It is important to know the cause of heart failure because, if it is mechanical (such as a leaking valve), you will need a mechanical solution (a new valve). If it is heart muscle failure, you will need tablets.
A high blood pressure will need urgent treatment. Investi gations sort this out. Usually you will have an ECG, a chest X-ray, blood tests and an echocardiogram.
The doctor at the hospital told me that I have heart failure. For some reason, he told me to report back for a chest X-ray.
Why do I need a chest X-ray for heart failure?
An X-ray picture of your chest will tell him about the size of your heart and its shape; this will help the doctor work out the cause of your heart failure. He will also get a picture of your lungs and can tell whether there is any infection or fluid there. You will be asked to stand in front of an X-ray plate, and then told to breathe in and hold your breath for a few seconds. As you hold your breath, the picture is taken. Holding your breath will prevent a blurred image occurring. The X-ray dose is very small and not in any way dangerous.
Why do I need blood tests for heart failure?
Your doctor will need to make sure that you are not anaemic, as this can make heart failure worse. Your kidney function will also be checked and any evidence of a congested liver looked for. Blood may also be taken to make sure that your thyroid gland is not under- or overactive. Any evidence of liver damage from alcohol will be monitored. Liver congestion is not unusual in heart failure and improves rapidly with treatment. A test for Brain Naturetic Peptide (BNP) is frequently performed and elevated levels identify heart failure.
My sister is very concerned that she has been given an appointment to have an echocardiogram. What is this?
This is a painless, simple test which tells us about the size of her heart, how well it is working, how strong the muscle is and how the valves are working. It is often used to assess the significance of a heart murmur and the size of a heart attack, to see if any clots are forming and to calculate the efficiency of the heart’s muscle pump.
How is an echocardiogram performed?
The room, in a hospital or at your family doctor’s, is usually darkened to allow the doctor or technician (cardiac physiologist) to see the screen. You may be asked to lie on your back or side. A special type of jelly is put on your chest and a probe applied to the jelly. The probe is moved over your chest. Ultrasound waves (it is not an X-ray being taken) are bounced off your heart and a picture of the heart’s movements and structure made.
You are usually able to see what is happening and the pictures are stored on video or disc which the doctor may show you. It usually takes 20 minutes and is painless, with no side effects. Doppler ultrasound is also used and this measures the blood flow. It makes a noise like a washing machine.
My doctor wants a special echocardiogram to see if I might benefit from a pacemaker. What is this about?
A new treatment for heart failure is a special pacemaker which is used when the two heart pumps are out of synchrony that is, not beating at the same time. A special echo measures the dysyn chrony index. If this is abnormal, it suggests that the heart can be brought back in line with a cardiac re-synchrony pacemaker. The efficiency of the heart will be improved and you will feel better.
Sometimes this special pacemaker will be combined with a defibrillator which may prevent you dying suddenly.
I have heard that some echocardiograms are done by the patient swallowing a tube. Is this true and, if so, what is happening here?
Yes, it is true. The reason is that your gullet is situated behind the heart, and a scan from the gullet (or oesophagus, pronounced ‘eesof-a-gus’) gives better pictures than one on the chest, when the probe has to steer round the lungs. This is known as transoesophageal (via your food pipe) echocardiography (TOE or TEE in America). It is done when we need specialised additional information, particularly on valve or clot problems. The tube is not large and is usually passed after you have been given relaxing medication and a local spray anaesthetic to the mouth. Some people do find it unpleasant but it is a very important test to help guide your treatment.
I have an appointment at the hospital for a nuclear scan. This sounds rather dangerous to me. Is it harmful and how is a nuclear scanning done?
The radioactive levels are low and not at all dangerous – you won’t glow in the dark! A scanning machine takes pictures of your heart following an injection of a radioactive material (usually thallium or sestamibi) into a vein. If your heart is healthy, the thallium is absorbed and an even picture will be shown. If there is damage to your heart, the thallium will not be taken up well by the bits of your heart that are not working efficiently. If there is scar tissue from a heart attack, there will be a gap or a hole in the picture as no thallium will be taken up.
If your heart is made to work hard by an exercise test or by the injection of a stimulant to speed it up, the thallium will not travel well to any areas where there is a poor blood supply (such as in that caused by coronary narrowing). When your heart rests between beats and the demand for blood falls, thallium can reach this area. In this way, the scanner can give a very accurate and useful picture to your doctor.
First it shows a deficit, but then shows whether this deficit can be rectified. If the scanner shows a hole in the picture which does not improve, then it is likely that the muscle is dead and cannot be improved.
The hospital has written to me and told me that I need a test called a SPECT. What is this?
This is single photon emission computed tomography. It is a 3-D scanning system. You will lie on a table and the scanner rotates to take pictures from different angles, again helping to identify damaged muscle or muscle suffering from a lack of blood supply. It is a sophisticated test but simple to do – like a standard sestamibi scan but with bells on!
I have had test after test until I feel that I could not be tested further. I now have been summoned for a nuclear scan. When is nuclear scanning specifically helpful?
Nuclear scanning can be very useful for people with angina, after a heart attack and when there is heart failure. It is a means of trying to assess the importance of each narrowing present, and whether any good can be done by treatment. It is more expensive than an exercise test but useful when exercise tests cannot be done (for instance if you have arthritis), or when specific information on your heart muscle is needed that a treadmill exercise test cannot provide.
My wife was told that she is going to have a PET scan. How is PET different from SPECT?
PET is positron emission tomography and this is a much specialised technique involving nuclear scanning, and it accurately tells us about blood flow and whether the heart muscle is hibernating or not. It is a very expensive test, so is used only when really necessary. It can, however, identify where help might be possible when other tests have not been able to show what can done; so, used carefully, it represents value for money.
