Dr. Alla Gopala Krishna GokhaleFirst Surgeon in Telangana & Andhra Pradesh to do Heart Transplant, Lung Transplant & Minimal

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All About Heart Failure

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All About Heart Failure

Heart Failure (HF) – a condition in which a weakened heart can’t pump enough blood throughout the body. This leads to reduced quality of life, frequent hospitalization and high mortality. Although Heart Failure, like other heart ailments, has been acquiring epidemic proportions in India in the recent past, it has not received adequate public attention.

Heart Failure usually can’t be cured, but thanks to advances in technology and drug discovery, it can be effectively managed and patients’ quality of life is improved. Coupled with appropriate lifestyle changes, the inexorable progression of the disease can even be arrested. Hence the importance of early diagnosis and treatment.

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WHAT IS HEART FAILURE?

Heart Failure does not mean that heart has stopped working or is about to stop working. Heart Failure is a condition in which the heart becomes so weak that it has trouble pumping a normal amount of blood carrying enough oxygen and nutrients to meet the body’s needs. While the word ‘failure’ sounds alarming as it implies that the heart has suddenly stopped working, the medical term actually describes a chronic syndrome that typically develops slowly.

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SIGNS AND SYMPTOMS In the early stages, Heart Failure may not have any symptoms. In the

later stages, the patient may have severe symptoms because the weakened heart is unable to pump enough oxygen-rich blood with each contraction to satisfy the body.

The most common symptoms are – 1. Difficulty in Breathing 2. Chronic Cough 3. Edema 4. Loss of Appetite 5. Fatigue 6. Rapid or Irregular Heartbeats 7. Mental Confusion or Impaired Thinking 8. Increase in Body Weight 9. Extreme Fatigue and Weakness 10. Cyanosis (blue color of skin), low blood pressure (hypotension), cold sweating and gradual loss of consciousness are late features of CHF

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WHAT CAUSES HEART FAILURE? Heart Failure is caused by many conditions that damage the

heart muscle, including – 1.Coronary Artery Disease 2. Heart Attack 3. Cardiomyopathy 4. Strain on the Heart 5. High Blood Pressure (Hypertension) 6. Diseases of Valves of Heart 7. Diseases of Muscle of Heart  8. Birth Defects of Heart

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TYPES OF HEART FAILURE Heart Failure may be of two types – left-sided Heart Failure and

right-sided Heart Failure.

Left-sided Heart Failure occurs when the left ventricle cannot adequately pump oxygen-rich blood from the heart to the rest of the body. The main symptoms include shortness of breath, fatigue and coughing. There may also be lung congestion (with both blood and fluid).

Right-sided Heart Failure occurs when the right ventricle is not pumping adequately, which tends to cause fluid build-up in the veins and swelling in the legs and ankles. Right-sided Heart Failure usually occurs as a direct result of left-sided Heart Failure. It can also be caused by severe lung disease.

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TYPES OF HEART FAILURE Heart Failure is also defined in terms of the cardiac cycle. Systolic

Heart Failure means that the heart is unable to pump adequate amounts of blood during its contraction. Lung congestion and swelling (edema) of the lower extremities are typical symptoms of systolic Heart Failure. Coronary artery disease, high blood pressure and heart valve disease cause systolic Heart Failure.

Diastolic Heart Failure refers to the heart’s inability to relax between contractions and allow enough blood to enter the ventricles. Symptoms may be identical to those of systolic Heart Failure. Diastolic Heart Failure is often a precursor to systolic Heart Failure. Coronary artery disease, high blood pressure and cardiomyopathy cause diastolic Heart Failure.

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DIAGNOSIS There is no single test that can diagnose Heart Failure. The patient may have to

go some of the following tests–

1.ECG (Electrocardiogram) 2. Chest X-ray 3. BNP Blood Test 4. Thyroid Function Tests 5. Echocardiogram 6. Holter Monitor (Ambulatory Electrocardiography, EKG) Test 7. Nuclear Heart Scan 8. Cardiac Catheterization 9. Coronary Angiography 10. Ejection Fraction (EF) Test 11. Magnetic Resonance Imaging (MRI) 12. Positron Emission Tomography (PET) Scanning 13. Radionuclide Heart Scan

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TREATMENT

Treatment for Heart Failures aims at –1.Slowing its progression (thereby decreasing the risk of death and the need for hospitalization)2.Reducing symptoms (water retention, shortness of breath, etc.)3. Addressing heart rhythm disturbances.4. Improving the quality of life.

Heart Failure is a chronic and progressive condition that can be managed but rarely cured. Many people’s symptoms and heart function will improve with proper treatment. In some cases, doctors correct Heart Failure by treating the underlying cause.

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TREATMENT Treatments, or a combination of treatments, are selected based on

the type, cause and severity of Heart Failure and the overall health and other factors such as age of the patient.

Treatment may include –

1.Lifestyle changes.2. Medications for Heart Failure and underlying causes, such as coronary artery disease, heart valve disease, high blood pressure and arrhythmias.3. Surgical procedures including heart transplantation in extreme cases.

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LIFESTYLE CHANGES If the Heart Failure has been diagnosed as mild, lifestyle changes along with

medication will be effective in slowing its progression. A patient should observe the following dos and don’ts –

1.Eat a Healthy Diet2. Exercise Regularly3. Keep Blood Pressure Low4. Monitor Symptoms5.Maintain Fluid Balance6. Limit Salt Intake7. Take Medications as Prescribed8. See the Doctor Regularly9. Bed Rest10. Stress Reduction11.Others lifestyle changes that may reduce the symptoms of heart failure include stopping smoking or other tobacco use, eliminating or reducing alcohol consumption, and not using harmful drugs.

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MEDICATIONS Doctors usually treat Heart Failure with a combination of medications

depending on the symptoms. Several types of drugs have proved useful in the treatment. The main medicines are –

1. Angiotensin-Converting Enzyme (ACE) Inhibitors2. Angiotensin II (A-II) Receptor Blockers (ARBs)3. Digoxin (Lanolin)4. Beta Blockers5. Diuretics (Water Tablets)6. Aldosterone Antagonists7. BiDil8. Cardiac Glycosides (eg. Digoxin)9. Other Medications – Nitrates for chest pain, a statin to lower cholesterol or blood-thinning medications to help prevent blood clots may be given with Heart Failure medications.

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SURGICAL TREATMENT Surgery is aimed at stopping further damage to the heart and improving its

function. Procedures include –

1.Heart Pumps2.Pacemakers & ICDs3.Coronary Artery Bypass Grafting Surgery4.Coronary Stenting5.Heart Valve Surgery6.Infarct Exclusion Surgery (Modified Dor or Dor Procedure)7.Cardiac Resynchronization8.Heart Transplant9.Cardiac Wrap Surgery10.Enhanced External Counterpulsation (EECP)

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HOW IS ACUTE HEART FAILURE TREATED?

Acute heart failure is a condition when symptoms especially breathlessness suddenly become severe and distressing and usually requires admission to hospital. The primary cause for acute heart failure is excessive collection of fluid in the lungs that interfere with proper oxygenation of blood. It is treated with diuretic medicines that are injected directly into the vein to help remove this excessive fluid. A strong painkiller like morphine may be given to help reduce anxiety and an oxygen mask to ease breathing.

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