Management of heart failure requires an integrated approach comprising of regular medical intervention, diet and exercise
Our heart is the strongest muscle in the body, and it beats continuously during our life span. We attach little priority for its healthy functioning. Heart failure is something that is not known to most of us. Therefore, even if we have symptoms of heart failure, we tend to overlook any signs and do not take cardiologist’s opinion.
Heart Failure is gradual weakening of heart muscle resulting in reduced pumping of blood. However, many-a-times, heart failure is confused with a heart attack. A heart attack is the sudden stoppage of the heart’s blood supply. If a heart attack is not managed within the golden hour, it will gradually lead to heart/cardiac failure. The threat of heart failure, engulfing larger population, is becoming a stark reality and it is evident from the rising mortality rate of more than twenty percent, if left untreated. India is witnessing ten-year younger patients of heart failure as compared to the global average age.
Dr Ajay Bahadur, Sr. Consultant and Head – Cardiology, Apollo Medics, Lucknow expressed his concern about rising patients of heart failure and said that almost sixty-five million people, worldwide are suffering from heart failure, and fifty percent of these people will die in the next five years, if not treated in time.
The developing scenario makes it incumbent upon the society, to spread awareness of the emerging threat of heart failure, about its likely causes, symptoms, management, and treatment. To take this forward, Beat Heart Failure, an initiative by the Times of India in partnership with Novartis, took this responsibility of educating common people of India about heart failure, its management and treatment. The leading hospitals from all over the country have joined to enlighten and share knowledge about living successfully with heart failure.
Doctors from Apollo Medics Hospital, Lucknow, have added strength to the ongoing campaign by agreeing to address the concerns of the people on heart failure and apprise them about integrated management of heart failure treatment comprising regular medical intervention, diet, exercise and much more.
We appreciate the initiative taken by TOI and will remain sincerely invested as proud partners in all such initiatives. And as one of the leading cardiac super specialty hospitals in Uttar Pradesh we stand committed to better super specialty heart care for all – By Dr Mayank Somani, MD & CEO, Apollo Medics – Lucknow
The doctors who joined the discussion were-
- Dr Ajay Bahadur: Sr. Consultant and Head – Cardiology
- Dr Vijayant Devenraj: MCh – CTVS
Heart failure is the heart’s inability to pump blood sufficiently to the whole body to meet its needs for proper functioning, expressed Dr Bahadur. It may be due to various factors such as Coronary Artery Disease (reduction in the blood supply of the major vessels of the heart), Valvular heart disease (damaged valves of the heart), Congenital heart disease (inherent birth deficiency), Rheumatic heart disease (damage to the heart due to inefficiently managed throat infection) and Cardiomyopathy (weakening of the muscles of the heart).
The heart failure can be acute that develops suddenly or chronic that happens over a period, said Dr Devenraj. The current propensity of younger population, in India, of getting afflicted with the heart diseases, may be attributing to the rising number of youngsters suffering from coronary artery disease, which was once thought to be affecting people above fifty years of age. In addition, rheumatic heart disease continues to be endemic in our country, and the prevalence of various infections, especially the most recent challenge of coronavirus, are turning out to be contributory causes.
Doctors determine the capacity of the heart through Ejection Fraction, which means how well your left ventricle pumps out blood with each contraction. Once there is a blockage, the heart gradually reduces ejection fraction, leading to ischemia of the heart muscles. A person with an ejection fraction of sixty percent, may turn into a reduced thirty percent ejection fraction after an acute episode of heart failure, where contractile power of heart is reduced.
Acute heart failure can be further divided into the critical events like massive heart attack or an infection. The critical event reduces the functioning of heart to twenty to thirty percent. Another type of acute heart failure may be due to acute decompensated heart failure which results from an underlying disease of the heart, comorbidities that weaken the heart, infection, or blood loss.
When a patient suddenly dies due to a cardiac event, it is often called sudden cardiac death or arrest. This develops due to arrhythmias (irregular heartbeat), explained Dr Bahadur.
Diabetes, hypertension, obesity, and smoking are modifiable risk factors. It is necessary to manage them, to avoid any further complications. Regular checking of blood sugar, blood pressure, avoiding smoking and daily exercise will go a long way in mitigating the threats associated with heart failure. Non-modifiable risk factors include genetic factors.
Medical sciences have progressed a lot in last decades. Multiple wonder drugs have come to the rescue of patients with heart failure. These medicines have been proven beneficial to patients and even prevented them from worsening cardiac health. The patient must be compliant with his medications. Guideline-directed medical therapies, based on global best practices, have proved beneficial to patients with reduced ejection fraction.
Management of heart failure requires a multimodal approach that includes – strictly following the prescribed medication, lifestyle management such as regular exercise, taking proper nutrients, and controlling fluid intake. Patients who are referred to heart failure clinics, have shown tremendous improvement. The heart failure clinic has a team of skilled heart failure specialists, paramedics, counselors and dietitians addressing the patient’s health.
When a patient presents to the hospital with acute heart failure, selecting the best option of treatment and unearthing the causes of heart failure is of utmost importance. If the reason is coronary artery disease, both the issues (heart failure & coronary artery disease) are addressed and treated together. It may require revascularization procedures, such as early angiography, angioplasty, bypass surgery or valve replacement surgery.
In the end-stage heart failure cases, two surgical options are the bridge to transplant (LVADS) and destination therapy (heart transplant). Left ventricular assist devices are implantable devices that help the left ventricle of the heart to pump blood. These devices are used almost frequently now. The person can live a comfortable life for a few years with these devices. A heart transplant gives a person a near-normal life, but the drawback is the lack of availability of organs.
The doctors gave a ray of hope in the management of heart failure. They shared that a twelve-year-old girl suffering from heart failure due to Leptospira infection has renal failure and liver failure, but she is doing well with the available treatment. Similarly, a boy of twenty-four years has heart failure due to typhus infection, but it is entirely reversible with the treatment.
Prevention is better than cure. If a person shows risk factors of developing heart failure, then regular screening, investigations, follow-ups with the physician are necessary for early diagnosis and treatment. Management of blood sugar levels, blood pressure levels and cessation of smoking will go a long way in ensuring healthy living. It is essential to increase awareness among the general population about the likely symptoms that include shortness of breath, rapid changes in weight, disturbed heartbeat and swelling in ankles, feet, leg or tummy besides importance of healthy living.
Remember, heart failure isn’t about stopping. It’s about starting life in a new way. To know more about how to manage heart failure, visit https://www.toibeatheartfailure.com/patientguide.php
“The views and opinions expressed in the article by the panelists/experts are based on their independent professional judgement and are disseminated in public interest. These views should not be considered as a substitute for professional advice of a registered medical practitioner. The purpose of this article is not to promote any medical procedures or medication and/or recommend a certain doctor. For any specific health issues, please consult your registered medical practitioner. BCCL, its Affiliates and its group publications disclaim any liability for the accuracy or consequences flowing from adherence to their expert views.”