The heart is a vital organ made up of muscle, blood vessels, heart valves and nerves. The main function of the heart is to receive utilized deoxygenated blood, pump it into the lung to be oxygenated or “refreshed”, then, receive this oxygenated blood from the lung and to pump it around the body, supplying it with oxygen and nutrients needed for energy and growth.
Heart failure occurs when the heart is no longer able to relax to receive blood (“stiff heart”) or to pump blood through the body effectively (“weak heart”).
This can cause accumulation of fluid in various parts of the body, such as the lungs, abdomen or lower limbs. Reduced blood flow can also result in dysfunction in vital organs such as the kidneys, liver or brain.
Heart failure is one of the leading causes of recurrent hospitalisation and reduced life expectancy in the world. Quality of life is also reduced in a heart failure patient. However, these can be greatly improved with appropriate management.
Some conditions may cause the heart to become too weak or too stiff to pump blood efficiently. Some common causes include:
Diagnosis of heart failure is made by your doctor based on the following:
Risk factors of heart failure include:
A person with heart failure may present with one or more of the following symptoms:
The following tests may be performed for the diagnosis of heart failure:
Treatment of cause of heart failure
Treating the underlying cause of heart failure is important in regaining heart function. Such treatments include stenting or coronary bypass operations for blocked arteries, repair or replacement of damaged heart valves, stopping alcohol consumption.
Living with heart failure will involve lifestyle modification. This is a pivotal, yet often overlooked, aspect of heart failure treatment. Useful lifestyle changes that can help reduce the risk of your condition deteriorating include:
Several types of medication have been proven to improve survival, reduce hospitalisation, and improve symptoms and quality of life of heart failure patients. They may also result in improved function of the heart over time. You may be prescribed with more than one of these medications.
Heart failure is now understood to be a condition that does not involve the heart alone. It also involves the entire body’s organ systems. Two of the systems most closely linked to heart failure are the kidneys and the neurohormonal (nerves and hormones) system. Heart failure medication is prescribed to target these systems to achieve a new balance, leading to improved symptoms and overall outcomes.
You may be prescribed with heart failure medication belonging to the various drug classes below:
At each clinic visit, your doctor may alter the dosage of your heart failure medication, or add on another medication, depending on how you have tolerated your medications since the previous visit. This is because the highest tolerated dosages of heart failure medication is believed to be most beneficial to the patients.
It is important that you take these medications regularly. It will be helpful if you understand the reasons for taking the medicines, know the dose and desired effects of the medicines. While side effects are uncommon, you should inform your doctor, heart failure nurse or pharmacist should you develop any side effects, or suspect that your symptoms may be caused by your heart failure medication.
Do receive your immunization against influenza and pneumococcal disease according to your doctor’s advice. This will help prevent or reduce the severity of these conditions.
Patients with moderate to severely weak heart function are prone to developing abnormal heart rhythms, and are at increased risk of sudden cardiac arrest. The Implantable Cardioverter Defibrillator (ICD), a pacemaker-like device, is implanted to detect abnormal heart rhythms. When an abnormal heart rhythm is detected, the ICD delivers an electric shock to restore normal heart rhythm. It is important to note that the ICD’s function is to deliver the life-saving shock when such life-threatening abnormal rhythm occurs. It does not lead to improved heart function nor relieve the heart failure symptoms.
In a subgroup of patients, a similar device (the Cardiac Resynchronisation Therapy Defibrillator or CRTD) with an additional lead may be implanted. This device has resulted in improved heart function in up to two-thirds of our patients.
Advanced heart failure treatment
In spite of optimal medication, heart function in some patients may continue to deteriorate, leading to debilitating symptoms affecting their quality of life. In suitable patients, advanced options such as artificial heart pumps (known as Ventricular Assist Devices) and heart transplants may be discussed by your attending cardiologist.
Palliation and End of life care
In some patients, the above therapy may still not be adequate and their heart failure condition worsens. The aim of therapy will then focus on symptom relief and improving quality of life. This is done by a specialist team trained specifically for this. The medical team may broach the topic of end of life care with these patients and discuss the option of hospice care.
Your doctor can make a referral to a palliative care service. Seek advice from your doctor on the type of palliative care services most suitable for you or your loved ones.
A comprehensive list of in-patient and out-patient hospice services available in Singapore is listed here: https://singaporehospice.org.sg/services/
Government subsidy is available through means-testing. Medisave can also be used for palliative care services. Please seek advice from your healthcare provider. If there are any financial concerns, ask to speak to a social worker.
Some useful websites with information on heart failure:
A. The Heartbeat Trust Click Here
B. UK National Health Service Click Here
C. Keep It Pumping Click Here