Heart failure refers to the heart's inability to pump blood as efficiently as it should. This leads to a decrease in the blood supply to other major organs of the body like kidneys, lungs, and brain, which leads to an accumulation of fluids in the lungs. The most common symptoms of heart failure are due to the accumulation of fluid – swelling of the legs, shortness of breath, and fatigue.
Types of Heart Failure
There are two subtypes of heart failure based on whether the ejection fraction (Pumping Capacity) of the heart is normal or reduced.
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Heart failure with a reduced ejection fraction
This type, also known as systolic heart failure or HFrEF, develops when the heart is too weak and doesn't contract normally.
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Heart failure with a preserved ejection fraction
This type of heart failure, also known as diastolic heart failure or HFpEF, happens when the heart is too stiff and doesn't fill with blood normally.
Heart Failure Causes
Heart failure is caused by many diseases which primarily damage the heart muscle. Coronary Artery Disease which causes heart attack is the main cause of heart failure with reduced ejection fraction. When a person suffers a heart attack, it results in the death of heart muscles which in turn leads to decreased pumping ability of the heart. The other major cause of heart failure with reduced ejection fraction is cardiomyopathy which causes dilatation of the heart chambers. High BP and obesity are common causes of heart failure with preserved ejection fraction. Looking for Heart Failure Treatment in Hebbal Bangalore, visit Manipal Hospitals.
Diagnosis of Heart Failure
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Echocardiogram
An echocardiogram is the main diagnostic tool in the diagnosis of heart failure. It uses ultrasound waves to assess the size and pumping function of the heart.
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B-type natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP)
BNP is a hormone produced by the heart. The BNP or NT-proBNP levels are higher than normal in heart failure patients.
These two tests form the basis for the diagnosis of heart failure and also help in classification of the heart failure. Other Investigations which help in the management of heart failure are ECG, Xray Chest , Cardiac CT scan/ MRI scan, and catheterization of the heart. Consult with our Interventional Cardiologist in Hebbal Bangalore to know more about the tests.
Management of Chronic Heart Failure
Heart failure is a chronic condition that requires life-long treatment. Treatment usually includes a combination of lifestyle modifications, medicines, and sometimes a device to protect the heart from abnormal rhythms. The life style modifications include dietary changes like limiting water intake and restricting the salt intake. One also has to stop smoking and consumption of alcohol and do regular exercises. Medicines are recommended based on the type of heart failure and the severity of symptoms.
The following are a few of the frequently recommended drugs to treat chronic heart failure:
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ARNI
The ARNI has two medicines in a single pill. One is called Valsartan and the other is called Sacubitril. This drug can help in reducing fluid retention and also helps in relaxation of blood vessels. It also has shown to improve the pumping function of the heart and prolong life.
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Mineralocorticoid/aldosterone receptor antagonists (MRAs)
Mineralocorticoid receptor antagonists help to protect the heart from hormone effects that can happen when a person has heart failure. It prevents the remodelling of the heart chambers and also helps in removing the excess fluid accumulated in the body.
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Beta-blockers
These drugs control the heart rate, prevents arrhythmias and lowers blood pressure.
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SGLT2 inhibitor
These medications originally developed for treating Diabetes are now increasingly used in the treatment of heart failure in people with or without diabetes.
These four drugs form the four pillars in the treatment of heart failure. Along with these medications other drugs like Diuretics to remove excess water, antihypertensive medications, and rate control medications can be given.
Heart rhythm treatment
In some people with heart failure, an abnormal heart rhythm (arrhythmia) develops. Some benign abnormal heart rhythms are treated with medications. Some dangerous arrhythmias such as Ventricular tachycardia/Fibrillation will require a device that shocks the heart and returns it to a normal rhythm. The device is called an Implantable Cardioverter-Defibrillator (ICD). It is implanted under the skin below the collar bone.
Another potential problem in people with heart failure is abnormal electrical conduction in the heart. This can cause the walls of the left ventricle to contract out of sync, making the heart work less efficiently. A special type of pacemaker, called "Cardiac Resynchronization Therapy Pacemaker" (CRTP) or biventricular pacing, can treat this problem. When combined with ICD it is called CRT-D. These devices are usually used in the last stage of heart failure.
Consultant - Interventional Cardiologist
Manipal Hospitals, Hebbal, Bangalore
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