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What is heart failure?
Heart failure is the term used to describe the
symptoms and signs which occur if the heart
becomes less efficient at pumping blood around
the body, either while you are resting or
exercising.
How a normal
heart works: Circulation of the blood
is essential as the blood delivers nourishment
to all the tissues and organs of your body. It
also transports waste materials to the lungs and
kidneys, which then excrete them from the body.
The heart consists of two muscular pumps which
work in harmony. Blood from the muscles and
organs of your body enters the right side of
your heart. The heart pumps the blood to the
lungs where it takes up oxygen and eliminates
the carbon dioxide it has been carrying. This
oxygen-rich blood then enters the left side of
the heart. From here it is pumped through the
arteries to all parts of your body including the
heart muscle itself. The movement of the blood
through the heart is regulated by a system of
valves which ensure that the blood flows in the
correct direction. There are four valves - one
at the entrance and one at the exit of each of
the two pumping chambers.
What causes heart failure?
Heart failure may be the result of damage to the
heart muscle. The damage is most commonly caused
by a heart attack, but sometimes it may be
caused by excessive alcohol consumption or a
virus infection. This may be referred to as 'cardiomyopathy.'
Cardiomyopathy is a condition of the heart
muscle where the cause is often not known.
Heart failure can also result from conditions
which put an extra workload on the heart. The
heart may have coped with this increased
workload for many years before heart failure
occurs. Problems which can cause an increased
workload include:
high blood pressure (hypertension)
anaemia,
heart valves that either leak or are too narrow,
thyroid gland disease, or
an excessively fast or slow heart rate.
Heart Rhythms: The heart is a muscular pump which circulates
blood through the body and lungs. It has four
chambers - two upper ones called the right and
left atria, and two lower ones called the right
and left ventricles.
Normal heart rhythms:
The heart’s pumping action is controlled by tiny
electrical impulses produced by a special part
of the right atrium called the ‘sinus node’.
This is sometimes called the heart’s natural
‘pacemaker’. The rhythmical impulses produced by
the sinus node cause the atria to contract and
push blood into the ventricles. The atria are
joined to the ventricles but the electrical
impulses all travel through to the ventricles
via one special place, called the atrio-ventricular
node or ‘AV node’. This acts like a junction box
and is sometimes called the ‘AV junction’. The
impulse is delayed a little before it enters the
ventricles through fibres which act like ‘wires’
(the Purkinje system). When the impulse reaches
the ventricles they both contract, pushing the
blood out of the heart to the lungs and the rest
of the body. So, in a normal heart rhythm, each
impulse from the heart’s pacemaker makes the
atria and the ventricles contract regularly and
in the correct sequence.
Sometimes the heart will beat faster or more
slowly, depending on your state of health and
whether you have been exercising or resting.
When the heart is beating fast, this is called
‘sinus tachycardia’. When it is beating slowly
it is called ‘sinus bradycardia’. These are
normal heart rhythms and do not mean that there
is anything wrong with your heart.
Sinus tachycardia (normal but fast rhythm)
While you are resting, your heart’s pacemaker
fires off between 50 and 100 impulses a minute.
It is the pumping of blood that produces your
pulse, which can be felt for example at the
artery in your wrist. By taking your pulse,
doctors can examine the rate and rhythm of your
heart.
Doing exercise creates certain reactions in the
nervous system and in the body’s chemicals,
which make the pacemaker speed up. When the
heart rate produced by the sinus node goes above
100 beats a minute, the rhythm is called ‘sinus
tachycardia’. (Tachy = fast, cardia = heart.)
The chemicals involved are called ‘catecholamines’,
one of which is adrenaline. Adrenaline is also
released when we are frightened; it prepares our
body for action. The heart beats rapidly and
powerfully to pump out more blood, to make you
ready for ‘fight or flight’.
The heart rate may also be increased if you have
an overactive thyroid gland or if you have a
fever (for example with influenza), or anaemia.
Sinus bradycardia (normal but slow rhythm):
When the sinus node slows the heart rate to
below 60 beats a minute, the rhythm is called
‘sinus bradycardia’. (Brady = slow, cardia =
heart.) Many athletes have sinus bradycardia.
Also, when you feel sick or nauseous it is
normal for your heart to slow down. Sometimes
the heart may slow down too much and produce a
faint.
‘My heart sometimes seems to
have an extra beat’ :
Extra heartbeats - called ‘ectopic beats’ - are
very common. They may be extra beats either from
the atria (atrial) or ventricles (ventricular).
They are more common in people who have heart
disease, but most people have at least one
ectopic beat in every 24 hours.
Most ectopic beats go unnoticed. If you do
notice an ectopic beat it feels like a thud in
the chest, or an irregular heart rhythm.
Sometimes you may notice one when you are in bed
lying in a position where you can ‘hear’ your
heart rhythm. Tiredness or alcohol may
accentuate these extra beats. Some people
believe that coffee and tea may provoke ectopic
beats but this does not happen often.
Ectopic beats are not in themselves dangerous
and they do not damage your heart.
Fast, regular beats:
If you feel your heart is beating too fast, but
still regularly, this can be one of three
things:
normal sinus tachycardia (see Heart Rhythms) or
supraventricular tachycardia (which is common)
or
ventricular tachycardia (which is not common).
Supraventricular tachycardia
(Also known as SVT, or Paroxysmal SVT or PSVT)
Supraventricular tachycardia is a disturbance of
heart rhythm caused by rapid electrical activity
in the upper parts of the heart. In these
attacks the heart beats very fast, usually at a
rate of between 140 and 240 beats a minute. In
most cases the heart is normal in every other
way.
Symptoms may be uncomfortable but are not
harmful. The most common symptom is palpitation,
but there may also be dizziness or even, very
occasionally, fainting. Attacks usually start in
youth and may recur over many years but tend to
lessen as the person gets older. Some people
find that certain things can trigger an attack,
such as an emotional upset, physical activity,
certain foods and drinks (especially coffee), or
alcohol.
An attack may last from a few seconds or minutes
to several hours. They can often be stopped by a
technique called the ‘Valsalva Manoeuvre'. This
involves taking a breath in and then ‘straining
out', with the airway closed at the back of the
throat. Or try swallowing something cold - for
example some ice cream or a small ice cube.
You may be able to prevent the palpitations by
avoiding the foods or drinks which seem to
trigger them. Or your doctor may be able to
prescribe medicines to help (see What treatment
is given for palpitations.). If the attacks are
troublesome, you may need to have some tests
done. These might include an ECG
(electrocardiogram) and/or a 24-hour ECG
recording. If these fail to identify the
problem, you may need to have
electrophysiological testing. All these tests
are described in How do doctors diagnose
palpitations?
A special group of supraventricular tachycardias
are caused by electrical impulses travelling
along an abnormal pathway between the upper and
lower chambers of the heart. These tachycardias
occur in patients with Wolff-Parkinson-White
syndrome or Lown-Ganong-Levine syndrome. If you
have one of these syndromes you may need to be
referred to a specialist centre for more
detailed tests of the electrical activity of
your heart.
Ventricular tachycardia:
Ventricular tachycardia is a condition where
there is a fast rate - between 120 and 200 beats
a minute - in the ventricles (the two larger
chambers of the heart), while the rate in the
atria (the two smaller chambers) remains normal.
This may be caused by increased activity of the
electrical impulses to the ventricles.
This condition usually occurs as a complication
of heart disease, but it is also sometimes seen
in otherwise healthy people. The attacks may
last just for a few seconds or minutes, or may
even continue for some hours. The first symptoms
may be faintness, or fast, regular palpitations
with breathlessness and sometimes chest pain. An
electrocardiogram (ECG) will show whether it is
ventricular tachycardia or another type of
abnormal heart rhythm (see How do doctors
diagnose palpitations?)
If symptoms occur, immediate medical help should
be obtained as it might be necessary to give an
injection or an electric shock to stop the
attack. However, many attacks of ventricular
tachycardia do stop on their own and do not need
immediate treatment.
Drugs such as amiodarone, or flecainide may be
given by mouth to prevent the attacks recurring.
You may be asked to have electrophysiological
testing to assess how well the drugs are
controlling the abnormal rhythm. This test is
described in How do doctors diagnose
palpitations?
If the drugs are not effective and you have
frequently recurring attacks, it may be
necessary to consider an alternative form of
treatment. This could be:
either surgery to identify and remove or destroy
the affected area giving rise to the abnormal
rhythm
or having an implantable defibrillator. This is
a device which gives out an electrical impulse
or shock whenever you have a ventricular
tachycardia attack, and reverts the heart to its
normal rhythm.
These options would only be suggested in certain
circumstances and would depend on your medical
history. These treatments are described in How
do doctors diagnose palpitations?
Fast, irregular beats:
Atrial fibrillation - or AF - is a very common
type of palpitation. It occurs in about 3 in
every 100 people over 60 years old, but it may
also affect younger people. It can be
intermittent (paroxysmal), with attacks lasting
for a few minutes or hours, or it can become
permanent.
Atrial fibrillation is a type of arrhythmia
(irregular heartbeat) in which the atria beat
very rapidly, at up to 400 beats per minute. As
the AV node cannot conduct all these impulses,
only a minority are passed on to the ventricles.
The ventricles respond by beating quickly (at
about 180 beats a minute) and irregularly. The
speed and irregularity of the arrhythmia can
produce quite unpleasant palpitations. If the
atrial fibrillation is particularly rapid, the
heart’s pumping action is disturbed and may
cause breathlessness. Fortunately, AF is not
immediately dangerous. However, in some cases
the fast irregular rhythm may lead to a clot
forming in the heart, with a risk of it becoming
dislodged and possibly causing a stroke. AF
therefore needs to be investigated and treated.
There are many causes of AF, including too much
alcohol, an overactive thyroid gland, high blood
pressure, lung infections, and heart disease.
The term ‘lone atrial fibrillation’ is used when
there is no evidence of heart disease.
There are various ways of
treating AF.
If you have a normal heart rate but only
experience occasional attacks of atrial
fibrillation, you may not be given any treatment
except for low-dose aspirin.
The drug digoxin may be given to slow a rapid
heartbeat, or other drugs may be given to help
control the heart rhythm or to revert it to
normal.
Anticoagulants (for example warfarin) might be
given if you have a high risk of blood clots
forming - for example if you have rheumatic
heart disease.
Electrical ‘cardioversion' or ‘defibrillation'
might be given to restore the heart's normal
rhythm. This is described in What treatment is
given for palpitations?
In the rare cases that fail to respond to the
treatment above, other procedures such as
catheter ablation therapy and pacemaker
implantation may be considered. These are
described in What treatment is given for
palpitations?
If you find your heart is beating too slowly,
but with a regular beat, then this can be either
normal sinus bradycardia (described in Heart
Rhythms) or it could be a form of ‘heart block’.
Heart block can produce slow, ponderous
palpitations and often comes with dizziness or
attacks of fainting. Heart block occurs when the
heart tissue that conducts the electrical
impulses is diseased. Sometimes, sinus node
disease may produce ‘sick sinus syndrome’, which
is a combination of bradycardia and tachycardia.
Some people with bradycardias may be advised to
have an artificial pacemaker implanted.
How do doctors diagnose
palpitations? The doctor will ask you about the pattern and
frequency of your attacks and exactly how the
palpitations feel. He or she may ask you to tap
out the rhythm with your hand. The doctor needs
to decide whether the palpitations reflect a
normal heart rhythm and need no treatment, or
whether you have an arrhythmia - an abnormal
heart rhythm - which needs to be investigated.
In either case, you may have a blood test for
anaemia and to check your thyroid function.
Tests to help diagnose palpitations
Electrocardiogram (ECG)
Sometimes arrhythmias cause no symptoms; they
can only be detected by feeling the pulse or
doing an electrocardiogram (ECG) recording which
gives information about the rhythm and
electrical activity of the heart. Almost all
patients who have symptoms associated with their
palpitations will have an ECG. The ECG helps to
identify the source of the abnormal rhythm. It
is painless and usually takes about five
minutes. Small metal patches, set in sticky
tape, are put on your arms, legs and chest and
are connected to a recording machine. A reading
is then taken.
Sometimes an ‘exercise ECG’ is used to try and
provoke palpitations so that they can be
analysed. An exercise ECG means taking an ECG
recording while you are exercising on a
treadmill or stationary bicycle.
When palpitations occur very often but not often
enough to be captured on an ordinary ECG, a
24-hour ECG will be recommended. This involves
having a portable ECG recorder, about the size
of a walkman, strapped to your waist for 24
hours while you do your normal activities. You
will be asked to keep a simple ‘diary’,
recording what activities you do and when, and
making a note of any times that you have
palpitations or other symptoms. The ECG
recording will be analysed to detect any
arrhythmias. Special attention will be paid to
the times that you felt palpitations or other
symptoms.
If your palpitations occur infrequently, an
‘event recorder’ may be used. This is a small
device which is held in position on your chest
to record the electrocardiogram. The recording
is then transmitted to the hospital either over
the telephone or by post.
Electrophysiological testing:
If palpitations are a major nuisance or if your
doctors are unable to make a definite diagnosis
from the ECG tests, you may be advised to have
electrophysiological testing (sometimes called
an ‘EP test’), which allows doctors to analyse
the heart’s electrical activity in great detail.
Fine tubes called ‘electrode catheters’ are
introduced through a vein and/or an artery,
usually in the groin. They are then gently moved
into position in the heart where they stimulate
the heart and record the electrical impulses.
Often, the abnormal arrhythmia that is causing
the palpitations can be started and stopped by a
sophisticated external pacemaker. This gives
doctors the opportunity to examine the actual
arrhythmia problem as it occurs and is a great
help in diagnosing the problem and planning the
treatment.
What treatment is given for
palpitations? If your palpitations are caused by an
over-awareness of the heart’s normal activity,
then you may just need reassurance that your
heart rhythm is OK or that any palpitations you
do have are harmless. In other cases it may be
worth avoiding ‘triggers’ such as coffee,
alcohol and certain ‘over-the-counter’ cold
remedies.
If your palpitations are persistent and
troublesome, you may need to take
‘anti-arryhthmic drugs’. You may be referred to
a specialist who will be able to prescribe the
best drug for your particular arrhythmia. The
drug to be used is chosen with care, as you may
need to take it for many years.
Sometimes drugs are not effective in controlling
the abnormal rhythm. However, over the past few
years there have been dramatic advances in the
treatment of arrhythmias, including
cardioversion, sophisticated pacemakers,
catheter ablation therapy and implantable
defibrillators.
Cardioversion:
This form of treatment is very successful in
treating various types of tachycardia (fast
rhythms) such as atrial fibrillation and
ventricular tachycardia. Under a general
anaesthetic, the doctor applies a direct
electrical current shock to the chest wall,
which is synchronised to your own waveform
pattern seen on the ECG. The procedure is
usually free from side effects but, if you have
had atrial fibrillation, you will need to take
anticoagulant drugs such as warfarin or heparin
for a few weeks both before and after the
cardioversion. You will need to go back for
regular check-ups after the cardioversion,
because the irregularity may recur up to six
months afterwards.
Cardioversion is not usually performed on people
who have had atrial fibrillation for many years,
because of the increased likelihood of the
rhythm reverting back to atrial fibrillation,
and because of the possibility of dislodging
clots in the heart.
Pacemakers:
If you have heart block, you may be advised to
have an artificial pacemaker implanted. Most
pacemakers are inserted by ‘transvenous
implantation’, which takes about 30-60 minutes.
It is usually done under local anaesthetic and
does not cause any pain or discomfort. You will
usually need an overnight stay in hospital and a
day’s bed rest after the procedure.
There is a small risk of infection at the site
where the pacemaker is fitted. If you notice
redness, inflammation or a discharge, tell your
doctor immediately as the infection can spread.
If that happens, the pacemaker will need to be
removed.
There is also a small risk of air leaking from
the lungs to the chest (a pneumothorax) during
the operation to implant the pacemaker. Chest
X-rays will be taken before you leave hospital
to check whether this has happened.
Catheter ablation therapy:
Catheter ablation therapy (sometimes just called
‘ablation therapy’) may be used to correct
supraventricular tachycardia, atrial
fibrillation, ventricular tachycardia and
Wolff-Parkinson-White syndrome.
Catheter ablation therapy is carried out using
the same techniques as for electrophysiological
testing (see How do doctors diagnose
palpitations? ). The process can take up to
three hours, but is rarely painful. You will
need to stay in the hospital for a short while
afterwards.
The origin of the abnormal arrhythmia causing
the palpitation is located and radio frequency
energy is used to destroy the affected areas
that are causing the abnormal rhythm.
In some cases where there is an abnormal
electrical pathway, this can be selectively
ablated (destroyed), leaving the normal
electrical pathway intact. However, in other
cases it may be necessary to destroy all the
electrical pathways between the atria and the
ventricles. In these cases, it will then be
necessary to have an artificial pacemaker
fitted.
Nine out of ten catheter
ablation therapy procedures are successful.
Implantable defibrillators (Also called
‘implantable cardioverter defibrillators’ or ‘ICDs’)
An implantable defibrillator consists of two
parts:
a pulse generator - a device much smaller than a
pack of playing cards and weighing about 100g
(4oz) - which is implanted below the muscle or
skin below the left collar bone, and
a wire (or wires) which are usually passed
through a vein to the heart.
The device monitors the heart rhythm and can
sense if there is about to be a severe
disturbance in heart rhythm. If the disturbance
is not too severe, it will deliver a short,
rapid burst of electrical impulses. If this is
ineffective, or if it senses a more severe
disturbance, then it delivers a bigger
electrical shock to the heart, which stops the
abnormal rhythm and allows the normal rhythm to
resume.
Implanting a defibrillator involves an
operation. It is usually done under general or
local anaesthetic and requires a two- or
three-day stay in hospital.
The electrocardiogram (ECG)
Information about the tests and investigations
which can help to diagnose heart disease, or
assess the condition of your heart. You may be
reading this because your doctor has just
advised you to have some tests to find out if
you have heart disease.
Or you may already know that you have heart
disease and need tests to find out more about
your condition.
It can be worrying to be referred for these
tests, and it's natural to feel a bit anxious.
All sorts of fears may be running through your
mind.
If you feel anxious, ask if your partner or a
relative or friend can go along with you. For
some tests they can sit with you. With others
they may be able to sit outside or wait in the
hospital so that they're close at hand when the
test is over. They may also be able to talk to
the doctor or technician with you afterwards.
Some of the tests involve high-tech equipment
with lots of machines, wires and computer
screens, which can make it feel very lonely and
impersonal. This booklet explains what all the
equipment is for and what the tests can show. If
you still feel uneasy, remember that it often
helps to get fear out into the open, so tell the
doctor or technician how you feel. They can then
explain things to you and reassure you.
The electrocardiogram (ECG)
An electrocardiogram, or ECG, records the rhythm
and electrical activity of your heart. If your
GP (family doctor) thinks that you may have
heart disease or a heart problem, he or she may
refer you to a local hospital for an
electrocardiogram. Some GPs may do the test in
their surgery. Some people have an ECG before
having an operation. Others have one as part of
a routine health check-up, even if there is no
suspicion of heart disease.
What happens?
Several small patches, set in sticky plaster,
are put on your arms, legs and chest and
connected to a recording machine. The patches,
called 'electrodes', are connected to wires
which lead to the ECG recorder. This recorder
picks up the electrical signals produced by each
heartbeat. The machine records a few beats from
each set of electrodes onto paper.
The ECG machine only records signals from your
body. It does not give electric shocks and does
not affect your heart in any way. The whole test
takes about five minutes and will not be
uncomfortable at all.
What can the test show?
An ECG can detect problems with your heart
rhythm. It can show if you have had a heart
attack, either recently or some time ago. It can
also tell if your heart has become enlarged or
is working under strain.
The ECG is a simple and useful test but it has
some limitations. An abnormal reading does not
always mean that there is something wrong. On
the other hand, some patients who have serious
heart disease may have a normal ECG.
What is valvular heart
disease? Information for people who have a problem with
one or more of their heart valves, and for their
family and friends
The job of a valve is to make sure that fluid
flows only in the right direction. Your heart is
a muscle which pumps blood around your lungs and
the rest of your body. There are four valves in
your heart. These valves guard the entrances and
exits of the two pumping chambers in your heart
(the right and left ventricles). The valves at
the entrances are there to make sure that the
blood only goes into the ventricles. The valves
at the exits only let blood out.
A diseased or damaged valve can affect the flow
of blood in two ways.
If the valve does not open fully, it will
obstruct the flow of blood. This is called
‘valve stenosis’. If the valve does not close
properly, it will allow blood to leak backwards.
This is called ‘valve incompetence’ or
‘regurgitation’.
Both stenosis and incompetence put an extra
strain on the heart. If you have stenosis, the
valve will obstruct the flow of blood, so your
heart will have to pump harder to force the
blood past the obstruction. If you have
incompetence, a leaking valve will mean that
your heart has to do extra work to pump the
required volume of blood forwards. This is
because your heart will be wasting energy as
some of the blood is going backwards too.
As well as your heart having to work harder, the
blood behind the affected valve will be under
increased pressure, called ‘back pressure’. This
can cause a build-up of fluid either in your
lungs or in the lower part of your body,
depending on the valve affected.
How can I reduce my risk of
further coronary heart disease?
The major risk factors for coronary heart
disease that you can do something about are:
smoking,
high blood pressure,
high blood cholesterol, and
physical inactivity.
Obesity (being very overweight), drinking too
much alcohol, and having too much salt can also
increase the risk of coronary heart disease.
Your risk of further coronary heart disease will
depend on how many of the above risk factors you
have, and how strong each individual risk factor
is. Knowing about your risk factors may
encourage you to deal with them and help you
feel more in control of your heart disease.
If you smoke, stop smoking:
Continuing smoking after a heart attack doubles
the risk of having another attack within one
year. If you do smoke, now is the time to stop.
This is the single most important step you can
take to help you recover. From the moment you
stop smoking, the risk of heart attack starts to
reduce and is halved after one year of stopping
smoking.
However, giving up is much easier said than
done. Talking to friends and relatives who have
stopped, joining a stop-smoking group, and
talking to your GP or practice nurse may help
you. Your GP, practice nurse or pharmacist can
also give you advice including information on
nicotine replacement products such as chewing
gum and skin patches, bupropion (Zyban) tablets,
and local NHS stop-smoking services.
The NHS Smoking Helpline on 0800 169 0 169 can
offer information on stopping smoking, and
support for people who are finding it hard to
stop. Or you can contact QUIT on 0800 002200 for
practical help in stopping. QUIT also has
helplines in different languages.
Control high blood pressure:
High blood pressure increases the risk of a
heart attack and of strokes. And, over time, it
can cause the heart muscle to become less
efficient. For each 5 mmHg reduction in
diastolic blood pressure, the risk of coronary
heart disease is reduced by about 16%. (Blood
pressure is measured in millimetres of mercury,
abbreviated to 'mmHg'.)
If you have high blood pressure, it is essential
to control it. Your target is to have a blood
pressure below 140/85. If you have diabetes,
your target is below 130/80. Some people can
control their blood pressure by losing weight,
doing more physical activity and cutting down on
alcohol and salt. However, many people need to
take medicines too.
Watch your cholesterol:
If you have had a heart attack, the level of
cholesterol in your blood will be measured. The
aim is to have a total cholesterol level of
under 5mmol/l. (Mmol/l means millimols per litre.)
If your blood cholesterol is even slightly above
this level, you can greatly benefit from
reducing it.
A healthy diet will help. This means cutting
down on fats in general, especially saturated
fats, which are found mostly in meat and dairy
products. It has been estimated that reducing
the amount of saturated fat people have by 10%
is linked to a reduction of about 20% to 30% of
deaths from coronary heart disease.
Many people with coronary heart disease also
need drugs to keep their blood cholesterol at a
level which brings the greatest benefit.
Eat plenty of fruit and
vegetables:
People who eat at least five portions of fruit
and vegetables a day are less likely to have
heart disease. We do not know exactly why, but
it is thought to be due to the antioxidant
vitamins they contain. However, there is not yet
enough evidence that taking vitamin tablets has
the same effect. Even if you already have
coronary heart disease, it is still helpful to
eat plenty of fruit and vegetables.
Fish and fish oils:
Eating oily fish once or twice a week may help
to reduce your level of triglycerides (fatty
substances found in the blood), and prevent
blood clots from forming in your coronary
arteries. It can also help to improve the
chances of survival after a heart attack. The
particular oil in fish that has these beneficial
effects is known as 'omega-3'. It is found
mainly in oily fish such as herring, kippers,
mackerel, pilchards, sardines, salmon, fresh
tuna, trout and anchovies.
Keep active:
In the UK, people who are not physically active
are twice as likely to have a heart attack
compared with active people. Even if you have
already had a heart attack, a programme of
exercise reduces the risk of having another
attack. The activity needs to be aerobic - that
is when the muscles of the arms, legs and back
are used rhythmically and steadily so that
breathing and heart rate are increased. Examples
of aerobic activity include brisk walking,
swimming, cycling and some gardening.
Physical activity has other
benefits too. It can:
reduce your heart rate and lower your blood
pressure while you are resting,
improve your cholesterol levels, and
help to control diabetes.
It can also mean less angina, an earlier return
to work, and fewer visits to hospital. These
benefits also apply to people who have had heart
surgery and to people with heart failure.
If you have recently had a heart attack, going
on a rehabilitation programme is a very good way
of making sure that you exercise at a level that
is safe for you. If you have had a heart attack
at some time in the past, ask your doctor how
much and what sort of activity you can safely
do.
If you have angina, you can still exercise, but
it is important to limit yourself to what you
can easily manage. Avoid getting breathless and
do not try to 'walk through' chest pain. Also,
avoid very cold and windy weather. Always have
your GTN (glyceryl trinitrate) spray or tablets
to hand in case you need them.
Control your weight:It is important to control your weight, not just
to help your heart but also for your general
fitness. By keeping close to the recommended
weight for your height, you will keep your blood
pressure down and reduce the workload of your
heart.
If your doctors feel that you are significantly
overweight, they will ask the hospital dietitian
to give you advice on how to reduce your weight.
If you have any questions once you get home
about what or how much you should be eating, ask
your GP or district nurse. You can also ask
questions at your cardiac rehabilitation
programme.
To find out if you need to lose weight, check
the chart opposite. If you fall in the
overweight, fat or very fat category, you need
to lose some weight. Don't try to lose the extra
weight too quickly. Losing weight slowly and
steadily (about one pound a week) is more
healthy, and you're more likely to keep the
weight off for good. If you are very overweight,
losing even 10 kilos (22 pounds) will benefit
your health.
Also, remember that losing
weight means both eating healthily and doing
more physical activity.
Control diabetes:
Men who have diabetes that started in adult life
have about three times the risk of a heart
attack compared to those without diabetes. Women
with diabetes have about four times the risk of
heart attack. It is very important to make sure
your blood sugar is well controlled. Doing more
physical activity, controlling your weight and
taking your medicines regularly will all help.
Control feelings of stress,
anxiety and depression:
There is some evidence that stress, anxiety and
depression can contribute to coronary heart
disease. Also, psychological distress may
increase the chances of smoking, becoming
overweight or obese, having too much alcohol,
and having high blood pressure - which are all
risk factors for coronary heart disease. And,
for people who already have atherosclerosis
(build-up of fatty material within the walls of
the coronary arteries) or symptoms of coronary
heart disease, psychological distress can make
their symptoms worse.
Counselling and a particular type of therapy
called 'cognitive behavioural therapy' can help
people understand and manage the causes of
stress, anxiety and depression. Antidepressant
medicines can also help most people. However,
medicines for anxiety should only be used for
one or two weeks until other treatments are
found and in place.
Symptoms of anxiety include sadness and
tearfulness, loss of enjoyment with work,
leisure, food or sex, a low self-opinion, poor
concentration and sleeping problems. Depression
and anxiety can also cause physical symptoms
which are sometimes very similar to the symptoms
of heart disease - for example tiredness, chest
pain, breathlessness and palpitations.
Symptoms of stress often include a feeling of
frustration, tension, anger, difficulty in
sleeping and loss of concentration. Some people
find that they get headaches, butterflies in
their stomach and a racing heart.
If you think you are depressed or very anxious,
talk to your GP who will be able to treat you or
refer you for counselling or therapy. However,
if you are stressed, there is much that you can
do to manage it. Learning to recognise your
symptoms of stress and its causes are the first
steps towards managing it effectively.
Some useful tips for managing
stress are given below.
Learn relaxation skills.
Practise deep breathing.
Take more exercise - for example, walking,
swimming or cycling. Exercise is a good way of
releasing tension.
Get enough sleep.
Take time to relax every day.
Don't take on too much. Learn to say 'No'. |
