12905 Heart Failure Surgery

Overview

Heart failure does not mean your heart has stopped. It means your heart is not pumping blood as strongly or as smoothly as it should, so your body may not get all the oxygen and nutrients it needs. This can cause tiredness, breathlessness and swelling. Heart failure surgery is a group of operations and device procedures that can fix some of the problems causing your heart to struggle. Examples include bypass surgery to improve blood flow, valve repair or replacement, and small implanted devices that help the heart beat more safely and in a better rhythm. Not everyone with heart failure needs surgery. Your doctor will look at what is causing your heart failure and whether a procedure could help you.

Heart failure is a common long-term condition, affecting millions of people around the world. Surgery for heart failure is much less common than other treatments. Only some people need it, usually because of a blocked artery, a faulty valve or a heart rhythm problem that medicines cannot control well.

Heart failure is more common as people get older, and it affects men and women. It is more likely in people who have had a heart attack, have high blood pressure, have heart valve problems, have a heart muscle condition that runs in the family, or who have had certain infections or long-term alcohol use. In children, heart failure is rare and is usually linked to a heart problem present from birth.

Symptoms

Common symptoms

• Breathlessness when you move around, climb stairs or lie flat
• Feeling very tired or lacking energy for everyday tasks
• Swelling in the ankles, feet, legs or sometimes the tummy
• Putting on weight quickly because of extra fluid
• A dry cough, especially at night or when lying down
• Waking up short of breath and needing to sit up
• Dizziness or feeling light-headed
• Less appetite or feeling full quickly
• Needing to pass urine more often at night

Symptoms in children

• Fast breathing or heavy breathing, especially during feeds
• Sweating a lot while feeding or playing
• Poor feeding and slow weight gain or poor growth
• Being unusually sleepy or floppy
• Blue tinge to the lips or fingertips (this needs urgent medical attention)
• Swelling around the eyes or in the legs

Symptoms in older adults

• Confusion, memory problems or feeling more muddled than usual
• Unusual tiredness, weakness or falls
• Loss of appetite or weight loss
• Swollen legs that may be mistaken for another cause
• Breathlessness that is put down to getting older or to a chest problem

Causes

Main causes

• Damage to the heart muscle after a heart attack, or narrowed arteries not getting enough blood to the heart
• Long-standing high blood pressure, which makes the heart work harder
• Heart valve problems, where valves are too narrow or do not close properly
• Cardiomyopathy, a condition where the heart muscle becomes weak, thick or stiff
• Heart rhythm problems that make the heart beat too fast or unevenly for a long time
• Heart problems present from birth
• Long-term heavy alcohol use, some infections, or certain medical treatments such as some types of chemotherapy
• Other conditions such as thyroid disease, anaemia or kidney disease

Risk factors

• High blood pressure
• Previous heart attack or narrowed heart arteries
• Diabetes
• Smoking
• High cholesterol
• Being overweight
• Drinking a lot of alcohol over many years
• An inactive lifestyle
• A family history of heart muscle disease or early heart disease
• Some medicines, recreational drugs or treatments that can affect the heart
• Kidney disease, thyroid disease or sleep apnoea (breathing that repeatedly stops and starts during sleep)

When to see a doctor

See a doctor urgently if:

• You have new or worsening breathlessness, especially at rest
• Your legs, ankles or tummy are swelling, or the swelling is getting worse
• You gain weight quickly over a few days without changing how you eat
• You feel faint, very dizzy or your heart is racing or pounding
• You are waking at night short of breath

Book a routine appointment if:

• You feel more tired than usual doing your normal activities
• You have a cough that will not settle, especially at night
• You want to talk about whether heart surgery or a device might help you
• You are finding it hard to manage your medicines or follow your care plan
• You feel low in mood, anxious or worried about your heart
• You are planning travel, pregnancy or a big change in activity and want advice

Diagnosis

Your doctor will start by asking about your symptoms, your past health, your family history and your medicines. They will examine you, listening to your heart and lungs and checking for swelling. A simple blood test can show whether your heart is under strain. If heart failure is possible, you will usually be referred for a heart ultrasound scan and other tests. If a procedure might help, you may also see a heart specialist (cardiologist) or a heart surgeon for a fuller assessment.

Tests that may be done

• Blood tests, including one that measures a hormone released when the heart is stretched (a natriuretic peptide test)
• An echocardiogram: a painless ultrasound scan that shows heart size, pumping strength and valve function
• An ECG (electrocardiogram): a quick recording of the heart's electrical rhythm
• A chest X-ray to look at heart size and fluid in the lungs
• A heart MRI scan for detailed pictures of the heart muscle
• An exercise or stress test to see how your heart copes with activity
• A coronary angiogram: a test using dye and X-rays to look for narrowed heart arteries
• A Holter or rhythm monitor worn for a day or more to record your heartbeat
• Lung function tests or other tests to rule out other causes of breathlessness

What to expect at your appointment

You may have several appointments and tests over a few weeks before any decision is made. Most tests are quick and painless, though some involve a small needle or a thin tube. Bring a list of your medicines and, if you can, someone with you to help remember what is said. Before any operation, you will have a full pre-surgery assessment including blood tests, heart and lung checks, and a chance to ask questions. Your heart team should explain what the operation involves, what the recovery will be like, and what the benefits and risks are for you.

Treatment

Treatment for heart failure aims to help your heart work better, ease your symptoms, keep you out of hospital and help you live longer. Most people start with lifestyle changes and medicines, and these usually continue even if you have a procedure. Surgery or a device is considered when there is a specific problem that can be corrected, such as a blocked artery, a damaged valve or an unsafe heart rhythm. Your care is usually shared between your family doctor, heart specialists, nurses and other health professionals.

Self-care at home

• Weigh yourself at the same time each day and write it down. Tell your doctor about fast weight gain.
• Eat less salt, as salt makes your body hold on to fluid. Avoid adding salt and limit salty processed foods.
• Follow any advice your doctor gives you about how much fluid to drink.
• Take your medicines exactly as prescribed and do not stop them on your own, even if you feel better.
• Stay active within what feels comfortable, and ask your team about a supervised exercise or cardiac rehab programme.
• Stop smoking and avoid second-hand smoke. Ask for help if you need it.
• Keep alcohol within the limits your doctor advises, or avoid it if you have been told to.
• Keep your vaccinations up to date, including flu and pneumonia vaccines, as infections can make heart failure worse.
• Rest when you need to and pace yourself, but try not to sit still for long periods.
• Go to your follow-up appointments and tell your team about any new symptoms.

Medical treatments

Medicines are the foundation of heart failure care. Different types work in different ways: some help the heart pump more strongly, some lower the workload on the heart, some remove extra fluid and relieve swelling, and others help control blood pressure and heart rhythm. Your doctor will adjust your treatment over time based on your symptoms, blood tests and heart scans. You may also be offered a structured exercise and education programme, sometimes called cardiac rehabilitation, which helps you build strength safely. Devices that use small electrical impulses to help the heart beat in a better rhythm, or to correct dangerous rhythms, are another option for some people. Always ask your doctor or pharmacist before taking any new medicine, including over-the-counter remedies and herbal products, as some can interact with heart medicines.

When is surgery considered?

Surgery or a device procedure may be offered when a specific problem is found and the possible benefits outweigh the risks. Common examples include: coronary artery bypass surgery, which uses a healthy blood vessel from elsewhere in the body to bring blood around a blocked artery; angioplasty with a small mesh tube (stent) to open a narrowed artery; heart valve repair or replacement when a valve is too narrow or leaks; and implanted devices such as a pacemaker, a defibrillator (a small device that can correct a dangerous heart rhythm) or a device that helps the heart's chambers beat in step. For more advanced heart failure, options can include a mechanical pump that helps the heart circulate blood while you wait for or instead of a transplant, or a heart transplant in selected cases. Not every procedure suits every person. Your heart team will discuss what is realistic for you, including the recovery time, the risks and what the operation can and cannot fix.

Living with this condition

Living with heart failure usually means paying a bit more attention to your body than before. Daily weighing, watching for swelling and taking medicines on time become part of your routine. Many people find that planning their day helps, with activity spread out and rest built in. After surgery, recovery takes weeks to months, and it is normal to feel tired at first. Build up slowly, follow your team's advice about lifting and driving, and go to your follow-up appointments. Most people find that a steady routine makes life feel more manageable and predictable.

Lifestyle tips

• Keep a daily weight and symptom diary so you notice changes early
• Eat a balanced diet low in salt, with plenty of vegetables, fruit, whole grains and lean protein
• Stay as active as your team advises, and build up gradually
• Stop smoking and get support to quit if you need it
• Limit alcohol as advised by your doctor
• Get enough sleep, and tell your doctor if you snore heavily or feel very sleepy in the day
• Manage stress with relaxation, hobbies, or talking to someone you trust
• Keep up with vaccinations and routine health checks
• Plan travel with your team, and carry a list of your medicines with you

Diet and exercise

A heart-friendly diet is low in salt and rich in vegetables, fruit, whole grains, beans, nuts, oily fish and lean protein. Too much salt makes your body hold fluid, so check labels and cook more meals from scratch where you can. Your doctor may also give you a daily fluid target. Exercise is good for most people with heart failure. Walking, gentle cycling or a supervised cardiac rehabilitation programme can improve your breathing, strength and mood. Start slowly and stop if you get chest pain, severe breathlessness or dizziness. Ask your team what level of activity is safe for you, especially in the first weeks after surgery.

Mental health and emotional wellbeing

It is very common to feel worried, low or frustrated when you have a heart condition. You may worry about your future, feel anxious about symptoms, or find that your mood affects your sleep and appetite. These feelings are understandable and treatable. Talking to your doctor, a nurse or a counsellor can help, and so can support groups where you meet people in a similar situation. If you ever feel hopeless or have thoughts of harming yourself, please reach out for help straight away, either to your doctor or to a crisis support service in your area. You do not have to cope alone.

Prevention

Not all heart failure can be prevented, but many of the things that lead to it can be reduced or managed. Keeping blood pressure and cholesterol in a healthy range, not smoking, staying active, eating well, limiting alcohol and keeping to a healthy weight all help protect the heart. If you already have heart failure, good treatment and self-care can slow it down, reduce flare-ups and keep you out of hospital.

Vaccines

Vaccinations are an important part of heart care. Flu, pneumonia and COVID-19 vaccines are usually recommended because infections can put extra strain on the heart and trigger worsening symptoms. Ask your doctor or pharmacist which vaccines are right for you and when to have them.

Screening programmes

There is no routine screening test for heart failure in people with no symptoms, but if you have risk factors such as high blood pressure, diabetes or a strong family history of heart disease, your doctor may check your heart and blood pressure regularly. If you have had a heart attack or a heart valve problem, you will usually have follow-up checks to catch problems early.

Complications

If left untreated

• Worsening breathlessness and swelling that limit everyday life
• Fluid building up in the lungs, which can become an emergency
• Kidney problems caused by reduced blood flow
• Dangerous heart rhythms
• Frequent hospital stays
• Liver damage from long-term fluid build-up
• Serious problems during pregnancy, so planning with your team matters

Long-term outlook

Many people with heart failure live for many years and enjoy a good quality of life, especially when the condition is found early and treated well. Surgery and devices help some people feel much better, live longer and get back to the things they enjoy. Recovery can be slow, and it is normal to have good days and harder days. Keeping in touch with your heart team, taking your treatment and looking after yourself make a real difference. If you are worried about your outlook, talk openly with your doctor, who can give you honest and personal information.

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