Don’t be afraid of Heart failure, treatment available for every stage

Heart failure is a common complex clinical syndrome of symptoms and signs caused by impairment of the heart’s action. It is a life-threatening disease and addressing it, should be considered a global health priority. At present, approximately 26 million people worldwide are living with heart failure. The outlook for such patients is poor, with the rising mortality rate. Furthermore, heart failure places great stresses on patients, caregivers and healthcare systems. Despite the burden that heart failure imposes on society, awareness of the disease is poor. As a result, many premature deaths occur. This is in spite of the fact that most types of heart failure are preventable, if people were taught to recognize the symptoms and seek immediate medical attention, besides following healthy lifestyle. Public awareness campaigns focusing on these messages have great potential to improve outcomes for patients with heart failure and ultimately to save lives.

Understanding heart failure is the key for its management & treatment, therefore The Times of India started the initiative Beat Heart Failure in partnership with Novartis to increase awareness through multiple discussions with the expert doctors from the leading hospitals about heart failure, its management & treatment options. Cardiologists from Fortis Hospitals, Mumbai, have also joined the conversation to share their insight about heart failure, its management, including clinical evaluation diagnostic tools, essential initial investigation, and echocardiography.

“Heart failure is often confused with heart attack, or its symptoms are ignored as signs of old age or other diseases. This can lead to delayed diagnosis, and the patient might reach the doctor at an advanced stage of the disease. One must not ignore these symptoms and seek medical advice immediately. Regular health screening should be done to ensure that any possible heart disease could be diagnosed at an early stage, to ensure timely treatment.” Dr Hasmukh Rawat, Senior Consultant, Interventional Cardiology, Fortis Hospital (Mulund).

The doctors contributed to the discussion were namely:

• Dr Atul Limaye: Interventional Cardiology, Fortis Hospital, Mulund
• Dr Brajesh Kunwar: Interventional Cardiology, Fortis Hospital, Vashi
• Dr Zakia Khan: Interventional Cardiology, Fortis Hospital, Kalyan

Dr Atul kicked off the conversation by explaining that heart failure for patients and doctors is different. A patient believes that heart failure means that it has failed, but for doctors, it is a slowly progressing condition. Heart failure is the inability of the heart to pump blood efficiently to meet the body’s requirements. It can be due to coronary artery disease, heart attack, or idiopathic causes. Heart failure is also the inability of the heart to relax its muscles where it can pump blood but cannot fill completely. This can be due to long-standing hypertension of ten to twenty years where the patient has neglected his disease and not taken treatment, resulting in stiffening of the heart muscles as they age.

Our body gives early warning signs and symptoms provided we don’t ignore them, said Dr Zakia. Chest pain or exertional angina, breathing difficulty, profound fatigue or palpitation are the common symptoms in patients having blockages or early warning signs of heart failure. The symptoms manifest while they are walking, climbing stairs or after a meal, or even during the sleep.

Sometimes people feel uneasy and confuse their symptoms with dyspepsia which presents itself with sweating or vomiting while they are walking or get up during midnight. People need to take notice as they may have symptoms of heart failure. They self-administer antacids, and when the symptoms don’t resolve, they go to the hospital, but by that time a lot of heart muscles have died due to the delay, averred Dr Zakia.

On being confronted with a constellation of visible symptoms which are of progressive nature, it is critical to seek medical help and attention for early evaluation in an OPD.

The Indian subcontinent is going through an epidemic of heart attack, remarked Dr Brajesh. More and more youngsters are presenting themselves in the emergency with a heart attack. This is due to the unhealthy lifestyle and associated comorbidities such as high incidence of diabetes in India. A heart attack damages the heart, and if the patient does not reach on time, it becomes difficult to salvage the heart muscles. He added that they can be treated early if a patient visits the physician at the onset of symptoms without loss of time.

The typical symptom besides others that a heart failure patient report is that they suddenly wake up at night gasping for breath, which is clinically known as paroxysmal nocturnal dyspnoea, or orthopnea. Patients feel breathlessness aggravates when they lie down and resolves when they sit up. On further examination of the patients, it is assessed that they are more fluffed, and there is swelling on the face or limbs, even legs are also swelled. Gradually, increasing fatigue is seen in the patients, which was not present earlier.

Initial evaluation and assessment of the patient by the doctor generally helps in clinical understanding of patient’s heart function and general condition of the person concerned, said Dr Atul.

Preliminary investigations are done to determine the cause and extent of heart failure damage. Electrocardiography is done to take a record of the heart’s rhythm and electrical activity. Echocardiography and other investigations include cardiac MRI or CT, which are more detailed investigations, and are recommended to determine the extent of heart damage. CT coronary Angiogram combines a CT scan with a special contrast material to check for narrowed or blocked arteries in the heart.

A standard blood biomarker test for heart failure is NT-proBNP. If the levels are higher than average, the patient has heart failure. The higher the levels, the more serious the condition is. A positive NT-proBNP and changes in the ECG confirm heart failure, elaborated Dr Zakia.

Doctors focus on knowing the cause and administer differential treatment. The treatment generally starts with guideline-directed medical therapy and the treatment for precipitating causes of heart failure. Doctors also conduct a battery of blood tests that help in knowing any contributing deficiency. Certain medications are recommended, which are the pillars of heart failure management. Patient’s prognosis depends on the cause and extent of heart failure. Heart failure can be reversed from a decompensated stage to a re-compensated stage in most patients. The pumping function can improve and become normal, if the patients seek the right kind of help.

If the patient does not improve with medicines, the cardiologist resorts to devices. The devices include cardiac resynchronization therapy devices that are specialized pacemaker devices to help synchronize heart rhythm. In the end-stage of heart failure, an LVAD or a heart transplant is recommended.

Apart from medical management, it is imperative to educate patient about the treatment and achieving lifestyle management targets. Restriction of fluid intake or salt intake. Physical activities are also important, starting with baby steps, a six-minute walk, and gradually increasing it without putting too much pressure on the heart.

Most of the hospitals have established heart failure clinics or OPDs. They work on the principle of holistic treatment. A heart failure clinic comprises a team with a cardiologist and other heart failure specialist paramedical staff. The patient is given medical management, mental health counseling, specialized diet, and cardiac rehabilitation.

People should not get stuck on percentage of ejection fraction which is fifty-five to sixty percent for a healthy person. Even with a low ejection fraction, daily activities can be performed without any trouble, if the proper treatment is taken. Doctors shared examples of a patients with an ejection fraction of twenty percent but with the right kind of treatment have been doing well and some are even running half marathon or even full marathon.

The doctors ended the conversation with a message of hope. Don’t despair, treatment is available for every stage for vast majority of heart failure patients.

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.”