heart does not pump well (systolic heart failure). Patients can have either of these types of heart failure, or a mix of the two. The distinction is important because it affects what medications are used to treat the condition
Uncontrolled high blood pressure is the most common cause of diastolic heart failure. The higher the blood pressure, the more work the heart has to do to pump blood out to the rest of the body. The heart is a muscle, and like other muscles, if it has to do extra work, it will get bigger. That sounds good – a bigger, muscular heart – but it isn’t
As the heart gets bigger, one of two things can happen. First, that thicker muscle may reduce the amount of space inside the heart. Second, the increasing thickness of the muscle can cause the heart to become stiffer. In either case, the heart has a harder time filling with blood, and pumps out a smaller amount of blood with each heartbeat. That is when patients begin to experience symptoms of diastolic heart failure – like fluid retention, shortness of breath and feeling tired.
This is why it is so important for patients with diastolic heart failure to take their blood pressure medications. If untreated, high blood pressure can lead to worsening heart failure. In fact, this is one of many reasons why controlling blood pressure is important for every patient.
Patients with systolic heart failure have a different problem – their heart doesn’t very pump well. A normal heart pumps out between 55-70% of the blood in the ventricle with each beat. This is called the ejection fraction. People with heart failure have an ejection fraction of less than 55% however and this is very important, you don’t necessarily have heart failure if your ejection fraction is below 55%. It is very important to not think about the numbers as people who are diagnosed with heart failure need to think about how they feel. The EF is not directly proportional to how you feel. This can be the result of coronary artery disease, a heart attack or a heart valve problem. However, this type of heart failure also responds to medications that we often use to treat high blood pressure.
The two main types of medicines we use to treat systolic heart failure are beta-blockers and ACE-inhibitors ends in a lol. There are many kinds of ACE-inhibitors ending in a pril. Sometimes a patient will not tolerate an ACE-inhibitor, and a clinician will substitute another kind of medication called an Angiotensin II Receptor Blocker.
While these medications are frequently used to treat high blood pressure, they serve a different function when used to treat a patient with systolic heart failure. ACE-inhibitors are important because they help the heart “remodel” in a healthier way. Particularly after a heart attack, ACE-inhibitors can enable the heart to assume a more natural shape and function. Over time, this can improve the ejection fraction (the amount of blood the heart pumps out with each beat).
Beta-blockers also work by slowing the heart down and allowing it to fill more completely between beats. Beta-blockers have been shown to improve quality of life and decrease hospitalisations in patients with systolic heart failure.
If you have any reason why you can’t take your medications tell your Doctor or Nurse.
The final action you can take to control your heart failure is to follow a low salt diet. Salt worsens heart failure by causing the body to retain fluid. Unfortunately, salt is in about every prepared food you buy in the supermarket. So, unless you make all of your own food at home, it can be quite difficult to avoid. Just be conscious of the amounts you are eating.
For patients with heart failure, a low-salt diet means eating no more than 2 grams (or 2,000 milligrams) of sodium per day. If you make your own food, that is a little less than one teaspoon of regular salt.
Figuring out how much salt is in a prepared meal or can of food, can be tricky. Even foods that say, “low salt” often contain more salt than patients with heart failure should eat. And, food labels typically state how much salt they contain per serving. But because there are often multiple servings per package, the total amount of sodium is often higher.
Because they are so important, it is worth repeating the three things you can do to stay healthy with heart failure: weigh yourself daily, take your medications as directed, and follow a low-salt diet. If you have any questions about these recommendations, or other concerns then make sure you speak to your clinician.