial effects and
264.73 -> ease the load on the strained heart.
267.3 -> Apart from drugs there are things like
269.8 -> there are some devices that we can use
271.6 -> to improve the function of a heart for
273.88 -> example there are special sorts of
275.56 -> pacemaker called resynchronisation
277.92 -> pacemakers, which force the chambers of
280.48 -> the heart to beat more synchronously and
282.7 -> improve function and can actually
284.5 -> improve life expectancy, and they can
287.29 -> often be combined with a device called a
289.66 -> defibrillator which will administer a
292.15 -> life-saving electric shock if a patient
295.3 -> with heart failure, becomes, goes into
298.22 -> unstable, life-threatening rhythm.
300.96 -> In certain circumstances surgery
303.3 -> can be indicated to correct an abnormal valve,
305.6 -> or to bypass the coronary artery.
Source: https://www.youtube.com/watch?v=rbF1Rv-qALU