What is heart failure?
When your heart is working less efficiently can’t pump enough blood that you need.
Your heart chambers respond to stretching to hold more blood to pump. This helps to keep blood moving but gradually the heart pumping deteriorates.
Your kidneys react to this by retaining more salt and water.
What are symptoms:-
Depending on severity of disease, one cane have mild, moderate or severe symptoms.
Fluid overload – As a result of fluid retention you develop swelling in ankles and legs (called edema). This leads to bloating of stomach and loss of appetite.
Fatigue and weakness – less blood and flow to your muscle can cause fatigue and weakness. Less blood to brain may lead to dizziness.
Causes:-
Heart attack, high blood pressure, diabetes, atrial fibrillation (fast heart beat) disease of valves of heart, disease of heart muscle – (cardiomyopathy), congenital heart defects.
Smoking by causing heart attack leads to heart failure.
Diagnosis:-
Diagnosis of heart failure is based on clinical examination and few tests.
Blood test: For sugar, cholesterol, kidney and thyroid. Also NT-proBNP is blood test which help in diagnosis. Higher levels are seen in heart failure.
ECG: Shows heart rate and rhythm, chamber enlargement and electric conduction delay in heart.
Echocardiogram: This is sonography of heart and is most important test. It gives complete interaction of heart pumping, heart valves and is most important tool for diagnosis as well as to seen response to treatment.
X-ray chest: Gives information of water build up in lungs and size of heart.
Treatment:-
Three important medications to improve heart pumping are betablocker, ACE inhibiter / ARB / ARNI and third is Aldosterone Antagonist.
Unfortunately majority of patients do not get target dose of these drugs.
Diuretics are used to reduce fluid retention.
Newer Antidiabetic drugs like SGLT2 inhibitor also gives lot of benefits to patient with heart failure even if they don’t have diabetes.
Correction of iron deficiency also improve outcome of heart failure patients.
Diet:-
Salt restriction of less than 1500 mg previous day is important way to manage heart failure.
When to report to Doctor / A & E:-
- If weight gain more than 2 kg in week,
- Increasing swelling of ankle, feet,
- Worsening of breathlessness,
- Feeling tired or harder time to do daily activity,
- Fast heart beat or palpitations,
- Decrease urine frequency and quantity,
- Dizziness, loss of appetite.
Advanced treatment:
Some candidates with heart failure are candidates of special procedures and surgery.
- CRT (Cardiac resynchronisation) It is type of pacemaker which helps to improve heart pumping.
- ICD (Intracardiac defibrillation) Some heart failure patient may require ICD, to prevent and treat cardiac arrest. It is also a type of pacemaker.
- Heart valve surgery for affected valves.
- Heart transplant for advanced heart failure, not responding to all treatment options.
