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Weak or Stiff Heart Pump

Problems with this electrical system can cause the heart to beat too slowly, too fast, in a disorganized way, or to stop suddenly.

This reduces the blood flow and oxygen to your body and vital organs, resulting in what is known as heart failure. 

Heart failure

Types of heart failure

There are two main types of heart failure.

A weak pump

When the heart muscle is weak and gets stretched out. The heart becomes less effective at pumping blood through the body.

A stiff pump

When the heart muscle cannot relax between beats because it has become stiff. The heart can only partially fill with blood between beats. 

Heart failure cannot be cured and it usually gets worse over time. However, people can learn to live active, healthy lives through a combination of close monitoring, healthy living and medications.

There are many factors that could increase your risk of heart failure. The most common causes include: 

  • heart attack 
  • high blood pressure 
  • heart valve problems 
  • heart defects at birth 
  • lung conditions 
  • excessive use of alcohol or drugs.

Other possible causes of heart failure include: 

  • obesity 
  • sleep apnea 
  • infections affecting the heart muscle 
  • abnormal heart rhythm 
  • conditions such as severe anemia, severe kidney disease or thyroid disease
  • exposure to chemotherapy or radiation. 
 

Cardiac Services BC's heart failure program has developed a number of resources and tools to help patients and caregivers learn more about their condition and self-manage it effectively.


Learning about heart failure

Co-management

In addition to things your health care provider can do for you to help manage your heart failure, there are things you can do every day to achieve your best health. You need to work together in order to co-manage your condition. The heart failure program has developed a number of co-management resources to support health care professionals to provide education around how to take good care of yourself, what to watch for, and when you should contact your health care provider.


Coping

Medications

 



Symptoms

Heart failure can cause fluid to back up in your lungs and in other parts of your body. This can result in symptoms including:

  • shortness of breath, especially when lying down
  • tiredness
  • fluid retention marked by:
    • sudden weight gain
    • bloating
    • swelling of the ankles, feet, legs, base of spine or abdomen
    • increased urination at night
  • persistent cough
  • loss of or change in appetite


Treatment

Diagnosis

There is no single test for heart failure. Instead, your doctor will do a number of tests. The results of all your tests will be used to determine if you have heart failure.

Tests can include:

  • blood tests to check certain enzymes
  • a chest x-ray to look at the size of your heart
  • an electrocardiogram (ECG) to look at the electrical activity of your heart
  • an exercise stress test to look at hour your heart responds to exercise
  • a nuclear medicine scan to get a close look at the pumping of your heart
  • an angiogram to look for blockage in your heart arteries; this is done using diagnostic cardiac catheterization
  • an ECG or ultrasound of the heart to look at the movements of your heart and measure how strongly your heart is pumping.

Treatment

There is no cure for heart failure. Instead, treatment is focused on helping you live a longer and healthier life.

Care management

Effective management of heart failure requires a combination of close monitoring, healthy living and medications. Your health care providers will work with you and support you to manage your condition on a day-to-day basis.

Medications

There are a variety of heart failure medications that may be useful. Your doctor may prescribe a combination of medications including one or more of these:

  • beta blockers
  • angiotensin converting enzyme inhibitors (ACE inhibitors)
  • angiotensin II receptor blockers (ARBs)
  • diuretic (water pill)
  • aldosterone blocker
  • warfarin
  • digoxin

Self-management

Your daily activities can have a major impact on the progression of heart failure. It's important for patients and/or their caregivers to play an active role in their health by:

  • monitoring symptoms, including daily weights
  • managing diet, including limiting sodium, fluids and potassium
  • ensuring daily activity through regular exercise
  • managing blood pressure
  • maintaining a healthy weight
  • avoiding unhealthy habits such as smoking
  • taking medications as prescribed

Surgical procedures

For some people, surgery and medical devices are needed to treat the problem that led to the heart failure. Treatments could include:

  • coronary artery bypass graft (CABG)
  • valve repair or replacement surgery
  • an implanted device such as a pacemaker and/or defibrillator

Treating advanced heart failure

Because heart failure is a disease that gets worse over time, some patients will reach the point where medical management is no longer working well for them.

It's important for the health team, the patient and the family to work in partnership to discuss medical options and make care decisions centred on the patient's wishes and goals of care. Some people may choose advanced treatment approaches; others may decide that they don't want to pursue aggressive medical interventions and prefer supportive care. A range of care options may be available.

A heart transplant is when a person's diseased heart is replaced with a healthy one from an organ donor (someone who has died and whose organs have been donated). Not everyone is a good candidate for heart transplant.


If the transplant team determines you are a good candidate for a heart transplant, your name will be placed on a wait list. Once a donor heart is found that is a good match, you will undergo surgery at St. Paul's Hospital in Vancouver. 


Most people stay in hospital for one to three weeks and need to remain in the Metro Vancouver areas for up to three months post-surgery. 


You will gradually return to normal routine and daily life, but your health will be monitored for life. You will also need to take anti-rejection medications, antibiotics, nutritional supplements and other heart medications for life.


 

If you are a candidate for a heart transplant you will need to wait for a heart. Sometimes, if you are very sick, you may need the use of a mechanical heart called a ventricular assist device (VAD) to buy you some time while you wait. A VAD takes over some or all of the pumping function of the heart as a bridge to transplantation. The device is implanted during an open heart surgery procedure. 

 

Living with advanced heart failure is difficult, and the medical decisions can be complicated. It helps to communicate with others about your personal priorities regarding your care and your quality of life. You may wish to explore the following resources.


Advanced heart failure personal action plan

This communication tool, developed by a provincial Heart Failure working group, can help you and your family document details about how you want to be cared for. It should be reviewed with your health care provider to ensure he or she understands your personal care priorities and wishes.


Advance care planning

Advance care planning is the process of thinking about, and writing down, your wishes or instructions for future health care treatment in the event you become incapable of deciding for yourself. A useful website for information about advance care planning is www.AdvanceCarePlanning.ca.


Palliative care

Palliative care is a service available for people living with any disease, at any age and at any stage of an illness. You don't need to stop your medical care to receive palliative care. Palliative care can help with managing symptoms, maximizing quality of life, providing spiritual and psychological support, and discussing goals of care with you and your family. Your health care provider can help you access palliative care services in your community.


 

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