Heart Failure

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.

• 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

• 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 

• 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

• • 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 
    10. Coronary angiogram
    • Done to rule out any coronary artery disease

    (Davidson)

    
    

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

• • 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
    2. Angioplasty
    • a catheter with a balloon is inserted to open up the blocked artery
    3. Valvular heart surgery
    • surgery is done to either to replace or repair the damaged heart valve
    4. 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]

    5. Heart transplant
    • done when all other treatment fails