Heart Failure Pathway

The main symptoms of heart failure include:

• Breathlessness 
• Reduced exercise tolerance (an inability to do what you were once able to do)
• Fatigue
• Swollen legs (oedema)
• Having trouble breathing when lying flat

Many other heart conditions can lead to heart failure. The most common reasons for heart failure are: 

• Coronary artery disease (CAD) is when the arteries have become narrowed due to the buildup of fatty plaques on the arterial walls. This can weaken the heart muscle over time. 
• Hypertension (high blood pressure) that is not properly managed requires the heart to work harder to pump blood around the body. Over time, this can make the heart weakened or stiff.
• A previous heart attack might have caused damage to the heart muscle, affecting its ability to pump blood to the body. 

Other reasons for heart failure can include:

• Valvular heart disease
• Cardiac arrhythmias
• Overconsumption of alcohol, some medications and drugs
• Obesity
• Genetic conditions that predispose you to heart failure

A variety of blood, imaging and breathing tests are used to diagnose and monitor heart failure.  These could include:

• Electrocardiogram (ECG) – This simple, non-invasive test records your heart’s rate, rhythm and electrical activity. It’s also called a resting ECG.
• NTproBNP – This is a blood test that measures your levels of natriuretic peptides, a protein that is released when your heart is under strain.
• Echocardiogram – An ‘echo’ for short, this test uses ultrasound waves to create a moving image of your heart.
• Cardiac MRI – This non-invasive test uses an MRI machine to create magnetic and radio waves to show detailed pictures of the inside of your heart. 
• CT angiography – A computed tomography (CT) scan is a non-invasive imaging test that looks at the coronary arteries for calcium buildup and plaque.
• Cardiac catheterisation – In this minimally invasive procedure, a thin, flexible tube is inserted into the artery via the groin, arm or neck. X-rays and contrast dye are used to take detailed pictures of the coronary arteries. 
• Breathing tests – Simple, non-invasive breathing tests can measure your lung capacity.
• Cholesterol and lipid testing – Blood tests to assess your blood cholesterol and lipid levels can determine if you have a lipid problem that can make your heart failure worse.  

In most cases, heart failure is not curable so you’ll need to manage your condition for the rest of your life. Your treatment will depend on the cause and severity of your heart failure. We’ll work with you to come up with a customised treatment plan that includes medication, rhythm correction devices if necessary, lifestyle changes and self-education. 

Medications

You may need several medications to treat and manage your heart failure. It can feel overwhelming at first to take so much medication, but it’s important to take your tablets carefully and stay in close contact with your cardiology care team to manage your dosage and any possible side effects. You will likely be prescribed a number of the medications below. 

• Diuretics reduce the amount of fluid in your blood or lungs.
• ACE inhibitors and ARBs relax the blood vessels around the body to help reduce the strain on the heart.
• Beta-blockers slow down your heart rate so that it can beat stronger.
• MRAs (Spironolactone and Eplerenone) help prevent water and salt from building up in the body.
• ARNIs (Entresto) lowers blood pressure and reduces sodium levels, which reduces stress on the heart. 
• SGLT2 inhibitors (Dapagliflozin and Empagliflozin) are used to reduce blood sugar levels in type 2 diabetics but they have also been proven to be effective in all heart failure patients with reduced ejection fraction. 
• Vericiguat makes it easier for the heart to pump blood through the lungs.

Implantable medical devices

In some cases, your consultant might suggest a surgically implanted device to help your heart work more effectively. 

• Pacemaker – A pacemaker is implanted just under the skin which sends electrical signals to the heart to keep it beating regularly and at the right speed. 
• Implantable cardioverter-defibrillator (ICD) – This surgically placed device delivers an electric countershock to the heart when a life-threatening abnormal rhythm is detected.
• Cardiac resynchronisation therapy (CRT) – This is a special pacemaker that makes the ventricles contract more efficiently and in a more synchronised way. 

Surgical interventions

Surgery can be recommended to treat any underlying cause of your heart failure. Some solutions that might be recommended include:

• Coronary angioplasty to treat blocked arteries
• Minimally invasive mitral valve surgery to allow the mitral valve to close properly
• Heart valve surgery to repair or replace damage valves
• Coronary artery bypass graft (CABG) surgery to treat severely blocked arteries
• Heart transplant for when heart failure can’t be corrected by other medical or surgical options.

Lifestyle changes

In addition to taking tablets, you’ll need to take an active role in managing your condition. There are many lifestyle changes that you can adopt that will have a big impact on your quality of life. 

• Reduce your fluid and sodium intake to control your blood pressure and avoid fluid retention.
• Seek out a local heart failure exercise rehabilitation programme to strengthen your heart muscle.
• Set up a system of shared care and open communication among yourself, your GP, your community heart failure nurse and your cardiologist team.
• Learn all you can about the self-management of your condition. There are many helpful resources for you and your family and friends that can be found on the charity site Pumping Marvellous. 

As part of the London Medical family, our cardiology clinic has access to various specialties – all under one roof. So whether you need a personalised weight management programme, expert nutritional advice or support with quitting smoking, we’re here to help look after your whole health.