Heart Of The Matter: Understanding Heart Failure


Heart failure is a serious medical condition that affects millions worldwide, transcending age, profession, and social status. Renowned fashion designer Rohit Bal, celebrated for his exquisite creations on the runway, has faced a unique challenge in his personal life – a battle with heart failure. And guess what? He’s not alone on this rollercoaster. Sunil Grover and Remo D’Souza had their share of heart scares too. It’s a reminder that our hearts need some serious attention, no matter how fancy our lives may seem.

What is Heart Failure?
Heart failure is a chronic condition where the heart is unable to pump blood effectively, leading to a variety of symptoms such as fatigue, shortness of breath, and fluid retention. It can result from various factors, including coronary artery disease, hypertension, or previous heart attacks. Despite its name, heart failure doesn’t mean the heart stops beating; rather, it’s a condition that requires ongoing management and lifestyle adjustments. The 2 main types of heart failure are systolic and diastolic. Systolic heart failure is when the left ventricle fails to contract effectively, reducing the heart’s ability to pump blood. Diastolic heart failure is when heart chambers are enlarged and have difficulty contracting and relaxing.

Stages of heart failure:
Heart failure is a progressive condition that is often categorized into stages based on the severity of symptoms and the impact on an individual’s quality of life. The American Heart Association (AHA) has defined the stages of heart failure as follows:

1. Stage A – At risk for heart failure
Individuals in this stage are at risk of developing heart failure but do not yet have structural heart abnormalities or symptoms. Interventions at this stage focus on managing risk factors, such as hypertension, diabetes, and lifestyle modifications.

2. Stage B – Pre-heart failure
In this stage, individuals have structural heart abnormalities (e.g., reduced left ventricular ejection fraction) but do not exhibit symptoms. Treatment aims to prevent the development of symptoms and may include medications and lifestyle modifications.

3. Stage C – Symptomatic heart failure
Individuals in this stage have both structural heart abnormalities and symptoms of heart failure, such as fatigue, shortness of breath, and exercise intolerance. Treatment involves a combination of medications, lifestyle changes, and possibly device therapy.

4. Stage D – Advanced heart failure
Individuals experiencing symptoms of heart failure that disrupt daily activities or result in recurrent hospitalizations. Advanced interventions, including heart transplantation or mechanical circulatory support (ventricular assist devices), may be considered.

Some of the causes of heart failure are:
1. Coronary artery disease (CAD): Atherosclerosis, a buildup of plaque in the coronary arteries, can restrict blood flow to the heart muscle, leading to damage.
2. Hypertension: Prolonged high blood pressure forces the heart to work harder, causing gradual damage to the heart muscle.
3. Myocardial infarction (Heart attack): A heart attack can cause permanent damage to part of the heart muscle, affecting its ability to pump efficiently.
4. Valvular heart disease: Malfunctioning heart valves can impede blood flow and strain the heart.
5. Cardiomyopathy: Diseases that directly affect the heart muscle and result in weakening and impaired function.
6. Diabetes: Uncontrolled diabetes can contribute to cardiovascular complications, increasing the risk of heart failure.

Signs and Symptoms:
Recognizing the signs and symptoms of heart failure is crucial for early intervention. Common manifestations include:
1. Shortness of breath: Difficulty breathing, especially during physical activity or when lying down.
2. Fatigue and weakness: Persistent tiredness and a sense of weakness, hindering daily activities.
3. Fluid retention: Swelling in the legs, ankles, or abdomen due to fluid buildup.
4. Rapid or irregular heartbeat: Fluttering sensations in the chest or an irregular heartbeat.
5. Persistent coughing: Often accompanied by white or pink phlegm, signaling fluid accumulation in the lungs.

Accurate diagnosis is essential for developing an effective treatment plan. Medical professionals employ various diagnostic tests and procedures, including:
1. Echocardiogram: Uses sound waves to create detailed images of the heart’s structure and function.
2. Blood Tests: Assessing cardiac markers or specific proteins is crucial in diagnosing and managing cardiovascular conditions. Cardiac markers are substances released into the bloodstream when the heart is stressed or damaged, providing valuable information about cardiac health.
3. Electrocardiogram (ECG or EKG): Records the heart’s electrical activity to identify irregularities.
4. MRI or CT Scans: Provide detailed images for a comprehensive assessment of heart function.
5. Stress test: Measures the heart’s response to exertion, helping identify potential issues.

According to medical experts, heart failure is not always an end-of-the-road situation. When detected early enough, it can be managed and add years to your life. While it is a chronic condition, it can be effectively managed with a combination of lifestyle modifications, medications, and, in some cases, surgical interventions.

1. Medications
People suffering from heart failure may need multiple medications. The commonly used medicines include:
-Diuretics: Also known as water pills, they help remove excess water and certain electrolytes and control high blood pressure.
-ACE inhibitors: Angiotensin-converting enzyme (ACE) inhibitors widen the blood vessels, allowing the blood to flow more freely and the heart to pump blood more efficiently.
-Beta-blockers: They slow down the heart rate, lower the blood pressure, and widen the blood vessels.
-ARBs: Angiotensin II receptor blockers (ARBs) lower blood pressure and allow the blood to flow more easily.

2. Surgical Interventions
Some of the commonly recommended surgical treatment options are:
Angioplasty: Performing angioplasty to open obstructed blood vessels surgically.
CAB: Redirecting blood supply around a blocked artery through coronary artery bypass surgery.
Valve: Substituting a defective valve with an artificial mechanical valve.
Heart transplant: Conducting heart transplantation for individuals with end-stage heart failure or congenital heart disease.

3. Medical devices
-Implantable cardiac defibrillator (ICD): Designed to monitor, detect and halt abnormal heartbeats.
-Cardiac resynchronization therapy (Biventricular pacing): Aimed at coordinating the simultaneous contraction of the heart ventricles.
-Ventricular assist device (VAD): Also known as a mechanical circulatory support device,  it assists the heart in pumping blood from the lower chambers (ventricles) to the rest of the body.

4. Lifestyle modifications
Some of the basic modifications can be:
Dietary changes to reduce sodium intake and manage fluid retention.
Regular exercise tailored to individual capabilities.
Smoking cessation and moderation of alcohol intake.
Managing stress and enhancing overall well-being.
Aim for 7-9 hours of quality sleep each night to reduce the risk of heart disease.
Schedule regular check-ups with a healthcare provider to monitor overall health and address any emerging risk factors.

Final takeaway
Heart failure is a multifaceted condition that demands comprehensive understanding and management. Recognizing its causes, identifying warning signs, undergoing timely diagnostic tests, and embracing appropriate treatments empower individuals to take control of their heart health. Collaborative efforts between healthcare providers and patients are pivotal in navigating the complexities of heart failure, fostering a proactive approach to cardiovascular well-being.

(The article is written by Monalisa Deka, Senior Health Content Editor and reviewed by Dr. Rajeev Sharma, Vice President, Medical Affairs)

1. American Heart Association. Heart failure. Available online at: https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure
2. UCFS. Heart failure.  Available online at: https://www.ucsfhealth.org/conditions/heart-failure
3. British Heart Foundation. Heart failure. Available online at: https://www.bhf.org.uk/informationsupport/conditions/heart-failure
4. American Heart Association. Stages of Heart Failure. Available online at: https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure/classes-of-heart-failure#:~:text=Heart%20failure%20can%20progress%2C%20so,function%20and%20severity%20of%20symptoms.

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