One of the other common but serious cardiac illnesses is heart failure. The heart works as a muscular pump to circulate blood to all parts of the body. If the heart is unable to pump or fill enough blood to meet the needs of the body, it is called heart failure. There are different ways we could classify heart failure, but the most common classification is based on the pumping function of the heart (called Ejection Fraction or simply EF).
If the pumping function is decreased, it suggests weakening of heart muscles and it is called systolic heart failure. Another type of heart failure is due to stiffening or poor relaxation of heart muscles and the heart cannot fill with blood properly. This is diastolic heart failure. Treatment options for both these types of heart failures are very different and usually an echocardiogram (ultrasound scan of the heart) is necessary to differentiate, as symptoms and signs are indistinguishable from one another.
The most common cause of weakened heart muscle is coronary artery disease (blocked heart arteries). Apart from high blood pressure, there is a long list of disorders which could cause heart failure. In some cases, even after extensive investigations, a specific cause cannot be found. If the weakening is due to blocked heart arteries, opening the blockages by stenting or surgery could result in improvement in heart function and symptoms.
Common symptoms from heart failure include bilateral leg swelling, shortness of breath, early fatigue, and many more. Diagnosis is usually made at bedside from clinical examination, but nowadays echocardiogram and blood tests (BNP) can be helpful. In most scenarios, further testing like electrocardiogram, chest X-rays, stress testing and/or heart catheterization may be necessary. Sometimes, a MRI of heart is performed to identify the cause for the heart failure.
Management of heart failure is complex and has multiple aspects. Simple changes like decreasing salt and fluid intake, checking body weight every day and regular exercise may help symptoms and prognosis. One of the main issues with heart failure is fluid overload, so diuretics (medicines to increase urine output) remain as the mainstay of treatment. There are medications (beta-blockers, ACE inhibitors and others) which can help improve the heart function and are routinely prescribed in patients with weak heart muscles (systolic). Role of these medications in patients with stiff heart muscles (diastolic) is not well proven.
Patients with very weak heart muscles (less than 35% function) are at a higher risk of sudden death due to abnormal heart rhythms. We recommend defibrillators (ICD) to be implanted to increase survival. These devices can keep track of the heart rhythm and provide an electrical shock when dangerous heart rhythm occurs. There are also specialized pacemakers (CRT-D) which can be used in specific group of patients which may improve heart function.
Management of advanced heart failure patients is expanding rapidly and mechanical implantable heart pumps are available, which helps the failing heart to pump adequate blood. Heart transplantation is available for patients with severe refractory heart failure. Close follow up with your cardiologist would be a key factor in successful management of heart failure.
Dr. Vijaiganesh (VJ) Nagarajan
Interventional Cardiologist
OakBend Medical Group
Read about Dr. VJ here.
Disclaimer: The contents of this article, including text and images, are for informational purposes only and do not constitute a medical service. Always seek the advice of a physician or other qualified health professional for medical advice, diagnosis, and treatment.
