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. This could be due to a weak or stiff heart. In congestive heart failure, there is a build-up of fluid in the tissues (an oedema).

Classifying Heart Failure

• Shortness of breath at rest or on exertion
• Difficulty in breathing when lying flat
• Persistent coughing or wheezing
• Waking up breathless at night with dry hacking cough
• Swollen ankles, legs or abdomen
• Sudden weight gain
• Tiredness and giddiness
• Loss of appetite or nausea
• Palpitation (increased heart rate)
  
  

The most common causes of heart failure are:

• Coronary heart disease and heart attack (which may be “silent”): In coronary heart disease, 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): Hypertension, a common cause, 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: Defects of the heart valves, congenital heart diseases, alcoholism, and drug abuse cause damage to the heart that can all lead to heart failure.

Heart failure can be precipitated by several events. The common precipitating factors are:

• Poor compliance to salt restriction, fluid restriction or medications
• Heart attack
• Worsening heart valves condition
• Abnormal heart rhythm
• Medical stress from infection, surgery or anemia
  
  

The diagnosis of heart failure is based on:

• Symptoms: Symptoms can provide important clues to the presence of heart failure. Shortness of breath while engaging in activities and episodes of shortness of breath during sleep are classic symptoms of heart failure
  
  
• Physical examination: The physician listens to the heart and lungs with a stethoscope for tell-tale signs of heart failure, such as irregular heart sounds, a rapid heart rate and murmurs of the heart valves. If there is fluid in the lungs, crackling sounds may be heard. Rapid breathing or other changes in breathing may also be present. Patients with heart failure may also have a rapid pulse.
  
  By pressing on the abdomen, the physician can feel if the liver is enlarged. The skin of the fingers and toes may have a bluish tint and feel cool if not enough oxygen is reaching them.
  
  
• Chest radiograph: Chest radiographs can show if there is fluid in the lungs or if the heart is enlarged. Abnormalities of heart valves and other structures also may be seen.
  
  
• Electrocardiogram (ECG; also called EKG): An electrocardiogram gives information on the heart rhythm and and evidence of previous heart attack.
  
  
• Other imaging tests:
  • Echocardiography can show if the heart wall or chambers are enlarged and if there are abnormalities of the heart valves. An echocardiogram can be used to find out how much blood is being pumped out of the heart chambers.
  • Magnetic Resonance Imaging can supplement the finding of echocardiogram and is excellent for cardiac tissue characterisation.
    
    
• Cardiac catheterisation: is used to measure pressure in the heart and the amount of blood pumped by the heart. This test can help find abnormalities of the coronary arteries, heart valves, heart muscle, and other blood vessels. Combined with echocardiography and other tests, cardiac catheterisation can help find the cause of heart failure.
  
  

Heart failure is usually treated with lifestyle changes and medicines.

Lifestyle changes

Dietary changes to maintain proper weight and reduction of salt intake may be needed. Reducing salt intake helps to lessen swelling in the legs, feet and abdomen. Other lifestyle changes that may reduce the symptoms of heart failure include stopping smoking or other tobacco use, eliminating or reducing alcohol consumption and not using harmful drugs.

Appropriate exercise such as walking, cycling, swimming, or low-impact aerobic exercises may be recommended, but it is important that heart failure patients only begin an exercise programme with the advice of their doctors. The National Heart Centre Singapore offers good Cardiovascular Rehabilitation and Preventive Cardiology Programme for patients identified to have multiple risk factors for heart disease or who have just undergone open-heart surgery.

Heart surgery

Surgery may be needed to correct abnormalities of the heart or heart valves that cause heart failure. 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

Severe or end-stage heart failure may result in heart muscles so damaged that available treatments will not help. When all other treatments do not work, patients are usually considered for mechanical assist devices and heart transplantation.

National Heart Centre Singapore (NHCS) Heart Failure Clinic

The clinic adopts a team approach to treat heart failure through a structured outpatient programme to prolong survival, improve quality of life and reduce hospital admissions. A specialist nurse clinician is on hand to provide phone consultations to patients.

Learn more on our Heart Failure Programme here.

What happens in advanced heart failure?

Videos on heart failure:

Living with Heart Failure

心脏衰竭患者 / Living with Heart Failure (Chinese version)

Health Management Guide for Heart Failure

Read our guide here.

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