When the heart fails-living with heart failure
"I need a doctor."
Not everyone resorts to this go-to course of action when they have found themselves tossing and turning in bed deep into the night, maybe because they can't quite catch their breath even at rest. You might also feel that your heart races faster than your capacity to keep track of the beats, and if you sit down, you might notice unusual swelling in your legs and even abdomen. What you might not realise is that this is exactly when to call a cardiologist.
Heart diseases are no better than a plague in fast-growing Bangladesh. In fact, World Health Organization (WHO) identifies cardiovascular diseases to be the top cause of mortality and morbidity in 2018, with 3 out of 4 people with the risk of developing a cardiac disease in their lifetime. In the vast group of heart diseases, however, what you need to worry about a little more than others is, perhaps, heart failure.
The second most common problem diagnosed by physicians, heart failure, which isn't, as the definition prematurely might suggest, a complete failure of the heart's capability to perform its function. Consultant cardiologist Dr Lim Choon Pin, providing expert opinion over at Mount Elizabeth Novena Specialist Centre of Singapore, on general cardiology and heart failure, among others, defines the condition as, "When the heart does not pump blood efficiently enough to meet the body's demands due to blockages in the heart's arteries, weak or stiff muscles of the organ, or even structural abnormalities such as "holes" in the heart, the condition which can arise is known as heart failure."
The key word being 'efficiently' here, heart failure can be of varying degrees and stages. But the tricky bit lies in the fact that the condition's prominent symptoms often go overlooked. So, the question remains; who are the people most likely to miss symptoms of heart failure?
Firstly, young people in the prime of their lives have quite a bit of reserves, and tend not to feel sick until a serious illness manifests advanced symptoms of a deteriorating condition. This is exactly what can prove detrimental for them, especially if signs of end-stage heart failure are detected too little too late. Secondly, people prone to a sedentary lifestyle, especially the ageing population of a country, fail to even exert themselves enough to notice alarming symptoms, or brush off symptoms such as shortness of breath and palpitations as part of ageing and do not realise they are ill in the first place.
The perfect solutions to the negligence is simply to opt for a healthy lifestyle to begin with and regular check-ups, as prescribed by your physician. But before we jump to the ways to combat the issues of a diseased heart, it's important to acknowledge that the condition occurs in stages; four, to be exact (just like in cancer).
Heart failure can be diagnosed at a pre-symptomatic stage, or only in advanced disease. In the first stage of the disease, the patient may be looking at 'a high risk of developing heart failure.' Characterised as pre-heart failure (or Stage A heart failure), conditions such as high blood pressure, blocked arteries, diabetes or even an addictive habit of nicotine and alcohol abuse puts one at risk of developing heart failure in the future. Consulting a physician to keep these risk factors of heart disease in check is in your best interest here.
"Simple lifestyle modifications such as quitting bad habits like smoking, lowering salt intake and undertaking regular exercise can work hand-in-hand with medications, which have advanced by leaps and bounds in the past decade alone," explains Dr Lim. Here, medications can target other cardiac diseases or even blood pressure and lower overall risk of developing the chronic condition known as heart failure.
The second stage of the condition (Stage B heart failure) has a structural disorder of the heart, but does not manifest overt symptoms of heart failure yet. Make no mistake, this scenario is also not to be taken lightly as previous conditions like heart attacks, detection of the walls of the ventricles having a hole or an obstruction, or even heart valve diseases can eventually lead to the development of heart failure symptoms.
But the good news is that a harmonious balance of lifestyle changes, medications and careful monitoring of the distrait heart will ensure healthy prospects. Consequently, Dr Lim recommends, "Physical activity which is good for the heart in the long run, medications known to reduce mortality and hospitalisation and keeping track of symptoms can lead to a good quality of life for people suffering from heart failure." Moreover, possible surgeries such as intervention for coronary blockage, or repairing valves (which are essentially "doorways" inside your heart, ensuring blood flows in the right direction) may be considered by your trusted physician.
This leads us to the third stage (Stage C heart failure). Here, serious measures must be taken as patients will now be said to have clinical heart failure. Symptoms may be experienced with even mild exertions and physical activities. A point of note here is that the severity of signs and symptoms can vary from person to person. "For example, if you are an athlete who runs 5 kilometres every day, with heart failure, you may run out of breath at just 2 kilometres or even 500 metres. You will notice a significant reduction in your tolerance as compared to your baseline. Even walking up a flight of stairs might be difficult for them, or maybe just walking about a room may feel like a chore," defines Dr Lim.
Now, physicians might recommend steps like reducing water and salt intake. The why of it is rather interesting. When the heart fails to pump blood efficiently around the body because of a weakened heart muscle, blood may flow slowly in the vessels, resulting in fluid leaking out of the blood vessels due to high pressure. This may lead to leg or abdominal swelling, poor appetite, and even cause water to enter the lungs, which is located right next to the heart. "Patients get out of breath as they are literally drowning," states Dr Lim. This is also why diuretics, or water pills might be prescribed with fluid restrictions at this stage. Other than that, pacemaker-like devices, called implantable cardiac defibrillators (ICDs), which are electronic devices to monitor the rhythms of the heart to prevent cardiac arrest, may also be recommended/implanted as patients with severely weak heart function are at increased risk of lethal arrhythmia.
This brings us to the final stage of heart failure (Stage D heart failure), where the condition does not seem to get better even with conventional treatment. "After trying medication to tweak the system and make the heart beat harder, at one point, it may feel like "flogging a dying horse." And that is exactly when we might need a "boost" in the form of a ventricular assist device (otherwise known as an artificial heart pump). A good quality of life is still possible after a successful operation to implant this pump," explains Dr Lim.
Ventricular assist devices or artificial heart pumps have been invented to support a badly damaged heart and help cardiac function. Of course, heart transplantation can also be an option, but with long waiting periods, and limited donor pools, not to mention that Bangladesh is still lagging behind in this regard, these electronic rescuers help about 80 percent of patients survive the long wait for a donor heart.
"Ventricular assist devices, in particular, are what's exciting in the field of heart failure. It is basically a heart in a box," comments Dr Lim. The device simply pumps blood from the lower chambers of the heart to the rest of the body and is especially useful to patients with an advanced case of heart failure, ultimately saving their lives. These devices have become smaller and more durable in the past decade and the risks of the surgery have also reduced significantly in recent years.
With the stages of heart failure duly dissected, the statistics of an aching heart is only worsening. Whether it's health not being a priority in the daily hustle and bustle of intensive schedules, missing follow-ups and delaying check-ups, anatomical deficiencies, or idiopathic reasons not diagnosed by physicians yet, heart failure needs attention. The age-old advice of prevention being better than treatment is a standalone truth that can never be refuted, and it all starts with a simple acknowledgment, "I need to take a look at my heart."
Photo courtesy: Parkway Hospitals Singapore,