Heart Failure
Condition Leaflet Number 2. Use this leaflet with Drug Leaflet Number 2.
What is Heart Failure?
Heart failure is a condition where the heart fails to pump blood effectively throughout the body. You may hear your
heath professional refer to it as 'Chronic Heart Failure' which sounds complicated but effectively describes the failure of
a chamber of the heart to pump blood as strongly as it would normally.
There are three main types of heart failure. They are: Heart Failure due to Left Ventricular Systolic Dysfunction (LVSD) - the left side of your heart becomes weak
 Heart Failure with Preserved Ejection Fraction (HFPEF) - either side becomes stiff and so it is difficult to fill with blood
 Heart Failure due to Valve Disease - a defect in one of the four heart valves causes the disease
Around 750,000 people in the UK suffer from heart failure and it is most common in those over 75. Unfortunately it is a
life-long condition and there is no cure so current treatment aims to help the body get rid of excess water through
lifestyle changes, drugs, devices or surgery. Heart failure is linked to many other conditions including high blood
pressure, coronary heart disease and heart attacks all of which the treatments aim to reduce or prevent.
Causes of heart failure? Why is it happening to me?
Often heart failure is not caused by one single factor, there are a number of conditions which make it more likely that
you may develop heart failure. These include: Coronary heart disease (see condition leaflet 3.)
 Arrhythmias (irregular heart rhythms)
 High blood pressure (see condition leaflet 4.)
 Anaemia (low iron levels)
 Damaged heart muscle (caused by infection, heart
 An over-active thyroid gland
attacks, alcohol or illicit drugs)
 Congenital heart diseases such as "hole in the heart."
Symptoms
The main symptoms of heart failure are: Breathlessness when you're more active than normal or even when you're resting
 Extreme tiredness or weakness
 Swelling of the legs, feet and ankles
Other symptoms that can be associated with heart failure include: Persistent cough that will not go away
 Weight Loss
 Nausea
 Waking up in the night gasping for air
 Lack of appetite
 Confusion or lack of concentration
Heart failure can affect the left or right side of the heart. Depending on which side is affected will mean differences in
symptoms.
Symptoms of Heart Failure
Left-sided heart failure means blood isn't pumped
Left-Sided Heart Failure
Right-Sided Heart Failure
out to the body as fast as it is received from the
Increased breathing rate Swelling of the legs which when pressed lungs so fluid collects in the lungs and symptoms
takes a while to return to normal
affecting breathing are experienced.
Crackles when breathing
Accumulation of fluid around your
abdomen
Right-sided heart failure usually occurs due to
Blue/purple appearance
already present failure of the left side of the heart
of the skin
and means blood isn't pumped out to the lungs as
fast as it is received from the body so fluid collects in the body and symptoms swollen legs and feet occur.
Diagnosis
To correctly diagnose the condition, your GP will ask you to describe your symptoms alongside performing a physical
examination. If the GP suspects heart failure test may be performed to confirm this. These include: Blood tests check if there is anything in your blood that indicates heart failure or another illness.
 An echocardiogram (ECG) (you will be referred for this) which looks at the detail of your heart and how it beats.
If you are confirmed as having heart failure, your doctor will classify the level of the condition according to The New
York Heart Failure Classification Scale; this places you in a category based on how much your physical exercise is limited
by the condition. There are four stages.
The stages range from stage I to stage IV and
symptoms worsen on increasing stage. You may
also have an idea of which stage you feel you are
at already after experiencing your symptoms.
New York Heart Association Classification
Stage
Symptoms
I
Heart disease but no limitations on physical activity
II
Mild limitations of ordinary activity (shortness of
breath/angina pains)
III Marked limitation in activity due to symptoms (struggles to
walk short distances)
IV
Severe limitations, comfortable only at rest
Treatment
Treatment of heart failure involves a combination of lifestyle changes and medicines:
Stopping smoking, eating a low-fat and high-fibre diet (including 5 portions of fresh fruit and vegetables daily and a
mixture of carbohydrates, meat and oily fish), trying to limit your salt consumption to under 6g per day (this is about
one teaspoonful), avoiding foods high in saturated fats (such as meat pies, cakes and butter) - this will also help you to
maintain a healthy weight, keeping your alcohol levels in line with government targets of 14 units a week for women
and 21 units a week for men and exercising often, all reduce the burden on your heart. If you stop smoking quickly after
a heart attacks your risk drops to near that of a non-smoker.
Medical treatment for heart failure can involve lots of different classes of drugs. Drugs for relief of symptoms are mainly
diuretics such as furosemide. These aim to reduce the amount of water you are retaining in either your lungs or
abdomen/ankles by passing it out in your urine. Other drugs are used to prevent the heart worsening and include ACE
inhibitors such as lisinopril, beta blockers such as bisoprolol, and other drugs such as spironolactone, losartan,
hydralazine and digoxin.
For further detailed information including how these drugs work in heart failure, doses, side effects and interactions
please refer to drug leaflet number 2 - drugs used to treat heart failure.
Monitoring Needed
Your GP will either yearly or 6 monthly ask you to come in for a blood pressure check, he should also check your
cholesterol levels, how you are getting on with treatment and if your symptoms are improving.
Further Information
If you are confused about any information you have read or been given it is always beneficial to speak to a healthcare
professional such as a doctor, pharmacist or nurse. Each of these people are specialists in different aspects of medicine
and will always help to answer any questions you have about any aspect of your condition.
If you feel you would like to read up on specific information about medicines used to treat heart failure or the condition
itself these websites may be beneficial to you: British Heart Foundation
-The British Heart Foundation is a charity that provides help and support to patients with CHD and heart failure. The
information they provide can be very useful. Available at:
http://www.bhf.org.uk/heart-health/conditions/heart-failure.aspx
 NICE
- The Heart Failure Quick Reference Guide from the National Institute of Health and Clinical Excellence, the
institution that initiates guidance for healthcare professionals for clinical conditions. Available at:
http://www.nice.org.uk/guidance/CG108/QuickRefGuide
 Patient.co.uk.
-This website aims to give patients a bit more insight into their conditions/medication in a language they can
understand. It is available at: http://www.patient.co.uk/health/Heart-Failure.htm
 NHS Choices.
-Another website that aims to provide patients with relevant understandable information. Available at:
http://www.nhs.uk/conditions/Heart-failure/Pages/Introduction.aspx
This leaflet has been developed in conjunction with the patients and GPs of Beech Hill Medical Centre,
Wigan and Liverpool John Moores University, Liverpool.
Drugs Used to Treat Heart Failure
Drug Leaflet Number 2. Use with Condition Leaflet Number 2.
The information contained in this leaflet should provide you with in-depth detail on
the medicines you will be or have already been, prescribed for the treatment heart failure. You
should refer to this leaflet after reading condition leaflet 2 - Heart Failure, which aims to give you a detailed overview of
the condition.
The drugs named are those most favoured by the general practitioners at Beech Hill Medical Centre, Wigan.
As with many medical conditions the treatment for heart failure is in stages. If you remain symptomatic while on first-line
therapy, your GP or specialist may choose to progress to second-line therapy where other drugs are added in or if surgery
is an option this is sometimes used.
First-Line Therapy
If you have been diagnosed with heart failure and are suffering from a lot of water retention
either in your lungs or in your legs/ankles you may be prescribed a diuretic for example
furosemide. This drug works to eliminate the excess water from your body by excreting it from
the body in your urine. You must take it first-thing in the morning, especially if you are planning
on leaving the house as it will make you need to go to the toilet soon after taking it. The dose
varies depending on the amount of water-retention you are suffering from.
As treatment your doctor will start you on two classes of drugs soon after diagnosis. The first
class of drugs are called ACE inhibitors, these work by inhibiting an enzyme which acts to raise
blood pressure. The two most commonly prescribed ACE inhibitors at your surgery are
'lisinopril' and 'ramipril'.
The other class of drugs used alongside ACE inhibitors in first-line
therapy are called beta blockers, these reduce the workload of the heart. The most commonly
prescribed beta blocker at your surgery for this condition is bisoprolol.
Second Line Therapy
If your symptoms are not improving after trying the two drugs in first line therapy your
doctor should refer you to doctor who specialises in this condition. The specialist doctor
will assess you and may decide to add a third.
At this stage he/she is presented with some choices; they could add a drug from a class called aldosterone antagonists
known as spironolactone, he/she may also choose to prescribe you an angiotensin 2 receptor blocker or they may add in
a drug combination called hydralazine plus a nitrate.
Third-Line Therapy
If you are still not responding as well as the doctors would like from any of the drugs described
above another drug may be added. It is from a class of drugs known as cardiac glycosides and is
called digoxin. This works by strengthening the force of your heart beat.
The dose is usually ONE to be taken DAILY.
Other Medication
Because heart failure is linked with other conditions such as high blood pressure, coronary heart disease, stroke and heart
attacks, it is important to keep your blood pressure at the right level and circulation flowing freely to prevent clots that
could cause a heart attack. Additional medication from that discussed above will be added and may include: A calcium channel blocker - this drug helps to keep your blood pressure at a target of 140/90mmHg
 Dispersible or enteric coated aspirin 75mg - this drug helps keep your circulation flowing correctly
 A statin - this drug prevents fatty deposits building up inside your arteries by lowering your cholesterol level
Calcium Channel Blockers
These drugs work by blocking the calcium channels in your body. Calcium is important for
muscles to contract so relaxing these muscles helps your veins and arteries to dilate lowering
your blood pressure. There are lots of different calcium channel blockers, the one most used for
high blood pressure at your surgery is amlodipine.
The doses for calcium channel blockers can vary depending on whether you are prescribed an
immediate-release tablet (one that releases drug as soon as you swallow it) or a controlled-release tablet (one that
releases drug slowly throughout the day). Always check the label on the box when you receive your prescription from the
pharmacy as to when to take your medication.
Dispersible/Enteric Coated Aspirin 75mg
This drug is what is known as an anti-platelet meaning it prevents your red blood cells and platelets
collecting together and forming a clot which could get stuck in a blocked vein or artery causing a
heart attack or stroke.
This medication can irritate your stomach so you should take it with or just after food and the dose
is ONE tablet to be taken DAILY, ideally in the morning with your breakfast.
If for any reason you cannot take aspirin your GP will prescribe you a different antiplatelet such as
clopidogrel or ticagrelor.
Statin
This drug prevents fatty deposits called atheroma building up your arteries causing them to narrow. It
works by lowering your cholesterol and as cholesterol is produced at night you need to take it before
you go to bed. The most commonly prescribed statin at your surgery is simvastatin. The dose is ONE
tablet to be taken at NIGHT.
Side Effects
A very common side effect of ACE inhibitors is a dry cough. Many patients unfortunately suffer from this but if you feel it
is impacting your life too much speak to your GP or pharmacist as there is an alternative class of drugs that help your
heart in the same way that ACE inhibitors do but without causing you the dry cough. If it is tolerable but irritating you may
find relief from a cough remedy such as simple linctus that should suppress the cough but doesn't interfere with your
medication.
Calcium channel blockers can cause headaches and dizziness, these are usually mild but if you are concerned, speak to
your doctor or pharmacist.
Statins can cause muscle aches and pains. These are usually manageable but if they become severe make an appointment
to see your doctor as muscle wastage can develop which is a serious condition.
Interactions
Because of the way ACE inhibitors, angiotensin 2 receptor blockers and beta blockers work they can interact with
medicines such as decongestants (these are found in many cold and flu remedies e.g. Sudafed and Lemsip). You should
avoid using these decongestants if you are taking one of these types of medicines. Decongestants you can take include
menthol preparations such as Albas Oil.
These medicines can also interact with anti-inflammatories such as ibuprofen that are able to be bought over the counter
and are present in many muscle rub preparations. Always tell your pharmacist if you are taking an ACE inhibitor,
angiotensin 2 receptor blocker or a beta blocker before you buy anything over the counter.
Statins interact with certain classes of antibiotics called macrolides and some antifungals. If you are prescribed
clarithromycin, erythromycin or clindamycin or antifungals such as itraconazole, fluconazole or ketoconazole you should
discontinue your statin whilst you are taking the course of antibiotics or antifungals. Some of these antifungals are found
in many over-the -counter preparations for thrush so be cautious before purchasing one of these products.
Statins also interact with grapefruit juice so you should avoid this if you take statins.
Further Information
If you feel you would like to read up on specific information about medicines used to treat heart failure these websites
may be beneficial to you: Patient.co.uk
This section of the website aims to provide patients with information on many classes of drugs in a language they can
understand. Available at: http://www.patient.co.uk/dils.asp
 Electronic Medicines Compendium.
This website isn't aimed at patients so you may find it complicated but provides the patient information leaflet found
inside the box of a particular drug or a summary of the product characteristics according to the manufacturer of the
medicine. Available at: http://www.medicines.org.uk/emc/
This leaflet has been developed in conjunction with the patients and GPs of Beech Hill Medical Centre,
Wigan and Liverpool John Moores University, Liverpool.