Understanding heart failure

[Music] hi guys um my name is sanup I I'm a consultant cardiologist in York hospital and today I wanted to do a video on the subject of heart failure um a few people have written to me and said could you explain heart failure to us um and whilst it may not be relevant to a lot of people who watch this um I thought I'd do this video because someone somewhere might benefit from it um so the first thing to understand understand is what what is heart failure now a lot of people automatically assume that um the word heart failure means that the heart has failed or the heart is you know it's is synonymous with death this is not true okay what heart failure simply means is that the heart is failing to keep up with the body's requirements okay so that can be because there's a problem with the heart or it can can be because the body's requirements are excessive so the heart is doing what it should do but if the requirements placed upon it are excessive uh then the heart can fail to keep up with the body's requirements the end result is pretty well much the same um but um let's talk about what kind of things can make the body's requirements go up so in particular for example things like thyroid uh disease so the thyroid gland you know causes the heart to work much harder um it asks a lot more of the heart and the Heart fails to keep up with the body's requirements uh similarly um anemia you know if you are anemic and if you are severely anemic then the heart then the heart has to work much harder to try and get blood around the body and that can lead to heart failure however those are not the really dangerous ous causes of heart failure the because they're caused by something else so if you treat the thyroid gland if you treat um the uh anemia if there's an infection for example that can sometimes cause people to go into heart failure if you treat that then the heart itself is normal okay those causes which place excessive demands on the heart are called are called um high output cardiac failure or high output heart failure I the heart is producing an output but the output is simply not enough to match the requirements of the body the more Sinister uh type of heart failure is low output heart failure and that is because there's a predominant problem with the heart and therefore in some way the heart is Damaged um or there's a leaky valve or something like that and therefore the heart is not capable of meeting the body's requirements now the time this is most noticeable is when the body is asking for more so on exertion so the body asks for more and although the heart may be able to keep up with the body's requirements at rest or when the body exerts itself uh the heart is unable to keep up with the body's requirements and this usually manifests with symptoms of breathlessness and exercise intolerance I you can't do as much on exercise or you can't do as much exercise as you are you would think you would be able to because the heart is failing to keep up with the body's requirements so how does the heart become damaged um well the commonest way is through heart attacks there are substantial number of people who can have heart attacks and not really know about them now this is by no means meant to scare the majority of young people who are healthy and will not have this problem however in the older population particularly diabetic patients it is possible or particularly patients who have bad high blood pressure it is possible that you can damage your heart have silent heart attacks and therefore the heart is now damaged uh there is a scar and therefore there's not as much heart muscle to pump blood out um that's the most common way uh but also things which are toxic to the heart so alcohol in excess if you're someone who uh you know are drinking excessive amounts of alcohol for several years that can be toxic to the heart and the Heart muscles um can get affected and the Heart can weaken and that again has the same effect uh similarly uh some chemotherapy agents can do this similarly um there is something called um a viral dilated cardiomyopathy so viruses can sometimes do this but in essence the basic idea is that the heart for some reason becomes weak and therefore is not able to pump out enough blood now what happens then okay let me just explain this to you so you can understand exactly what starts happening the heart pumps less Blood Out the kidneys are used to getting a certain amount of blood but because they're getting less blood than they expect they think that the body is dehydrated and there therefore the kidney's function is to try and absorb more fluid into the body to try and restore this volume they don't understand that the reason they're not getting enough is not because there's a shortage of blood it's simply because the pump that is pumping the blood is weak so they will absorb more water through the urine and therefore you are now having more volume within the blood vessels and the idea is that the kidneys think that by restoring the volume they will then get more um blood coming to them but the problem is you have more volume but the heart is still weak so you're um so the heart is still going to pump less out and the kidneys are still going to try and absorb more water so you get into this vicious cycle where the kidneys are absorbing uh but the heart is not pumping blood is not pumping more blood the kidney is absorbing water to try and restore the blood volume but the heart is still enable to pump the volume required to the kidneys and so you get into this hideous vicious cycle and what tends to happen is that you start filling up with fluid you know you get more and more fluid building up the heart gets progressively more and more stretched because there's all this extra volume coming in and therefore it becomes dilated and this condition where the heart becomes dilated and is weak is often referred to as a dilated cardiomyopathy a big heart enlarged heart which is weak dilated cardio meaning heart myopathy meaning weak muscle so dilated cardiomyopathy is the same as a weak heart and this is how it happens and what tends to happen is for a lot of people what they tend to find is they start swelling up they start developing swelling of their ankles they start developing bloating of their stomach some of this extra volume extra fluid leaks out into the lungs so a lot of people will then say Oh when I lie down I start getting more breathless and I have to prop myself up um on three or four or five pillows just to be able to breathe and um um and they say that um uh sometimes if they're uh sleeping sometimes they have to wake up and they have to sit on the side of the bed because they're getting so breathless and sometimes they develop a nocturnal cough and what is amazing is for a lot of patients they struggle with this because it comes on relatively slowly and they struggle with this and they can go two three months before they end up presenting themselves to hospital and by that time they're profoundly swollen they've got fluid everywhere they've got fluid all the way up to their stomach you know and the way you can tell is you press on their feet and your your thumb or your finger when you press will leave an indentation suggesting that there's fluid in in the legs so this is what heart failure is it's not it doesn't automatically signify that you know you're going to die and nowadays we have great treatments available uh which can actually allow people with heart failure to leave lead pretty normal lives okay and in some cases where the mechanism of the heart failure the cause of the weak heart is not a heart attack there is considerable Chan that with good treatment the heart can normalize uh so uh the first thing always whenever we get patients who have heart failure is to try and work out why they have the heart failure and the way you work out why they have the heart failur as you do in echocardiogram the echocardiogram will confirm that the heart is weak normally they have a figure um called the ejection fraction and that tells us how much blood comes out of the heart every time the heart beats and a normal ejection fraction is around about 60% and usually if your ejection fraction is sort of below 45 50 to 45% then uh that would be termed as having heart failure that is mild heart failure if it's sort of around about 35 to 45% that would be called moderate heart failure and if it's less than 35% I less than half because remember 60% is normal then that's called severe heart failure and it's worth knowing that a person with heart failure a person with a weak heart doesn't feel as good or live as long as a person with a strong heart however as I say treatments are there are some really really good treatments and the survival of patients with heart failure has improved considerably so um the first thing you want to do when you get patients uh Who present with heart failure is to try and get the fluid off and you have to ask the kidney to stop absorbing all this extra fluid and that is done by giving the patient diuretics or water tablets they're called they're not really water tablets they are uh um tablets designed to get rid of water diuretics so that's things like fide or banide and what they basically do is they stop the kidneys from absorbing water and you start urinating more and as you start urinating more slowly and gradually this all this extra fluid goes away and the patient feels better their leg swelling gets better their breathing gets better that doesn't mean you've cured the heart failure because they're still left with that weak heart um but you've gotten their symptoms better then there are some tablets which are designed to actually reduce or delay the progression of heart failure remember heart failure is not a static thing it's not just one bit of damage what happens is this Progressive uh absorption water Progressive stretching of the heart Progressive weakening of the heart and so what you have to do is try and put a stop to that as well and there are three V three agents which are available which are particularly good at that beta blockers ACE inhibitors or Angiotensin 2 antagonists and finally alerin antagonist so beta blockers most people are familiar with ACE inhibitors are things like Ramipril or linil and then alistan antagonist or things like spalatin and whenever you go if you are diagnosed or if someone you um Love is diagnosed with heart failure it's important that they are taking all three agents because what we know is having a little bit of the three separate agents is much better than having lots of just one agent because they work in different ways to try and strengthen the heart up or at the very least try and prevent the heart from getting weaker uh and we know that those people who manage to take these agents tend to live longer from their heart failure than people who don't so it's really important uh to bear that in mind finally nowadays we also have the ability to put in special devices called pacemakers uh and these are called um biventricular pacemakers and basically what biventricular pacemakers are are it's a mechanical way of making the heart pump more effectively as the heart gets bigger and bigger and bigger it becomes flabby and so different parts of the heart contracted different times so you know if you have a flabby bag and you press on one side instead of everything going out some goes here so by putting in this B ventricular pacemaker what you can do is you can make different parts of the heart all contract at the same time and therefore lead to a more uh effective contraction I more blood goes out and that is really the mechanism of heart failure and the treatment of heart failure so if you are aware of people that you may know or love who are complaining of progressive breathlessness who are finding that their legs are beginning to swell up who finding that they're not able to sleep flat and they're going to have to they're trying to prop themselves up at night that could well be heart failure the best thing is go to your GP or consult with a cardiologist have an echocardiogram and this will put your mind at rest now some people say can you have heart failure and have a strong heart and the answer is yes you can and there is another way in which you can get heart failure if the heart is not weak and if you don't have any of those conditions that I described at the beginning where the demands are increased and that condition is called diastolic heart failure now in people who have high blood pressure what can happen is that the heart doesn't become weak it can still contract but it becomes uh stiff and therefore does not relax quick enough and because it doesn't relax quick enough it doesn't fill with as much blood so when it contracts it still pumps out less blood to the kidneys and therefore you can still get into this vicious cycle where you absorb more and more uh fluid uh and so that is diastolic heart failure which tends to occur in patients who have high blood pressure um it's always a good idea if you have heart failure to try and avoid salt because we know salt retains water um and other than that that it's just really good to try and lose weight and keep going with your exercises Etc because we know exercise and um and um um a good diet weight loss is all very good in heart failure so I hope this was useful uh it's slightly different to what I normally do but I think there are lots of people out there who may know someone who has heart failure who may have some questions about heart failure and I hope this explanation goes some way into trying to answer some of the questions that may have been raised by people who have recently been diagnosed with heart failure um I'm really grateful to you all of you for taking the time to watch my videos I get some great feedback and I'm always grateful uh to hear from people and I'm always really appreciative when people leave um nice comments and I'm very grateful um um if you find this useful please do consider sharing it because it'd be nice for my message to get out there I want to try and Empower people I want to try and make people aware of their health I want people to try and take control of their health so that they don't develop diseases or they identify diseases at an early stage and get good treatment for them at an early stage equally well I don't want people to worry unnecessarily about their health um and I hope that some of these videos will help with that so if you um have enjoyed the video please do consider sharing it if you want to get in touch with me you can do so through my website uh which is yor cardiology.com

Channel: York Cardiology

Views: 78,288

Keywords: #hangoutsonair, Hangouts On Air, #hoa, heart failure, systolic heart failure, diastolic heart failure, pacemakers, diuretics, ACe inhibitors, Beta blockers, health

Id: JRujYGCegBo

Length: 16min 56sec (1016 seconds)

Published: Wed Jan 06 2016