Our heart is a pump designed to beat endlessly throughout our life without a break. Due to poor lifestyle choices, associated co-morbidities, aging, or infections, the heart muscles may either weaken or get damaged. This weakening of the heart muscles is known as heart failure. In India, heart failure patients are ten-year younger compared to the global average age. We need to understand and talk about heart failure, its causes to restrict the rise in mortality rate. Dr. Vivek Jawali, Chairman, Department of Cardiovascular Sciences, Fortis Hospital, Bangalore showed his concern on the rising cases of heart failure and said -”
The number of people with heart failure (weakened heart muscles) is increasing in India, and they should follow up with the experts, in major hospitals for treatment guidance, right from the early stage. The family physicians can be remotely guided by these seniors on appropriate management. The success rates are much superior when the treatment is as per the national guidelines.” To spread awareness around heart failure, its management, and treatment, The Times of India in partnership with Novartis launched the initiative called Beat Heart Failure. The initiative has been running successfully for the last two and a half years and is currently in its fourth phase. Top cardiac teams from leading hospitals in the country have taken part in the initiative. Doctors from the prestigious Fortis Hospital, Bangalore have also joined the initiative, to enlighten the common people about the causes, treatment options, medical, surgical, and lifestyle interventions to manage this progressive disease.
The doctors who have joined the discussion were – · Dr. Vivek Jawali: Chairman – CTVS (Cardiothoracic and Vascular Surgery) · Dr. Rajpal Singh: Director – Interventional Cardiology & Heart Failure · Dr. Shashidhara: Director – Interventional Cardiology https://www.facebook.com/TOIBLR/videos/889953615018348 A heart attack occurs, when the coronary artery, which supplies blood to the heart, gets blocked or clogged, causing cessation of the heart’s blood supply and damage the muscles. A cardiac arrest can be defined as a sudden heart stoppage when a large chunk of the heart muscles gets affected and dies. Whereas heart failure can be due to many reasons like viral myocarditis. It can start with gradual deterioration of the heart muscles, resulting in lessening its ability to pump blood to meet the human body’s needs, explained Dr. Jawali.
The incidence and prevalence of heart failure seem to be assuming pandemic proportion in India, on account of the adoption of an unhealthy lifestyle, especially by the younger generation. Poor and unhealthy lifestyle is multiplying the adverse impact on heart muscles, in addition to the burgeoning burden of viral infection, diabetes, hypertension, and converting patients on cancer medication to become cardiotoxic.
Heart failure is a progressive disease, with significant risks of morbidity, mortality, and continuous erosion of heart muscles averred Dr. Shasidhara. Any admission or readmission to the hospital puts an economic burden and emotional strain on the patients and their families. He also added that the advances in medical sciences have provided humankind with multiple drugs, advanced therapies, including surgical options, to help patients live longer and a better quality of life.
The nature of heart failure diseases preordains holistic treatment, which is the cornerstone of establishing a heart failure clinic comprising cardiologists, nurses, pharmacists, psychologists, dieticians, and other paramedical staff to administer. Heart failure clinics chart out the administration of drugs, follow-up schedules, and referrals for appropriate device therapy at the right time. Indian guidelines for managing the disease have shown remarkable results with decreasing re-admissions, expenses, and mortality rates in heart failure patients.
Cardiologists say that the shorter the time between the occurrence of heart attack to the treatment, the greater the chance to save the lives of the heart muscles. It takes just twenty minutes to block an artery in the event of a heart attack and inflict irreparable damage, added Dr. Singh. Thrombolytic drugs (recanalize the vessels) or primary angioplasty (placement of a stent) are almost equally effective in managing heart failure in the first two hours. Beyond that time, primary angioplasty is the treatment of choice to salvage any damage or complication.
The elderly or diabetics are prone to silent heart attacks with symptoms like dizziness, gaseous issues, pain in the back, neck, jaw, or burping that a layperson does not associate with a heart attack. Many individuals do not perceive these as heart attack symptoms and presume them as signs of acidity, said Dr. Shridhara.
Dr. Jawali explained that in case of a silent heart attack, it is likely that the heart muscles are weakened or damaged, which may gradually develop into heart failure. He elaborated that the heart has two parts, the right, and the left. Suppose a patient shows up with breathlessness, it is due to the weakness of the left side of the heart that resulted in congestion of the lungs, whereas patients with weak right heart will come up with a swollen body (water logging in feet, abdomen). It is necessary to know the root cause of the development of symptoms.
The common term used, when talking about heart failure is reduced ejection fraction. Ejection fraction is the amount of blood pumped by the heart in each contraction. On average, it is sixty percent for a healthy person. As it declines, it implies that heart failure is deepening.
Innovative medical management led to reducing mortality and improving the quality of life in many patients. After a person is diagnosed with heart failure, we try to ascertain the cause and degree of reversibility by looking at an angiogram, said Dr. Singh. Appropriate drugs are recommended for optimal management of the patients after evaluation of vital functions.
The patient’s commitment is critical to ensuring revival and avoiding expensive treatment.
In case of heart failure, since the pump is weak, the preload on the pump is reduced by managing the fluid intake and taking a salt-restricted diet. The heart must pump in the vessels, and if the vessels have a small diameter, the amount of work done by the heart is increased. When the heart has to run fast to eject the blood, it may not be able to cope and eventually fail. Therefore, effective medicines are available to manage the dilatation of the vessels and address the heart’s rhythm abnormalities.
Doctors finally recommend devices, on noticing unsatisfactory outcomes from medications, but it varies from case to case. Various surgical options for heart failure are valve replacement surgery, bypass surgery, cardiac resynchronization therapy device, LVADs, and heart transplant. Cardiac Resynchronizations Therapy Devices (CRT- Devices) are a type of tiny, specialized pacemaker to manage the desynchronization in the heart. The left ventricle assist device helps the left ventricle to pump blood into the aorta and then to the rest of the body.
A heart transplant is suggested when all other options are exhausted, and the patient is not improving. Post heart transplant, the patient lives a near-normal life, and the one-year survival rate after transplant is more than ninety percent, said Dr. Shashidhara.
Dr. Jawali mentioned that there are eighty-three centers capable of heart transplants in India, and before the pandemic, India had the largest number of heart transplants in the world in a year. Tremendous improvisations in logistics have been established for the movement of donated hearts by different teams involving airlines, police, doctors, and administrators, to ensure organ reaches on time for a transplant from one center in a city to another center in a different city.
The doctors ended the discussion with a ray of hope for the patients. The patients should have a positive attitude and discipline to live a near-normal life with heart failure. Treatment options are available at every stage of the disease. A lifelong commitment is required from the patients’ side, including compliance with medications, appointments, healthy food habits, prescribed exercise control of obesity, management of hypertension, and diabetes for lifestyle management.
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 Disclaimer: “The views and opinions expressed in the article by the panelists/experts are based on their independent professional judgment and are disseminated in the public interest. These views should not be considered as a substitute for the 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.”