What Is Heart Failure?
Heart failure occurs when the heart loses its ability to pump blood effectively. As the heart cannot pump adequately, there is relative stagnation and backward pooling of blood in the veins and organs.
Not only is there inadequate blood pumped into the organs, but whatever blood that reaches the organs also cannot be easily returned to the heart. This results in congestion in organs such as the liver and intestines. The liver enlarges with the pooled blood, causing pain in the right side of the abdomen, as well as the fullness of the stomach and jaundice; whilst the congestion of the intestines results in loss of appetite. Furthermore, congestion of these organs results in the accumulation of fluid in the abdomen, causing distention of the abdomen. The pooling of the blood in the veins causes distention of neck veins and swelling of the legs.
Similarly, congestion of blood in the lungs from a failing left side of the heart results in difficulty in breathing, accumulation of fluid in the lungs, chest cavity and coughing out frothy phlegm. The patient will find it easier to breathe when lying propped up.
Furthermore, due to the inadequate blood being pumped out by the heart into the arteries, there is inadequate blood flow through the organs and inadequate delivery of oxygen. Hence, the patient gets tired easily. The kidneys which get rid of the body’s waste products are unable to function properly as the amount of blood that filters through the kidneys is reduced. This results in further accumulation of water and waste products in the body, with the former aggravating the swelling of the body.
Thus, a patient with progressive heart failure would be breathless at rest, would often have to prop himself up while lying down and would easily become tired on exertion. He may have distended neck veins, abdominal fullness, upper abdominal discomfort and pain. Also, his legs may be swollen.
Causes of Heart Failure
The major causes of heart failure are coronary artery disease, high blood pressure, cardiomyopathy, and valvular heart disease.
Coronary Artery Disease
A major heart attack that often causes scarring and impaired functioning of the heart muscles. The heart becomes weaker, resulting in heart failure. In some patients, the heart muscles are not permanently scarred and can be salvaged by balloon angioplasty or bypass surgery. Others may continue to suffer progressive loss of heart muscles, ending in “end-stage heart failure”.
Long-standing high blood pressure, if untreated, results in enlargement of the heart and ultimate heart failure.
Cardiomyopathy is a state where the heart muscle becomes progressively weaker and gradually looses its ability to pump blood. In most of these patients, the cause is either not clear or unknown and hence, their condition is called ‘idiopathic cardiomyopathy’. It also can be familial due to gene abnormalities. In some patients, cardiomyopathy can result from viral infection affecting the heart, known as ‘viral myocarditis’. Many patients recover from it, but some suffer from permanent damage to the heart muscle resulting in heart failure.
Treatment
Prevention is the best form of treatment for heart disease. The control of risk factors for heart disease also applies to heart failure, such as coronary artery disease and high blood pressure. Medical treatment forms the main line of treatment for patients with heart failure. In recent years, many medications have been shown to benefit patients with heart failure. Some of these medicines not only improve the well-being of patients but also reduce their chances of hospitalization. Most importantly, these medicines have been shown by some studies to improve the survival rate of heart failure patients.
Treatment of heart failure includes changes in lifestyle. These include weight control, dietary restrictions, smoking cessation, restriction of fluid intake and abstinence from alcohol. Intake of salt promotes water retention and aggravates heart failure.
Some of the patients who develop heart failure are prone to develop irregular heart rhythms. These are sometimes dangerous and can lead to cardiac arrest causing sudden death. Some of these irregular rhythms can be controlled with medications. Others may require the implantation of special devices like “pacemakers” which can detect irregular rhythms and induce a small electric shock to stop the abnormal heart rhythms. These devices are known as “Automatic Implantable Cardiac Defibrillators” (A.I.C.D.). If the right and left heartbeats do not beat synchronously, implantation of CRT pacemaker, will synchronise the chambers and improve the efficiency of the heart.
What Is the Outlook?
There is no known cure for established advanced heart failure. Once heart failure becomes established, the patient’s survival is shortened. In fact, compared to terminal illnesses like cancer, the average survival probability of patients with advanced heart failure is equally poor. Only 50% of patients with heart failure can expect to survive beyond 5 years – this is equivalent to the survival rate for all forms of cancers combined.
Medications only serve to halt or delay the progression of the disease. Once heart failure becomes established, there tends to be continued deterioration of the patient’s heart with time. The failing heart will continue to become weaker resulting in congestion of water in the lungs breathlessness even while sleeping with a risk of danger to life. Unfortunately, when a patient reaches advanced heart failure, further medications are not going to help.
One effective method of treating heart failure is to replace the diseased heart with a new pump – in other words, a heart transplant. The main difficulty and limitation in this area lie in the shortage of donor hearts and lack of heart transplant programs in many countries in Asia. The patient also needs to fulfil certain criteria such as age, condition of other organs to determine the suitability for heart transplantation.
Left Ventricular Assist Device (LVAD)
A viable option for heart transplantation is the implantation of a Mechanical Heart Device called a Left Ventricular Assist Device (LVAD). This is an electrically operated heart pump that is attached to the heart and acts as a booster pump which drains the blood from the left ventricular chamber of the heart and pumps into the circulation restoring normal blood flow to the body. Once the normal blood flow is restored, the congestion of the lungs, liver and kidney are removed with the recovery of these organs. The heart failure is reversed and soon the patient can get back to a normal life, back to work and no more feels breathless. These patients are able to travel even by air to other continents.
The question often asked is how such an ill patient can undergo heart LVAD surgery, safely? The surgical risk is less than 10% as once the pump is attached, the circulation returns to normal allowing recovery from heart failure rapidly. The pump is powered by rechargeable batteries which the patient carries outside the body in a waist pouch or a pair of holsters on in a handbag if the patient is a lady. These pumps can last many years without any mechanical problems as long as the patient maintains a healthy lifestyle and take care of the accessories. They need to continue some of the medications to support the heart and blood thinners.