Heart failure is a serious public health concern, therefore it becomes important to know what it is, how to prevent, diagnose, and manage it. Heart failure is a condition which is caused either by ineffective pumping or inadequate relaxation of the heart. It is the culmination of various other diseases, says Dr Sunil Kumar, consultant, Interventional Cardiology, Columbia Asia Hospital Hebbal. “Heart failure does not mean that the heart has completely stopped working, but that its capabilities have reduced. Left unaddressed, it can lead to decreased quality of life and complications like irregular heart rhythm (arrhythmias), recurrent hospitalisations, and sudden cardiac death. There are different stages of heart failure and treatment is focussed on slowing its progression into advanced heart failure,” mentions Dr Divya Marina Fernandes, Interventional Cardiologist, Aster RV Hospital, Bengaluru.
“Heart Failure has a 50% mortality rate in five years. 30% of deaths in the US and 33% of deaths in India are due to heart failure alone. Majorly, there are two types of heart failure, preserved ejection fraction and reduced ejection fraction. In India growing cases of heart failure is of preserved ejection fraction. The reason for rising heart failure in India is due to increased hypertension. Earlier there was a myth, weak heart leads to heart failure which isn’t correct,” says Dr Sai Ravi Shankar, Consultant Cardiologist, Apollo TeleHealth.
Dr Kumar points out, “There are various reasons for heart failure but the most common cause is heart becoming weak due to a previous heart attack. Other causes are the development of blocks inside the heart which causes weakness of the heart without causing any heart attack, viral infections which affect the heart muscles, nutritional problems like thiamin and selenium deficiency, uncontrolled diabetes, thyroid problems, excessive alcohol intake, persisting cardiac rhythm disturbance, and uncontrolled hypertension for a long time. Rarely heart failure can also occur due to stress, which is called stress cardiomyopathy.”
“Heart failure is often connected to lifestyle factors, therefore it is important to follow a healthy diet and lifestyle from a young age. Management of diabetes, obesity, and hypertension is of utmost importance. A healthy diet with lots of vegetables, grains, pulses, lean meat, sufficient hydration, supported by cardio exercises such as walking, jogging, swimming, playing sports, etc, basically any activity that gets the heart rate up is good to maintain a healthy heart. Fluid and salt restriction is usually advised for these patients. Unhealthy fats, salty and oily foods, excessive consumption of sugar, alcohol and smoking among others can all damage the heart over the long run, so it’s best to quit these as soon as possible, adds Dr Fernandes.
TREATMENT OPTIONS FOR HEART FAILURE
Dr Shankar says, “The treatment for heart failure has stages. First is identifying and treating the cause. The major cause for health failure is heart blockage which is treated by CABC, angioplasty with stent and valve replacement. The new drugs that are proven helpful for heart failure are ARNI, SGLT2 and Beta-Blockers that have been available in India as well. The non-surgical treatments that are available in India are New Assist Device i.e ICD, CRT, LVAD, TAH (total artificial heart). These are called the bridge to transplant. If the heart patient has reduced ejection fraction we take help of non-surgical treatments before going for the surgical options. But the cost is Rs 25 lacs approximately so lots of people can’t afford it.”
Dr Ashish Agarwal, Head & Senior Consultant, Department of Cardiology, Aakash Healthcare suggests some non-transplant surgical options in heart failure:
Coronary revascularisation: This treats ischemic cardiomyopathy, the most common cause of heart failure across the world, and events it may cause, such as myocardial hibernation, myocardial stunning, and myocardial cell death. For patients with ischemic cardiomyopathy, coronary revascularization should be the first treatment modality.
Mitral reconstruction: This treats mitral regurgitation (MR), a common event in heart failure patients. Along with another surgical intervention termed percutaneous mitral valve repair system, MR can better restore left ventricular remodeling, and gives patients a better quality of life.
Stem-cell regeneration of myocardium: The process replaces myocytes lost from the injured cardiac region and is a viable nontransplant treatment for heart failure. The myocardium could be regenerated by injecting stem cells such as peripheral blood stem cells, skeletal myoblasts, and bone marrow stem cells, into the damaged heart.
Geometric ventricular reconstruction: This is another nontransplant surgical means to treat heart failure.
PRE-EXISTING CVD, COVID-19 AND RISK OF HEART FAILURE
Are patients with pre-existing cardiovascular disease infected with Covid-19 at higher risk of heart failure? Dr Shankar replies, “Patients with Covid-19 and pre-existing heart disease can lead to more heart muscle damage which eventually weakens the heart, the virus can lead to more blockage in the heart, heart rate irregularity, and sudden cardiac deaths. The people with heart disease should take utmost care, that is wearing a mask, sanitising, and social distancing followed by regular medications and immediate consultations with the doctor in the case of an emergency. Also, Covid-19 vaccine is proven to be safe for heart disease patients.”
Dr Agarwal opines, “People with pre-existing cardiovascular disease (CVD) are more likely to have a more severe form of the infection. It may lead to heart failure as their hearts are weaker than normal. However, not all CVD patients who contracted Covid-19 have died, many have recovered as well.” He suggests one should take precautions to not get infected by Covid-19 such as wearing a mask, maintaining the medicine schedule, avoiding outside exposure unless mandatory, washing hands, and maintaining social distancing.
Ways to lower the risk of heart failure
Heart failure risk can be reduced if we address and treat the risk factors effectively. Since the most common cause of heart failure is heart attack, reducing the risk of heart attack will help in reducing the risk of heart failure. Some of the measures to do so: · Having a healthy diet (low calorie and low-fat diet) · Regular exercise · Effective management and treatment of the risk factors such as diabetes, hypertension, and high cholesterol levels · Taking medications and regular check-ups · Nutritional deficiency can be treated with a healthy diet. If there is any cardiac rhythm disturbance, consulting the cardiologist and treating them would reduce the risk of heart failure.—By Dr Sunil Kumar, consultant, Interventional Cardiology, Columbia Asia Hospital Hebbal