Heart failure in children can be reversed if caught in time

PTI, Feb 2, 2022, 12:38 PM IST

Our heart has the most exhausting job. It pumps blood across, about sixty thousand miles of blood vessels in our body, without taking a break. If any obstacle occurs in the functioning of the heart, it leads to heart failure. Heart failure is a lifelong non communicable disease. It is crucial to talk about heart failure, as the mortality rate is more than 20%. Moreover, in India, patients are ten years younger than the global average.

Beat Heart Failure, an initiative by The Times of India in partnership with Novartis strives to spread awareness about heart failure and its management and treatment. In the fourth leg of the initiative multiple panel discussions are being hosted with senior doctors from India’s best hospitals. One such discussion was conducted with doctors from PSG Institute of Medical Science and Research on heart failure and how regular treatment can help lead a quality life for adults as well as children with heart failure. “Heart failure is very much treatable. Of course, curable with transplantation in deserving patients.” These are the encouraging words said by Dr J. S Bhuvaneswaran – Director PSG Super Specialty Hospitals Peelamedu, Coimbatore for the heart failure patients. The discussion was conducted with the following doctors from PSG institute of Medical Science and Research: 1. Dr Vinoth Doraiswami: Consultant Paediatric Cardiology 2. Dr K. Tamil Arasu: Consultant, Cardiology 3. Dr Prem Krishna Anandan: Consultant, Cardiology 4. Dr R.B Vidhyakar: Consultant, Cardiology https://fb.me/e/l4JCOlqxH Dr Arasu started the discussion by saying that people often believe that heart failure is a death sentence, instead they should understand that heart failure is a gradual weakening of heart muscle and due to that heart is working at a reduced capacity. When the heart pumps blood, it contracts (called Systole) and relaxes (called Diastole). When anything affects the two then gradually heart failure ensues. The common causes of heart failure in adults are hypertension, diabetes and ischemic heart disease. During a heart attack when a patient delays in reaching the hospital, the heart muscles get damaged and results in heart failure. The natural course of the disease can be modified with the available treatment, if not completely reversed.

Dr Prem added that most patients complain of breathing difficulties but instead of visiting a cardiologist, they prefer to go to a pharmacy and self-prescribe medication. By the time patient realizes that symptoms are not relieved, the disease has progressed, and heart failure is set in. The other symptoms which are difficult to manage because heart is on decompensated stage are – fatigue, oedema of lower limbs, abdomen, deranged renal function and low blood pressure.

Dr Vidhyakar explained the difference between heart attack and heart failure. Heart attack is the sudden stoppage of blood supply of the heart. The symptoms developed are chest pain, dizziness, heart burn, abnormal heartbeat. Heart failure is diagnosed when the heart is not working up to the stage it should work. Diabetes, hypertension are the common causes of coronary artery disease which puts a burden on the heart. As a result of increased burden, the heart is unable to overcome, and patient is in a heart failure stage.

The good news is that a patient can lead a near normal life with heart failure provided they are compliant with their medicines and follow-ups with the doctor said Dr Arasu. It is essential to keep in control the input and output of fluids. Input of fluids includes everything from a glass of water to water related food, added Dr Prem. Charting the amount of fluid taken in and urine output will help in the management. The fluid intake in an individual depends on the stage of the disease. The amount of salt intake should be closely monitored, because if the salt content is high then it will result in water retention. The medicines taken by heart failure patients should be checked, because a single painkiller can precipitate the symptoms. Any other comorbidities such as anaemia, hyperactive thyroid should be addressed. Flu shots should be taken on time to avoid any unnecessary burden on the heart.

Dr Vidhyakar said that heart failure is reversible in the early stage when the patient sticks to their medications. The ingredients of impending structural heart failure include diabetes, hypertension and smoking. The medication should be followed at appropriate dosage and the patient should be in touch with their medical team.

Dr Doraiswami talked about the lesser-known topic i.e., heart failure in children. It occurs in almost two to three percent and the mechanism of development of heart failure is the same as adults, but the cause is different. Congenital heart disease is a condition that is present since birth and is the primary cause of heart failure in children. CHD is correctable and the child can live a normal life if the surgery is done on time.

Children cannot tell their symptoms. It is the responsibility of the parent to understand symptoms and take doctor’s advice. Some of the common symptoms are- –> growth not in line with their age or stunted growth –> easy fatigability compared to children of their age group –> swelling of lower limbs If the congenital defects are repaired on time, then heart failure comes back to normal and eventually medicines can be stopped. Viral myocarditis is the second most common cause which can be managed by medicines but, difficult to bring the heart back to normal. In the first two stages of heart failure children can go to school but not allowed to participate in active sports. In the last two stages the children are unable to do any strenuous activity and if the symptoms are progressing then they are advised home schooling.

It is difficult to restrict fluid in young children. The only management is to increase the dosage of the medicines. A child around fifteen sixteen years can be taught to restrict fluid depending upon their weight. The parents should be alerted about the danger signs of heart failure in children such as an increasing swelling, fatigability, increased respiratory rate etc. One of the major symptoms is when child stops taking the feed. This shows that the child’s heart is becoming decompensated. A calorie regulated scientific diet plan can be followed in children for dietary management.

For adults, Dr Arasu mentioned that repeated hospitalizations are seen due to consuming NSAIDS and other over the counter medicines and due to non-compliance dietary restrictions. Anaemia and thyrotoxicosis can also put burden on heart, which can result in heart failure. Fluid retention and weight gain is another factor for heart failure. Fluid retention prevents the heart chambers to completely fill with blood and completely expand. If this condition is not managed immediately, may result in a medical emergency.

Dr Prem said that the common mistake done by patients is that they talk to their peers and take alternative system of medicine to manage fluid retention. If the fluid retention is not handled properly it may result in renal shutdown and the patient may have to undergo dialysis. Some patients take intravenous fluids without consultation when they feel tired. This also increases fluids in the body and the patient complains of acute breathlessness, fall in oxygen saturation and cold sweaty extremities.

People have a tendency tooverexert themselves by physical activity to reverse the effects of the disease. Too much exercise in a person whose heart cannot tolerate the stress will do more harm than good. For them, proper Cardiac Rehab programme is recommended. It is a science-based food intake and exercise management programme, where patients are taught exercises and dietary management in a graded manner.

The final message from the doctors to prevent heart failure is to monitor the values such as heart rate, blood pressure, blood sugar. The patient must control diet and take medications on time. Regular follow ups with the physician are necessary. New scientific devices such as left ventricular assist devices are available for end stage heart failure. The patient needs to be compliant and talk to the doctor when they or their loved ones develop any symptom of heart failure.

Remember, heart failure isn’t about stopping. It’s about starting life in a new way. It can be managed with regular treatment and right lifestyle modifications. To know more about how to manage heart failure, visit https://www.toibeatheartfailure.com/blog Disclaimer: “The views and opinions expressed in the article by the panelists/experts are based on their independent professional judgement and are disseminated in public interest. These views should not be considered as a substitute for professional advice of a registered medical practitioner. The purpose of this article is not to promote any medical procedures or medication and/or recommend a certain doctor. For any specific health issues, please consult your registered medical practitioner.”