Living With Heart Failure: Risk Factors And Warning Signs

Heart failure also known as congestive heart failure is a chronic condition which occurs when the heart is unable to pump blood sufficiently to meet the metabolic demands of the tissues in the body. A weakened heart results in inadequate blood supply to the cells leading to fatigue, shortness of breath and other symptoms of heart failure. While heart failure can create challenges in daily routine activities such as walking, climbing stairs or carrying groceries, it can also be fatal in some cases and is a condition that often cannot be reversed. Heart failure develops over time as the heart's pumping action grows weaker the body tries to compensate for this with hormonal and other mechanisms initially and then the compensatory mechanisms fail and the patient decompensates with risk to life .

Heart Failure: Risk factors and warning signs

Heart failure is more common among the elderly though there is an increasing incidence of the condition among young adults as well, due to risk factors such as diabetes and hypertension which are on the rise and from viral infections causing inflammation of the heart muscle. The causes for heart failure include diabetes, valve disease, congenital heart disease, hypertension, heart attack or coronary artery disease, family history of the disease, an enlarged or infected heart. The warning signs comprise:

• Lack of energy and feeling of weakness
• Shortness of breath
• Confusion
• Swelling in the feet and legs
• Difficulty in lying down flat
• Loss of appetite

Heart attack can cause feeling of weakness and lack of energy
Photo Credit: iStock

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Living with heart failure across the four stages

The American Heart Association/American College of Cardiology (AHA/ACC) suggested a four stage classification for heart failure (Stages A, B, C and D)

Patients in stages A and B do not show any symptoms or signs of heart failure and are not diagnosed as having heart failure. Stage A is in patients who are at "high-risk" of developing heart failure due to presence of risk factors like diabetes or hypertension, without any structural heart disease. Stage B is patients having structural heart disease without any signs and symptoms of heart failure. These asymptomatic patients were included in heart failure to emphasise prevention of heart failure. Stage C would include patients who have symptomatic heart failure and Stage D would be patients who have refractory symptoms requiring advanced heart failure treatment.

Managing patients in Stage A would include lifestyle modifications like cessation of smoking, encouraging physical exercise, managing obesity and control of diabetes, hypertension, lipid abnormalities with long term medications and close follow up. Patients in Stage C will need to be treated by a cardiologist specialising in heart failure treatment and will need specific treatment for heart failure with medications and close monitoring to detect worsening early and to offer advanced heart failure therapy as they get to Stage D.

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Treatment of patients in stage C is a combination of measures undertaken in the previous two stages along with other procedures depending on the condition. These include taking a beta-blocker (medications for reducing blood pressure), other medications that slow the heart rate, restricted sodium and fluid intake, undergo implantable cardiac defibrillator (ICD) therapy or cardiac resynchronization (CRT) therapy

Once the patient gets to stage D, they will require one of the forms of advanced heart failure treatment either heart transplantation of implantation of a left ventricular assist device (LVAD). Heart transplantation is considered the gold standard for treatment of advanced heart failure, due to shortage of donor hearts or sometimes if the patient is not a suitable candidate for a heart transplant due to not fitting into the stringent criteria for heart transplantation, they may be candidates for LVAD therapy as a bridge to transplantation or as destination therapy. Unlike heart transplantation, LVAD therapy can be done without any waiting period and those whose life is at risk while waiting for a heart will benefit immensely with this form of therapy. The survival after implantation of LVAD has steadily improved over the years and in the first two years the survival is quite similar to heart transplantation and as the technology improves further the long term outcomes are also likely to improve. Procedures such as LVADs have gained traction over the last few years due to limitations in undergoing a transplant and have become more technologically advanced and affordable over time and there have been nearly 35-40 LVADs implanted in India over the last two years.

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(Dr Julius Punnen, Senior Consultant Cardiothoracic Surgeon Surgical Lead - Cardiothoracic Transplantation and Mechanical Circulatory Support, Narayana Hrudayalaya)

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