What are the symptoms of heart failure?

When your heart does not pump enough blood around the body, fluid builds up because there is not enough energy to push the fluid through the kidneys into your bladder. The medical word for a build-up of fluid is oedema (pronounced 'ee-dee-ma'). If the fluid builds up in your lungs, you become breathless, with a wheeze or a cough, and you may produce frothy sputum. If the fluid builds up around your ankles, they will swell up and you will be able to see indentations from your shoes or socks or from pressing your skin with a finger (be careful, it can be painful).

My partner has been diagnosed with heart failure but no one would guess on meeting her. However, she does get breathless at night. Why is this?

Fluid builds up in her lungs when she lies down and, if she is asleep, her defences are down. She may wake up with a suffocating feeling. This is helped by standing or sitting up, as this will take the pressure off her lungs. Some people open the window, feeling the need to gulp in fresh air, others walk around or go downstairs to make a cup of tea. If you can reassure her that all is well, this will help her to keep calm. She should tell her doctor that this is happening as medication can help to relieve it.

I have heart failure. Am I right to be worried that I will not be able to lead an active life?

Patients with minimal heart failure usually have no limitations to ordinary physical activity. Mild heart failure leads to breathlessness on walking a mile on the flat, one or two flights of stairs or a long incline. Moderate heart failure tends to cause symptoms more readily - walking half a mile on the flat or one flight of stairs leads to needing a rest. Severe heart failure causes breathlessness on minimal effort and even at rest. Everyone is different, so personal issues are usually best discussed with your doctor.

The good news is that we have treatments that can relieve or at least improve any symptoms so that a better exercise ability and quality of life can be enjoyed. People with more severe symptoms have to learn to adapt their lifestyle once all treatments have been tried and they still remain limited. If you are overweight, reducing your weight can help by taking some of the workload off the weakened heart pump.

You will probably be able to go on holiday and travel as usual, but make your plans more carefully to avoid rushing to catch aeroplanes or trains. Discuss with your doctor if you are planning long journeys while you are on water tablets (see the section Treatment below) as these may need adjusting: dehydration can be a problem on long flights.

Sexual activity doesn't usually present a problem and is not harmful. As in all forms of exercise, breathlessness might limit what you can manage, so take advice if this occurs (see Chapter 8). Some tablets can make you lose your sexual drive and, if this has happened, you should mention this to your doctor rather than accept it. Your doctor may be able to change your medication. Remember, don't suddenly stop taking your medication as this could be dangerous. People often keep to themselves their worries and anxieties. Don't do this - most of your problems can be alleviated: don't be afraid to let the doctor know what's on your mind.

I had a heart attack recently. My cardiologist tells me that my heart has weakened and that I have now got heart failure. Will the symptoms be noticeable?

Your weight may go up from the retention of fluid (1 kg = 1 litre or 1 lb = 1 pint). Your doctor will monitor treatment by measuring your weight loss after you have been prescribed diuretics (these are pills to make you pass more water). There are other symptoms that you might notice:

• feeling tired and washed out;

• swollen ankles ('I can't get my usual shoes on');

• swollen tummy (so your clothing is tight); and

• on occasions, you may get a bit confused.

My doctor says I have a hibernating myocardium. What does he mean?

Your heart muscle looks weak and damaged but is capable of getting a lot of its power back; the damage is not irreversible. The heart is literally hibernating. If your heart only appears to be damaged, it may be possible to strengthen it by angioplasty or surgery. If that is possible, your quality of life and length of life will be greatly improved.

The doctor will check your heart to see what its strength is, either with an echocardiogram, perhaps a nuclear (thallium) scan, or a technique known as positron emission tomography (PET for short). See the section Tests below.

Should I discuss the diagnosis of heart failure with my family?

It is always important with any illness to discuss its effects with close family and friends and, if appropriate, workmates. Having heart failure may limit you because of breathlessness, fatigue and weakness. Your family and friends will be worried about you - by bringing them into the picture they will be able to help and support you.

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