Heart failure

Before an accurate diagnosis of heart failure is made, different tests are done in GP surgeries and hospitals to discover how the heart is performing and which parts of it are damaged. Tests make it possible to gather detailed information such as the size of the heart and which, if any, arteries are narrowed. Tests may also be done later on to see whether treatment is working and give doctors a better idea of what stage someone's heart failure has reached (for more information see British Heart Foundation or Heart Failure Matters).

Many of the people we talked to remembered angiograms quite clearly (see 'Angiograms and angioplasty'), but were less clear about electrocardiograms and echocardiograms and what they were used for. Some people had been told their heart was enlarged, and one man wondered if he could have another test to find out if his heart had returned to its normal size now that he was having treatment and feeling better.

Would like another test to find out if his enlarged heart has returned to its normal size.

Would like another test to find out if his enlarged heart has returned to its normal size.

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Age at interview: 64

Sex: Male

Age at diagnosis: 63

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But no, if you've got it you can only live with it, you can't do anything about it. You know it's something you can't just, in fact mind you some of these medicines though they do, they do... put a regression on the heart, like the heart will go back to its normal size. Normally with heart failure it's your heart enlargement and then it does regress the heart a bit some of these tablets like you know sort of brings it back down to a normal size so I'm hoping mine has gone back down to its proper size. I asked the doctor if he could do another echo cardiograph on it so that he could find out like but he said, 'We don't normally do that!'. But I don't know why, I'd like to know though you know. If you could, I mean if he'd follow it up himself, yeah we'll check it and see if it has gone back down and I'd be quite happy then, I'd know I'm making progress you know. So I don't know. You see I don't now at the moment whether I'm... I feel alright but I don't know whether it's getting, my heart is getting worse or it's getting better. I feel okay, so I assume it's getting better you know. In fact I feel brilliant sometimes I really do.

Electrocardiograms (or ECGs) detect abnormalities in the heart beat by recording electrical activity and rhythm, as do exercise ECGs, usually undertaken on an exercise bike or treadmill. People varied in the length of time they could spend on a treadmill; some managed a couple of minutes before getting short of breath and one man, a retired farmer, walked for 10 minutes at a slow pace. ECGs also show if there has been previous damage to the heart, and one woman who had had a heart attack said she always carried her ECG printout with her to save time in case she ever needed emergency treatment.

He describes his experience of an electrocardiogram.

He describes his experience of an electrocardiogram.

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Age at interview: 72

Sex: Male

Age at diagnosis: 59

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The woman says, 'You're absolutely hopeless'. She says, 'You've got one speed, and you can't go any faster! That's why, because you walk every day, and you're a farmer and you walk every day, and you've got that speed and that's it!'. She says, 'Your heart won't allow you to do any more, and that's it'. She says, 'You're hopeless. You won't go any faster!'. So I came off it then.

How long were you on it?

Oh, about 10 minutes. Yeah.

And were you walking at an incline?

Yeah. Aye.
 

She carries a copy of her ECG printout with her in case of emergency.

She carries a copy of her ECG printout with her in case of emergency.

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Age at interview: 69

Sex: Female

Age at diagnosis: 67

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Yes, my regular monitoring is at a hospital, and that's very close and very reassuring, because I know that if I get into trouble I can just go through and ask them to help me. Its quite intense monitoring, a lot of tests are done, scanning and... blood tests, blood pressure, body scanning and things and they get the history of it and its... I have an area which I've accepted now, and don't get afraid, but it's a blockage as well. It's something to do with the electrical impulses and the nerves and valves wherever they are, just go a bit askew and block themselves out, and that always shows up on the ECG. So if I carry an ECG chart with me wherever I go and a list of all my medications, so that if anybody else takes my ECG and suddenly finds this blip in my graph, I say, 'Don't worry its just my blockage you know, its been there for yonks, you know'

Yes I do take the ECG graph with me, 'cos if I ever, and the rest of my medication, because if I ever was in trouble in another town, and I had to go into an A & E department, if I collapsed and I couldn't breathe and I had a real major oedema problem, they take ECG's and they come across this blip which is not a very nice looking one, I can say to them don't worry I've had it before, its it's a it's a left bundle blockage (laugher) all these you know veins all blocked together, its like a M25 blockage, you know.  
 

The echocardiogram ('echo' or 'heart scan') is an ultrasound picture of the heart shown on a monitor which the patient as well as the doctor can see straightaway. Echos could be reassuring and people enjoyed being able to talk to medical staff involved with the procedure. Echos provide several measurements, including the ejection fraction (how much blood is being pumped out), which give doctors more detail about heart function. A retired doctor who was told he had heart failure after an echo said he wanted to know what a 'normal' ejection fraction was. He had asked his consultant and looked on the internet but had not found the answer. Others noticed that during the test they were able to hear as well as see the heart, which one woman thought others might find strange.

She describes an echocardiogram.

She describes an echocardiogram.

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Age at interview: 65

Sex: Female

Age at diagnosis: 59

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I've had a scan on my heart, that was done at the Memorial. Now that's not stressful at all. I mean obviously you're apprehensive, but he talks to you all the time he's doing it. It was on your chest, right up under your arm, up under your chin and right round and under your ribs and everything, they really go very deep. It's like a little, like a mouse but it's on your chest. You have like a gel on and they're looking at the screen, they have a screen in front of them, then they're taking pictures all the time. 

 

He wonders whether his ejection fraction was normal and what it meant.

He wonders whether his ejection fraction was normal and what it meant.

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Age at interview: 59

Sex: Male

Age at diagnosis: 58

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No, no I didn't really find answers to some of the questions I was looking for on the net,  for example I... the ejection fraction test - I knew what my ejection fraction was but I didn't know what the norm was and when you're told your ejection faction is 25%, you know that in a sense that's a quarter of normal and I didn't think that could be right, but I actually had to ask my consultant what the 'normal' was and then he wouldn't give me a really clear answer because I think there are different definitions of 'normal', but the answer broadly was around 60% is normal. So 25% of 60 isn't too bad you know its half, its not a quarter! So you know I'm quite a sort of a competent internet user and I didn't find it terribly helpful.
 

Several people couldn't remember which tests they had had and didn't know either the names or purposes of the tests, though they appreciated that information from tests was useful to doctors.