All you need to know – A heartbeat away!

The number of elderly people and nowadays young people developing heart failure is increasing. Before we look at what leads to heart failure, it’s necessary for us to understand what exactly heart failure is. The general notion is heart failure means that the heart has stopped working or will eventually stop working.

Heart failure is a condition in which a weakened heart is unable to pump the normal amount of blood carrying oxygen and nutrients throughout the body. Heart failure cannot be termed as a disease but is a chronic syndrome that generally develops slowly.

If the heart failure is mild, it may not significantly affect a person’s lifestyle and day-to-day living. On the other hand, severe heart failure can affect a person’s every move and can be fatal. Thus the severity can range from a very mild heart failure to a severe heart failure.

Treatment is essential in all types of heart failure. It can help significantly and, in most non-severe cases, can allow the person to enjoy a normal and full life. Medication can also significantly help those suffering with severe heart failure to improve their day-to-day living and live longer.  Although Heart Failure, like other heart ailments, has been acquiring epidemic proportions in India in the recent past, it has not received adequate public attention.

1. The prevalence of heart failure increases with the age from less than 1 per cent in the 20-39 yr. old age group to over 20 per cent in the people age 80 yr. or older
2. The life time risk of developing heart failure is estimated at about 20 per cent both men and women
3. The lifetime risk of developing HF at the age of 40 yrs. is 11.4 per cent for men and 15.4 per cent for women.
More than 500,000 new cases are diagnosed each year
4. Around 30 to 40 per cent of patients die from heart failure within 1 year after receiving the diagnosis.

Signs and symptoms

Many people with heart failure remain undiagnosed because their symptoms are often overlooked, ignored, or attributed to aging and in today’s times often attributed to excess stress. The symptoms result from the inability of the heart to pump blood around the body efficiently and the result could affect the patient’s left side, right side, or even both sides of the body. Symptoms depend on which side is affected and the severity of the heart failure. In the early stages, Heart Failure may not have any symptoms, however, in later stages it will become severe. It’s important to be aware of the symptoms to take adequate medical treatment at the onset of this condition itself.

The most common symptoms are difficulty in breathing, chronic cough, loss of appetite, fatigue, rapid or irregular heartbeat, mental confusion or impaired thinking, cyanosis (blue color of skin), low blood pressure (hypotension), cold sweating and gradual loss of consciousness etc.

In addition to the above symptoms, a physician may detect signs of Congestive Heart Failure, which may include an abnormal heart murmur caused by valve-related disorder, a crackling sound of fluid in the lungs caused by pulmonary congestion, a rapid heartbeat (tachycardia) or abnormal heart rhythm (arrhythmias), swelling and fluid retention in the liver or the gastrointestinal tract, enlargement of the heart (hypertrophy) and liver malfunction.

Seriousness of the condition

Seriousness of a heart failure depends on how severe the condition is. When a weakened heart can’t pump enough blood throughout the body, it leads to reduced quality of life, frequent hospitalization and high mortality. Heart failure may occur for a number of different reasons:

1. Chronic high blood pressure- When the blood pressure is very high, the heart has to work much harder to pump blood through the arteries. This results in enlargement of the heart, especially the left ventricle, which is the heart’s main pumping chamber, making it less efficient.

2. Coronary artery disease- The buildup of cholesterol and fatty substances or plaque on the walls of the arteries may decrease the blood supply to the heart muscle to do its work.

3. A previous heart attack- the heart muscle may have lost its strength or weakened because of a previous heart attack. During a heart attack, the heart muscle is deprived of oxygen, resulting in tissue death and scarring. The development of heart failure depends on the extent and location of the scarring.

4. Diseased heart valves- A narrowed or leaking heart valve fails to direct blood flow properly through the heart. The problem may be something you were born with, an inherited condition, or the result of an infection.

5. Irregular heart rate- medically known as cardiac arrhythmia, irregular heart rates can lead to heart failure, but they usually have to be severe and last a long time. They change the pattern of filling and pumping of blood from the heart.

6. Cardiomyopathy- Disease of the heart muscle itself can lead to heart failure. Causes of cardiomyopathy include infection, alcohol abuse, cocaine abuse, and family predisposition.

Diagnosis & treatment options for heart failure

Heart Failure usually can’t be cured, but thanks to advances in technology and drug discovery, it can be effectively managed and patients’ quality of life improved. Coupled with appropriate lifestyle changes, the relentless progression of the disease can even be arrested. Hence the importance of early diagnosis and treatment. The doctor may arrange for tests that include a chest x-ray, blood and urine tests, an electrocardiogram, a painless test where small sticky patches connected with wires to a computer are placed on your chest. The computer records the information from your heart.

In addition, the doctor may conduct an echocardiogram, which simply involves moving a probe across the chest. Doctors can see how well the heart is pumping, can assess if the valves are working, the thickness of the wall of the heart, and the size of the chamber.

Cardiac resynchronization therapy (CRT) is considered to be one of the effective forms of treatment for heart failure that uses an implantable device to improve the pumping efficiency of the heart. In healthy people, the four chambers of the heart contract in synchrony to move blood through the body (people experience this as their heartbeat). In many patients who have heart failure, the electrical impulses that coordinate the contractions of the heart’s chambers may be impaired. As a result, in up to 30 percent of people who have advanced heart failure – or 10 percent of all people with heart failure – the two lower chambers (ventricles) no longer contract at the same time. This may worsen the symptoms of the disease. In cardiac resynchronization therapy, a stopwatch-sized device is implanted in the upper chest in an attempt to resynchronize the contractions of the ventricles by sending tiny electrical impulses to the heart muscle. For those patients with heart failure who have electrical conduction problems of the heart, resynchronization therapy improves the flow of blood from the heart throughout the body, which may result in reducing symptoms, reduced hospitalizations and reduced mortality.

A treatment plan for a heart failure may vary from person to person. Some of the common plan may include some or all of the following:

Medications to strengthen your heart’s pumping action help blood flow better through blood vessels, or regulate your heartbeat

1. Changes in the amount of your physical activity
2. Setting limits on the amount of salt and fat in your diet
3. Increasing the potassium in your diet, if instructed
4. Losing weight if necessary
5. Reducing your fluid intake, if necessary

While heart failure is a serious condition, it is not necessarily the death sentence that its name suggests. Thousands of heart failure patients live well with this condition. Though it cannot be cured, it can be successfully managed with your doctor’s help and advances in medical technology, the patient can feel better and subsequently see their quality of life improving.

Source: Dr. Suresh Vijan, Consultant Cardiologist,Lilavati Hospital, Fortis Mulund & Hinduja Khar Hospital