Tuesday, 27 September 2016

New Form of Heart Failure on the Rise


A World Heart Month initiative

New Form of Heart Failure on the Rise

New Delhi, September 27, 2016: Heart failure is routinely described as the progressive loss of ability of the heart to pump blood. But, there is another form of heart failure where the blood–pumping ability of the heart remains near normal, said Padma Shri Awardee, Dr. KK Aggarwal, President HCFI & President Elect IMA. This second form of heart failure is too often overlooked and is just as lethal.
In this condition the heart muscle becomes thickened. The chamber inside gets smaller and the heart is unable to relax to accommodate the blood it needs to pump out. As there is no room for the heart to relax, the blood backs up into the lungs. This kind of anomaly is not picked up by standard measurements of "ejection fraction" –– the percentage of blood in the heart that goes out with every beat.
Quoting two studies published in the New England Journal of Medicine, Dr Aggarwal said that this form of the disease is called "diastolic heart failure" because the problem occurs during the diastole portion of heart activity, as the heart relaxes after a beat. Nearly one–third of these patients have an ejection fraction greater than 50 percent, which is very near normal. However, the death rate for this kind of heart failure matches that of patients with the more common form of heart failure, with more than 20% of all the patients dying within a year. There is a steady increase over 15 years of heart failure with normal or near–normal ejection fraction.

For patients, the symptoms of both types of heart failure are the same: Shortness of breath, difficulty exercising and fluid retention in the body. Physicians cannot make a diagnosis on the basis of symptoms or routine examinations. One has to have an echocardiogram and see the heart pumping and see if the ejection fraction is normal or reduced. Until now, relatively little attention has been paid to diastolic heart failure. Advances have been made against systolic heart failure, in which the ejection fraction falls below normal but not much has been done about diastolic heart failure.
Pacing for heart failure
For patients with advanced heart failure waiting for cardiac transplant, biventricular pacing not only improves the quality of life but also prolongs life. If the ejection fraction is low the combo device also gives an electric shock when the heart stops. It is said that all patients with low ejection fraction should ask their doctors for possible implantation of these devices.

Signals of heart failure
One of the commonest presentations is breathlessness on exertion, which is often confused as a part of aging or being obese. Not being able to climb stairs may be the earliest sign of hypertensive diastolic heart failure. Other signals are:
1.      Feeling extra tired even after a good night’s sleep. People with heart failure may limit activities they like to do or take naps to avoid feeling tired.
2.      Weight gain: Call your doctor if you gain weight for more than 2 days in a row or if you gain 2 or more pounds.
3.      Shortness of breath: Heart failure makes breathing harder, especially during exercise. Lying position may make it worse.
4.      Swollen ankles, legs, belly, and/or lower back, the swelling is often worse at the end of the day.

5.      Going to the bathroom more at night.

1 comment:

  1. Is this hypertrophic and restrictive type of cardiomyopathy?In that case septal infarction by injecting ethanol into the septal artery can be tried in HOCM.Restrictive cardiomyopathy is caused by amyloidosis,chagas,sarcoid,hemochromatosis,endomyocardial fibrosis,Fabry's disease and eosinophilic disorders.Treating this condition will ameliorate the symptoms.

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