Heart Failure

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Understanding Heart Failure

Heart Failure occurs when the heart muscle becomes impaired. This results in the obstruction of the normal heart functions and/or severely limits the ability of the heart to pump sufficient blood to the different parts of the body. Heart failure also interferes with the kidney's normal function of eliminating excess sodium and waste products from the body. As a result of this, the body retains more fluid, resulting in swelling of the ankles and legs. There can also be fluid collection in the lungs causing shortness of breath. The changing fluid dynamics of the body in heart failure can also affect the kidneys and the liver. The condition can develop gradually or can manifest all of a sudden. It can affect people of all age groups and is not gender-biased in any manner.

Heart failure is a major public health concern and is one of the most recognized but hidden problems in our country. It is estimated that more than 3 million cases develop every year. Approximately 70 percent of heart failure cases are the direct result of damage to the heart from coronary artery disease.

Through a comprehensive treatment program, education, and rehabilitation, heart failure can be successfully treated and managed. The Heart Transplant Program at Gleneagles Global Hospitals is designed to meet the challenge of caring for this growing population of heart failure patients. This comprehensive program focuses on improving patient quality of life through medical treatment, vital education, and support services.

Understanding Heart Failure

Patients who are diabetics or elderly or who have undergone procedures like Bypass Surgery or Angioplasty or CRT device or Pacemakers should suspect heart failure if they have shortness of breath, swelling in the leg, or wheezing. Such patients are recommended NT Pro BNP blood test and ECHO scan.

Yes, surprisingly one of the most common associations of heart failure nowadays is in coronary disease patients who had angioplasty for previous heart attacks or bypass surgeries or had pacemaker/ CRT devices implanted. This is only an association and has many causes such as re-block of an artery, or graft after angioplasty or bypass surgery. This problem is more common in patients aged over 40.

This is more common in younger patients. There is a varied group of idiopathic illnesses called Cardiomyopathy. Cardiomyopathy means degenerative disease of the heart muscle. This has various causes numbering in hundreds. For example, post child delivery, some young women develop a debilitating heart muscle disease called Post-Partum Cardiomyopathy. This can progress rapidly to death if not treated. Another reason is viral illness of heart muscle called Myocarditis leading to dilated cardiomyopathy. Other causes are cancer chemotherapy drugs, alcohol abuse, familial causes, etc.

One common early treatment, employed by physicians is to start patients on diuretics like LASIX. This just masks the illness by reducing leg swelling and body fluids. Diuretic treatment for heart failure does not treat the root cause of the problem. It increases the chances of patients having a kidney dysfunction and causes low potassium and sodium levels in the body. More depressingly, use of diuretics masks the external signs of the illness and gives patients a false sense of relief.

The best way is to be guided by biomarkers, such as NT pro BNP and ECHO cardiography. If kidney function is normal, the advised drugs are Nephrolysin Inhibitors (Sacubutril), ACE Inhibitors, ARB and Beta Blockers . But if kidney function is deranged, and BNP is high, then the patients should be given a short course of Injectable drugs like Milrinone which improve kidney congestion.

Treatment Approaches

Injection Milrinone is one of the most underused drugs for advanced heart failure in India. The awareness for this wonderful drug is limited, probably due to its high cost.

Non-invasive therapies like external counter-pulsation (EECP) is an FDA approved Option especially for Heart failure with narrowed thin coronary arteries (not suitable for bypass surgery or angioplasty).

Yes, many patients develop weakness of right side of the heart and such patients get sicker more rapidly and tend to develop liver and kidney dysfunction plus abdominal swelling (ASCITES). Many such patients have high lung blood vessel pressure called Pulmonary Hypertension.

Heart failure in children is again common and seen especially after surgeries for congenital heart disease and also due to cardiomyopathy in infants and young.

In advanced heart failure, who are what is called INTERMACS grading less than 4 - Only long-term options are heart transplants and LV pumps called LV assist devices.

Such patients generally need Inotrope Injections like Milrinone, Dobutamine. Next level is an aortic balloon pump. If they are very sick they will need short duration mechanical heart assist in the form of ECMO pumps.

What Causes Heart Failure?

Heart attacks are the most common cause of heart failure. A heart attack results in the complete blockage of blood supply to a certain part of the heart, resulting in the death of cells in that part. Over the course of time this results in increased pressure on the remaining heart muscles, resulting in heart failure.

The coronary artery disease is a very common heart condition. The narrowing of the arteries is caused by the build-up of plaque and fats in the arteries and causes disruption to the flow of blood and can cause a sudden heart failure. The blockages typically build up over years and therefore can be very hard to detect in the early stages.

Blood pressure, is typically the rate of blood flow through the blood vessels and the resistance the blood vessels offer in return. High blood pressure can be a result of either excessive blood pumped by the heart or narrowing of the arteries. Over the course of time this results in increased pressure on the remaining heart muscles, resulting in heart failure.

Congenital heart diseases refers to all the different heart disorders or conditions caused by defects present at the time of birth. The common congenital heart conditions would be deformities of the chambers of the heart causing mixing of the pure & impure blood leading to lower levels of oxygenated blood in the body.

Valves in the heart stop the flow of blood in the wrong direction. People with valve defects experience internal leakages of blood and/or narrowing of the valves. In both cases there is excessive pressure on the heart to keep pumping blood in the correct direction.

What are the Different Types of Heart Failure?

Acute heart failure is a condition that rapidly develops over a short span of time and affects the heart's ability to pump adequate amount of blood to the different parts of the body. The condition could be either caused by the weakening of the heart muscles with advancing age or by the narrowing of the arteries, blocked due to cholesterol.

Chronic heart failure is a condition that reduces the heart's ability to pump adequate amount of blood to the different parts of the body. The condition develops gradually over a period of time and caused due to the weakening of the heart muscles. It is a lifestyle condition and can be well managed or avoided altogether with good lifestyle practices.

The left side of the heart pumps blood to the body and the weakening of left chamber reduces the heart's ability to pump adequate amount of blood. The failure could be diastolic or systolic.

The right side of the heart pumps blood to the lungs and weakening of the muscles on the right hand side causes malfunctions in the blood flow to the lungs. This could be caused by heart attack or valve damage.

This is a common occurrence of heart failure with heart chambers in either side of the heart equally affected.

How is Heart Failure Diagnosed?

This is the first step of diagnosing a heart condition. Study of the past medical history and present physical condition helps the doctor understand the possibility of you developing a heart failure. Understanding your lifestyle pattern, checking basic vitals etc., would form a part of this diagnosis.

An ECG helps determine the electrical activity in the heart and its beating rhythm. The ECG could potentially reveal problems with the heart rhythm, possible heart enlargement and patterns of blood supply.

An EEG employs ultrasound waves to examine the condition of the heart, its functioning and the condition of the valves.

Blood for the diagnosis of heart failure will seek to check for anemia, kidney or liver problems, thyroid function and the levels of natriuretic peptides. Higher levels of natriuretic peptides can potentially cause heart failure.

A chest x-ray and/or a cardiac MRI are employed to detect possible heart failure. A chest x-ray helps the doctor, understand the size, placement & condition of the heart. The cardiac MRI will provide detailed images of the heart & blood vessels.

What are the Symptoms of Heart Failure?

Shortness of breath is a common symptom experienced by those suffering from heart failure. It is the result of fluid accumulation & congestion of the chest.

Due to the reduced amount of blood flow to the limbs, there is a reduced amount of oxygen & nutrition available to the muscles. Hence, the excessive tiredness & fatigue.

Swelling of the limbs is another common symptom of heart disease, caused by the excessive accumulation of fluids in the body.

The loss of muscles in the heart results in the healthier muscles trying to compensate by working harder. This causes increased heart rate and irregular heartbeat.

Excessive fluids accumulation can cause you to feel full and thereby the lack of appetite. Fluids in the liver or other abdominal organs can leave a nauseous feeling.

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