The answers were compiled with the help of the British Heart Foundation.

Do doctors and consultants talk to each other about whether or not someone has had their diagnosis?

Communication between GPs and hospital doctors should be good but unfortunately it does not always work like that. Most patients - with the exception of those admitted as emergency cases - are admitted to hospital with a covering letter from their GP. This letter goes to the duty consultant at the hospital and the patient will probably be looked after by junior doctors at first. Hospital doctors do not as a rule contact GPs about individual patients whilst they are in hospital, though they will write a letter to the GP when the patient is discharged saying what has been done.

Is it possible to deduce you have heart failure by the medicines you have been prescribed?

Yes - it can give clues. If your prescription includes a diuretic (e.g. frusemide) and an ACE inhibitor it may mean you have heart failure, but both drugs are used for other heart problems. ACE inhibitors are often used for the treatment of high blood pressure.

Are doctors obliged to give every patient a diagnosis if they have a serious illness?

Doctors have a positive ethical duty to tell the truth but many will only do so if they are asked direct questions by the patient. Doctors want to foster trust based on honesty and shared understanding, but many think the term 'heart failure' is too negative (as well as unscientific) to be helpful. This means that some doctors when giving someone a diagnosis of heart failure may not use the term itself - preferring to use other terms instead - and other doctors will.

Reviewed March 2010

The answers were compiled with the help of the British Heart Foundation.

What causes coronary heart disease?  
(Also known as coronary artery disease and ischaemic heart disease.)

Some people are more likely to get coronary heart disease than others, for example if you come from a family with a history of heart disease (e.g. if a relative has had a heart attack or angina before the age of 65) your doctor may advise you to keep an eye on your cholesterol levels and weight. Having diabetes or high blood pressure can also mean you may be more likely to get coronary heart disease. 

If you are very overweight, if you smoke cigarettes and if you drink a lot of alcohol you are more likely to develop coronary heart disease.  

Coronary heart disease happens when the coronary arteries have narrowed over time and the heart is not getting as much oxygen as it needs to work efficiently. When the narrowing process (atherosclerosis) begins there may be no outward signs of it and some people with the condition will not know they have it.  

When the coronary arteries become so narrow that any extra workload on the heart - for instance walking or climbing stairs - causes pain and discomfort what began as atherosclerosis may become coronary heart disease. Coronary heart disease is serious because it can cause angina, heart attacks and also heart failure. It can also, though more rarely, cause sudden death. 

Doctors believe that taking regular exercise - walking for 20 minutes 4 or 5 times a week - can help to keep your heart in good working order, as can eating a well-balanced diet which includes 5 helpings of fruit/vegetables every day. Regular exercise and a balanced diet are the best ways we know of to keep weight and cholesterol levels down which help to minimise the chances of getting coronary heart disease.  

What causes 'low' blood pressure?

Low blood pressure can be caused by several different things and is not necessarily anything to worry about. Usually people with low blood pressure feel no different from those with normal blood pressure.  

For people with heart failure having low blood pressure may be a side effect of drugs such as beta-blockers that are designed to lower blood pressure. Having low blood pressure may cause dizziness or faintness, and may happen if you stand up suddenly to walk too far. Low blood pressure can also be caused by diabetes. Some people experience low blood pressure as tiredness, depression and anxiety. It is always a good idea to ask a doctor or specialist nurse for advice as it may be possible to alter a particular drug or lower the dose.

It may be helpful for people with low blood pressure to sleep with several pillows. Sometimes people are also advised to wear support socks or stockings to stimulate their circulation.

What should my blood pressure be?

Your heart is a pump that beats by contracting and then relaxing. The pressure of your blood flowing through the arteries varies at different times in the heartbeat cycle. The highest pressure (known as systolic pressure) occurs when the beat or contraction of your heart forces your blood around your circulation. The lowest pressure (diastolic pressure) occurs between heartbeats.

Blood pressure is measured in millimetres of mercury (abbreviated to 'mmHg'). A blood pressure reading gives two numbers. The first number is the systolic pressure and the second is the diastolic pressure.

Target blood pressure for adults is 140/85 (140 systolic and 85 diastolic). If you have diabetes, your target is below 130/80. However, there is no fixed dividing line between normal blood pressure and slighly raised blood pressure. How these 'borderline' pressure levels are regarded varies between doctors.

 
Reviewed March 2010

The answers were compiled with the help of the British Heart Foundation.

How do doctors decide which test to use?

The doctor will examine your heart rate and rhythm, take your blood pressure, and do a careful physical examination. If you have symptoms that lead the doctor to suspect that you have heart failure, he or she may take blood tests to find out whether the heart is under strain, and to exclude anaemia, thyroid disease or kidney damage. Other tests include a ECG or electrocardiogram, chest x-ray, and an echocardiogram (an ultrasound scan of the heart).

Why does the heart become enlarged?

The heart becomes enlarged because of the extra strain imposed on it. The heart works harder and the muscle thickens. There are many causes of enlarged heart. It can sometimes develop as a consequence of a severely leaking heart valve. This puts more workload on the heart muscle, causing the heart to enlarge to cope with the strain, and is usually accompanied by symptoms of breathlessness. This enlargement of the heart could be reversed within two years after surgical replacement of the valve. A common cause is high blood pressure. As we get older, our blood vessels loose their elasticity. They become less resistant and pipe-like in character, which can cause the blood pressure to rise. This causes the heart muscle to increase in size, which leads to enlargement of the heart because it has to work harder to circulate the blood. There may be few symptoms in the early stages of heart enlargement, unless the heart's pumping efficiency continues to decline as a result of the increased workload. Enlargement of the heart can occur with cases of cardiomyopathy (disorders of the heart muscle) or coronary artery disease. It can also occur if the heart is affected by myocarditis, the result of a viral infection. 

What is an ejection fraction and what should it be?

When the left ventricle of the heart contracts and forces blood out into the body, it's called "ejection" since it is "ejecting" the blood out into your arteries. The "fraction" part is because that pumping chamber the left ventricle never quite manages to pump out all the blood inside it - there's always a little bit left behind that lies around waiting for the next contraction. The amount your left ventricle does pump out per beat is called the "ejection fraction". The amount pumped out is measured as a percentage of the total amount of blood in the ventricle per heart beat. It's a rough measure of the heart's function and normally between 40% and 60%.

Reviewed March 2010

The answers were compiled with the help of the British Heart Foundation.

Why is it beta-blockers can cause dizziness? 

Beta-blockers slow the heart rate down by stopping the actions of hormones such as adrenaline. Beta-blockers are designed to help protect the heart from strain and to stop it beating too hard as it tries to cope with the demands of exercise or stress. Sometimes beta-blockers work too well and the heart rate can become too slow. When this happens the circulation slows down and you may feel slightly faint or dizzy. Always tell your doctor or specialist nurse about any feelings of dizziness or faintness and ask them to explain what drugs you are taking and why. Do not stop taking your beta-blockers suddenly or lower your dose without talking to a member of your medical team.

How do ACE inhibitors bring down high blood pressure?

ACE inhibitors work by making the walls of the arteries relax and dilate. They block the action of an enzyme (angiotensin I) in the body that helps regulate blood pressure.

Reviewed March 2010

The answers were compiled with the help of the British Heart Foundation

Should people who have high cholesterol expect to be prescribed a statin to help prevent heart disease in later life?  

Not all people with high blood cholesterol levels are prescribed statin drugs. These can be effective in particular for people at high risk of, or with existing coronary artery disease or stroke. There is more interest in prescribing statin drugs for people at risk of CHD rather than just their cholesterol level. However, some people have inherited very high levels of cholesterol with a strong history of coronary heart disease. They may have familial hyperlipidaemia and will more than likely have been taking statin drugs for some years to help control their cholesterol levels in the blood.

How long is it safe to take warfarin and digoxin? 

There is generally no harm in taking digoxin or warfarin for a long time, providing that regular blood tests are carried out to check the blood clotting time if taking warfarin, and to check the digoxin levels in the blood if taking digoxin.

Why is aspirin prescribed for people with heart failure?

There is a strong likelihood that people with heart failure have high blood pressure, or coronary artery disease. Aspirin is an antiplatelet drug which can help stop the platelets  (tiny blood cells) from clumping together and forming a clot. Aspirin is usually given to people with coronary artery disease or controlled high blood pressure.

Reviewed March 2010

The answers were compiled with the help of the British Heart Foundation

Can all hospitals do angiograms and angioplasties? 

Not all hospitals have the facilities to offer coronary angiograms or coronary angioplasties. These procedures do generally need to be carried out in a cardiology unit. There are a number of hospitals throughout the country which can perform these tests and carry out angioplasty with stent implantation. It's worth checking with your general practice where the nearest hospital is to you.

How long do most stents last? 

Most people who have angioplasty also have a stent insertion.  A stent is a short, mesh tube which is inserted into an artery to hold it open after you've had angioplasty. The stents themselves may be able to last indefinitely but their main role is to keep the artery open after the angioplasty procedure. Studies have found that 90% to 95% of patients who have had angioplasty with stent have not needed a repeat procedure or bypass surgery in the following five years.

What is special about a drug-eluting stent? 

Drug-eluting stents are coated with a drug which can reduce the inflammation and cell growth that sometimes occurs after angioplasty.  People who have angioplasty with drug-eluting stents are less likely to need a repeat procedure. The drugs can vary - one particular drug is called sirolimus which is a form of immunosuppressant drug and this has shown some very good results.

Reviewed March 2010

The answers were compiled with the help of the British Heart Foundation

What are the important facts about cholesterol?

Cholesterol is a fatty substance mainly made in the body by the liver. Cholesterol plays a vital role in the functioning of every cell wall throughout the body. It is also the material which the body uses to make other vital chemicals. However, too much cholesterol in the blood can increase the risk of getting coronary heart disease.

Cholesterol has a special 'transport system' for reaching all the cells which need it. It uses the blood circulation as its 'road system' and is carried on 'vehicles' made up of proteins. These combinations of cholesterol and proteins are called 'lipoproteins'. There are two main forms of lipoproteins. Low density lipoproteins (LDL) carry cholesterol from the liver to the cells. High density lipoproteins (HDL) return excess cholesterol to the liver.

If you have high levels of cholesterol, you run a greater risk of coronary heart disease. The risk is particularly high if you also have a low level of HDL cholesterol and a high level of LDL cholesterol. A high level of triglycerides also increases the risk of coronary heart disease and stroke.

The blood cholesterol, triglycerides, HDL and LDL are measured in units called millimols per litre of blood, usually shortened to 'mmol/litre' or 'mmol/l'. Your target is to have a total cholesterol level under 5 mmol/l, and an LDL level under 3 mmol/l.

There can be quite a lot of variation in the levels of blood cholesterol and other blood fats - both from day to day and at different times of the day. So your doctor won't be worried if you have one high reading. He or she will not usually decide about treating you with drugs until they have a series of these readings. 

After a heart attack the blood cholesterol measurement may give a falsely low reading. So you might not have the blood test until about three months after the attack. 

Some people have high cholesterol levels as a result of an underactive thyroid gland, or chronic renal (kidney) failure, or alcohol abuse. Also, 1 in 500 people have high cholesterol levels because of an inherited disorder called familial hyperlipidaemia.

How is obesity defined?

It can be hard to know whether excess weight is likely to cause medical problems, so doctors generally use a formula which can be applied to both men and women. The Body Mass Index (BMI) gives a measurement of body fat based on a person's height and weight. To calculate your BMI, divide your weight (in kilograms) by your height in metres squared. A BMI of more than 30 means you may be classified as obese. A BMI of between 25 to 29.9 means you may be classified as overweight. A normal BMI is between 18.5 and 24.9.

Is it important to know what caused your heart failure?

It is important to find out why your heart has been under strain, as this will affect the treatment needed. Heart failure may result from having had a heart attack, a faulty heart valve or long-term high blood pressure. Or it may be caused by abnormal heart rhythms, or an inherited heart muscle condition. Each of these conditions needs to be carefully investigated and depending on the findings, specific treatment either as an operation or as drugs can be treated.

Reviewed March 2010

The answers were compiled with the help of the British Heart Foundation.

Who gets access to specialist heart failure nurses?  

If a heart failure specialist nurse service is available in a particular area patients with a confirmed diagnosis of heart failure will get access. At the moment these specialist services are not available throughout the UK.

Can you request to have a specialist heart failure nurse?

If you have been given a confirmed diagnosis of heart failure you may like to ask your cardiologist, GP or other healthcare professional what kind of support is available for you. In some areas this may include access to a heart failure nurse.

Are there plans for this kind of nursing service to be spread across all parts of the country?

Resources are being increased for these services. An award from the New Opportunities Fund of nearly £10m is going to mean more than 75 additional BHF heart failure nurses around the country.

Reviewed March 2010

The answers were compiled with the help of the British Heart Foundation.

What kind of rehabilitation should people with heart failure expect to be offered? 

Though most hospitals will try to provide advice and support to people with heart failure as part of cardiac rehabilitation programmes, many hospitals do not as yet have specialist heart failure nurses available to provide advice and back-up for people with heart failure. People with heart failure and their carers or families should discuss their needs for rehabilitation (advice, support, exercise classes, information) with their GPs and consultants. GPs should be able to provide information about any NHS services for heart failure in the locality. Hospital cardiology departments may be able to put you in touch with local patient support groups as will the British Heart Foundation.

How should you go about setting up a patient support group?

The BHF encourages the development of a network of Heart Support Groups throughout England and Wales to ensure there is a group near you. If you are thinking about setting up a Heart Support Group, they can help you.

The BHF has seven dedicated Patient Network Co-ordinators, who can offer you further support and advice - both when you're just setting up and as your group grows and develops. Their role is to identify where support groups exist, and also to target areas where groups are needed. The PNC can assist in setting up new groups and, once established and affiliated, maintains a link by phone and occasional visits. If you'd like to talk to somebody about setting up a new group please call the Heart Support Group team on 0207 554 0396.


Reviewed March 2010

The answers were compiled with the help of the British Heart Foundation

Where can family carers get help?  

The BHF has a good booklet called 'Caring for someone with a heart problem' - this provides information for carers on how to look after their partner (a relative or friend) and themselves. There are also several groups such as Carers UK which provide information and advice for carers.

Reviewed March 2010

The answers were compiled with the help of the British Heart Foundation.

How do doctors decide when to replace a pacemaker?

People with pacemakers have regular checks at their pacemaker clinic, where the technicians can accurately assess the battery power in your pacemaker. They can then calculate when the battery is likely to need replacing. This can help to avoid any risk to you, but for this reason it is vital that you attend all the pacemaker clinic appointments.

Reviewed March 2010

The answers were compiled with the help of the British Heart Foundation.

How old is 'too old' for a heart transplant? 

There is no clear age that is a cut off point for being ineligible for heart transplant. However, there is a clear shortage of donor organs and younger people have more successful recovery after surgery. There have been 65 and 70 year old patients who have successfully undergone heart transplantation. 

What other things apart from the state of your heart are taken into account when a transplant decision is made? 

The consultant will take into consideration your general health apart from your heart condition, such as your kidney and liver function to assess whether you are fit enough to cope with surgery and with the drugs that you will have to regularly take after having recovered from the heart transplant.

Reviewed March 2010

The answers were compiled with the help of the British Heart Foundation.

How usual is sudden death in heart failure?

Figures vary, but in some studies of sudden death, 25% of the patients have had heart failure. Therefore some patients are advised to have an implantable cardioverter defibrillator which can help revert the heart beat and avoid a fatal cardiac arrest.

Reviewed March 2010

The answers were compiled with the help of the British Heart Foundation.

What are the dangers - if any - of long flights?  

If you have a long flight (over 2 hours), you are at risk of being immobile for a significant period of time. The cabin is pressurised to a similar altitude to 6000 feet. Therefore it is best to walk in the aisle at regular intervals so that you reduce the risk of a thrombosis (blood clot) in the legs. If it is difficult to walk in the aisle, you could simply move your feet - raising your toes with your heels on the ground - for several minutes every half an hour to prevent a sluggish circulation in the legs.  It is best to avoid alcohol and limit drinks containing caffeine (tea, coffee and cola). Drink plenty of water to avoid dehydration, which is especially common during night flights.  If you have recently undergone surgery or have suffered from deep vein thrombosis (DVT) in the past, your doctor may suggest that support stockings may be beneficial on long-haul flights. If you have painful and swollen calves after a flight, it would be advisable to see your doctor.

How can people with heart failure get travel insurance cover if they travel outside the EU?

The BHF has a list of sympathetic insurance companies that patients have found to be supportive of heart patients. Some of these do have certain criteria but if you phone the BHF heart information line 08450 70 80 70 the staff will be able to send or name some sympathetic insurance companies to help you.

What should you do if you need medication for heart failure when you are away from home? 

It is important to ensure that when you go away that you have adequate stocks of medications to tide you over during your stay away from home. If there are medications that need to be prescribed while you are away, you will need to register temporarily with a GP who will be able to support you and if necessary prescribe the appropriate drug after assessing your general condition. Sometimes it's useful to take a patient held record card that can tell a medical professional more about your condition.

Reviewed March 2010

The answers were compiled with the help of the British Heart Foundation.

Is it advisable for people with heart failure to follow the Atkins (or other high fat) diets? 

The Atkins diet is high in fat and low in carbohydrate. It is not recognised by nutritionists as a safe or suitable diet for young, old or particularly cardiac patients. It would be far more important to have a low salt and low fat diet. Some people with heart failure may need to lose weight but not all. The BHF has some excellent publications to guide people about a healthy diet.

How much alcohol is it safe to drink with heart failure?

It would be wise to have no more than one or two units of alcohol a day. A unit is a glass of wine, half a pint of beer or a measure of whisky.

Where can I get help with giving up smoking? 

Whatever method you choose to quit smoking, it is important to think it through and prepare yourself as best you can for the difficulties ahead. The NHS Smoking Helpline on 0800 022 4332 can offer information on stopping smoking. And, people who are finding it hard to stop can be referred on to speak to a counsellor.

QUITLINE®  0800 00 22 00. (Calls are free) is a phone helpline for people who want to stop smoking. They also have helplines in different languages:

Bengali 0800 00 22 44 (Mondays 1pm to 9pm)

Gujerati 0800 00 22 55 (Tuesdays 1pm to 9pm)

Hindi 0800 00 22 66 (Wednesdays 1pm to 9pm)

Punjabi 0800 00 22 77 (Thursdays 1pm to 9pm)

Urdu 0800 00 22 88 (Sundays 1pm to 9pm)

Turkish and Kurdish 0800 00 22 99 (Thursdays and Sundays 1pm to 9pm)

Reviewed March 2010

The answers were compiled with the help of the British Heart Foundation.

Is there any research evidence to show that complementary approaches work in heart failure?

People with heart failure can benefit from relaxation methods and breathing exercises, and massage. However herbal medicines may cause potentially serious adverse effects such as arrhythmias, chest pain, and heart failure, high or low blood pressure or over anticoagulation due to interaction of the drugs. Therefore it would depend on which complementary approach is considered. It is vital that you take the drugs prescribed by the doctor and there may be helpful approaches that complement the conventional heart failure treatment. Always discuss this with your doctor first.

Where can you find information about herbal remedies and whether they are likely to affect your medication?

As yet, we have only a limited knowledge and understanding of the potential interactions of herbal treatments and conventional medicines. Herbal medicines and supplements can sometimes be used alongside conventional drugs and treatments. But some supplements might interact with your medication, so it is especially important to check this out with your GP or pharmacist first. For example, recent studies have shown that St John's Wort, a popular herbal anti-depressant remedy, can increase the breakdown of certain drugs in the liver and therefore reduce their effectiveness. The drugs that have found to be affected by St John's Wort include warfarin, digoxin, theophylline, anticonvulsants, some antidepressants, cyclosporin, HIV drugs and oral contraceptives. The British heart Foundation has an information sheet about herbal medicines, and your doctor or pharmacist would be able to confirm whether a herbal medicine is unsuitable to take with your conventional medicines.

Reviewed March 2010

The answers were compiled with the help of the British Heart Foundation.

Do any of the drugs for heart failure make it dangerous to drive?

The drugs that are commonly taken to relieve the symptoms of heart failure such as ACE inhibitors, beta blockers or diuretics should not affect your ability to drive. However if you find that the heart failure causes symptoms that stop you from being able to drive effectively, then the DVLA suggest that you should not drive until those symptoms are controlled.

Reviewed March 2010

The answers were compiled with the help of the British Heart Foundation

What are the best ways to reduce anxiety and stress for people with heart failure?

There are several tips available to help people manage their stress. These include:

1. Physical activity - cycle, swim, walk
2. Practice deep breathing
3. Talk to someone you trust
4. Accept what you cannot change
5. Avoid self-medication: cigarettes, alcohol, coffee, tranquillizers
6. Get enough sleep. Be aware when you are tired and take steps to rest and refresh yourself
7. Take time out to play
8. Do jobs one at a time
9. Examine how you manage your time and set a timetable - don't overload it
10. Develop an absorbing hobby
11. If you are sick - don't try to pretend that you are not
12. Eat sensibly:  fresh fruit and vegetables, whole meal bread and pasta, whole meal cereals, cut down on fatty, sugary foods
13. Take time to relax daily
14. Don't be afraid to say 'no'
15. Delegate to colleagues, family and friends
16. Be realistic about perfection and what you can achieve
17. Recognise that you are a person of worth - a unique individual with valuable qualities that are continually being developed

Reviewed March 2010

The answers were compiled with the help of the British Heart Foundation.

Is pregnancy dangerous for women with DCM or other heart valve diseases?

Women with dilated cardiomyopathy are prone to more problems during pregnancy and delivery, sometime the heart failure can worsen during the pregnancy. If you have dilated cardiomyopathy it is important that you are supervised jointly by an obstetrician and a specialist cardiologist. Women who have valve diseases would need to check with their cardiologist first before considering pregnancy, as the effect of their heart condition on their pregnancy would vary from one person to another. Some people may need to have treatment before becoming pregnant while others may be able to become pregnant with few problems.

Reviewed March 2010

The answers were compiled with the help of the British Heart Foundation

Do doctors recommend that people should use pill/dosette boxes?  

Pill or dosette boxes don't really have as much security as other forms of containers for drugs. Increasingly there are blister packs that may prove useful. Blister packs are monthly sheets of pills with Monday to Sunday and breakfast, lunch, etc. in a separate blister containing all pills for that particular time. The name of each pill is given on the back of each blister.

Reviewed March 2010