Heart failure

People's ideas about causes of heart failure

The causes of heart failure are complex (see 'What causes heart failure' and 'Other causes of heart failure'). Those who have a family history of heart disease, those who smoke, are overweight or have diabetes are more likely to develop heart disease than those who do not. Many of the men and women we talked to were aware that diet and smoking were possible causes, but put forward many other theories including stress (see 'Stress and heart failure'), shift work, pollution, viruses, too much exercise, growing old, getting angry, and also bad luck. A doctor with heart failure said he found it unhelpful to dwell on the question “why”?

He finds it unhelpful to speculate about causes of heart failure.

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Age at interview: 59

Sex: Male

Age at diagnosis: 58

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I think it's a difficult question. People ask it, I think the family would like to know the answer to that question... I think... I had two jobs; I was medical director of a health authority which was a very high pressure job, a high-profile job, many many big public meetings, much responsibility for my patch trying to improve and change things, plus I'd kept my general practice going as well. So a lot of stress, but I don't think heart failure is caused by stress myself, ischaemic heart disease... I suspect is in my genes. I've got a lot of Welsh genes and I think that may be the majority of it! [smiles] I did smoke when I was a young man but I gave that up by the time I was 25, so I can't blame smoking.

I actually think its unhelpful to waste time wondering 'why', because no answer to the 'why' really helps with the question about 'what do we do next', and I think for myself it was more difficult to get my head round a prognosis, what the future would be for me, because... again you ask questions which people can't answer, and I suppose as a doctor I should know that my cardiologist couldn't tell me how long I was going live. But when you have a lot of things you want to do, get sorted out, it would be nice to have a much better idea of... the prognosis that you face.

There were mixed feelings about whether smoking should be blamed for people's heart failure, especially if people had smoked in the past, but stopped years before their heart failure started. Others, though smoking at the time of diagnosis, thought other things like stress and shift work were more important. Several said that some doctors blamed smoking for everything, and one man thought he was misdiagnosed with emphysema because he was a smoker. Others said that they had connected smoking with cancer rather than heart disease until they became ill.

How smoking and working shifts affected his heart.

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Age at interview: 64

Sex: Male

Age at diagnosis: 63

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Well it's very difficult. I did smoke at the time, I did smoke which I don't now, I did smoke and I think shift work and stress sometimes can bring a lot of it on. I think stress more than anything, more than probably the smoking. I know they all decry the smoking, but I think the shift work didn't do any good for me at all, I think I shouldn't have been in that type of work.

No it was indoor work. Yes we worked, it was all machinery, we were manufacturing components for engines so it was all indoor work yes. Under artificial light I might add, no windows, and you know you didn't know night from day all the time. And we were, it was years ago, it was quite dusty as well, you know with the cast iron being machined and stuff like that. Later years they got extractors fitted and thing's like that, it was a lot better you know. But I think a lot of the stress and shift work and working upside down you know, that creates it.

So no smoking I don't smoke as well. I used to smoke years ago, oh I used to smoke. I don't know people keep saying how many did you smoke and I say well I can't remember, maybe it could be 20, 25... I don't know really I forgot. I packed smoking cigarettes up in '76, I did smoke a pipe after that and cigars you know so I don't know. And then I got, stopped the pipe a number of years ago and I packed up the, well I packed up the pipe when I had the triple heart by-pass to be quite fair and I never had any, I've had the odd one since but that's it you know. Well one or two maybe I don't know, I mean I can't be absolutely sure no. But I don't smoke now, I don't use them. Yeah.

Describes how smoking affected doctors trying to make a diagnosis.

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Age at interview: 56

Sex: Male

Age at diagnosis: 53

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Well I also smoked a pipe, alternated between cigars and pipe for, since I was 16. When I... that became an issue I stopped smoking, but I didn't, it didn't help or anything, I didn't feel any better. Uh, I think... I think the... sad thing about anyone who suffers any of these complaints, is when they first see a doctor, maybe its necessary, but I always think its an excuse, 'Do you smoke?', and if you say 'Yes' then that gets blamed for everything. And its wrong, that's wrong.

Either, they couldn't decide whether, it was in the sac between, couldn't decide whether it was between my heart and my lung, and they couldn't decide what sac it was in. So it was a fairly unusual... diagnosis in so much that I was surrounded by young doctors etcetera who listened to it because although they'd read about it, nobody'd heard of it. To me it sounded like bubbling coffee every time I breathed, but to them it sounded like two bits of leather rubbing together. I was hearing a different sound to what they were hearing.

So I had 15 days in hospital with that, came out, went back to work...things seemed to be fine, got to Christmas of '91, and just after Christmas returned to college and was finding that I was extremely breathless. Any time on my feet caused me breathlessness, I had to climb stairs and it became a real hazard to me. I couldn't sleep at night at all, tried everything, tried different positions, ended up sleeping in this chair for several weeks and finally I slept at the dining room table sitting up. Couldn't get any sleep in any respect.

Wife eventually forced me to go to the doctor's. I went to one doctor who said to me I had to realise I did have a problem with my heart, not much you can do about it blah, blah, blah. Came home, spent another several days in distress, decided to go to another doctor in the practice who gave me much the same story as the first one had given me. Sent me home. All this time I was gradually getting worse. We decided to go to the third doctor in the practice who is supposed to be a specialist in heart. Went in, spoke to him, not congenial at all, not sympathetic. Asked if I smoked, I said, 'No, but I do like a cigar occasionally.' told me that was the problem, I had emphysema, I would just have to learn to live with it and gave me a nasal spray.

He gave up smoking after his heart attack.

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Age at interview: 66

Sex: Male

Age at diagnosis: 64

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Well I used to smoke 50 to 60 cigarettes a day, that can't be good, you know. But it never struck me that...cancer is the thing you think about when you smoke, not heart attack actually. It's cancer that you think about. And for some reason that doesn't seem to worry you. But the only, I mean when I had my heart attack, they told me to stop smoking and I did. I stopped smoking straight away because they said it gave me a 50% chance of living longer. So I thought well a 50% chance is better than no chance. I mean I've seen people in there, because there's quite a few people in the hospital who've had a heart attack at the same time sort of thing. And they were nipping out for the odd fag and I'm thinking well you know, why do it? They've told you that it gives you 50% more chance of getting over the heart attack if you don't smoke. I think to pack in smoking you've got to be frightened to death, you have, you've got to be frightened to death to pack it in!

High levels of cholesterol in the blood may mean that you have a greater chance of developing heart disease. Cholesterol levels may be reduced to some extent by eating less fat and exercising more regularly, and also by cholesterol-lowering drugs called statins. Many people knew that having a high cholesterol level in the blood was a risk and had taken steps to change their diet. Some found it difficult to give up fatty foods, for instance one man said that he had been in the habit of eating a lot of animal fat since his childhood, and another said that it was hard to avoid a high fat diet because of his cultural background. He also thought he should have been prescribed statins earlier on in his treatment. Another person said that knowing your cholesterol level could be unhelpful unless it could be changed, and that it might cause more worry than reassurance.

He reflects on his childhood eating and smoking habits.

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Age at interview: 80

Sex: Male

Age at diagnosis: 75

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Well I don't know. They all say you shouldn't eat animal fat. Well as kids we always used to eat well. Dad had a big allotment, and we always had plenty of vegetables and that. I used to love to pour the fat at my vegetables, nice and wet. I hate a dry meal, so whether that had anything to do with it, because my dad died of heart trouble. And I used to put, like, this fat and that on my food. Whether that sort of started furring things up, I don't know.

What about smoking and drinking?

Oh I smoked from about 12, I started having little puffs about 12 and then let's see..'56, 1960, I was coughing up and that all day long and that all smoking about 30-odd fags a day!

His cultural background makes it difficult to alter his diet and lower his cholesterol levels.

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Age at interview: 54

Sex: Male

Age at diagnosis: 49

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I think one of the things is very interesting but I think, I'm not sure if I'm right or wrong [laughs], after the heart attack, the first heart attack or just before I had a heart attack the first time, I should have been on the cholesterol tablets. I was very, it was very high, I was told it was very high, but nobody prescribed them to me, and I don't know why. And when, you know when I learned a lot about my experiences, how the cholesterol and everything, I was wondering why I didn't get cholesterol tablets rather than they advise... well they advised me to lose weight, this is a normal thing to lose weight, the diet, the food and all this, but I wasn't really keeping to it, you know what I mean. I mean to say that's one thing which I think, I should have been on cholesterol tablets a long time ago... otherwise you know they, I think they do their best to control the, the heart and you know to protect from another from heart attack.

When they told you, when they suggested that you lose weight and do more exercise did you try to do that?

Yes I did but I think it's, again it's to do with the culture and the background. I mean to say, if you, if you come from a different background the kind of food, or the type of food you're eating is totally different which is [long pause] which is affecting the cholesterol and the fat and weight, so that's... I try to but may be it was not enough.

Can you tell me what cultural background you're from and what you do eat?

Middle East, Middle East, and so most of the things is high cholesterol. It's like lamb and... the kind of rice, sweets, cakes and the oil we use, everything is oil, oil, oil, fat and butter and all this kind of thing. It's not like, it's not like the English diet where everything is healthy and vegetables, boiled. As I said even the vegetables are in the oil and fat. So the kind of foods is very very important of course.

Many people said they were told that their heart failure could be the result of a virus. One woman had been told that a virus may have caused her heart failure, but she wondered if she and her mother might have had the same pattern of illness. A raised risk of some types of heart disease can run in families; where this risk had been inherited people wondered if there was anything much they could do to combat it.

She thinks her heart failure may have been caused by a virus or her genetic inheritance.

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Age at interview: 55

Sex: Female

Age at diagnosis: 53

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They said I'd had a virus and that the virus had affected my heart, had damaged one side of my heart. But they didn't necessarily say that the virus was sort of in the last couple of weeks even. It could have been earlier than that but they weren't really sure when it was. Now I had had a very bad 'flu, that was the Easter, I had had a very, very bad 'flu about Christmas so whether that was it I don't know.

What do you think?

I honestly don't know, I really don't know. The only thing I can say is my mother had the same thing when she was quite young, 9 years old actually, and that was after a 'flu - and I don't know the extent of the damage but she always took tablets for the rest of her life. After saying that, she led a normal life but I always remember her saying that she had a heart problem after having 'flu when she was 9 years old. So perhaps it's a weakness in our family. And perhaps it misses a few, I don't know, I don't know.

Last reviewed April 2016.
Last updated April 2016.