Heart Failure and Sudden Cardiac Death

 

What do you mean by heart failure? 

The heart is one of the most important organs of the body, as it primarily pumps blood, distributing oxygen and nutrients, throughout the body. Normally, a well-functioning adult heart could go on for three cardiac cycles or 72 beats per minute—this rate changes for children whose heart rates are normally and relatively faster. However, minor dysfunctions or abnormalities in the heart may affect our normal functions.When these dysfunctions or abnormalities occur, our heart functions at a lesser capacity and is not able to pump oxygenated blood to the whole body. This condition is known as ‘heart failure, which is sometimes known as congestive heart failure and is a global problem that is growing rapidly among people of various age groups. It is a condition that is caused either by ineffective pumping or inadequate relaxation of the heart.Heart failure is a chronic condition that 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, and shortness of breath which leads to heart failure.

 

Heart failure is often misunderstood as a condition where your heart fails to function, however, it occurs when one or more chambers of the heart has failed to keep up with the volume of blood flowing through them. As a result, the blood often backs up and fluid can build up in the lungs, causing difficulty in breathing. Conditions like high blood pressure, high cholesterol, and diabetes may damage or weaken your heart triggering heart failure. It also develops when the heart muscles become too stiff to pump blood. Not only that, abnormal heartbeats (arrhythmia) and inflammation of the heart muscle (myocarditis) area are also some of the root causes of heart failure. Often it is confused with a Heart attack, which is a sudden stoppage of blood supply to the core. Currently, 8-10 million Indians are diagnosed with heart failure, and 1 million are added every year. It is alarming with a more than 20% mortality rate among people ten years younger than the global average.

 

How is Heart Failure linked to Sudden Cardiac Death?

Most sudden cardiac deaths are caused by abnormal heart rhythms called arrhythmias. Moreover, the most common life-threatening arrhythmia is ventricular fibrillation, which is an erratic, disorganized firing of impulses from the ventricles (the heart’s lower chambers). According to American Heart Journal, patients with heart failure are 6 to 9 times more likely than the general population to experience ventricular arrhythmias that can lead to sudden cardiac death.

 

What are the common causes and risk factors of Heart failure?

Heartfailure is common among the elderly, however, there is a rise among young adults as well due to the risk factors such as diabetes and hypertension, which are on the rise. Apart from this, other factors such as valve disease, congenital heart disease, hypertension, history of a heart attack, coronary artery disease, family history of the disease and an enlarged or infected heart can also lead to heart failure. Heart failure is a progressive condition, and it gets worse over time because the heart's pumping action grows weaker.

 

According to the New York Heart Association Classification, heart failure can be broadly classified into 4 stages. These stages range from high to advanced risk of heart failure. The first two stages are considered to be the pre-heart failure phase. The third stage refers to heart failure patients who had or currently have symptoms of the disease and the fourth stage refers to patients with advanced symptoms of heart failure.  

 

Some common symptoms of heart failure include: 

 

·         Chest pain  

·         Shortness of breath 

·         Fainting 

·         Fatigue 

·         Swelling in the limbs 

·         Rapid or irregular heartbeat 

·         Persistent coughing or wheezing with white or pink foamy tinge of blood or mucus 

·         Swelling of the abdomen 

·         Rapid weight gain  

·         Nausea and lack of appetite 

·         Decreased alertness 

 

Treatment options available for patients to manage heart failure

·         Coronary bypass surgery. If severely blocked arteries are causing your heart failure, your cardiologist may recommend coronary artery bypass surgery. The procedure involves taking a healthy blood vessel from your leg, arm, or chest and connecting it below and above the blocked arteries in your heart. The new pathway improves blood flow to your heart muscles.

·         Heart valve repair or replacement. Doctor may recommend repairing or replacing the valves if they witness a faulty heart valve that can cause heart failure. Heart valve repair or replacement may be done as open-heart surgery, minimally invasive surgery, or a heart procedure using flexible tubes called catheters (cardiac catheterization).

·         Implantable cardioverter-defibrillators (ICDs). An ICD is used to prevent complications of heart failure. It is a device similar to a pacemaker. It's implanted under the skin in your chest with wires leading through your veins and into your heart. The ICD monitors the heart rhythm. It tries to pace your heart or shock it back into normal heart rhythm. An ICD also works as a pacemaker and helps in speeding up your heart rhythm.

·         Cardiac resynchronization therapy (CRT). Also called biventricular pacing, CRT is a treatment for heart failure in people whose lower heart chambers (ventricles) aren't pumping in sync with each other. A device called a biventricular pacemaker sends electrical signals to the ventricles. The signals trigger your ventricles to contract in a more coordinated way, which improves the pumping of blood out of your heart. 

·         Heart transplant. Some people have such severe heart failure that surgery or medications don't help. These people may need to have their hearts replaced with a healthy donor heart

Tips to manage heart failure  

Heart failure can be managed or treated depending upon the stage of the disease as the severity increases with every stage. In the earlier stages, the treatment consists of medication and lifestyle changes while in the more advanced stages, a surgery or transplant or device implantation becomes necessary for most of the patients. Maintaining a good quality of life is as important as survival for most patients living with chronic, progressive illnesses. People with heart failure can also live an improved quality of life by following their treatment plan and undertaking precautionary measures regularly. Some of the modifiable risk factors can be controlled through the following measures:

·         Refraining from consuming any substance that can hamper the mind and body. Therefore, quit smoking and avoid consuming any recreational drugs

·         Engaging in outdoor activities and exercises is extremely crucial for maintaining heart health. However, one must be careful of the kind of exercise their body can sustain 

·         Eating healthy and well-balanced diet rich in fruits, vegetables, whole grains, low-fat dairy products, skinless poultry and fish, nuts, and legumes 

·         Managing stress levels and getting enough sleep helps in improving heart health 

·         When it comes to the treatment of heart failure, identifying it at an early stage can be the most beneficial

 

When to consult the doctor? 

Heart failure is a progressive disease that develops over time. With timely interventions, one can live a normal life. It is recommended to watch out for the persisting symptoms and get regular check-ups to monitor heart health. Ignorance of these symptoms can even lead to fatal consequences in the future. If one is already diagnosed with heart failure, it is also very important to follow the proper medication prescribed by the cardiologist.  The first step to treat heart failure is communicating clearly with the doctor. Heart failure is treatable and manageable at every stage. Remember, heart failure isn't about stopping. It's about starting life in a new way.

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