Heart failure

Heart failure occurs when the body's demands for energy are not supplied properly because of a weakness in the heart itself. Heart failure from damage to the heart muscle is common and, at present, 0.3% of the UK population is affected each year. However, it becomes more of a problem with increasing age, as it affects 8% of those over 65 years of age. Put another way, many thousands of people develop heart failure each year, and this represents 5% of acute emergency admissions to hospital. Because heart failure is common in elderly people, one of the reasons why we are seeing more cases of heart failure is the fact that people are living longer. In total up to 2% of the population actually suffers - roughly 1 million people in the UK. Each year 120 000 people are admitted to hospital with heart failure and stay on average 11 days. Heart failure costs the NHS over £300 million per year. Heart failure, if not treated, can significantly shorten life and reduce its quality but we now have means of helping people to live longer and feel better.

CAUSES

Are the causes of heart failure known?

Heart failure usually occurs because of a weakness of the heart muscle. The heart then doesn't pump as strongly as it should. The most common cause of damage to the muscle is a heart attack but it can also be due to:

• narrowing (hardening) of the coronary arteries;

• high blood pressure;

• narrow or leaking valves;

• a disease of the muscle itself (cardiomyopathy), where the muscle is affected directly, usually by a virus, and not as a consequence of other problems such as high blood pressure;

• excess alcohol consumption over many years.

My daughter has been diagnosed as having cardiomyopathy -what is this condition?

Cardiomyopathy (pronounced 'car-dee-oh-my-opathee') is a disease of the heart muscle. The muscles may be too thick - this is known as hypertrophic cardiomyopathy (hypertrophy means thickening) - or too thin and too weak so that the heart enlarges and looks flabby (doctors often call this a 'saggy bag' heart). Both conditions can cause heart failure. The commonest is the weak heart and the medical term for this is congestive cardiomyopathy. Hypertrophic cardiomyopathy is usually inherited and can be the cause of sudden death in apparently fit young people. Although coronary disease can weaken the heart muscle, your daughter's diagnosis of cardiomyopathy is probably related to disease of the heart muscle even though she has normal coronary arteries.

I have read of footballers and other sports people dropping dead from HOCM - what is this?

Hypertrophic cardiomyopathy (see above question) can cause so much thickening of the heart muscle that it obstructs the flow of blood leaving the heart. It then becomes Hypertrophic Obstructive Cardiomyopathy or HOCM. This obstruction is increased when physical exercise or strong emotion increases the heart rate. It can then block the flow of blood or cause the heart's electric system to become so irregular from lack of oxygen that the person collapses (we call this syncope - sudden loss of consciousness). Sadly, this collapse can be out of the blue and fatal. If the problem can be detected earlier, treatments are available with medication to help prevent a collapse. People with HOCM should be managed in specialised units to allow for optimal care, as it is not a straightforward condition.

How often do sports players collapse and die?

Hypertrophic cardiomyopathy affects one in 500 people and along with other very rare conditions, it is estimated that 0.2% of the athletic population may have a problem with the heart that could affect them at some time. Deaths during sports have been estimated at between one in 100 000 and one in 300 000 in young athletes. However, in older people, because of the increased chance of having coronary disease, the death rate varies from one in 15 000 for joggers to one in 50 000 for marathon runners. Dramatic and newsworthy death during sports is rare. Currently, the Football Association is using some of its income from TV coverage to screen all young would-be football stars by ECG and echocardiography - a commendable approach to safety in the sport.

My husband has heart failure but the doctor says his heart is OK, he's just anaemic. How can this be?

The heart can fail because of other problems. If there isn't enough blood (through anaemia or blood loss, e.g. after an accident), the heart will overwork until it fails, because there is so little blood to pump around. It may also fail if the thyroid gland is overactive (thyrotoxicosis) because an overactive thyroid gland drives the heart very fast and can cause it to go into atrial fibrillation (see Chapter 6). Usually the heart recovers when the conditions are treated.

If the heart valves are to blame for weakened muscle, can they be replaced?

Yes. An operation to replace defective heart valves is a successful way of relieving heart failure, providing the heart muscles (the 'pump') are not too severely damaged (see Chapter 7).

I have been told that I have heart failure. Is heart failure dangerous?

It can be if not treated properly. People with mild heart failure usually lead a normal life, but those with more severe heart failure will be restricted in what they can do: the weaker the heart, the greater the problem. The good news is that modern drugs, especially the ACE inhibitors (see the section Treatment below), can add many high quality years to the life of anyone with heart failure. If you have heart failure, ask your doctor about ACE inhibitors if you are not taking them - they are very important drugs, and can help you a lot.