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Many of us have seen our loved ones complain of symptoms such as chest pain or increased fatigue in daily activities. Then a doctor performs a few tests and diagnoses heart failure. This story is repeating itself for many families across India. Heart failure is the progressive weakening of the heart muscle and is often mistaken for a heart attack. Due to their ignorance of the disease, patients do not consult doctors at the right time. Treatment begins too late, often requiring surgery with various complications and sometimes becoming unmanageable. In India, the death rate is over 20% and patients here are ten years younger than the world average.
Beat Heart Failure – A Times of India initiative in partnership with Novartis aims to raise patient awareness as patients panic and bombard the doctor with endless questions when they are diagnosed with heart failure. To explain what it is, the main signs and symptoms, disease progression, disease management, life expectancy and the impact of Covid19 on heart health and when to see a doctor if l patient’s condition deteriorates at home, doctors from BLK -MAX Super-Specialty Hospital, New Delhi have joined the initiative –
Dr Subhash Chandra (President and HOD Cardiology)
Dr Neeraj Bhalla (Senior Director in Cardiology)
Dr Ramji Mehrotra (Senior Director and Head -CTVS Cardiothoracic Vascular Surgery).
“Our body is a great miracle and our heart is designed to pump tirelessly from the very moment before we are born until the person’s death. The first signs of life are recognized on ultrasound by checking for fetal heart movement, ”explained Dr Neeraj Bhalla. Our heart is a muscular pump that must constantly contract. It receives and expels the blood. There are many reasons that can weaken it and lead to heart failure, and often it is not easily reversible but can be controlled or managed.
To simplify heart failure, Dr Subhash Chandra gave an interesting analogy. Think of a mechanical pump in the house that drains the municipal supply and puts it in the overhead tank. This tank distributes the water in the pipes of the kitchen and the bathroom. If the pump weakens, the water flow in the house is slow. The heart works the same way. It collects blood from various parts of the body and sends it to the lungs for oxygenation. The blood then returns to the heart. Then, it pumps oxygenated blood to all parts of the body. It is a muscle that can weaken for a variety of reasons. If this pump weakens, multiple symptoms result.
Whereas, when the blood flow to the heart is blocked, it causes a heart attack. The blockage is most often a buildup of fat, cholesterol, and other substances, which forms plaque in the arteries that supply the heart (coronary arteries).
In India, the main causes of weakened heart muscle are coronary heart disease due to alcohol consumption, erratic lifestyle, tobacco chewing causing premature heart attacks, genetic reasons, high fat foods, diabetes. Other causes of heart failure can be viral fevers, rheumatic disorders, or valve disorders. The most common cause is when the heart’s blood supply is compromised due to blockages. It causes the heart to activate a compensatory mechanism where it begins to beat slowly to preserve its muscles and not die.
“The heart is muscle, and muscle is life. When a person has a heart attack, part of the muscle dies if the arteries close for a long time. Therefore, it is necessary that the emerging opening of the vessels during the attack best preserves the heart muscle and prevents heart failure and subsequently the whole course of the patient. It is the golden hour after the infarction that will determine the patient’s prognosis, whether he leads a disabled or an active life. If not managed in time, it will gradually weaken the heart and cause heart failure to progress, ”said Dr Ramji Malhotra.
You have to know how much muscle is working to understand whether heart failure is reversible and whether the person can lead an everyday life. After a heart attack, the doctor does an angioplasty and an assessment of how well the heart is working through a survey called an echocardiogram (ECG). It will reveal the ventricular function of the heart and calculate the ejection fraction (the efficiency of the blood pumped by the heart).
An ordinary person does not understand the reason for their symptoms and should not see a doctor. Some of the signs and symptoms are:
1) Breathing difficulties associated with exertion, which worsen at an advanced stage or at night. Person needs more than one pillow or lies on one side. The person cannot lie on their back.
2) The patient wakes up suddenly in the middle of the night breathless, feeling suffocated while sleeping. This is a sign that tells the cardiologist that the patient may be in an emergency.
3) Increased fatigue and difficulty doing daily activities such as climbing stairs, gardening, sexual activity.
4) Swelling of the feet or compensating weight gain as the body tries to conserve fluids to increase the efficiency of the heart.
Once a person is diagnosed with heart failure, they should regularly contact their cardiologist. There have been huge advances in treatment compared to two or three decades ago. The death rate from cardiac involvement has fallen by 50%. These advances have also improved the quality of life. Cardiologists suggest regular echocardiography. The cardiologist checks the ejection fraction and therefore offers additional care whether the management of the symptoms requires medication or surgery. The treatment planned depends on the causes and extent of the heart failure. The doctor suggests having a home emergency kit for patients with low ejection fraction.
Nowadays, younger patients are seen more frequently in emergency departments with heart problems. The pandemic has resulted in worsening heart health and an increase in heart deaths. Multiple external factors further precipitated this crisis. Patients with heart disease who recover from covid are more prone to cardiac death. Various studies have shown that Covid19 increases blood coagulability (thickening of the blood), pulmonary embolism, myocarditis, etc. Stress also increased during this time. All of these factors together contribute to the increase in heart disease.
A person with a history of Sars-cov2 should have a heart exam, and people with associated comorbidities should seek medical attention at all times. People should exercise caution when resuming physical activities. After contracting Covid19, people often need to see their doctor if symptoms persist and feel tired, experience weight gain, swelling of the feet, increased urination, heartbeat, or dizziness.
There are many ways to manage heart failure. The first is to adopt a healthier lifestyle with regard to diet and exercise, weight control, avoidance of smoking and drinking alcohol, and the second is regular treatment. A lot of progress has been made in medical science and there are many treatment options available as well. Remember that heart failure is not a death sentence; this is the opportunity to change the trajectory of your health.
To learn more about managing heart failure, visit https://www.toibeatheartfailure.com/blog
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 viewed as a substitute for professional advice from a licensed physician. The purpose of this article is not to promote any medical procedures or drugs and / or to recommend a certain doctor. For any specific health concerns, please consult your licensed physician.