Heart failure

What causes heart failure: heart attack and angina

Most of the people we talked to did not know what had caused their heart failure, though many realised that the heart could be affected by many things. It was not always important for everyone to know what had caused their heart failure.

This section concentrates on the experiences of those who said their heart failure was caused by coronary heart disease and heart attacks. (For cardiomyopathy and valvular disease see 'Other causes of heart failure'.) A few also interpreted heart failure as meaning that their heart - like them - had simply grown old.

Heavy smoking is a known risk factor for heart failure. Several older men had started smoking when they were teenagers and had maintained the habit until middle age. A retired miner who took up smoking when he was 14 said he had had a heart attack at 46 and had managed to give up smoking years later when he retired.


He started smoking aged 14 and gave up when he retired.

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Age at interview: 75
Sex: Male
Age at diagnosis: 65
I smoked, I used to have a fag, I used to smoke about twenty a day, which was Capstan. Used to be the best in those days. If you could smoke a Capstan you were, you were with it, you know! [laughs] So' and then after my heart attack I got a milder brand, which was Embassy! [smiles] Thought I was doing better 'cause I got a milder brand, but it was rather strange, they say smoking is just a habit, because there were days when we had trouble in the mine, I'd worked twelve hours underground, I'd been at work eighteen hours, and never had a cigarette because you couldn't. But when I came to the surface, went to my office, the first thing I did was open the desk drawer and have a fag! And coughed my heart up, you know! [smiles]. 

So after a while I realised it just couldn't go on, you couldn't. The doctor told me about smoking like, and I tried really hard. And different ones would say, 'Come on, come on you silly devil, have a fag, have a cigarette'. And at the finish I had a badge 'Please don't give me a cigarette. I've stopped smoking' [laughs]. And I used to put that on me coat. And I just packed in, stopped. I just stopped and, mind I was bad-tempered you know, bit me nails and after about a month I could manage it alright. I've never had a cigarette since about 19' well 1982 I retired, 1984'1986...1988, haven't had a fag since, cigarette since, have no desire to have one.

About half of all those diagnosed with heart failure already have coronary heart or artery disease which is generally thought to be linked to smoking, eating a high fat diet and taking too little exercise. Several people acknowledged that eating too much, drinking too much alcohol and working too hard had played a big part in their heart problems.


He thinks that working too hard and living life to the full led to a heart attack.

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Age at interview: 74
Sex: Male
Age at diagnosis: 73
Well I think deep down we all know what causes it..I think it was my lifestyle, really. I used to smoke a lot although I've been off them for 40 years now, believe it or not, yes, but I used to smoke 40 a day anyway. My work was great fun but stressful. I used to drink quite a bit in work, not alcoholically, but I used to be a heavy drinker at times. And then when dealing with the press, etc., I used to feel I had to drink because they looked asquint until I learned the old habit of using Canadian dry ginger in your glass instead of a whisky and they wouldn't know the difference! At least I think they didn't!

But we used to work hard and play hard and certainly at the times of meetings in London and meetings in Glasgow, I would be up at 6 o'clock getting the place ready for the meetings at half past eight. Finishing meetings about 6 o'clock at night, then going to the bar before dinner, talking business, dinner business with wine, etc., and then probably be redesigning things that had gone wrong during the day right up to 12 o'clock at night when you tumbled into bed! So admittedly that only went on sort of at a fortnight at a time about twice a year, sort of thing, so it wasn't punishing the whole story. But you had other things happening that sometimes raised the blood pressure a bit but those were quite hard times of, well you didn't feel then, you thoroughly enjoyed it, in fact, but it was rather punishing on one's body I would say, yes. And driving down to London with all my toys, as I called them, all my designs and things, for displays, etc was probably not the best way of going.

Okay, so a mixture of lifestyle and work?

And feeding of course. I was too fond of my steak and chips rather than other things, which would, if you follow? Coming from Glasgow our diets were particularly bad.

Well I'm sure you weren't eating deep-fried Mars bars?

No, no, no. I never got quite to deep-fried Mars bars! I was intrigued mind you, but fish and chips I think is about my, or steak and chips preferably.

Damage to the heart caused by one or more heart attacks can also lead to heart failure, and this was common amongst those we talked to. Some had been able to take early retirement, but others could not afford to stop work and had changed to less physically demanding jobs. Some said that having a heart attack had frightened them into giving up smoking straightaway; changes in drinking and eating habits and trying to exercise more regularly were also common.


Having heart failure forced him to look for a less physical job.

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Age at interview: 47
Sex: Male
Age at diagnosis: 41
And so I pestered them actually, I didn't think I'd have the nerve but once again I couldn't dare say anything about my heart. This was also verified by the fact when I worked at the previous place, there was a chap there who'd had a heart attack and had been in to have a heart bypass, and I was talking to the foreman one day and he was looking at me, and he'd often confided in me because I was a very good boy [laughs]. In other words, I kept my mouth shut and I got on with my work.  And so he thought I was a friend of his, and he turned round and said, 'Our money-boy there has been inside'. (You see that's my reference to being in hospital, being 'inside'.) So anyway he said, 'I'll tell you what, if you want a fact, he's got a bad heart, I'd get rid of him'. 'Is that right?' 'Yes' he said, 'Well he's a lame duck isn't he?'  

And there he was talking to somebody with severe heart failure who was his hardest grafter! And he kind of, I wanted to have a go at him you know because I'm not one for sort of standing back when something needs to be said, and then so when I went for this other interview I had this in mind, don't you dare mention having a heart failure.  

So I got the job as an inspector and I went and it was basically an inspector, lovely job, you just looked at something, compared it with a drawing and said yes or no.  

Several people had been told they had had 'silent' heart attacks and not known about them until other symptoms prompted medical tests; for instance one woman who went into heart failure after bouts of vomiting was told she had probably had a silent heart attack and known nothing about it at the time. Most people with heart attacks have obvious chest pain but some, especially women, may have other symptoms such as vomiting, breathlessness or fatigue without pain; this is known as a ‘silent heart attack’ (see also Heart attack site). A few who had high blood pressure said they had been given medication but did not necessarily connect it with heart failure.


Her 'silent' heart disease presents itself as serious vomiting and nausea.

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Age at interview: 59
Sex: Female
Age at diagnosis: 55
Yes, once the nausea and vomiting stops I actually do feel quite a lot better. That just makes me feel so wretched that it is actually almost like, it's like status something. 'Status' is usually used in medicine when it's something that keeps on like 'status epilepsy', you keep on and on. And my consultant now and I call this 'status vomitus' because I actually don't stop. I don't sleep in between; it's just incessant. It's actually non-stop, it just wears me out, I'm exhausted.  

I mean now we actually know what does tend to stop it, it's much better. When I go into hospital I have intravenous infusions and they start giving me the drugs that help stop it straight away and so it does now stop between 2' and 3 days. Interestingly, we don't know whether this is a symptom of my cardiac disease or not but I think we think it is. Most people get angina, chest pain, I don't actually get chest pain, I've got silent heart disease and we think that the nausea and vomiting is a symptom of me either going into heart failure or of heart attacks. We're just not completely sure. I always get said to me, 'You're a very unusual presentation'. 

Several people experienced pains in their chests and arms both before and after diagnosis. Some referred to their pains as angina, but did not necessarily see it as a contributory factor in heart failure.

A few people saw heart failure as part of growing old and as the result of ordinary bodily 'wear and tear'. Not everyone used the term 'heart failure' ro describe their heart problems), which they said they half-expected because of their age (see also 'People's ideas about causes of heart failure').


Last reviewed April 2016.
Last updated April 2016.

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