Heart Failure

The function of the heart is to take deoxygenated blood in and pump out the oxygenated blood to the rest of the organs. In the case of heart failure, the heart fails to pump the amount of blood that it normally pumps. Certain conditions like hypertension or narrowed coronary arteries due to cholesterol deposition weaken the heart walls over a period due to which the blood is not pumped efficiently.

The conditions that cause heart failure are not all reversible. However, treatments are provided to improve the signs and symptoms of heart failure.

Heart failure is usually related to other condition or disease that may include the following:

• Coronary artery diseases: This is a condition in which the coronary arteries are narrowed or get blocked
• Congenital heart defect: A defect that is present from birth can affect walls of the heart
• Heart attack: When a heart attack occurs, the blood supply to the heart is stopped which may lead to heart failure
• Cardiomyopathy: This is a condition in which the heart muscles weaken due to reasons like infections, drug or alcohol abuse, genetic issues.
• Other conditions: Other medical conditions like high blood pressure, diabetes, kidney disease, thyroid problems and heart valve disease may lead to heart failure.

Lifestyle changes like weight management, exercising and avoiding alcohol and drug abuse are vital, which needs to be avoided

Symptoms of Heart failure

Heart failure can be a chronic (ongoing) or acute (sudden) condition. The symptoms of heart failure include:

• Shortness of breath on exertion followed by shortness of breath even at rest
• Paroxysmal nocturnal dyspnoea or PND, i.e. shortness of breath and coughing that usually occurs in the night
• Easy fatigue and tiredness
• Pedal oedema i.e., accumulation of fluid in the feet or lower legs that increases in the evening time
• Intermittent chest pain
• Increased frequency of urination at night
• Stomach pain
• Loss of appetite
• Indigestion
• Dry cough
• Giddiness

Diagnosis of Heart failure

A number of clinical symptoms and lab investigations help in the diagnosis of heart failure. The clinical signs of heart failure are:

• Tachycardia: abnormal rapid heart rate
• Pulse alternorme (alternate pulse is weak)
• Pedal oedema
• Cold periphery
• Cardiomegaly: an enlarged heart that may lead to abnormal heart rhythms
• S3
• Constrictive defect

Further lab investigations suggested are:

• 2D Echo: to investigate the left ventricle function, pulmonary arterial hypertension (high blood pressure of lungs) and inferior vena cava plethora (lack of collapsibility)
• Blood tests: Haemoglobin (to check for anaemia), elevated B-type natriuretic peptide (BNP) or N- terminal pro-b-type natriuretic (NT pro-BNP) to detect, diagnose or evaluate the severity of heart failure.
• ECG (Electrocardiogram): To give an idea about conduction defect and changes due to a heart attack.
• Chest X-ray: To view the condition of the heart and lungs. 2D echo provides details about the size of heart chambers, pumping function of the heart, any leakage of valves, lung pressure and presence of fluid. Other tests suggested are CT – Scan, MRI, Coronary angiogram, Myocardial biopsy and stress test.

Treatment of Heart failure

After the diagnosis of heart failure, various non- pharmacological and pharmacological measures are suggested to the patient. A change in lifestyle is recommended to the patients diagnosed with heart failure. Weight management, exercises that do not cause physical strain, drug and alcohol abstinence, reduction in intake of salt and restrictions on fluid intake are suggested. Other methods of treatment include:

• Medication: Medicines like diuretics help attain frequent urination, so that fluid is not retained in the body are suggested. Medications to improve the heart pumping function and reduction of load on the heart are prescribed by the cardiologists.
• Surgery: Depending on your medical history and current status, surgeries are performed to improve the heart pumping function. Coronary bypass surgery and heart valve replacement or repairs are the types of surgery performed. With various trial and encouraging results, heart transplants are also a preferred method of treatment
• Implantable devices: Implantable Cardioverter Defibrillators (ICDs) help in providing a direct shock treatment through pacemaker, whenever an abnormal rhythm is detected. Cardiac resynchronisation therapy (CRT – P/D) is used in which by programming a pacing device, the heart is stimulated mechanically to establish the synchronisation of heart-pumping functions.

Dr T Pramod Rao
MD, DNB (Medicine), DM (Cardiology)
HOD & Sr Consultant – Department of Cardiology
OMNI Hospitals, Kukatpally