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Heart failure

Heart failure has several causes, including acute damage that can occur after a heart attack, hypertension, valvular disease and arrhythmias.
Hello. I’m Dr Sam Boateng. Today we’re going to talk about heart failure. Heart failure is the inability of the heart to pump a sufficient amount of blood to the tissues of the body. And it usually occurs because there is an impaired pump function of the heart that usually results in a decrease in cardiac output.
Heart failure, unfortunately, is a progressive disease that has a poor prognosis, with about 40% of patients dying within the first year. And this costs the NHS about 600 million pounds a year. So what are the main causes of heart failure? This can occur as a result of coronary artery disease, high blood pressure, valvular disease; it can occur even as a result of pregnancy. So what are the symptoms of heart failure? This can include fatigue and intolerance to exercise, oedema, which results in accumulation of fluid in the lungs and in the lower limbs, and also a reduction in the ejection fraction, usually down to below 40%.
So there are four main stages of heart failure, ranging from class one to class four. Class one is considered relatively mild, where the symptoms may only be present in response to intense exercise. By the time the patient reaches class four, or what is described as end stage heart failure, the symptoms will be present even at rest. Heart failure may be diagnosed using the electrocardiogram, or the ECG, that measures the electrical activity of the heart. This will also enable the doctors to determine precisely where the damage has occurred, especially in response to coronary artery disease.
A chest x-ray may also be used to determine the extent of any heart enlargement that may occur, for example, in cases where there’s been high blood pressure, and also determine the extent of any fluid accumulation in the lungs. Finally, magnetic resonance imaging, or MRI, may also be used to determine the function of the heart. And this enables the blood flow through the chambers also to be determined. So what are the treatment options for heart failure? Unfortunately, heart failure is a progressive disease, and there is no real cure for the condition. So most therapeutic options are designed to try and slow down the progression of the disease.
When the function of the heart decreases sufficiently so that the patient is no longer able to carry out basic functions, ventricular assist may be offered. This is an instrument that unloads the heart and helps the pump function of the heart, and it’s usually connected to the apex of the heart. And this assists in the function of the heart by helping it to pump oxygen and nutrients to the tissues. Beyond this, the only real option is heart transplantation.

Heart failure is a common condition that affects 10 per cent of people over 70 years of age (in the UK). It has several causes, including acute damage that can occur after a heart attack, hypertension, valvular disease and arrhythmias, some of which we will discuss later in the week.

In this video Dr Sam Boateng will discuss in detail the pumping mechanism of the heart and what happens when it can no longer pump efficiently.

You can download the Week 3 supplement, which contains additional images and descriptions to help you understand the topics covered in this video.

British Heart Foundation resources

You can find out more about this topic in the following booklet on Living with heart failure produced by the British Heart Foundation.

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Heart Health: A Beginner's Guide to Cardiovascular Disease

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