Heart Failure and comorbidities
Prevention is definitely better than cure when it comes to matters of the heart, and a little care and knowledge can go a long way in ensuring this
Heart failure' these two terms can strike fear into anyone's heart. But is it truly the death sentence it is made out to be?
To dispel myths about this diseaseand educate people on ways to avertit, The Times of India launched the Beat Heart Failure' initiative in partnership with Novartis. The mission engages with stakeholders in healthcare who share their expert opinions on diagnosis, prevention, management and treatment.
Kicking off its 4th leg, the campaign recently spoke to doctors from Jaipur's Eternal Hospital (a unit of Eternal Heart Care Centre & Research Institute). They discussed various aspects of heart failure and its relation to existing co-morbidities - Dr Jitendra Singh Makkar, HOD & Director, Cardiology & Electrophysiology; and Dr Sanjeev Sidana, Associate Director- Cardiology.
Contrary to popular misconception, heart failure and heart attackare distinctive ailments. Heart failure is a gradual weakening of the heart muscle, while heart attack is sudden stoppage in blood flow due to a blockin the arteries.Explaining it further, Dr Makkar stated that the heart's function is to pumpblood to all organs in the body as required. Its inability to do so is heart failure.However, if diagnosed early, recovery is definitely possibleand the patient can survive several decades with proper treatment.
When the heart is unable to pump enough blood, the body compensates for this inability, which leads to increase in pressure and reduction in output. Inadequate supply of blood to the lung, can lead to lung congestion, which results in breathlessness. The reduced lung performance can result in weakness and inability to perform work. So, the three significant yet common symptoms of heart failure are swelling of the ankles, breathlessness and fatigue.
Dr Sidana believes that it is pertinent to address heart failure especially in the backdrop of existing co-morbiditieslike diabetes or hypertension. Since these can eventually lead to heart failure, lack of awareness about these conditions could result in delayed treatment. This invariably requires surgery, or could cause death.
Incidentally, most heart ailments develop over-time. A person might not suffer a heart attack even with 70% to 90% blockage, though they might display symptoms like chest pain during any activity.
Dr Makkar pointed out that while patients with co-morbidities are more vulnerable to heart failure, its incidence also rises with age. This could well include diabetes, smoking, a sedentary lifestyle, obesity or hypertension.
Many young diabetics are also suspectable to heart failure. Though there is a correlation between diabetes and heart failure, but not all diabetics will suffer from disease, as this depends on how well they manage their condition.
Dr Makkar also noted that high cholesterol (LDL) is most strongly associated with heart attack. Total cholesterol above 250 is considered high cholesterol. And an LDL count of over 100 is bad news even for people with normal overall cholesterol reading. While those with diabetics should ensure it is less than 70.
This is whyhe urged people to get lipid profiling and recommended life style modifications for patients with borderline LDL counts, which can bring it under control within six months. Only when this fails, patients are put on medicines.
Another perilous co-morbidity that Dr Sidana pointed out is hypertension. Here the heart is forced to do the heavy lifting, putting it under significant strain and heart has to pump more blood, causing heightened pressure. As the load increases, the left ventricle might initially compensate. However, soon it could lead to hypertension, resulting in heart failure.
Smoking and obesity arethe other major risks for heart failure.A non-smoker with 50% blockage in their arteries can increase life expectancy by 50% to 70%. However, smoking will add to the deposits in the compromised artery, increasing the likelihood of clots, which will result in a heart attack.
Heart failure has four stagesand the ideal scenario is when there is no damage to the heart muscles. In such cases, if the blood pressure is normalised, diabetes brought under control and the patient adopts a healthy lifestyle, itminimises the chances of heart failure.
The major risk factor in Stage 1 ishypertension, diabetes, obesity, smoking or family history. Since the patient is asymptomatic, they are often oblivious about any heart failure issues. It is regularly diagnosed during the investigation of another ailment, when the doctor might detect structural heart disease, changes in the heart, some muscleor arteries, which could lead to heart failure.
Dr Makkar stated that the patient is symptomatic in Stage 2 and displays signs like severe breathlessness, swelling in the ankles, and inability to sleep in the night. These are important symptoms, and treatment can be started at this stage. If left untreated, patients might need to be admitted to a hospital, which can be classified as Stage3.
Stage 4 is when medicines stop working and the patient goes into refractory heart failure. With the help of advancement in medical sciences, it is not difficult to treat, even though it might need interventions like heart transplant.
Currently, there are many treatments to deal with the condition, but timing plays a critical role. The first three hours are golden for patientswith blocked arteries and muscle damage to regain many functions. While some muscles might be damaged, heart failure still can be reversed by therapies, like cardiac remodelling, stated Dr Makkar.
Revolutionary medicines too have proven their efficacy in reducing heart failure, and related deaths. Patients need to continue taking these throughout their lives to ensure better recovery.
Doctors recommend that patients with heart failure should consult their doctor about the four drug classes used for its treatment and whether they are receiving itin appropriate doses. A healthy lifestyle is the best safeguard against heart failure, where it can be controlled in the first stage itself.
If medication is started early on, it can prevent escalation to the later stages of the disease. For later stages, devices can be easily implanted to help the patients. If that too fails, then heart transplant is practical, feasible and easily accessible process. Hence, patients have little reason to lose hope.
Remember, heart failure isn't about stopping. It's about starting life in a new way. Heart failure can be managed with regular treatment and right lifestyle modifications.
Disclaimer: 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.
