Heart Failure

When a SCAD event occurs it often leads to a heart attack. In most SCAD survivors the heart muscle injury following a SCAD heart attack is small and heart failure would not be expected, but in a few patients the injury is larger and some of these patients may experience symptoms of heart failure.

• Breathlessness (with exertion or at rest – variable to each individual).
• Oedema (fluid retention or swelling) – caused by fluid building up in the body as a result of the heart not adequately pumping. This may show as swelling in lower limbs, abdomen , fluid can also collect in the lungs making breathing more difficult.
• Orthopnoea – this is the inability to lie flat due to fluid collecting in the lungs.
• Fatigue – feeling excessively tired and fatigued, due to inadequate oxygen supply to the muscles. (This is of course a common symptom and may be due to causes other than heart failure.)

It’s important to note that you may not necessarily experience any of these symptoms. 

• Echocardiogram – non-invasive ultrasound test to look at the heart structure and function. Sometimes an ejection fraction (EF) is noted or it may be described as mild/moderate or severely impaired, it’s important to note that normal EF is usually more than 50% (average figures are between 55% and 70%), no-one has 100%.
• CMR – Cardiovascular Magnetic Resonance Imaging, also referred to as cardiac MRI, it’s a non-invasive assessment of the function and structure of the cardiovascular system.

The mainstay of treatment is medication because the scientific research shows that a combination of medications can stabilise and improve the function of the heart as well as improve the long term outcomes.

The medications that are used to treat Heart Failure are:

• Ace Inhibitors – Lisinopril, Ramipril, Enalapril, Captopril – reduces the body’s ability to retain sodium, which is linked to fluid retention.
• ARBs – Candesartan, Valsartan – works in a similar way to ACE inhibitor, often prescribed as an alternative if patients get the side effect of dry cough with ACE inhibitor.
• Sacubitril/Valsartan – Entrestro – a relatively new drug to Heart Failure, currently only prescribed to patients who have severe LV dysfunction.
• MRA – Eplerenone, Spironolactone – shown to improve long-term outcomes in patients with severe LV Dysfunction.
• Beta-blocker – Bisoprolol, Carvedilol, Nebivolol – these are the only licensed beta-blockers for use in Heart Failure. They help the heart to pump in a more efficient way by remodelling the cells within the muscle of the heart and slowing it down.
• Diuretics – Furosemide, Bumetanide, reduce water retention in the body.

All of the above can potentially have side effects, however it’s important not to just stop any prescribed medications, if you think you are having problems then discuss this with your cardiologist/Heart Failure specialist nurse or GP.

Managing your symptoms can really help to improve your quality of life, being mindful with fluid intake, especially important if you are experiencing symptoms of fluid retention. Taking your prescribed medications will also benefit you long term as there is evidence to show that they improve the heart function and reduce your chances of hospital admission due to worsening Heart Failure.

Find out if you have a local Heart Failure specialist nurse in your area that you can be referred to, they will be able to support you through the difficult times with symptom management, medications and direct you to other services such as cardiac rehabilitation and benefits advice.

Work with your clinical team and heart failure nurse. For some patients weighing yourself daily can be helpful – this is to detect for any sudden increases that may be associated with increasing fluid retention, a fluctuation of 1-2lb either way is normal but an increase of more than this over a few days can be a signal that things may be deteriorating and should prompt you to seek advice from the healthcare team that are looking after you.

Taking your prescribed medications – very important to improve the long-term prognosis.

Physical activity – pacing yourself according to how you feel each day, strenuous exertion, such as heavy lifting, should be avoided but in general exercising within your limits is good for heart failure patients.

Sleeping – if you have trouble breathing when you are lying down try using 2-3 pillows to prop yourself up.

Rest– when you are tired.

Eating healthily – aim for freshly prepared foods wherever possible, reduce but preferably cut salt from your table, there’s lots of information available online around healthy eating, the BHF is a good starting point.

Salt and fluid – reducing added salt in the diet is generally good advice and is particularly important in patients with heart failure as this makes fluid retention worse. For fluids, the guidance for more significant Heart Failure patients is to restrict fluid intake to 1.5 litres per day, this is especially important for those patients who are struggling with fluid retention. Discuss with your clinical team and heart failure nurse to see if this applies to you.

Stop smoking – everyone knows the detrimental effect that this has on health outcomes, if you do smoke then think about trying to stop, you can discuss this with your GP or Practice Nurse, there are lots of NHS funded initiatives to support patients who want to stop smoking.

British Heart Foundation

NHS information on Heart Failure

Ejection Fraction information

Thanks to Julie Harris, Heart Failure Specialist Nurse, for writing this information and to Dr David Adlam for reviewing it.