Heart failure can result from various underlying conditions and can affect overall quality of life and life expectancy. This post explores the causes, symptoms and treatment options. Quality of life implications, and life expectancy considerations for heart failure are cause for a heart transplant for few heart failure patients.
The Reality Of Having Heart Failure
I found out what heart failure feels like in late August 2021. I had experienced some chest pain, breathlessness and shooting pains down my left arm with a tingling sensation. Despite being otherwise healthy and fit I was suffering from a mysterious respiratory illness. I had been seeing a lung specialist for the past 18 months, who was treating me for asthma.
I took the symptoms of chest and arm pain seriously and went to the local hospital ED to have it checked out. After an ECG and blood tests, I was told that nothing was wrong with my heart. That is, I had not suffered a heart attack or similar event.
Why You Might Need A Second Opinion
Always the self advocate, I asked the ED Doctor what test I needed to find out what was exactly wrong with my heart. My instincts told me that there was something off. The Doctor, bless him, booked me in for an Echo (Cardiac Ultrasound) for that week on Friday.
A few days later I was feeling OK and I was tracking through the bush along the fire trails at the back of my home in the Blue Mountains. I was in the middle of my bush bootcamp if I can call it that. This involved hiking for 6 to 8 KM, combined with lunges, squats, tricep dips, sit ups and push ups. It was a Wednesday afternoon.
I thought to myself perhaps I don’t need to go for the Echo. I am so glad I did.
The sonographer completed the Echo and asked me to wait in the waiting room. I was not to leave until I saw the Cardiologist, who I did not have an appointment with at the time. I waited until all her patients had been seen.
Sorry, Not Asthma, Heart Failure
In her office the cardiologist told me I had end of life stage heart failure of the right ventricle. She explained that my level of fitness had been compensating for a very sick heart. Her next question was “tell me about your lungs as Right Ventricular Heart Failure is caused by a severe lung issue”.
I explained that I had been seeing a lung specialist for 18 months and was being treated for asthma. I informed her that in that time I underwent 3 contrast CT Scans and an MRI scan. However, I was diagnosed with and was being treated for severe asthma.
The cardiologist asked her administrator to print off the CT and MRI reports. The cardiologist then informed me (for the first time) that I did not have asthma but tumours that ranged from my voice box to my diaphragm and throughout my right lung. I was sent for an emergency Cardiac MRI. I was referred to another lung specialist who I saw as an urgent case the next day. He put me in hospital that night, where I stayed for 15 nights.
By The Way…
During this first hospital visit, I was also diagnosed with Aspergillosis (inflammation of the lungs) and Aspergillomas (tumours of Aspergillus). I did not have asthma at all but a mould infection in my lungs that was left untreated for the previous 18 months.
Wait There Is More…
On top of having end of life stage heart failure and the lung infection I was told there was another complication. The pulmonary (Lung) mould infection had caused an immune response known as Sarcoidosis (inflammation that causes lesions called granulomas). The granulomas had spread from my voice box to the diagram throughout my lungs and torso. The granulomas literally ate away at my healthy heart.
As well as having heart failure the granulomas had caused extensive scaring in the heart. Unfortunately the scarring was interrupting the electrical system of the heart. I started to experience sustained ventricular tachycardia (VT). Each episode was life threatening. I was regularly hospitalised for VT storms.
In a 14 month time frame I endured:
- 290 odd days in hospital
- 17 General Anaesthetics,
- 22 plus surgical procedures, day admissions,
- 4 Defibrillator operations,
- 5 Heart Ablation surgeries,
- A Right Lung Lobectomy
- A bout of breast cancer involving extreme breast surgery and radiation treatment
- 70 plus outpatient Pathology visits
- 3 X PET Scans
- 20 approx. CT scans
- 29 approx. X rays
- 14 approx. MRIs
- 1 X MiBi
- 4 X Bronchoscopy and Lung Lavage
- 5 Lung Function Tests
- Allergy pin prick testing
- 2 X Lung biopsies
- 5 X Lymph Nodes Biopsies for Sarcoidosis
All of this before I had even begun my heart transplant journey.
Heart Failure And Heart Transplant
You may be considered for a heart transplant if you have end-stage heart failure. This means your heart disease is very severe and other treatments have failed. Treatment, typically involves frequent hospital visits, trying various medications, or procedures like implantable devices (ICD or VAD), and surgeries (angioplasty, stenting, valve surgery, cardiac bypass).
From the list above you can see that my medical team tried everything to save my life. I was finally listed for a heart transplant after an 18 month struggle to meet the heart transplant eligibility requirements by overcoming multiple comorbidities.
Research, Research, Research!!
Having no knowledge of heart failure, I did a great deal of research during my initial days in hospital. I was full of questions and needed straight answers. Below, I have summarised the main points for you here. I used a variety of resources and highly recommend them if you need more information. I have provided the links at the end of the post. However, I have done the legwork for you to start you off.
What Is Heart Failure?
Heart failure, also known as congestive heart failure, occurs when the heart muscle doesn’t pump blood as well as it should. This can result from various underlying conditions and can affect overall quality of life and life expectancy. Below is a detailed overview of its causes, symptoms, treatment options, quality of life implications, and life expectancy considerations.
Causes
Heart failure can be caused by a variety of conditions that damage or weaken the heart, including:
- Coronary artery disease: This is the most common cause, characterised by narrowed or blocked heart arteries, leading to heart muscle damage.
- High blood pressure (hypertension): Over time, high blood pressure can make the heart work harder, leading to muscle thickening or weakening.
- Cardiomyopathy: This includes diseases of the heart muscle itself, which can be genetic or due to other factors like infections or alcohol abuse.
- Heart attacks: These can cause damage to the heart muscle, reducing its ability to pump effectively.
- Valvular heart disease: Dysfunction of the heart valves can lead to improper blood flow and increased workload on the heart.
- Arrhythmias: Abnormal heart rhythms can lead to inefficient heart pumping.
- Congenital heart defects: Structural problems present at birth can lead to heart failure later in life.
- Chronic diseases: Conditions such as diabetes, thyroid disorders, and severe forms of anaemia can contribute to heart failure.
Symptoms Of Heart Failure
Symptoms of heart failure can range from mild to severe and may include:
- Shortness of breath (dyspnea) during activity or when lying down
- Persistent coughing or wheezing
- Swelling (edema) in the legs, ankles, and feet
- Fatigue and weakness
- Rapid or irregular heartbeat
- Reduced ability to exercise
- Increased need to urinate at night
- Swelling of the abdomen (ascites)
- Sudden weight gain from fluid retention
- Lack of appetite and nausea
- Difficulty concentrating or decreased alertness
Treatment For Heart Failure
Treatment for heart failure focuses on managing symptoms, improving heart function, and addressing the underlying causes. Options include:
- Medications: Commonly prescribed drugs include:
- ACE inhibitors and ARBs to relax blood vessels
- Beta-blockers to reduce heart rate and blood pressure
- Diuretics to reduce fluid buildup
- Aldosterone antagonists to prevent sodium retention
- Digoxin to strengthen heart contractions
- Lifestyle changes: Recommendations often include:
- Eating a heart-healthy diet (low in sodium and saturated fats)
- Regular physical activity tailored to the patient’s condition
- Quitting smoking and limiting alcohol intake
- Monitoring and managing body weight
- Medical devices and surgery:
- Implantable cardioverter-defibrillators (ICDs) and pacemakers for managing arrhythmias
- Ventricular assist devices (VADs) for severe heart failure
- Heart transplant in cases of end-stage heart failure
Quality of Life
Heart failure can significantly impact a patient’s quality of life. Common challenges include:
- Physical limitations due to fatigue and shortness of breath
- Emotional stress and anxiety about the condition and its management
- Frequent medical appointments and hospitalizations
- Dietary restrictions and medication side effects
- Impact on daily activities and independence
Support from healthcare providers, family, and support groups can help manage these challenges and improve quality of life.
Life Expectancy
Life expectancy for heart failure patients varies widely depending on the severity of the condition, underlying causes, and the effectiveness of treatment. Factors influencing prognosis include:
- Stage and severity: Heart failure is classified into stages (A-D) and classes (I-IV) based on symptoms and physical limitations. Advanced stages and higher classes typically indicate a poorer prognosis.
- Age and overall health: Younger, healthier patients generally have a better prognosis.
- Response to treatment: Patients who respond well to treatment and adhere to management plans can live longer and healthier lives.
- Comorbid conditions: The presence of other diseases such as diabetes, kidney disease, or chronic obstructive pulmonary disease (COPD) can worsen the outlook.
Studies suggest that the 5-year survival rate for heart failure patients is about 50%, but this can vary widely based on individual factors
Remember …
It is important to remember that in my own experience my heart condition was not diagnosed in ED/Hospital. I passed the blood tests and ECG as the only left ventricle is sufficiently measured during an ECG. You really need to have a cardiac expert to recognise signs of Right Ventricle of the heart in an ECG. Therefore, there is room for error in many Emergency Departments.
I did not have a heart attack therefore my blood did not pick up traces of Troponin. Troponin is a protein found in your heart muscle/blood sample after a heart attack.
I can not stress enough how important it is for you to get a second opinion, ask questions and or self advocate when you instinctively know things are off or not how they should be. When you are in the trenches, only you know your body like you do. Only you will look after your health better than anyone else.
If I had continued with the original lung specialist and not insisted the ED Doctor refer me for further testing I certainly would not be alive today.
Back yourself!!
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References
Australia, H. (2023, August 10). Troponin blood test. Healthdirect. https://www.healthdirect.gov.au/troponin-blood-test
Health, S. V. H. (n.d.). St Vincent’s Heart Health. St Vincent’s Heart Health. Retrieved May 31, 2024, from https://www.svhhearthealth.com.au/conditions/heart-failure
Heart failure – Symptoms and causes. (2023, April 20). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142
What is heart failure? (n.d.). Heart Foundation. Retrieved May 31, 2024, from https://www.heartfoundation.org.au/your-heart/heart-failure
What is Heart Failure? (2018, January 11). Www.Heart.Org. https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure
