Heart 2 Heart Back

Heart Failure

HEART FAILURE

Dr G Sengottuvelu. MD., DM., DNB., FRCP (Glasgow),
FSCAI (USA), FMMC, FCSI.
Fellowship in Interventional Cardiology (France)
Senior Consultant & Interventional Cardiologist,
Apollo Hospitals, Chennai


Heart Failure describes the clinical syndrome that develops when the heart cannot maintain adequate output, or can do so only at the expense  elevated ventricular filling pressure. In mild to moderate form of heart failure, heart pumping is normal at rest and only become impaired when the metabolic demand increases during exercise or some other form of stress. Almost all forms of heart disease can lead to heart failure. Heart failure is most common in the elderly population.  The prevalence of heart failure rises from 1% in those aged 50-59 years to over 10% in those aged 80-99 years.Heart failure is the most common cause is coronary artery disease & Myocardial infarction (heart attack).  Although the outlook depends to some extent on the underlying cause of the problem, untreated heart failure carries a poor prognosis; approximately 50% of the patients with severe heart failure are sought due to left ventricular dysfunction, pump failure or malignant arrhythmias.

INVESTIGATIONS:
1)      Routine blood test, TSH, ECG, Chest X ray, Echo, NT Pro- BNP 

LIFE STYLE MODIFICATION:
1)      DIET: Good general nutrition and weight reduction for the obese, avoidance of high salt foods and added salt especially with patient with severe congested heart failure
2)      ALCOHOL: Moderation or elimination of alcohol consumption, alcohol induced cardiomyopathy requires abstinence.
3)      SMOKING: Cessation of smoking improves the life span.
4)      EXERCISE: Regular, moderate and aerobic exercise within limits of symptoms.  
5)      VACCINATION:  Consider influenza and pneumococcal vaccines

MANAGEMENT OF CHRONIC HEART FAILURE:
Education of the patient and their relatives about the causes and outcome of the heart failure can help adherence to the management plan.  Some Patient needs to weigh them self daily as a measure of fluid overload & to adjust their fluid accordingly. Treatment of the underlying cause of the heart failure (eg. Coronary artery disease) is important to prevent its progression.

Medicines
Your doctor will prescribe medicines based on the type of heart failure you have, how severe it is, and your response to certain medicines. The following medicines are commonly used to treat heart failure:

• ACE inhibitors lower blood pressure and reduce strain on your heart. They also may reduce the risk of a future heart attack.·         
• Aldosterone antagonists trigger the body to remove excess sodium through urine. This lowers the volume of blood that the heart must pump.·         
• Angiotensin receptor blockers relax your blood vessels and lower blood pressure to decrease your heart’s workload.·         
• Beta blockers slow your heart rate and lower your blood pressure to decrease your heart’s workload.·         
• Digoxin makes the heart beat stronger and pump more blood.·         
• Diuretics (fluid pills) help reduce fluid buildup in your lungs and swelling in your feet and ankles.·         
• Isosorbide dinitrate/hydralazine hydrochloride helps relax your blood vessels so your heart doesn’t work as hard to pump blood. Studies have shown that this medicine can reduce the risk of death. 

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