I read that Heart Failure is a progressive illness, but I also read how lots of people's Ejection Fraction can improve, and in some cases by substantial gains. So my question is, if Heart Failure is progressive is it possible for symptoms to start to get worse? Symptoms such as "Shortage of Breath", " Swollen Ankles ", " Lack of Energy " etc. without any change to Ejection Fraction or, does it follow that Ejection Fraction changes result in a change of symptoms ?? EF improves you feel better, or EF is Lower you start to feel worse.
What I am trying to understand is the Progressive aspect of Heart Failure and the Why it Progresses and more importantly how is it measured. Or is it not possible yet to give an accurate measurement in regards to how H F is progressing.
Not easy to put this question into words, just trying to understand what other people think about " progressive "
Frank W
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Prada47
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Hello, Frank I've pondered this before too. Describing the illness as progressive makes it sound quite hopeless, like it will definitely get worse, but all the chat about new treatments and improving ejection fractions can contradict that. The impression I get from my consultant (and how pleased he is by stability, i.e. no improvement) is that my condition will begin to deteriorate at some point...but when might that be and what form will that deterioration take? I don't know. And if medicine keeps making advances, might an effective treatment be found before my heart failure "progresses"? I really don't know. As for what constitutes the severity of heart failure - again, no idea! Different doctors place different emphasis on ejection fraction and symptoms don't always correlate with how low your EF is. Patients who experience less severe symptoms apparently have better outcomes, even if their EF would predict otherwise. But then I'm pretty sure EF can predict likely prognosis too. And the symptoms of heart failure can act like a vicious circle too - fluid retention causes breathlessness and breathlessness causes fatigue... The more I think about heart failure, the less I understand what it is. It's not even a disease in its own right really, just a description of a certain set of symptoms with various underlying causes. And yet it is a condition in its own right, but is that only because we've given it a (stupid) name? I don't know! Sorry, none of this answers your question. I hope someone out there has more of a clue than us.
I suppose I was looking for an answer to a $64000 question OAPs will know what that was.
It's Just when I read about people in the end stages of H F, I wonder to myself how did it progress, did they have pneumonia or something similar which caused the demise. Another thing which has prompted me to think about this.
I was looking at an Aunts death certificate yesterday and she died of Congestive Heart Failure in December 1971 aged73 ( I do a lot of Family History ) but had forgotten H F was on her death certificate. I have all the Death Certs for my Maternal and Paternal Male and Female lines from 1837 onwards so I know what they all died of.
Regards Frank W
Hi Frank,
I`m not a medic so I`ll try and explain my understanding of your question. The EF refers to the right side of the heart and how much blood is squeezed out of the chamber when the heart contracts, heart failure can be related to either side of the heart or both sides as is my case LVDD (left ventricular diastolic dysfunction) which means the left side of the heart is unable to fully expand and draw the blood back from the bodies extremities hence the swollen ankles and legs, but the right side is still able to contract near normal albeit with less blood being delivered from the left side, so in my case I have HF due to LVDD with a preserved EF 50+.
HF is a natural progression of the deterioration of the heart tissue which can be accelerated by a cardiac event, many of the modern drugs can help to slow this process and the heart given time can regenerate a blood supply to itself therefore easing the symptoms but given all this my understanding is that HF is progressive and my condition indicates this to be true .
Thanks for your reply, I have replied to Laura with info on an aunts death cert which mentions Congestive Heart Failure, now looking at my mothers, Cause of Death (a) Left Ventricular Failure (b) Ischaemic Heart Disease. In my case I have Left Ventricular Systolic Dysfunction and Left Bundle Branch Block with moderate HF 40 to 45% EF it has been down to 27% at one time after CABG which was classed as severe. I think I am starting to understand a little bit more about HF. HF nurse said I was NYHA Stage 2 last time I saw her which is I can do most things without to much bother !!! bending to tie my shoes and showering are just a little difficult ( short of breath ) being the difficulty.
A Cardiologist once told me should my QRS widen further I may need a CRT (maybe I have that wrong ) but I am now wondering if that is an indication of HF progressing. QRS duration was 120 milliseconds in March 2017 and was 136 milliseconds in March 2018 so I think that is a slow progression lol . I had PCI stents in March of this year and the Cardiologist wanted to check my EF had been preserved after the intervention, which it was. I do feel really quite well but, the Progressive thing does bother me a bit as I feel sure it bothers a few of us, as it's a nagging thing in the background.
You are right HA is like a itch that you can`t reach to scratch always there.
I had my first HA in 03/11 ended up with 3 stents and a CA during the procedure after which general health not to bad apart from the angina could do most thing that I had before walk the dogs about 6 miles a day gardening etc, had the second one in 09/11 but didn`t take much notice just put it down to a bad angina attack but ended up in A&E from the GP`s surgery about a week later with severe chest pain had the usual tests ecg normal but troponin raised so ended up in critical care waiting for angio at Glenfield (was my area`s heart centre at the time) had a nuclear profusion scan while in patient found a large area if ischemia at the back of the heart so ended up at Glenfield on the hurry up with a cardiac nurse escort. First cardiologist started the procedure but then said he wasn`t able to put the stents in so had to call his boss he came in had a look and said he couldn`t make any promises after 4 attempts finally got the stent in place. Everything downhill from then had a stroke last year, on a good day can manage to walk about 10 metres before breathless and angina on a bad bay pain will start as I wake up and the heart rate rises, so it goes. Just take each day as it comes and I don`t worry about or plan the future most days just glad to be alive. So I`m still of the opinion HF progresses and is aligned to the severity and damage done by any cardiac events.
Hi Frank. I have HF and was diagnosed 23 months ago. My LH ventricle was at 19% when I was sent to A&E by my surgery. I had water in my mouth all the time and could not lie flat. I did not know what HF was.
Within a few months my output had increased to 24% and in March this year was up to 43%. I had a pacemaker put in June last year.
My HF was caused (they think) by the chemotherapy treatment I had 13yrs ago when diagnosed with breast cancer. It is what it is and I am fortunate to be here. One of my friends died and another has had it spread to her ribs. She’s 55. We had our first daughters within a few weeks of each other.
What I learnt from having cancer is to appreciate my life and my family & friends. And I’m alive. I’ve lost a lot of weight and improved my diet. I get to walk my dogs every day on National Trust land and it isn’t wonderful in the rain and mud but it’s glorious at other times. I try and remember this when I’m cold,wet and muddy! Or I’m exhausted from the meds.
Amazing medical discoveries are being made all the time so you never know. They have advanced hugely in some cancer treatments. My eldest has adenoid cystic carcinoma that started in the ear and returned in the lungs. 5th time of treatment since she was 19. Surgery was the original option and now it’s by ablation. So who knows with heart failure. I’ve an appointment next month with the HF consultant who i believe is putting on additional meds that women have responded particularly well to. Will keep you all posted.
Hi Frank... I am not medical at all however I had a HA 23 years ago which left me with LV damage and my EF reading was 44%. I remained at moderate HF for 21 years! Able to carry on with life as Normal Then 18 months ago my E.G. suddenly went down to 30% and so was recommended I have a CRT device. This can help to increase the pumping of the heart and ( so the doctors tell me) can in some instances stop the deteriorisation of the heart. I do feel better for having the device andl am hoping my EF number will also have improved... however I feel the best indicator for me is how well I look and feel... and how much more I can do with the CRT Device. I have also been told they have started to give the device to younger people before they become too deteriorated as the device can halt or at least slow down the deteriorisation and give better quality of life. So do see CRT as a good thing.... but if your HF is at mid 40s i hppe lile me ypu remain at that level fir many years.
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I've pondered this before too. Describing the illness as progressive makes it sound quite hopeless, like it will definitely get worse, but all the chat about new treatments and improving ejection fractions can contradict that. The impression I get from my consultant (and how pleased he is by stability, i.e. no improvement) is that my condition will begin to deteriorate at some point...but when might that be and what form will that deterioration take? I don't know. And if medicine keeps making advances, might an effective treatment be found before my heart failure "progresses"? I really don't know. As for what constitutes the severity of heart failure - again, no idea! Different doctors place different emphasis on ejection fraction and symptoms don't always correlate with how low your EF is. Patients who experience less severe symptoms apparently have better outcomes, even if their EF would predict otherwise. But then I'm pretty sure EF can predict likely prognosis too. And the symptoms of heart failure can act like a vicious circle too - fluid retention causes breathlessness and breathlessness causes fatigue... The more I think about heart failure, the less I understand what it is. It's not even a disease in its own right really, just a description of a certain set of symptoms with various underlying causes. And yet it is a condition in its own right, but is that only because we've given it a (stupid) name? I don't know! Sorry, none of this answers your question. I hope someone out there has more of a clue than us.
For those pondering about a CRT Pacemaker
From heart failure to preserved ejection fraction 
Newbie looking for reassurance after heart failure clarification
