Heart Health: Expert Explains The 4 Stages Of Heart Failure Treatment

According to National Centre for Biotechnology Information (NCBI), incidences of heart failure are rising in India due to population, epidemiological and health transitions. This prevalence can be due to the rise in coronary heart disease, hypertension, obesity, diabetes, and rheumatic heart disease. This can be attributed to the lifestyle choices people have been making in recent past. Hence, it is important to make people aware of the ill- effects of living a sedentary life.

What do you understand by heart failure?

Heart failure also known as congestive heart failure is a chronic condition that occurs when the heart is unable to pump blood efficiently basis the body's need for blood and oxygen. Insufficient blood supply to the cells leads to fatigue, shortness of breath, and other symptoms of heart failure. In some cases, heart failure can be fatal, and it cannot be reversed. It is a progressive disease and when left untreated, can cause irreversible damage to the heart. While it is a serious condition that cannot be cured completely, the disease can be managed through medication, lifestyle modifications, procedures and therapies depending upon the stage of the disease. Medical technology has made it possible for patients with end-stage heart failure to live a normal and fulfilling life.

Risk factors and warning signs

Although heart failure is a common condition among the elderly, risk factors such as diabetes and hypertension are on the rise among young adults as well. A number of factors can result in heart failure, including diabetes, heart valve damage, congenital heart disease, hypertension, heart muscle disease, heart muscle inflammation, coronary artery disease, family history of heart disease, and a large or infected heart. There are several warning signs, including:

• Shortness of breath
• Fatigue
• Confusion
• Rapid or irregular heartbeat
• Swelling in the feet and legs
• Reduced ability to excercise
• Narrowed blood vessels
• Sleeping difficulties caused by breathing problems
• Loss of appetite

Managing heart failure across four stages

There are several ways to manage heart failure, depending on its severity with each stage:

The first stage or Stage A is considered to be the pre-heart failure phase. It generally occurs when the patient has a family history of heart disease or is suffering from a medical condition such as hypertension, diabetes, alcohol abuse etc.

Management: This stage can be managed mostly by making lifestyle modifications such as being active by exercising regularly, quitting smoking and consumption of alcohol, and treating conditions like high cholesterol and high blood pressure through medication and lifestyle measures

The second stage or Stage B is also considered as pre-heart failure. It occurs when the patient is diagnosed with systolic left ventricular dysfunction (failure or dilation of the left ventricle of the heart) with no symptoms of heart failure. It affects those with heart failure or reduced ejection fraction i.e., the volumetric fraction of fluid ejected from a chamber in the heart

Management: Stage B heart failure can mostly be treated through the lifestyle modifications undertaken in Stage A along with a possible surgery or therapy for treating conditions like heart attack, congenital heart disease, valve disease, or obstructed coronary arteries.

The third stage or Stage C refers to heart failure patients who had or currently have symptoms of the disease.

Management: As part of their treatment, measures taken in the previous two stages are combined with other procedures, depending on their condition. Beta-blockers (medications to lower blood pressure), a salt-restricted diet, implanted cardiac defibrillator (ICD) therapy, and cardiac resynchronization therapy are some of the treatments available.

The fourth stage or Stage D refers to patients with advanced symptoms of heart failure.

Management: Along with treatments for the first three stages, patients in the fourth stage may require undergoing a heart transplant, heart surgery or get an LVAD (left ventricular assist device) implanted. An LVAD (Left Ventricular Assist Device) is a mechanical pump that is implanted in patients suffering from heart failure. It helps the left bottom chamber of the heart pump blood out of the ventricle to the aorta and the rest of the body. It restores blood flow to a weakened heart.

It is important for one to follow their treatment plan strictly and regularly and take steps to prevent the disease from worsening. This along with the right emotional support and medical advice can help patients in improving their quality of life.

(Dr. Praveen K Varma, Clinical Professor, Cardiovascular & Thoracic surgery , Heart Transplantation, Amrita Hospital Kochi, Kerala)

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