Do Not Fail Your Heart: An Awareness Initiative

Do Not Fail Your Heart: An Awareness Initiative

This health information in Q&A format is intended for the healthy population and for the patients with heart diseases as well, to bring awareness and aid better understanding of the heart failure disease. It will not replace or substitute a clinical consultation by the patient.

What is heart failure (HF)?

Heart failure (HF) is a symptomatic disease resulting from disorder in the cardiac structure and function leading to impairment of ventricular filling and/or ejection (pumping) of blood.

What are the symptoms of HF?

Symptoms of HF include exercise limitation in the form of difficulty breathing and excessive tiredness, leg swelling and in advanced stages, breathing difficulty at rest/minimal activity, requiring propping with 2-3 pillows while asleep, whole leg and abdominal swelling/fullness, loss of appetite and weight and sleep and concentration difficulty, affecting the quality of life of the patient.

What is the importance of its timely diagnosis?

From the time point of primary index cardiac event (e.g., heart attack), heart fails very slowly with time due to additional undiagnosed/untreated secondary damage(s) (e.g., minor/silent attacks, persistent/progressive disease- coronary disease, cardiomyopathy, etc.).

The patient may remain in a state of apparent well-being (quiescent stage-no or minimal symptoms) for a longer time since the index event, even without treatment. They may notice the symptoms of HF only at the stage of advanced disease with limited potential of complete cardiac recovery, meeting the need for heart transplantation.

What are the causes of HF?

HF can occur with reduced pumping capacity (ejection fraction) of the heart as well as with hearts of preserved pumping capacity.

The former usually accompanies dilated and abnormally shaped hearts and is most commonly caused by major heart attacks (myocardial infarction) followed by disease primarily involving cardiac muscle (myocarditis and cardiomyopathy).

The latter usually has normal sized heart but with increased heart wall thickness and is associated with coexisting uncontrolled diseases such as systemic hypertension (elevated BP), diabetes, obesity and chronic kidney disease.

What are the stages in the evolution of heart failure?

What is the prognosis and the treatment options for HF?

Heart failure with reduced cardiac pumping function is effectively treatable, thanks to the addition of newer drugs in the recent past to the therapeutic armamentarium.

Safe revascularisation options (bypass surgery and stenting) help improve HF status.

Heart failure pacing (cardiac resynchronisation therapy) and shocking (implantable cardioverter defibrillator) devices have seen newer improvements that may stabilise or restore the lost cardiac pumping function and prevent the occurrence of sudden deaths.

Timely and effective utilisation of these treatment options largely avoids and delays the need for cardiac transplantation.

Whereas, heart failure with preserved pumping capacity remains largely unattended and it has no effective definite treatment options as well, the better strategy would be its prevention in at-risk patients by the control of the above-mentioned coexisting diseases. Fortunately, we have started seeing the scientific evidence of newer drugs (used in diabetes) with significant meaningful benefits in this disease category.

What are the lifestyle measures advised in these patients?

Evidence based recommendations to the patients with HF:

• Adherence to medications at prescribed doses
• Dietary salt restriction (avoidance of added salts)
• Avoidance of over-the-counter drugs (e.g., pain killers)
• Cessation of smoking and alcohol
• Prompt treatment of infection and anaemia
• Control of comorbid diseases (e.g., elevated BP, diabetes, obesity and kidney diseases, etc.)
• Safe immunisation practices (influenza and pneumococcal infections)