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Heart Failure

Dr. Dhiren Shah guides you through the complete process of heart failure with a complete understanding of the process and videos from some of his best heart failure cases in India. 

CIMS Hospital is known as the best heart failure hospital led by Dr. Dhiren Shah – amongst the best heart failure surgeon in Ahmedabad and recognised amongst the top heart failure doctors in India.

How to Diagnose Heart Failure?

Medical History and Physical Examination: Check for the presence of risk factors, such as high blood pressure, coronary artery disease or diabetes. Examine the neck veins and check for fluid buildup in abdomen and legs. n Blood tests: Of kidney, liver and thyroid functions and other indicators n Chest X-ray n Echocardiogram measures the ejection fraction which helps classify heart failure and guide treatment. n Stress test measures how heart and blood vessels respond to exertion. You may walk on a treadmill or pedal a stationary bike or a six minute walk test that measures the ability of heart and lungs to take in oxygen and breathe out carbon dioxide. n Cardiac Computerized Tomography (CT) Scan or Magnetic Resonance Imaging (MRI) n Coronary Angiogram

What is Heart Failure?

Heart failure is often termed as Congestive Heart Failure (CHF). Heart failure is a chronic condition in which the heart fails to pump the blood.

Due the improper pumping action of the heart, the blood flow to the different parts of the body gets obstructed which results in the lack of oxygen supply.

Women tend to have higher chances of suffering from heart failure as compared to men, as the chances of developing heart diseases peri- or post-menopausal is very common.

Heart failure can be either acute or chronic. Acute heart failure have sudden onset, mostly a result of heart attack. Chronic heart failure is the result of ongoing bad heart conditions.

What is the mission of CIMS Heart Failure Clinic?

The mission of CIMS Heart Failure Clinic under the leadership of Dr. Dhiren Shah, amongst the best cardiac surgeon in Ahmedabad is to reduce the incidence of cardiovascular disease through exceptional education, prevention and delivery of quality care. Download the booklet that contains information on risk factors that may be present and medications you or your family member may be taking or will take at home. This general information will be helpful in dealing with your, or your loved one’s condition. Please ask any of the team members if you wish to receive additional information which may not have been addressed in this manual. We encourage you to write down details timely as well as any questions or comments on the “Notes” pages provided at the back of this booklet.

HEART FAILURE

What are the Goals of CIMS Heart Failure Clinic?

1) Complete evaluation to determine cause of heart failure

2) Determine disease progression/ prognosis.

3) Identify best treatment regimen.

 

Right combination of treatment prevents premature death. Implanting Specialized CRT and Defibrillators: Battery-operated CRT implanted by o u r e x p e r t electrophysiologist can stimulate the heart so that it beats w i t h a r e g u l a r rhythm and works more efficiently. Implanted cardioverter defibrillators act as internal “shock paddles “that respond automatical ly to a patient’s heart arrhythmias, delivering an electronic shock to return the heartbeat to a regular rhythm.

SURGICAL TREATMENT CoronaryArteryBypassGraft(CABG) High-risk: blocked or damaged arteries are repaired or replaced through surgery, Complex V alvular Recons truction procedures to reconstruct heart valves (e.g., separating fused leaflets or repositioning valve chords)so that valves open or close better Ventricular Remodeling Surgery can help some patients avoid the necessity for a heart transplant by restoring the heart to normal size, shape and function following injury to the left ventricle by a previous heart attack.

CIMS is one of the first hospital to offer LVAD Bridging to Transplantation. The device serves as a temporary bridge so that a patient can recover some life-sustaining degree of heart function prior to transplantation. Heart Transplant is a surgical procedure performed to remove the diseased heart from the brain dead patient and replace it with a healthy one from the organ donor.

What are the Warning Signs of Heart Failure

  • STOP YOUR ACTIVITY, REST, and REPORT to your doctor if any of these symptoms occur:
  • Pain, pressure, or tightness in chest: pain in neck, arm, jaw, or ear n Dizziness or fainting
  • Severe shortness of breath n Pulse rate below 50 or above 120 beats per minute n Nausea
  • Pain in calf of leg(s) n Ankle swelling, rapid weight increase or severe shortness of breath 0 n Temperature above 101 degree c

What are the common causes of heart failure?

  • Heart failure can be a cause of following:

    • Heart attack (the repetitive onset of heart attack may lead to heart failure)
    • Hypertension ( due to high blood pressure the workload of the heart increases making it difficult for the heart to pump blood properly)
    • Abnormal heart rhythm (abnormal rhythm causes the heart to work more, which makes the heart muscles weak, leading to heart failure) 
    • Heart valve abnormality (abnormality in the valve implies poor blood flow and weaken the heart muscle)
    • Stiffening of heart muscles (due to the presence of conditions like cardiomyopathy or myocarditis the heart muscles may cause stiffening of the heart muscles)
    • Congenital heart defects (due to the improper formation of the cardiac valves/ chambers the workload on the heart is increased, making it weak/ stiff)
    • Other diseases like emphysema, thyroidism, severe anemia etc 

What are the signs and symptoms of heart failure?

  • Heart failure may include the following symptoms:

    • Dyspnea (Shortness Of Breath [SOB]) 
    • Dyspnea is a major sign suggesting your heart isn’t working properly, as there are high chances that there is retention of fluid in the lungs
    • Loss of appetite 
    • Due to improper functioning of the heart there are high chances one might lose his or her appetite
    • Chest pain (in case of heart attack)
    • After heart attack pain in chest may be indicative of another heart attack or heart failure 
    • Reduced ability to perform exercise
    • As the heart is unable to pump adequate amount of blood to the body the capability of the body to perform activities reduces
    • Increased heartbeat
    • Since the workload of the heart is increased to meet the requirement of the body, the heartbeat gets increased
    • Fatigue or weakness
    • Improper supply of blood results in fatigue and weakness
    • Persistent cough/ wheezing
    • Buildup of fluid is common in heart failure
    • Swelling in legs and ankles
    • As the heart doesn’t work properly the fluid starts to get accumulated in the veins of legs causing oedema (swelling)
    • Ascites (retention of the abdomen)
    • The inability of the heart to function properly causes swelling of the stomach
    • Weight gain
    • Due to retention of fluid there are high chances of weight gain 
    • Fluid retention
    • As the heart doesn’t work properly the ability of the body to void fluid also reduces
    • Frequent urination
    • The improper functioning of the heart affects other organs and retention of fluid increases pressure on nearby organs too
    • Protruding veins
    • Sign of weakened valves, doesn’t allow blood to go back to heart
    • Irregular pulse
    •  Irregular pumping action of heart results in irregular pulse

How do you diagnose heart failure?

    • To diagnose the heart failure and its cause the cardiologist might run the following tests:

      1. Medical history
      • Medical history is taken to know about the present and past conditions of the patient
      1. Check for signs and symptoms
      • The obvious signs (such as swelling in legs, arrhythmia, shortness of breath, etc.) indicative for heart failure are looked for
      1. Blood test
      • Blood tests are done to rule out any chance of diseases
      1. Chest x-ray
      • Chest x-ray may indicate collection of fluid in the lungs, which might be a result of congestive heart failure

      (Davidson)

      1. ECG (Electrocardiogram)
      • ECG detects the presence of any heart abnormalities that might lead to heart failure

      (Davidson)


      1. Echocardiogram
      • Echocardiogram helps in assessing heart’s systolic and diastolic function, valvular heart disease, pulmonary artery pressure and pericardial diseases in patients who are suspected for congestive heart failure

      (Davidson)

      1. Stress test
      • Stress test measures the health of the heart, as it responds to exertion
      1. Cardiac CT scan
      • Test done to visualize the heart’s anatomy and its circulation
      1. MRI
      • MRI is done to detect heart diseases and its function 
      1. Coronary angiogram
      • Done to rule out any coronary artery disease

      (Davidson)


      1. Myocardial biopsy
      • It is an invasive procedure to detect heart disease

How do you treat heart failure?

    • The treatment plan for the heart failure depends on the severity of the condition. Treatment doesn’t reverse the heart’s condition but, prevents it from worsening and improves life span.

      The severity of heart failure can be classified as follows: 

      By New York Heart Association (NYHA)

      • As per NYHA heart failure can be classified into 4 classes:

      CLASS 1                  no symptoms, no limitation in ordinary physical activity 

          (example: shortness of breath while walking, climbing

            stairs etc)

      CLASS 2     mild symptoms and slight limitation during ordinary 

          activities (example: mild shortness of breath, mild 

          chest pain)

      CLASS 3     marked limitation in activities due to symptoms, even

          during less-than-ordinary activities (example: walking 

          short distance(20-100m), comfortable only at rest)

      CLASS 4                 severe limitations, experiences symptoms even while 

          at rest, mostly bed bound patients

    • MEDICATION
      • Early stage of heart failure can be treated using medications. Medications helps in:
      1. Improve heart’s ability to pump blood
      2. Controls heart rate
      3. Maintains the sodium and potassium level
      4. Reduces cholesterol level
      • Certain medications that might help include ACE inhibitors, angiotensin Ⅱ receptors, inotropes, digoxin, diuretics, β- blockers, etc.

    • SURGERY
    • Depending on the severity of the heart failure surgery may be 

      as follows:

      1. Coronary bypass surgery
      • the blocked coronary artery is replaced by the healthy artery
      1. Angioplasty
      • a catheter with a balloon is inserted to open up the blocked artery
      1. Valvular heart surgery
      • surgery is done to either to replace or repair the damaged heart valve
      1. Cardiac devices
      • cardiac devices are devices used to maintain normal rhythm of the heart
      • cardiac devices can be sub categorized as:
      • LVAD (Left Ventricular Assisting Device)/ Artificial heart

      [LVAD or artificial heart is a device used to 

      replace the failing function of the heart]

      • Pacemakers

      [it is a device used to control heart rhythm] 

      • AICD (Automatic Implantable Cardioverter Defibrillator)

      [used to prevent cardiac arrhythmias 

      -improper beating of the heart]

      • CRT (Cardiac Resynchronization Therapy)

      [coordinates the function of left and right 

      ventricles]

      • CRT-D (Cardiac Resynchronization Therapy 

      Device)

      [sends impulses to the both chambers of heart 

      for its normal functioning]

      1. Heart transplant
      • done when all other treatment fails

HEART FAILURE

What kind of medicines do I need to avoid ?

  • Do not take any herbal medications without the approval of doctor or pharmacist.
  • Do not take any pills for pain except Paracetamol.
  • Do not take any aspirin in addition to what is prescribed by the doctor.

What are the types of heart failure?

  • Types of heart failure are:

    1. LEFT SIDED HEART FAILURE
    • Most common type
    • Left ventricle doesn’t pump efficiently
    • Blood goes back into the lungs
    • Lack of oxygen rich blood to the body
    • Fluid retention
    1. RIGHT SIDED HEART FAILURE
    • Right ventricle doesn’t pump blood efficiently
    • Triggered by left sided heart failure
    • Causes swelling lower extremities
    1. DIASTOLIC HEART FAILURE
    • More common in women
    • Cause of heart diseases
    • Heart muscles become stiff
    • Lack of blood flow to the rest of the organ
    1. SYSTOLIC HEART FAILURE
    • Heart muscles cannot contract
    • Caused by cardiomegalia or weak heart
    • More common in men

What are the possible complications in heart failure?

  • Certain complications that might result after heart failure are:

    • Kidney failure
    • Heart valve problems
    • Arrhythmias
    • Liver damage

What is the rehabilitation process for heart failure patients?

  • Rehabilitation after a heart failure is very important and is carried out by medically supervised persons.

    The rehabilitation includes:

    • Advising patients about the do’s and don’ts.
      • Taking prescribed medicines
      • Regular walking
      • Taking blood thinning medicines on time
      • Avoid lifting heavy weights
      • Avoiding fatty foods (like ghee, cheese)
    • Activity modification is taught as per the patient’s condition.
      • Walking with chest belt
    • Certain exercises are taught for better healthy life.
      • Breathing exercises

    (inhale through the nose and exhale through mouth)

      • Chest expansion exercises

    (breath-in while raising hand, breath-out while lowering hand)

    • Patients are taught about their conditions and how they can manage it.
    • Time-to-time medical evaluation is advised.
    • Intake of diet and nutrition as per advise.
      • Low sodium and salt diet
      • Intake of food rich in protein
      • Fresh fruits and vegetables

How do you prevent heart failure?

To prevent a heart attack one may follow the following:

  • Healthy lifestyle
    • Reduce alcohol intake
    • Quit smoking
    • Proper sleep-wake cycle 
    • Regular check-ups
    • Weight monitoring
    • Vaccination
  • Healthy diet
    • Restricted sodium diet
    • Avoid intake of trans fat

What are the risks of heart failure?

  • People who are at high risk of developing heart failure are:

    • Chronic smokers 
    • High intake of tobacco interferes with the normal functioning of the heart
    • People having sedentary lifestyle 
    • Leading a sedentary lifestyle might lower down the normal functioning of the heart
    • Obese
    • The workload of the heart is increased which might result in heart failure
    • Increased intake of fatty food
    • Intake of fatty foods increases the cholesterol level and may block the heart
    • High intake of alcohol
    • Heavy drinking results in high blood pressure and weaken heart muscles
    • Congenital heart defects
    • Presence of defects since birth already interferes with the normal functioning of the heart
    • High blood pressure
    • High blood pressure is an indication of increased activity on heart
    • Coronary artery diseases
    • Due to the presence of coronary artery disease the blood flow from the heart is obstructed
    • Sleep apnea
    • Absence of breath during sleep is a dangerous condition and might interfere with the normal functioning of the heart
    • Viruses
    • Viral infection tends to infect the heart muscles causing inflammation and abnormal functioning of the heart
    • Irregular heart beat
    •  Irregular heart beat is often a sign of poor working heart
    • Certain medications
    • Certain medications like NSAIDs (Nonsteroidal anti inflammatory Drugs), blood pressure medicines, antidepressants etc tend to interfere with the normal functioning of the heart which might lead to future heart problems

What is Left Ventricular Ejection Fraction(LVEF)?

LVEF: is percentage of blood that pumps out of the heart during each beat LVEF: is a measurement to see how well the heart is functioning A low LVEF number can occur if your heart muscle has been damaged as a result of: n Heart attack n Long-term, uncontrolled blood pressure n Heart valve problems n Heart muscle disease What should you do? n Ask your doctor if your LVEF should be measured. n If your LVEF has been measured, ask for your LVEF number. n If you have a low LVEF number (35% and below) ask your doctor if you should see a heart failure or heart rhythm specialist.