Heart Failure

What is heart failure?

Heart failure is a condition in which your heart is unable to pump enough blood for your body’s needs. It happens when your heart is too weak to pump properly. Heart failure is a serious condition that needs early detection and medical care to avoid damage to other organs of your body.

Heart failure can develop suddenly or slowly over time as your heart gets weaker. It can affect either or both sides of your heart.

What caused heart failure?

In adults, heart failure can be caused by:

  • A weakening of the heart muscle (cardiomyopathy)
  • Blockages in your heart arteries. (coronary artery disease)
  • Drugs used to treat cancer
  • Immediately after delivery of a baby ( post-partum cardiomyopathy)
  • Heart valve disease
  • A heart problem you’re born with (congenital heart defect)
  • Abnormal heart rhythms not controlled by medicine
  • Failure of a previous heart transplant
  • Heart failure can also be hereditary
  • Infection/ inflammation of heart causing heart failure

In children, heart failure is most often caused by either a congenital heart defect or cardiomyopathy.

Risk Factors For Heart Failure:

Some factors are related to your lifestyle habits which can be modified and few are non-modifiable risks.

 Age. Older people have a higher risk of heart failure because aging can weaken and /or stiffen your heart.

Family history and genetics.  Heart failure can run in family.  You have a higher risk of heart failure if people in your family have been diagnosed with heart failure at early age.

Lifestyle: An unhealthy diet, smoking, heavy alcohol use can raise your risk of heart failure.

Other medical Illness.  Lung disease, infection mostly viral SARS-CoV-2 may raise your risk of heart failure. Long-term health conditions such as obesity, high blood pressure, diabetes, anemia thyroid disease, or iron overload also raise your risk.

Medicines:  Many of the medicines used for treatment of cancer chemotherapy can affect  your heart muscles making them weak.

Sex. Heart failure is common in both men and women.

Men are known to develop heart failure at a younger age than women.

Symptoms of Heart Failure

In addition, people who have left-sided heart failure may have the following symptoms.

  • Difficulty in breathing. Or hunger for breath. Initially it appears then you climb the stairs. As the disease progresses, you might feel difficulty at even walking across the room or even while getting dressed
  • Most patients with heart failure would not be able to sleep flat. They might need 2-4 pillows to sleep comfortably
  • Cough
  • General weakness
  • Bluish color of finger and lips
  • Loss of appetite
  • Pain in your belly
  • Swelling in your ankles, feet, legs
  • ​​​​​​​Needing to pee often
  • Weight gain due to swelling

Complications:

If heart failure is not treated at right time, it might affect the normal organs of the body as well.

  • Kidney or liver damage
  • ​​​​​​​Fluid buildup in or around your lungs and in your lungs
  • ​​​​​​​Malnutrition because nausea and swelling in your abdomen (area around your stomach) can make it uncomfortable for you to eat. Reduced blood flow to your stomach can make it harder to absorb nutrients from your food
  • Irregular heart beat and sudden cardiac arrest and death is known
  • Lung damage to the extent that no treatment can be offered for these patients

Treatment For Heart Failure:

Lifestyle changes 

Your doctor may recommend lifestyle changes along with medicines as part of treatment plan:

  • Lower your salt intake.
  •  Aim to reduce weight if you are overweight.
  • Get regular physical activity depending on your extent of heart failure.
  • Stop smoking and avoid alcohol.
  • Avoiding mental stress

Medicines 

Your doctor would prescribe medicines depending on your type and severity of heart failure.

Some patients might need a pacemaker or a defibrillator to allow heart to work properly.

Cardiac resynchronization therapy (pacemaker implantation). This can help both sides of your heart contract at appropriate time.

  • Ventricular Assist Device: You may use a heart pump until you have transplant surgery or as a long-term treatment.
  • ​​​​​​​ Implantable Cardioverter Defibrillator  (ICD): An ICD checks your heart and correct irregular heart rhythms that can cause sudden death

Patients who do not respond to the medical treatment need surgical treatment in the form of heart transplant or long term left ventricular assist device (LVAD) support.

What is a Heart Transplant?

Some patients with advanced heart failure who do not respond to the medical treatment needs heart transplant. A heart transplant is an operation performed to replace a patient’s damaged heart with a heart from a donor who is brain dead.

Who can have a Heart Transplant?

A heart transplant is a treatment option for a small number of patients with advanced heart failure.

Patients with long-standing heart failure

There are many different causes of heart failure that might lead to needing a heart transplant. The most common causes are:

  • Cardiomyopathies
  • Coronary artery disease or blockages in the vessels supplying blood to the heart
  • Heart defects since birth
  • Other causes of heart failure
  • Patients with sudden heart failure
  • Sometimes if a massive heart attack is not treated in time, the heart muscles develops irreversible damage affecting the pumping of the heart. Leading to sudden heart failu
  • Sometimes the stress of pregnancy causes heart muscles to go weak and lead to sudden heart failure after delivery of child. Some might have pre-existing heart problems

What are the benefits of Heart Transplant?

In carefully selected patients, a heart transplant is usually the best treatment for heart failure in patients who are resistant to medical treatment and are fit for surgery.

Main advantages of a successful heart transplant:

  • Most heart transplant patients live longer
  • Most heart transplant have a better quality of life

Who can have heart transplant?

  • In order to be considered for a heart transplant, you need to be fit enough for major surgery.
  • Your doctor would do some investigations to see if you are suitable for heart transplant. This includes basic blood tests and more advanced test to see the functioning of the heart. Your doctor would also perform investigations to measure the pressure in your heart to see if the heart failure has affected your lungs as well.
  • You also need to take the medicines to help prevent rejection of the transplant. These medicines are known as immunosuppressants.
  • Your doctor would explain to you the risk and benefits of the transplant. He will also make you aware of the medicines you might need to take before and after transplant.

What could go wrong?

Some patients might experience complications or problems either during the operation or in the days or weeks following a heart transplant. Bleeding and infection are more common complications.

Rejection. Rejection is when your body’s immune system starts to ‘attack’ your new heart. The body thinks that the new heart is a foreign thing which should not be in the body hence tries to act against it.

After a heart transplant, patients need to take medicines which are called immunosuppressants to avoid rejection. This might make you slightly more prone to infections. Your doctor would advise you accordingly. Even if you take your anti-rejection medications carefully, rejection can still occur.

The new Heart not pumping well. This could happen in 15-20 % of patients undergoing heart transplant.

There could be multiple reasons for severely impaired heart function. The most common could be the high lung pressure. If this happens, you would be put on an external heart lung machine called as an ECMO to support the heart till it recovers. This is a machine that helps pumps your blood for you and supports the function of the transplanted heart. This is usually needed for an average of 5 days.

Uncontrolled diabetes. If you have diabetes before the heart transplant, it is likely that your blood sugar will be more difficult to control after the transplant.

Stroke. A stroke (a blockage of the blood supply to the brain) can happen soon after a transplant. Strokes are more common in older patients, and in those who have had a stroke before. Likewise there are chances you have clots in your veins.