Time is muscle, do not delay heart failure treatment

PTI, Jan 18, 2022, 12:20 PM IST

Our heart is the main organ in the circulatory system which pumps blood to the whole body. Due to various reasons, such as diabetes and hypertension, it becomes weak and unable to function. Heart failure is the gradual weakening of heart muscle and is often confused with a heart attack. A heart attack is the sudden stoppage of the heart’s blood supply.

Heart Failure is now being called a pandemic of sorts with over 8-10 million heart failure patients in India alone. With the numbers growing at a fast pace, it is crucial to discuss heart failure.

Beat Heart Failure, an initiative by The Times of India in partnership with Novartis is a campaign that aims to spread awareness about heart failure, its causes, prevention, treatment, self-care management tips, and the advancements in procedures to manage heart failure.

Mr. Anil Vinayak, Group Chief Operating Officer, Fortis Healthcare said – “To identify, manage and treat heart failure, which affects a little over 1% of India’s population, mass awareness initiatives like this one are crucial. Cardiology & Cardiovascular Sciences is a Centre of Excellence at Fortis Healthcare and expert doctors at our facilities across the country offer treatments and care in line with international benchmarks. As knowledge partners in the Beat Heart Failure campaign, they have touched upon several minute aspects of heart failure – from medical management to surgical interventions, focusing on empowering people with easy-to-understand information.” Doctors from Fortis Memorial Research Institute, Gurugram joined hands with this campaign – 1. Dr. TS Kler: Chairman: Fortis Heart & Vascular Institute, Gurugram & Fortis Flt. Lt. Rajan Dhall Hospital, Vasant Kunj 2. Dr. Udgeath Dhir: Director & HOD, CTVS 3. Dr. Vinayak Agrawal: Director & Head https://fb.me/e/myS3FKbY6 Dr. Kler started the conversation while talking about the causes of heart failure. He said that heart failure can be divided into two components – one with normal Ejection Fraction as seen in Obesity, Diabetes mellitus and the second one is with decreased ejection fraction which is seen in cardiomyopathy, coronary artery disease, aortic stenosis. Ejection fraction can be defined by the amount of blood being pumped out of the heart with each contraction.

The three significant causes of heart failure in India are coronary artery disease, hypertension, and diabetes. These are primarily due to lifestyle choices. The cases of Rheumatic Heart disease are also prevalent in India, wherein the heart’s valves get damaged due to improperly treated throat infection. The other factor is Cardiomyopathy, where heart muscles are damaged and cause heart failure.

Time is Muscle, said Dr. Agrawal and added that we must manage heart failure on time to save the heart from further damage and preserve the heart’s muscle. There may be a sudden plaque rupture that may cause a blockage in the circulation resulting in a Myocardial Infarction (MI). It is necessary to manage MI in time to prevent significant damage to the heart. Immediate medical intervention is crucial.

Dr. Dhir expressed his concern about the higher number of heart failure cases in India because of not maintaining a healthy lifestyle. People here are generally complacent and would try to justify their choices as healthy. It is observed that Southeast Asians are genetically more prone to heart failures whereas a poor lifestyle also accounts for a higher number of heart failure cases. People are over-stressing themselves to meet professional and personal deadlines and, in the process, cause immense damage to their health. Some people live a completely sedentary lifestyle, and others work out excessively. They need to follow a middle path for the prevention of heart failure.

Dr. Kler remarked that there is no concept of regular health check-ups in India, and people are scared to visit the doctor. Whereas minimal health check-ups should begin by the age of twenty-five. Rather than going to the lab directly, a patient can visit a General Physician, he will get some basic tests done including physical examination, blood sugar fasting, lipid profile and will screen the patient for mild, moderate, or high-risk category, and advise for a TMT (treadmill test) or echocardiography (ECG) and basis the results refer to a cardiologist.

Dr. Agrawal added that there are nine major risk factors: smoking, lack of exercise, obesity, high blood pressure, high LDL levels, genetic predisposition, stress, gender, and diabetes that contribute to heart failure, and people in India are prone to almost all of them.

Regular blood pressure monitoring is known as hypertensives, once in the morning and evening is important, said Dr. Dhir. There should be a forty-minute difference between tea or coffee when measuring blood pressure and should always be taken lying down for the correct result. Normal blood pressure is 120/80mmHg. Pulse rate is also an important marker. If the pulse rate is within the normal range, the chance to develop heart failure is also low. Maintaining a chart of the blood pressure and pulse rate is helpful. Start measuring blood pressure from around the age of 18 for early detection.

Management of dietary patterns is also critical by controlling the salt intake, such as avoiding packaged foods, pickles, spicy Indian delicacies, and a sprinkling of salt on food. When it comes to exercise, the ideal duration is forty-five minutes of cardiac activity, such as a brisk walk of at least four km for a male with sixty-seventy kilograms weight and five feet eight inches in height.

People with diabetes have a sixty percent chance of contracting coronary artery disease added Dr. Aggarwal. It affects everything from the tip of the hair to the end of the toenail. Earlier management can only control blood sugar, which prevents Vascular effects of diabetes, but what kills a person with diabetes is MI or stroke. Now the cardio-glucocentric approach is the norm. Primary prevention includes statins to prevent plaque rupture along with lifestyle and dietary regulations.

Dr. Kler said that if a patient is experiencing symptoms like breathlessness, tiredness, swelling over the feet, cough while lying down, which gets better while sitting up, suffocative sensation while lying down, he should immediately visit a doctor. The approach is to get early diagnosed and treated early. We can reverse and treat all stages of heart failure.

Home management under medical supervision is also possible by avoiding strenuous activity, knowing your body, and weighing your body every Sunday. If weight increases, fluid restrictions are essential, control carbs, and visit the doctor regularly.

While explaining the surgical options, Dr. Kler dwelled on Refractory heart failure when the patient has tried all types of treatment but has no relief, the patient can be considered for – CRT or cardiac resynchronization therapy which helps in improving the heart’s contraction and is a sort of specialized pacemaker. The most effective option can be a Cardiac Transplant, which promises longevity of 5-10 years in the majority of patients. However, there is a scarcity of organs in India and there’s a strong need to popularize organ donation.

In the absence of organs and if the patient is above 70 years, LVAD or left ventricular assist devices, also called artificial heart is another effective option.

Remember, heart failure is not the end of life; it is a lesson to live life healthier. Timely check-ups, early detection, and intervention are key to living a happy & healthy life.

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 judgment and are disseminated in the public interest. These views should not be considered as a substitute for the 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.”