Heart Failure

Heart failure is a progressive disorder in which damage to the heart results in the weakening of the patient’s cardiovascular efficiency. It is generally a chronic, long-term condition though it can sometimes develop suddenly. While the most common cause of heart failure is coronary artery disease, this condition can also occur when an infection weakens the heart muscle or due to certain diseases like diabetes or thyroid problems, due to uncontrolled hypertension, renal failure, persistent fast heart rhythms, and also due to certain drugs used in cancer treatment.

Heart failure is on the rise as the ageing population is increasing. But today there is increased awareness and better diagnostic facilities available. More cardiac patients are therefore able to survive now & live longer.

Is Heart Failure the same as a heart attack?

No. Heart failure and heart attack are quite different from each other. Heart failure is not a disease by itself but a constellation of various signs and symptoms caused by a wide variety of disorders that include valvular, heart muscle, pericardial (covering heart’s layer) as well as other non-cardiac diseases. The beginning and severity of heart failure symptoms depend on the nature of the underlying heart disease.

How severe and life threatening is heart failure?

Heart failure may be sudden [acute] or maybe over a period of time (chronic). Heart failure can occur when the heart’s lower left chamber (left ventricle) is not able to fill with blood properly during the diastolic phase (when the heart relaxes and fills with blood), thus decreasing blood pumped out to the body. Systolic failure can occur when the left ventricle loses its capacity to contract normally. The heart cannot pump with enough force and push enough blood into circulation.

It becomes an emergency when the patient presents with acute heart failure and has a history of angina/heart attacks or severe high blood pressure.

Symptoms

Most of the signs and symptoms of heart failure are because of fluid collection and congestion in the legs, lungs, abdomen etc., and the inability of the heart to pump efficiently to meet the demands of the tissues and the organs in the body.

Some of the symptoms of heart failure are breathlessness, which could be an exaggerated, uncomfortable awareness of breathing. The breath does not go all the way down the lungs.

Other symptoms include:

• Shortness of breath
• Heavy breathing
• Tightness in chest
• Choking

Breathlessness may arise during exertion in the early stage of the disease, but may also occur at rest when the disease is advanced. There could be breathlessness occurring in a lying posture but relieved on sitting up. Patients usually say that they need three or more pillows to sleep comfortably at night.

This leads to Paroxymal Noctumal Dyspnoea (PND), which usually starts 2-4 hours after onset of sleep. Patients sweat a lot and develop a cough with breathlessness, which is generally relieved by getting out of bed.

Other prominent symptoms include fatigue and impaired effort capacity. Patients may also report abdominal fullness swelling of legs, nausea and loss of appetite.

Diagnosis

The physician diagnoses heart failure based on the symptoms the patients present with and the signs he observes while examining the patient.

The patient may have prominent neck veins, swelling of legs, may appear breathless, have increased the size of heart, swollen feet, enlargement of the liver, wheezing etc.

Once the clinical suspicion of heart failure is ascertained, certain tests are carried out to confirm the presence and the cause of heart failure. In a new patient with suspected heart failure, a blood test is done to assess BNP (Brasin Natriuretic Peptide]; If it is raised more than 100 Pg/ml, the possibility of heart failure is stronger. ECG and chest X-ray are routinely done and an echocardiogram reveals the function of the heart. An assessment of precipitating factors is also performed, with specific diagnostic tests to rule out reversible causes like hormonal or metabolic disturbances and infection.

Heart failure does not mean that the heart has actually stopped functioning. It simply means that the heart is functioning at a low capacity or lesser efficiency. Medical, surgical and advanced techniques can be used to treat heart failure. General measures advised to patients to control heart failure include – Rest, reduce salt intake and fluid restriction.

Treatment
The objectives of the drug treatment for heart failures are as follows : 

• Decrease fluid overload (Diuretics)
• Decrease the filling pressures within the heart (Nitroglycerine]
• Decrease the stress on the heart (Vasodilators]
• Improve or strengthen heart muscle performance (Digoxin and inotropes)
• Improve or prevent adverse changes in the heart (ACE inhibitors and AT ll blockers]
• Improve survival, decrease the need for hospitalization and prevent sudden death (Beta Blockers]
• Prevent dysrhythmia (Antiarrhythmic agents]
• Prevent blood clotting (Antiplatelets, Anticoagulants)

Drugs to treat Hypertension, Diabetes and Coronary Artery Disease are also given if required.

Surgical treatment includes coronary artery bypass graft surgery, valve surgery, surgery to restore heart size and geometry, and surgery for implantable ventricular assist devices. Heart transplantation is the last option.

Can Pacemakers help in this condition?

The loss of synchronized contraction of the right and left ventricle of the heart in heart failure patient can be rectified by implanting a pacemaker (Triple Chamber Pacemaker) that can improve the overall pumping effectiveness of the heart. This cardiac resynchronization therapy (CRT) provides symptom relief, improves survival, and decreases the frequency of hospitalization.

What happens in the case of advanced heart failure?

While the initial treatment for heart failure is with medicines, the overall prognosis for those who have moderate to severe heart failure with medicines alone is quite poor. Surgical options benefit many of these patients both in terms of prognosis and quality of life. There are several surgical and interventional options that may be considered.

Conclusion

If you are suffering from Heart Failure, with the right care, heart failure may not stop you from doing things you enjoy. Your outlook for the future depends on your symptoms, how well your heart muscle is working and also how well you respond to and follow your treatment regime.