Heart failure

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Diagnosis

If you have symptoms of heart failure, your GP should offer you some checks and a blood test to see how well your heart is working.


If your blood test shows you might have heart failure, your GP should refer you to a specialist heart failure team and you may be offered further tests.


Tests for heart failure

Tests you may have to diagnose heart failure include:


blood tests – to check whether there's anything in your blood that might indicate heart failure or another illness

an electrocardiogram (ECG) – this records the electrical activity of your heart to check for problems

an echocardiogram – a type of ultrasound scan where sound waves are used to examine your heart

breathing tests – you may be asked to blow into a tube to check whether a lung problem is contributing to your breathlessness; common tests include spirometry and a peak flow test

a chest X-ray – to check whether your heart's bigger than it should be, whether there's fluid in your lungs (a sign of heart failure), or whether a lung condition could be causing your symptoms

You can read more about tests for heart conditions on the British Heart Foundation website.


Stages of heart failure

When you're diagnosed with heart failure, your doctor will usually be able to tell you what stage it is.


The stage describes how severe your heart failure is.


It's usually given as a class from 1 to 4, with 1 being the least severe and 4 being the most severe:


class 1 – you don't have any symptoms during normal physical activity

class 2 – you're comfortable at rest, but normal physical activity triggers symptoms

class 3 – you're comfortable at rest, but minor physical activity triggers symptoms

class 4 – you're unable to carry out any physical activity without discomfort and may have symptoms even when resting

Knowing the stage of your heart failure will help your doctors decide which treatments they think are best for you.


Treatment

Heart failure is a chronic disease needing lifelong management. However, with treatment, signs and symptoms of heart failure can improve, and the heart sometimes becomes stronger.


Doctors sometimes can correct heart failure by treating the underlying cause. For example, repairing a heart valve or controlling a fast heart rhythm may reverse heart failure. But for most people, treatment of heart failure involves a balance of the right medications and, sometimes, use of devices that help the heart beat and contract properly.


Medications

Doctors usually treat heart failure with a combination of medications. Depending on your symptoms, you might take one or more medications, including:


Angiotensin-converting enzyme (ACE) inhibitors. These drugs relax blood vessels to lower blood pressure, improve blood flow and decrease the strain on the heart. Examples include enalapril (Vasotec, Epaned), lisinopril (Zestril, Qbrelis, Prinivil) and captopril.

Angiotensin II receptor blockers. These drugs, which include losartan (Cozaar), valsartan (Diovan) and candesartan (Atacand), have many of the same benefits as ACE inhibitors. They may be an option for people who can't tolerate ACE inhibitors.

Beta blockers. These drugs slow your heart rate and reduce blood pressure. Beta blockers may reduce signs and symptoms of heart failure, improve heart function, and help you live longer. Examples include carvedilol (Coreg), metoprolol (Lopressor, Toprol-XL, Kapspargo Sprinkle) and bisoprolol.

Diuretics. Often called water pills, diuretics make you urinate more frequently and keep fluid from collecting in your body. Diuretics, such as furosemide (Lasix), also decrease fluid in your lungs so you can breathe more easily.


Because diuretics make your body lose potassium and magnesium, your doctor may also prescribe supplements of these minerals. If you're taking a diuretic, your doctor will likely monitor levels of potassium and magnesium in your blood through regular blood tests.


Aldosterone antagonists. These drugs include spironolactone (Aldactone, Carospir) and eplerenone (Inspra). These are potassium-sparing diuretics that have additional properties that may help people with severe systolic heart failure live longer.


Unlike some other diuretics, spironolactone and eplerenone can raise the level of potassium in your blood to dangerous levels, so talk to your doctor if increased potassium is a concern, and learn if you need to modify your intake of food that's high in potassium.


Positive inotropes. These medications may be given by IV to people with certain types of severe heart failure who are in the hospital. Positive inotropes can help the heart pump blood more effectively and maintain blood pressure. Long-term use of these drugs has been linked to an increased risk of death in some people. Talk to your health care provider about the benefits and risks of these drugs.

Digoxin (Lanoxin). This drug, also called digitalis, increases the strength of your heart muscle contractions. It also tends to slow the heartbeat. Digoxin reduces heart failure symptoms in systolic heart failure. It may be more likely to be given to someone with a heart rhythm problem, such as atrial fibrillation.

Hydralazine and isosorbide dinitrate (BiDil). This drug combination helps relax blood vessels. It may be added to your treatment plan if you have severe heart failure symptoms and ACE inhibitors or beta blockers haven't helped.

Vericiguat (Verquvo). This newer medicine for chronic heart failure is taken once a day by mouth. It's a type of drug called an oral soluble guanylate cyclase (sGC) stimulator. In studies, people with high-risk heart failure who took vericiguat had fewer hospital stays for heart failure and heart disease-related deaths compared with those who received an inactive pill (placebo).

Other medications. Your doctor may prescribe other medications to treat specific symptoms. For example, some people may receive nitrates for chest pain, statins to lower cholesterol or blood-thinning medications to help prevent blood clots.