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Living with Heart Failure
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- Tom
- You should recognise what this is.
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- - Pump
- Tom
- It’s a Pump. This one dates back to about 1935. Same as the car. I hope it worked a lot better then than it does now!
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- - Pump
- Tom
- The fact is, we tend to take things like Pumps for granted unless they stop working, that is. And the same is true of the Pump in our body – the human heart. It Pumps blood around our bodies for an entire lifetime. Now, we all know we can’t live without a heart, yet we seldom give it a moment’s thought until something goes wrong, that is. Then we have to think about it very seriously indeed.
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- Tom
- When the heart stops Pumping efficiently, it’s known rather alarmingly as heart failure. Heart failure is a chronic condition. It cannot be cured. However, things can be done to help it. So, join me, as I go, eventually, and talk to some people who know how. Hopefully sometime today.
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- Janet
- Hello Tom
- Tom
- Hi.
- Janet
- Car trouble?
- Tom
- Not quite car trouble, but I want you to tell me about heart failure. Janet Reid – she’s a nurse who specialises in heart failure. Tell me, Janet, firstly, what causes this thing called heart failure?
- Janet
- Well, Tom, the thing is, heart failure isn’t a disease in itself. It’s actually due to some other underlying problem, the main reason being coronary heart disease, which can be a previous heart attack, long standing high blood pressure, or even a leaky or narrow heart valve. There is also a specific heart muscle disease known as cardiomyopathy that can cause it, but what’s important to remember with heart failure is that the patient’s sympToms can vary in their severity.
- Tom
- I see. So obviously it affects people in many different ways?
- Janet
- That’s right, Tom, it does. And the signs and sympToms are shortness of breath, either at rest or on exertion, or ankle swelling which is due to fluid retention. But we’d probably be better speaking to Harry, because he’s been living with heart failure for a number of years now.
- Tom
- That’s fine by me, but can we use your car? [Laughs]
- Janet
- You’re in.
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- - Entering car and driving off, then parking.
- Janet
- Tom, this is Harry.
- Tom
- Pleased to meet you.
- Harry
- Good to meet you.
- Janet
- Harry’s lucky because he has a heart failure nurse come to visit him. He’s on the appropriate medications and your sympToms are well controlled.
- Tom
- So Harry, tell me, what steps have you taken to control your sympToms?
- Harry
- Well, I’ll tell you what. Exercise is very important, so why don’t we take a wee walk and we can have a chat about it?
- Tom
- Fair enough. Lead the way.
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- Harry
- Well, the first thing I do in the morning is weigh myself and take a note of it.
- Tom
- Aye.
- Harry
- Now, if I put on 2 lb, say two days running, or 3 or 4 lb in a week, well, I would tell the doctor or the nurse. I take all my tablets in the morning, especially the diuretics, because they make you go to the loo quite a lot. You’re better, you know, you’re better to get that out of the way.
- Tom
- Aye.
- Harry
- And then I’ve got to watch how much salt I eat because salt, you see, attracts water to the tissues and that’s – you want to avoid that. Giving up salt isn’t really hard, I mean, you just have to avoid foods like cheese and bacon, and of course, heavily salted snacks like crisps and so on, and then of course, it’s always better to keep salt off the table at meal times. And I watch how much alcohol I drink – well, no more than two units a day and of course, I’ve given up the fags completely. And then I take as much exercise as I can. Now, a lot of people think it’s a wee bit risky to take exercise when you’ve got heart failure, but you’ve got to remember, the heart’s a muscle.
- Tom
- Uh huh.
- Harry
- You know, and like any other muscle, it gets stronger with exercise. I mean, it can be any sort of exercise – armchair exercise or short strolls or something like that, you know, it doesn't really matter. Every little helps.
- Tom
- I’ll race you to the car then! I could do with a cup of tea.
- Janet, you said earlier that heart failure isn’t an actual disease but rather caused by other underlying problems. So how does this influence the way you go about treating it?
- Janet
- Well there are treatments available for heart failure for people, but it’s important that you get the appropriate investigations to find the underlying cause of it.
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- It’s here in the Cardiology Unit that we need to do some tests to find the causes of heart failure and to make a diagnosis.
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- Janet
- As well as various blood tests, we do chest x-rays to look at the size and shape of the heart and for possible infection and fluid in the lungs. And the echo cardiogram uses ultrasound to look at the Pumping action of the heart. We may need to do other scans as well. Once we’ve made a diagnosis of heart failure we can find the best treatment for that person, mainly with the drugs we prescribe. The aim is to alleviate the sympToms of heart failure as much as possible and generally improve the quality of life and do our best to prolong it, and that’s where the Pharmacist comes in.
- Pharm
- The main aims of drug treatment are to treat any underlying disorders and alleviate the sympToms of heart failure. This usually involves taking several different types of drugs. Diuretics or water tablets help rid the body of the excess fluid that can collect in the lungs or settle in the feet or ankles.
- Ace inhibitors
- relax the blood vessels and make it easier for the heart to Pump.
- Betablockers
- help to slow the heart rate and lower blood pressure, making it easier for the heart to Pump efficiently.
- Digoxin
- and
- Amiodarone
- can be used to regulate the heart’s rhythm.
- Aspirin
- and
- Warfarin
- can be used to prevent blood clots from forming.
- Statins
- might be needed to help lower cholesterol levels.
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- Pharm
- It’s the fine tuning of these drugs that gets the heart to work as efficiently as possible and sometimes the smallest changes can make a big difference. I always remind people to keep notes on how they’re feeling, and to report any changes they notice. It’s also important to keep repeat prescriptions up to date, and to destroy any old medicines that you’re not taking any more, or that are out of date.
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- Tom
- Well let’s hear what a few more patients with heart failure have to say.
- Male
- Well, the first thing I do is I weigh myself just to check my weight to make sure that I haven’t increased or if I do put on extra weight, I normally know that there’s fluid gathering there.
- Female
- If my weight has increased, I tell my doctor or my heart failure nurse. They get me to take another tablet for maybe a couple of days. That gets my weight back down to normal.
- Male
- My breathing at night sometimes if I’m lying too flat in my bed, I find it restricts my breathing and it causes me to panic a wee bit, so usually I have to get myself extra pillows and sleep more upright and it makes my breathing a lot better.
- Female
- I look after myself. I get the flu jag once a year in the autumn, and I try to get out as much as I can.
- Male
- You’ve got to pace yourself, yeah. As I said before, your body knows your limitations. It tells you when to stop.
- Male
- I get a lot of blood tests. I actually feel like a pin cushion. I go to see the hospital doctor once every three month, and I usually see my GP once every two month and I see the nurse at the GP’s usually once every two weeks.
- Female
- The tablets help tremendously. I’ve one of these wee containers with four different compartments for the day which reminds you what to take when. I’m careful about what I eat. I’ve cut right down on how much salt I use in cooking, and I avoid things like crisps, bacon and sausages and of course, I try and eat more vegetables and stick to a healthy low fat diet as far as possible.
- Male
- I had hobbies that I used to like playing golf, go to the football and that, but I’m afraid they’re too much exercise for me to do now, so basically my only hobby now is maybe trying to take short walks somewhere, but as I say, you can’t go too far. It’s not only the getting there, it’s the getting back.
- Female
- I know some people get depressed. My doctor has suggested anti-depressants to help me cope if I get down but I’m lucky. My friends and family are there for me and I’m getting better at asking them to do things I can’t manage.
- Male
- I play a lot of bowls, I do a lot of fishing, I used to play a lot of golf. I’m hoping to start playing again, because I’m feeling an awful lot better.
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- Tom
- So, to recap. Report changes in your sympToms to your nurse or doctor as soon as possible. Monitor your weight daily and report sudden increases. Take your medicines as directed. Reduce salt intake. Speak to your nurse or doctor about how much fluid you drink in a day. Stop smoking and keep as active as possible.
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- - Driving then parking
- Tom
- Well thanks, Janet, that was really interesting and very useful. You take care now.
- Janet
- Ok then, bye Tom.
- Tom
- Bye now.
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- - Car door shutting. Engine starts
- Tom
- The fact is that while heart failure can’t be cured, it is possible to improve the quality of life. It’s a condition that needs constant monitoring, and any drug treatment has to be well controlled, but the heart failure nurses can be a great help with this. And the chest heart and stroke Advice Line is a good source of information and anything you want to know about heart failure is in a booklet called ‘Living with Heart Failure’. So thanks for watching, and go on, enjoy your life.
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