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Heart failure

Health amd Nutrition > Diseases > H

Heart failure (Contd)

Reviewed by Dr Neal Uren, consultant cardiologist and Dr Reginal Odbert, GP and Dr Patrick Davey, cardiologist

Right-sided heart failure
This can lead to:

  • venous leg ulcers.
  • general swelling of the legs, abdomen and, in men, possibly the scrotum.
  • possible liver enlargement if severe.

    • What can the doctor do?

  • Investigate the patient with a view to coronary artery widening (revascularisation) and valve replacement if necessary.
  • Treat any obvious causes of heart failure.
  • Give advice regarding risk factors such as smoking, excessive weight and high blood pressure.
  • Refer the patient for further investigation to identify the cause of the heart failure.
  • Prescribe medication.
  • Monitor the patient's health on a regular basis.

    • Which medication is used afterwards?

    Acetylsalicylic acid (aspirin) Aspirin is always prescribed unless the patient is intolerant to it. It has a mildly 'blood thinning' effect and goes some way to prevent further coronary events. Aspirin must be taken for the rest of the patient's life. Clopidogrel can be given as a substitute in people intolerant to aspirin.

    Agents for increasing cardiac function
    Digoxin helps the heart contract more vigorously.

    Nitroglycerin and other nitrates
    Nitrates such as glyceryl trinitrate or isosorbide mononitrate will increase venous capacity, reduce the resistance in the circulation and dilate coronary arteries. They help the heart to pump blood around the body more easily.

    Beta-blockers
    Beta blockers reduce the harmful effects of the excessive nervous system response to chronic heart failure.

    ACE inhibitors
    ACE inhibitors prevent the formation of a hormone which makes the blood vessels contract. This means that less effort is needed by the heart to pump blood.

    Diuretics
    Diuretics help the body excrete excessive fluid and salts in order to reduce the strain on the heart and blood vessels. The patient may need a potassium supplement because some diuretics cause a loss of potassium.

    What can be done to avoid heart failure from ischaemic heart disease?

  • Avoid smoking.
  • Avoid overeating.
  • Exercise regularly.
  • Eat a healthy, low-fat diet.
  • If you are suffering from a disease that can cause heart failure, such as high blood pressure, it is important to have it treated as soon as possible. The risk of developing heart failure will then be greatly reduced.
  • If you suffer from any of the above symptoms, contact your GP for advice.



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