Heart failure

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A 40-year-old man was experiencing difficulty in breathing and inability to sleep for more than a month. Although he ignored it initially, he finally consulted a doctor when the symptoms failed to subside. After a series of tests, the doctor declared that he was suffering from heart failure.

What is heart failure? Is it similar to a heart attack? Here is what Dr Santosh Kumar Dora, Cardiac, Cardiologist, Electrophysiologist and arrhythmia specialist, Asian Heart Institute, Mumbai, has to say about heart failure.

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Types

Heart failure is a clinical syndrome in which the heart is unable to pump the required amount of blood to different parts of the body. It can be due to the problems in the atria (upper chambers of the heart) or the ventricles (lower chambers of the heart). Depending upon the site of the abnormality, it is divided into systolic heart failure and diastolic heart failure.

Systolic heart failure: It occurs when the ventricles fail to pump blood to the organs. The inefficiency of the heart to pump out blood causes the blood to back up in the organs, leading to swelling of the cells and congestion in lungs.

Diastolic heart failure: When the ventricle receives less than normal amount of blood and fail to expand properly, due to the inability to fill the ventricle, it results in diastolic heart failure.

Causes

Heart failure can be caused due to an underlying condition of the heart or due to an infection. The comorbidities that are known to cause heart failure are --

Heart attack: As experiencing a heart attack previously weakens your heart muscle and also lowers the pumping of the organ, it can occur in people suffering from a heart attack.

Valve disease: It can be caused if the mitral or the aortic valve are either narrowed or leak of blood, following an injury, because it puts pressure on the heart.

High blood pressure: People suffering from hypertension can also suffer from heart failure if the blood pressure increases suddenly.

Viral infection: In rare cases, even infection of the heart can damage the heart muscle, increasing pressure on the heart and, in turn, leading to a heart failure. Also known as myocarditis, an infection in which the inner layer of the heart muscle is damaged, weakening the heart.

Risk Factors

Numerous factors can increase your likelihood of heart failure such as -

Diabetes: If you have uncontrolled diabetes and lead a sedentary life, your risk of suffering from a heart failure is high.

Hypertension: If you fail to take medications for hypertension or experience sudden increase in your blood pressure, it drastically increases your risk of heart failure.

Low haemoglobin: People with low haemoglobin level and those suffering from anaemia are at an increased risk of heart failure as compared to those with normal haemoglobin level.

Thyroid: If you already suffer from a thyroid imbalance, hypothyroidism (low thyroid level) or hyperthyroidism (high thyroid level), your risk of heart failure increases drastically.

Smoking: Among the other risk factors that put you at a risk of heart failure, excessive consumption of alcohol can put you at a high likelihood of heart failure.

High cholesterol: It is also important to monitor your cholesterol level as it is a known risk factor for heart disease and hence, might even increase your chance of suffering from heart failure.

Symptoms

The typical symptoms of heart failure include -

Shortness of breath: If you feel breathless even after minimal exertion or while sleeping or when you lie down flat, then it's better to consult a doctor and get tested. This could be because of the heart's inability to receive or pump blood.

Swollen legs: In the case of the systolic heart failure, blood pumped out of the heart fails to reach the other body parts, leading to swelling or oedema. It is commonly seen around the ankle.

Fatigue: Another common yet often ignored symptom is feeling tired or lack energy for performing even the simplest tasks.

Lack of sleep: Due to an inadequate supply of blood to different parts of body, coupled with an inability to breathe properly as you lie down, could be a key sign of heart failure. In this case, you might feel uneasy and fail to fall asleep as you lie down but do not experience any discomfort when sitting.

Changes in the neck veins: Another visible sign that indicates you might be suffering from a heart failure is when the veins present on the front side of the neck are very engorged or prominent.

Diagnosis

Visit your doctor immediately in case you experience any symptoms of heart failure. Your doctor might recommend a series of blood tests followed by ECG or X-ray (if needed).

BNP (B-type natriuretic peptide) blood test -- If you have difficulty in breathing, your doctor might order a BNP test. Also known as brain neuritic peptide, it is a blood test that is used to differentiate whether the person is suffering from a lung disease, asthma or a heart disease. If the test results are less than 150, the heart problem is ruled out. But if the value is greater than 150, it indicates an underlying heart disease.

To further know what type of heart problem you are suffering from, your doctor might recommend these following tests.

ECG (Electrocardiogram): It is usually recommended if you experience symptoms like chest pain or shortness of breath. In this, electrodes are placed on the chest that measure electric impulses and help you determine the functioning of the heart.

X-ray: Chest X-rays helps you to identify the underlying health problem, mainly, lung disease or heart disease. It aids in detecting fluid in lungs (pulmonary oedema) due to congestive heart failure or determine the changes in size and shape of heart, which could also indicate heart failure.

Transesophageal echocardiogram (TEE): It is a test that uses high-frequency sound waves to produce high-quality moving pictures of the heart and blood vessels. It helps the doctor to detect the size of the heart, the thickness of the heart muscles (walls) and the pumping ability of the heart and hence, determine your risk of heart failure.

In addition to this, few other tests are conducted, depending on the symptoms of the patient. These are -

CBC (complete blood count): To determine haemoglobin content and iron content in the blood as iron deficiency (anemia) puts you at a high risk of heart failure.

Lipid profile: For complete blood cholesterol level including the ratio of good cholesterol to bad cholesterol and triglycerides.

Electrolytes: In some cases, blood levels of electrolytes like sodium, chloride and potassium are also determined.

Kidney function test: It mainly involves detection of urea and creatinine, types of protein, in the blood.

Treatment

Heart failure is majorly divided into four types:

Stage 1: In this, the person might be able to perform daily activities without any problem and doesn't show any key symptoms.

Stage 2: At this stage, the person can perform his daily chores but with difficulty, as he might experience symptoms.

Stage 3: It is an advanced stage that is significantly symptomatic, and the person starts to experience difficulties in carrying out his daily chores.

Stage 4: It is the last phase of the condition in which the person experiences symptoms even when at rest. When a person shows class 4 symptoms, the patients might require hospitalisation. In this, the patient might be treated with IV fluids to stabilise the condition and simultaneously tested to find out the underlying cause of the disease.

Depending upon the type and stage of the heart failure, the treatment module is decided. For patients with symptoms of breathlessness, congestion or oedema, the standard treatment is recommended. It includes the use of diuretics, vasodilators and infusions.

Diuretics: These drugs are known to increase the urine output and hence, decrease the load on the heart caused due to oedema. In most cases, people show improvement with the treatment as the pressure on the heart and other organs is reduced, as excess water is removed from the body.

Vasodilators: They decrease the systemic vascular resistance and thereby reduce the afterload on the heart, which is the cause of heart failure. These drugs also work by increasing the pumping capacity of the heart.

IV fluids and injections: In the case of the last phase of the condition or when the patient is admitted to the ICU (intensive care unit), intravenous injections or tablets are recommended to maintain the electrolyte balance in the body without increasing the pressure on the organ.

If the patient is in the 3rd or 4th stage of the disease and is not responding to the treatment, then these are the next preferred options.

Pacemaker: Also known as CRT (cardiac resynchronising therapy), implanting a pacemaker near the heart increases the pumping capacity of the heart and thus, restores the normal functioning of the organ.

Heart transplant: In some subgroups, which is very rare, patients suffer from a left bundle branch block (lbbb) and hence, fail to respond to the conventional treatment. When none of the treatment provides useful results, the only feasible option left is to undergo a heart transplant.

Prognosis

The prognosis of the heart failure depends on the underlying cause of the condition, risk factors and the co-morbidities. Although the patient shows improvement after the treatment, the efficacy of the heart is reduced, which cannot be reversed at any cost. It means that the capacity of the heart to pump blood is less as compared to earlier and that the patient has to live with it for the rest of the life.

If the patient had suffered a heart attack earlier in his life, then the chances of prognosis are severely reduced because the heart muscles are already damaged due to the prior attack and a scar is left on the heart. The chances of reversal of the condition are 3 - 35% in such cases.

The risk of remission of the disease is around 50 - 55% in case of angioplasty. However, there have been instances where people survived with reduced breathing capacity.

The long-term prognosis of heart failure is awful in the case of medications, as the patients can lead a normal life only for 4 - 5 years after the treatment.

If the exact cause of the heart failure is known and corrected with treatment, then the survival chances can be improved, and heart failure can be reversed.

Prevention

You can lower the risk of heart failure by carefully monitoring the factors that increase your risk of heart failure including co-morbidities.

Quit smoking: As smoking is known to clog the arteries and hamper the normal flow of blood, if you are a smoker, cessation of smoking should be first on your to-do list to lower your risk of heart failure.

Go for a regular blood test: It is important to keep a tab on your blood cholesterol, iron and hormonal levels to further lower your risk fo heart failure. According to experts, high cholesterol levels, low iron content in blood (anemia) and imbalance of thyroid hormones can put you at risk of heart failure.

Maintain an active lifestyle: One of the key reasons for a drastic increase in lifestyle diseases like diabetes, obesity, heart disease and hypertension is a sedentary way of life. Whether you are overweight/obese or not, make it a habit of exercising at least 30 minutes every day for better heart health.

Relieve stress: The most common cause of heart disease, stress can increase your risk of heart failure as it can trigger the production of stress hormones, which can lead to heart disease. So it's better to meditate or calm your mind when stressed or after a long day at work by indulging in a hobby.

If you already suffer from a heart disease, have a low pumping capacity pumping or have a valve problem, here are few tips you need to keep in mind to prevent heart failure.

Restrict salt intake: Whether you suffer from hypertension or not, salt restriction is a must. Ensure that your daily salt intake should not exceed three grams. This also means cutting down on packaged foods, pickles, papads and junk food.

Limit your water intake: Yes, this might come as a surprise, but excessive intake of water or fluid can increase the pressure on the heart. The liquid that you drink gets absorbed in the stomach and starts to circulate in the bloodstream, causing the blood to enter the heart. This causes the heart to absorb the fluid (blood) thereby further increasing the pressure on the already overloaded pumping organ.

Increase fluid output: As increased fluid intake can lead to cardiac complications by overloading the heart, it is recommended to increase the liquid output to lower the risk. To do so, you need to take medications such as diuretics or vasodilators to increase the urine output. But remember to consult your doctor before taking any medications and never self-medicate, as it might worsen your condition.

Keep your weight under control: You can prevent your risk of heart attack or heart failure by keeping your weight under check. In some cases, people tend to gain weight (as much as 5 kg) within a month or two due to fluid accumulation and thus, experience symptoms of heart failure. To prevent such complications, it is a wise idea to measure your weight every week.

Go for a routine health check-up: If you suffer from a heart disease or already had a heart attack or have any co-morbidities, consider consulting a physician every three to six months. It helps to monitor your health and ensure that everything is under control.

 

The content has been verified by Dr Santosh Kumar Dora, Cardiac, Cardiologist, Electrophysiologist and arrhythmia specialist, Asian Heart Institute, Mumbai.

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