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.
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
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.
