17 questions about heart failure

Many people sometimes have it without even knowing it: heart failure! Fatigue, shortness of breath, tickling cough and poor sleep: it may be (chronic) heart failure. Cardiovascular disease is the number one cause of death in women.

Fortunately, doctors are increasingly able to detect heart failure at an early stage. However, it is sometimes a little more difficult in women than in men. So here are 17 frequently asked questions about heart failure:

1. What is heart failure?

Contrary to popular belief, heart failure is not a disease but a collective term for signs and symptoms. It is the result of damage to the heart muscle, which prevents it from pumping blood around the body. Any condition that damages the heart can lead to heart failure. In about 80 percent of cases, a heart attack is the culprit. Other possible causes include long-term high blood pressure, an infectious disease in the heart muscle (cardiomyopathy) or heart valves that do not work properly. Broken heart muscle cells do not repair. In their place, stiff connective tissue forms. The stiffer the heart muscle, the harder it is for the heart to fill with blood.

When we talk about heart failure, we usually mean chronic heart failure. That is, the symptoms develop gradually. There is also acute heart failure, when the heart suddenly stops functioning, for example due to an inflammation of the heart valve. This article is about chronic heart failure.


2. What do you notice about heart failure?

When the heart’s pumping function does not work properly anymore, blood accumulates in front of the heart or the heart does not pump out enough blood. As a result, you may experience a range of symptoms. Depending on the severity of the heart failure, these symptoms may only occur during (intense) exercise or at rest.

The body may retain fluid, causing the patient to develop swollen legs and ankles and gain weight without having to eat extra. If the blood accumulates before the heart, the pressure in the pulmonary blood vessels increases. As a result, the lungs become stiffer and less mobile.

The result is shortness of breath and irritable cough, especially on exertion. The cough and shortness of breath become worse when lying down. In addition, heart failure patients have to urinate more often at night than during the day, and especially more.
Studies show that 66 percent of patients experience severe limitations with physical activities such as climbing stairs. 36 percent have difficulty with daily activities such as showering or dressing, and 20 percent are hindered in social activities. These figures are three times higher than for older people who do not have an illness or disease.


3. What are the most common symptoms of heart failure?

The symptoms of heart failure vary from person to person. How severely they affect a person’s life also depends on many factors. The Heart Foundation states that there are three symptoms that are common in heart failure:

  1. Shortness of breath is the first. People with heart failure are particularly breathless under exertion, such as when climbing stairs or going for a long walk.
  2. Fatigue is number two. It usually creeps in, but people with heart failure often find they tire more and more quickly. Could you get through the day easily a few months ago, but now you really need an afternoon nap? If so, this could be a sign.
  3. Fluid accumulation is also common and is therefore included in this list of three common symptoms of heart failure. This is because the organs are receiving less blood, causing the kidneys to retain extra salt and fluid. For example, you might see an imprint of your sock on your ankles, or suddenly have a bigger belly. Sometimes you can gain up to 2 or 3 kilos of weight because of this fluid if you have severe heart failure.

However, these are not the only symptoms that occur with heart failure. Although these three are the most obvious and appropriate for heart disease, there can be symptoms in other areas of the body as well. For example, the UMC Utrecht hospital also reports these – sometimes surprising – symptoms of heart failure:

  • Cold hands and feet due to poorer blood flow.
  • A feeling of fullness in the upper abdomen and/or loss of appetite; this symptom is usually caused by fluid accumulation in the abdomen.
  • Blockage of the intestines: this organ also receives less blood supply from the heart, which decreases its pumping function and strength.
  • Palpitations.
  • Dizziness.
  • Memory loss, lethargy and feeling restless; this is due to a combination of fatigue and the reduced blood supply to the brain.


Caution! Do you experience sudden chest pain or severe shortness of breath? Then call the emergency number or the emergency number of your own family doctor. This may indicate a sudden worsening of heart failure or a heart attack.


4. Do women have different symptoms when having a heart attack than men?

Yes, in addition to the symptoms and complaints already known to men, women can have other symptoms.

A painful, pressing feeling in the chest is one of the most well-known symptoms of a heart attack. However, in women this complaint does not necessarily occur. Women are much more likely to suffer from more “vague” symptoms that you might not quickly associate with a heart attack.

Some symptoms that may indicate a heart attack in women are:

  • Pain in the back, left jaw angle, neck and shoulder.
  • Shortness of breath, feeling of lack of air.
  • Feeling flu-like; nausea, vomiting (vomiting) and chills.
  • Fatigue and feeling weak.
  • Anxiety.
  • No appetite.
  • A feeling of uneasiness.

As you may see, there are many symptoms that seem to be similar to symptoms you may have due to menopause or stress. Therefore, this is often the reason why women do not visit their family doctor or cardiologist in time. Take your symptoms seriously and be clear with your doctor about what symptoms you have and when they occur. Don’t try to come up with explanations yourself; the doctor is there to ultimately make the right diagnosis.


5. What are common symptoms in women that may indicate a heart problem?

Complaints and symptoms that may indicate heart problems in women include:

  • Pain between the shoulder blades and neck.
  • Pain in the jaw or jaws.
  • Dizziness and unexplained often extreme fatigue.
  • Shortness of breath.
  • A restless heavy feeling in the chest or feeling like there is a band around your chest.
  • Pain and/or cramps in one of the upper arms.
  • Nausea.

Of course, these symptoms may very well have a different and more innocent cause, but they can also indicate heart disease. Be on the safe side and get it checked out! It is better to go to the doctor once too often than to run the risk of missing out on heart disease.


6. Which risk factors can be a red flag for women?

A number of factors can indicate increased risk, including:

  • Heredity
  • High blood pressure
  • The menopause
  • High blood pressure during pregnancy (often hormonally related)
  • An unhealthy lifestyle
  • Obesity
  • Stress
  • Diabetes.

These are the most common factors, unlike in men, hormonal influences or changes often play a major role as well.


7. When should you see your doctor with symptoms of heart failure?

“Nothing to worry about” is what many people think when they hear everyday symptoms such as fatigue, shortness of breath, tickling cough and poor sleep. Or, “It must be because I’m getting older.” In this way, heart failure can remain hidden for a long time, while the patient feels increasingly worse. However, with the right medication and an appropriate lifestyle, the symptoms can often be significantly reduced. In short: if you are suffering from one or more of the above symptoms, see your doctor.

If in doubt or if you are worried, it is always smart to see a doctor anyway. You can book a consultation at HelloDoc Health!


8. What is the prognosis for heart failure?

Of heart failure patients who have symptoms only when they exert themselves, 20 percent die within one year and 50 percent within five years. For patients with symptoms at rest, the mortality rate within one year is as high as 65 percent. For the prognosis, it does not matter what the underlying cause of the heart failure is.


9. Is heart failure common?

The number of people with heart failure is expected to increase significantly in the coming years. This is because we are living longer and there are increasing numbers of people with diabetes, COPD (chronic bronchitis or emphysema) and severe obesity – they are at high risk of diseases that can lead to heart failure. In addition, better treatment options mean that heart attacks are becoming fatal in fewer and fewer cases. This means: more people with a damaged heart muscle and therefore more patients.


10. When are you at extra risk of heart failure?

Anyone who lives unhealthily – smokes, drinks alcohol excessively, gets little exercise or is overweight – has a greater chance of developing high blood pressure or a heart attack and therefore heart failure. Diabetics are five times more at risk of heart failure than non-diabetics, people with COPD are three to four times more likely. Incidentally, one in five patients diagnosed with COPD by their general practitioner actually has heart failure. Their shortness of breath is often wrongly attributed to COPD.


11. Do the symptoms of heart failure get worse over time?

Yes, unfortunately often they do. In a damaged heart, the remaining heart cells have to work extra hard to keep things running. This overload gradually damages the healthy muscle cells as well. Complaints like fatigue and shortness of breath will eventually get worse as a result. The rate at which this happens depends, among other things, on the effectiveness of the treatment and on the patient’s general condition. Additional strain on the heart, for example in the form of severe influenza or pneumonia, can suddenly make the situation worse.


12. From what age can you suffer from heart failure?

The majority of patients are over the age of 70. As age increases, the risk increases. Between the ages of 45 and 65, three in every thousand people suffer from heart failure. In people over 75, the figure is ninety in a thousand.


13. Is heart failure treatable?

Yes, but the damage to the heart muscle can usually not be repaired. Treatment is then aimed at reducing the symptoms and preventing the further deterioration of the heart’s pumping function as much as possible. There are different types of drugs for treating the symptoms. The most important of these are diuretics, which get rid of excess fluid, and medications that act on blood pressure and on the pumping capacity and rhythm of the heart. Furthermore, patients must above all learn to live sensibly and healthily. They usually learn how to do this at a special heart failure clinic in the hospital. Often, a combination of medication and an appropriate lifestyle is sufficient.

Sometimes it is necessary to implant a bilateral pacemaker, which ensures that the left and right ventricle continue to contract simultaneously. Patients who do not respond well to treatment in the form of a healthy lifestyle and medications or surgery may require a heart transplant as an extreme case. However, due to the limited number of donors, only a few people qualify for this each year.


14. What should you be aware of when receiving treatment in the hospital?

The care offered to patients with heart failure varies from hospital to hospital. That’s why Harteraad, the expertise center for living with cardiovascular disease, has drawn up a list of criteria that good heart failure care must meet. Among other things, this list states that there must be at least two heart failure nurses working in the hospital and that it must be possible to participate in a special rehabilitation program. Patients can take this list with them when they go to talk to their doctor about treatment.


15. Who is the best person to treat for heart failure?

In most cases, a general practitioner will make the preliminary diagnosis. Additional cardiological investigations at a hospital or clinic will then be required to determine whether heart failure is present and to identify the underlying cause of the symptoms.

All hospitals today have a dedicated heart failure clinic. The primary contact at the heart failure clinic is a specialist nurse. Under the supervision of the cardiologist, he or she will find out which dose of medication is best for the patient, give advice on exercise and diet, signal whether the symptoms are getting worse and adjust the treatment in good time. Where necessary, he or she collaborates with other specialties in the hospital and with the general practitioner or home care provider.


16. How does heart failure affect your daily life?

Heart failure is a major issue: patients have to learn to live with the knowledge that they have a (high) risk of dying soon, they have to take into account that they are physically less able, that they have to take medicines and that they can no longer eat and drink everything.
Because their bodies retain a lot of fluid, patients are advised, for example, to drink no more than two liters a day (including products such as yogurt and soup). If they do drink more, their symptoms often become (much) worse. This is a difficult rule of life for many patients.
Patients with serious symptoms may not drink more than 1.5 liters per day and are given a low-salt diet, with a maximum of 3 to 6 grams of salt per day. By way of comparison: the average Dutch person naturally consumes 9 to 10 grams of salt per day through food alone (i.e. without the addition of salt from the salt shaker).

Alcohol is allowed, but in moderation. For men, a maximum of two glasses a day, for women one. Alcohol in larger quantities further damages the damaged heart muscle. Anyone who smokes should definitely stop. Smoking reduces the blood flow to the heart muscle.
Patients should exercise daily. This improves the blood flow in the body and keeps them in good shape. However, it is important to choose a form of exercise that does not put a sudden strain on the heart.

Many heart failure patients worry about whether sex is too much of a strain on their heart. In terms of exertion, making love can be compared to climbing stairs. For patients who are well adjusted to their medication and can climb stairs at a reasonable pace (about twenty steps in 10 seconds) sexual activity is not a problem.


17. What new developments can we expect?

Doctors are increasingly able to detect heart failure at an early stage. This is done among other things on the basis of certain substances in the blood, so-called markers, which can indicate problems. More and more of these markers for heart failure are being found. The techniques for making an ultrasound or MRI of the heart are also becoming increasingly precise.

Research into new treatment methods is still in its infancy. Until recently, doctors thought that the pumping function of a damaged heart muscle decreased because it became less powerful. Recently it was discovered that it is not the force with which it contracts but the suppleness of the heart muscle that is decisive. This means that scientists must look for the solution in another corner. It is possible that new drugs will increase the suppleness of the heart muscle in the future. They are also looking at whether stem cells can replace damaged heart muscle tissue with healthy heart muscle. To date, this has not been successful.

One area where rapid progress is being made is in providing patients with home support and remote patient monitoring. This involves the patient performing all kinds of checks at home themselves and, via a device, being in contact with the doctor at HelloDoc Health, who can then provide remote advice based on the monitoring and test results.


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Sources: UMC Utrecht, SHE. Health ClinicsPlus OnlineGezondheidsnet

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