Heart failure

Heart failure and cardiomyopathy are forms of heart muscle disease with several potential causes including heart attacks (due to coronary artery disease), valvular heart disease, hypertension, arrhythmia, previous infection of the heart, and can be inherited within families.

Symptoms include breathlessness particularly on exertion, or made worse by lying flat or waking you in the night. Patients may experience fatigue and swelling of the abdomen and legs.

Diagnosis is based on investigations including bloods tests such as natriuretic peptides (NTproBNP or BNP), 12-lead ECG, chest X-ray and Echocardiography. Further assessment is then required to ascertain the precise cause of heart failure which may include coronary angiography, cardiac MRI or a nuclear myocardial perfusion scan (MPS).

Heart failure
Transthoracic echocardiogram- left ventricle and mitral valve

There are many medical treatments available for this condition to both reduce symptoms and hospital admissions but also to improve survival. This usually starts with loop diuretics, ACE inhibitors, beta-blockers, mineralocorticoid antagonists (MRA) and Ivabradine. There are newer drugs available including Sacubitril-Valsartan which may be beneficial in selected patients. Some patients who haven't responded to medical treatment or whom are deemed to be at increased risk of life-threatening ventricular arrhythmia may require invasive procedures such as biventricular pacemaker/defibrillator insertion.