As press reports focus on how designer Rohit Bal had heart failure, let me share that this condition is always not an end-of-the-road situation. When detected early enough, it can be managed and add years to your life. Otherwise, there has to be maintenance therapy. And often it is the result of poor management of lifestyle markers like blood pressure, cholesterol and plaque buildup that result in blockage, reducing blood flow to the heart and affecting its pumping function. What is heart failure? Heart failure is a condition when the heart muscle doesn't pump blood as well as it should. When this happens, blood often backs up and fluid can build up in the lungs, causing shortness of breath and other complications. In this condition, the heart can barely keep up with its normal functionality. So oxygenated blood cannot reach all parts of the body, thereby affecting overall functioning of vital organs. Usually, there are two types. Systolic heart failure is when the heart’s left ventricle, one of the bottom chambers of the heart, weakens and cannot contract normally when the heart beats. This weakness means less blood circulates throughout the body. Diastolic heart failure is when the heart chambers enlarge and lose their ability to contract and relax. As the heart chamber widens, it becomes weak. It often starts with the bottom chamber and goes to the top chambers. Certain heart conditions gradually leave the heart too weak or stiff to fill and pump blood properly. These conditions include narrowed arteries in the heart and high blood pressure. Which is why cardiologists these days talk about an early assessment of cardiac markers, in the early 20s. If these tests show a tendency of cholesterol and blood clotting, then the problem of atherosclerosis or blood clotting and plaque deposition can be arrested then and there. What we do not realise is that our lifestyle has worsened so much that our risk factors amplify earlier. Left unattended, heart complications arise early, in the 40s and 50s, consistent with the logic that triggers have already set in during our 20s. That’s why cardiologists insist upon an early assessment these days and advise that we keep both cholesterol and blood pressure in check. Why does the heart get enlarged? As a weak heart cannot contract or relax properly, it stretches to do so and ensure the body gets a fresh supply of oxygenated blood. Over time, this causes the heart to enlarge and increase in muscle mass. This boosts up pumping initially. There are other compensatory mechanisms at play too. The blood vessels become constricted to keep blood pressure up. The kidneys also try to retain more salt and water rather than excrete it through urine. This creates increased blood volume and consequently the required blood pressure for pumping function. However, all of this is an abnormal overstretch and actually stresses out the heart further. The temporary fightback measures don’t solve the real issue. So heart failure continues. And without symptoms, patients are in the dark about their condition for years while their heart deteriorates. Which is why early testing for heart health becomes a must. Signs and symptoms Heart failure results in fatigue and shortness of breath, with some people experiencing excessive coughing. Everyday activities such as walking, climbing stairs or carrying groceries can become very difficult. Swelling in the legs, ankles and feet are early indications. Then there are rapid or irregular heartbeats and wheezing. What tests do you need? An echocardiogram, ejection fraction, which is a measurement of the percentage of blood leaving your heart each time it squeezes, treadmill tests, angiogram and in certain cases a heart MRI scan are required. Treatment There is no cure but management to halt progression to the next stage of heart failure. Proper treatment may improve the symptoms of heart failure and may help some people live longer. Medication and lifestyle changes can improve quality of life. Try to lose weight, exercise, use less salt and manage stress. In severe cases, a heart transplant is an option or a device to help the heart pump blood.
