Heart failure: Your guide to diagnosis, treatment and helpful lifestyle modifications

In this second informative article in her series on heart failure, highly esteemed consultant cardiologist Dr Teresa Castiello sheds light on how the condition is diagnosed and treated. The leading specialist also details the key lifestyle modifications which can benefit patients diagnosed with heart failure.

How is heart failure diagnosed by doctors?

Medical history

First of all, the cardiologist will ask you about your medical history. Your doctors will question symptoms, cardiac and non-cardiac medical conditions, and family history. They will also ask about any risk factors for heart failure, including lifestyle. It is important also to have a list of medications to share with the doctor.

Physical exam

Your doctor will listen to your heart and check your body for signs of fluid buildup or for any sign that can help to clarify the diagnosis. They will also check your blood pressure, pulse, height and weight. They may check breathing rate and oxygen level.

Diagnostic tests

There are a number of tests that can be used to diagnose heart failure. These tests include:

• Blood tests: The NTproBNP is a key test for HF, this little peptide increases if the heart does not function properly, however it needs to be read in the clinical context, as other conditions may alter its value. Many other common bloods are also requested to assess the baseline organ function, such as full blood count, liver and renal function, glucose profile, iron profile, thyroid function , lipid profile etc.
• Chest X-ray: This test can show the size and shape of your heart and lungs. It can also show signs of fluid buildup in your lungs.
• Electrocardiogram (ECG): This test records the electrical activity of your heart. It can show abnormalities that suggest heart failure.
• Echocardiogram: This is an ultrasound test that uses sound waves to create a picture of your heart. It can show the size, shape, and function of your heart.
• Stress test: This test measures how your heart responds to exercise. It can help to determine if your heart is getting enough blood.
• Cardiac MRI: This test uses magnetic fields to create a detailed picture of your heart, looking also at potential scars or inflammation. It can show abnormalities that may not be seen on other tests. It is an essential test if your doctors suspect cardiomyopathy.
• Coronary studies: coronary angiogram via CT or via catheterisation may be indicated if your doctor suspect a blockage in the coronary vessels

What lifestyle changes can help manage heart failure?

There are many lifestyle changes that you can make to help manage your heart failure. These changes can help improve your symptoms, reduce your risk of complications, and improve your quality of life. While a dedicated article would provide a more comprehensive overview, here are a few key lifestyle changes to consider:

Adopt a heart-healthy diet

Prioritise a diet low in sodium, saturated fats, sugar, and processed foods. Emphasise fruits, vegetables, whole grains, and lean protein sources.

Monitor and control blood pressure and blood sugar levels

Regularly monitor blood pressure and blood sugar levels. Work with your healthcare provider to maintain optimal blood pressure and blood sugar control through lifestyle modifications or medication, if necessary.

Engage in regular physical activity

Cardiac rehabilitation programs and exercise regimens are crucial in supporting heart function. However, it is important to get guidance from your heart failure specialist.

Quit smoking and avoid second-hand smoke

Smoking significantly increases the risk of heart complications and worsens heart failure symptoms.

Limit alcohol consumption or avoid it altogether

Excessive alcohol intake can exacerbate heart failure symptoms and impair heart function.

Manage stress effectively

Implement stress management techniques such as relaxation techniques, like yoga and mindfulness, or counselling. Chronic stress can negatively impact heart health and worsen heart failure symptoms.

Maintain a healthy weight

Maintain a healthy weight through a balanced diet and regular physical activity. Obesity contributes to heart failure development and worsens symptoms.

Manage underlying health conditions

Effectively manage other underlying health conditions such as diabetes, kidney disease, and anaemia. Addressing these comorbidities can improve overall health and reduce the burden on the heart.

Prioritise adequate sleep

Aim for adequate sleep, typically 7-8 hours per night. Sufficient sleep is essential for overall health and can help manage heart failure symptoms.

What are the treatment options for heart failure, and are there any new advancements in care?

Heart failure (HF) treatment has seen remarkable advancements in the past decade. Treatment for HF not only alleviates symptoms but can also slow or even reverse disease progression, significantly improving quality of life. Currently, there are at least four key medications for HF, with more options rapidly emerging. The so-called "four pillars" of HF therapy are:

1. Beta-blockers: these medications slow the heart rate and reduce blood pressure, easing the workload on the heart and improving its efficiency.
2. ACE/ARB inhibitors: these medications reduce the activity of the renin–angiotensin–aldosterone system, reducing strain on the heart. More recently, ARNI (Angiotensin receptor-neprilysin inhibitor) enhances the positive mechanism of the heart, improving the heart function.
3. MRAs (mineralocorticoid receptor antagonists): these medications block the effects of aldosterone, a hormone that promotes fluid retention. They help reduce fluid buildup in the body, which can alleviate symptoms like shortness of breath and swelling in the legs.
4. SGLT2i (sodium-glucose cotransporter-2 inhibitors): these medications were primarily used to treat diabetes but have also shown great efficacy in improving heart outcomes in patients with HF (with or without diabetes).

These medications can work synergistically, meaning they enhance each other's effects, to actively improve heart function. Additionally, diuretics are crucial for managing fluid retention, a common sign of HF.

New medications are continuously being investigated and are expected to soon become integral components of HF therapy. Beyond medical therapy, implantation of medical devices like pacemakers, resynchronisation therapies or defibrillators are indicated for specific cases. Surgical interventions, such as bypass surgery or heart valve repair/replacement, may also be necessary in some instances. Non-medical interventions play an equally important role in HF management:

Lifestyle modifications

Making healthy lifestyle changes, such as adopting a heart-healthy diet, exercising regularly, maintaining a healthy weight, and quitting smoking, can significantly improve heart health and reduce the risk of complications.

Cardiac rehabilitation programs

These structured programs provide exercise training, education, and support to help patients with HF regain their strength, improve their physical fitness, and manage their condition effectively. Once other treatment options have been exhausted, mechanical circulatory support devices and heart transplantation may be considered in advanced HF centres for carefully selected patients.

While there are worldwide guidelines for HF treatment, it is essential to consult with a HF specialist to develop a personalised treatment plan tailored to the individual's specific needs and circumstances.
 

Read more about the symptoms and risk factors associated with heart failure in Dr Castiello’s other expert article on the condition.


If you would like the schedule a consultation with Dr Castiello to discuss your heart health, visit her Top Doctors profile today.