DR MILES DALBY

Heart failure is a complex condition, however from the patients perspective it is an illness that can result in breathlessness (on exertion or in more advanced cases at rest) and fluid retention (usually with swelling of the legs and or fluid in the lungs). The symptoms can range form very mild exertional breathlessness to a debilitating illness. Heart failure is also associated with a number of complex changes in the circulation and the body’s chemistry-which in turn provide the focus for a number of effective treatments.

The term heart failure doesn’t explain the precise cause however this is usually due to a problem with the heart muscle (typically due to a heart attack or an intrinsic problem with the muscle known as cardiomyopathy) or the heart valves.

The treatment of heart failure depends on the underlying cause and might involve correction of problems with the coronary arteries or heart valves.

A mainstay of treatment however and one of the great successes in modern cardiology is the drug treatment of heart failure. In addition to drug therapy which can be extremely effective, some patients have problems with the synchronisation or coordination of the pumping function of the heart and this can sometimes be improved with a special type of pacemaker known as a biventricular pacemaker. Known as cardiac resynchronisation therapy (CRT).

When investigating possible heart failure in the clinic your cardiologist will need to take history and perform a physical examination. In addition they will want to perform some tests which will often include blood tests, a chest x-ray , ECG and echocardiogram. Further tests to exclude significant coronary artery disease may be necessary such as a CT scan, myocardial perfusion scan, stress echo or coronary angiogram . An MRI scan may also be necessary.

Dr Dalby will discuss these tests, their implications and any subsequent tests, treatment or follow up with you so that you may reach a mutually agreeable management plan.