Heart failure: What everyone should know, according to a cardiologist

Heart failure is a complex condition in which your heart cannot pump or suck enough blood to meet your body’s needs. It does not mean your heart has stopped beating, Instead, the heart has become weak, stiff, or damaged, and cannot fill up with enough blood or pump it out properly.

The heart is a muscle bag, about the size of your fist, with four chambers: two atria and two ventricles. The right sided chamber gets blood from body organs and pumps blood to the lungs to get oxygen. The left sided chambers gets this oxygen-rich blood from lungs and pumps it to the rest of the body. In heart failure, this process of circulation of blood across cardiovascular system becomes deficient.

When your heart is too weak or a bit stiff, it tries to compensate by different mechanisms. It may get bigger, pump faster, or make extra muscle, but over time, these compensations fail.
This leads to the most common symptoms:
•Shortness of breath (especially during activity or at night)
•Fatigue and weakness, giddiness
•Swelling (edema) in the feet, ankles, legs, or belly
•Persistent coughing or wheezing especially during sleep
•Feeling full or bloated or abdominal discomfort
•sleep disturbances , loss of appetite

Most heart failure develops slowly over time due to multiple causes but it can occur suddenly also :
•Coronary artery disease (blockages in the heart’s arteries) and heart attacks if not treated in appropriate time
•Uncontrolled high blood pressure
•Diabetes
• valvular heart diseases
•Irregular heartbeats (arrhythmias)
•Alcohol abuse, smoking
•Viral infections of the heart muscle
Other serious illnesses such as kidney disease or thyroid problems
Overdose of medications
Chronic lung and liver diseases
Congestive heart failure is a term used when fluid buildup (congestion) causes swelling of body and breathing difficulty.

Your symptoms, medical history, and physical examination.
We may order tests such as:
•Blood tests to check for stress on the heart and kidneys
•Electrocardiogram (ECG) to look at heart rhythms
•Chest X-ray to check for fluid in the lungs and heart size
•Echocardiogram (ultrasound of the heart) to see how well it pumps and if there are valve problems
Cardiac MRI or cardiac PET scan to assess cardiac muscle
Coronary angiogram to assess blockages

Treatment focuses on improving symptoms, slowing the progression of the disease, and preventing complications.
Medicines help remove extra fluid, relax blood vessels, and make the heart beat stronger or more efficiently. Common medicines include diuretics, ARNI, beta blockers, SGLT2 inhibitors, Vericiguat.
There are advanced heart failure therapies available for certain subset of people
Implantable Cardioverter-Defibrillator (ICD)
An ICD is a small device placed under the skin of your chest, connected to your heart with thin wires. It monitors your heartbeat and can deliver a small electric shock if your heart rhythm becomes dangerously fast or chaotic, which helps prevent sudden cardiac death.
Cardiac Resynchronization Therapy (CRT)
If your heart’s chambers are out of sync with each other this therapy is useful. It uses a pacemaker with extra wires to coordinate the pumping of the heart’s lower chambers.Not everyone needs CRT, but for people with certain types of heart failure, it can be life-changing.
Left Ventricular Assist Device (LVAD)
This device is surgically placed inside your chest and connected to your heart. It helps blood flow to the rest of your body and can be used as a long-term solution or as a bridge while waiting for a heart transplant.
Heart Transplant
In rare cases when all other treatments fail and the heart is so damaged that it cannot support life, a heart transplant is considered. This means removing your failing heart and replacing it with a healthy heart from a donor.
Transcatheter valve replacement
Sometimes, heart failure is caused by a stiff or narrowed heart valve (most commonly, the aortic valve). TAVI is a technique of opening this narrowed valve through minimally invasive approach.
These advanced treatments are for people with severe heart failure who do not improve with medicines and lifestyle changes alone. Your cardiologist will decide if you need one of these devices or therapies, based on your heart condition
Angioplasty or bypass surgery
In some patient heart failure is because of lack of blood supply to heart muscle due to blockages which can be treated with either angioplasty or bypass surgery.

•Eat less salt, restricted fluid intake
•Exercise regularly, as tolerated, to keep your heart strong
•Maintain a healthy weight
•Quit smoking and limit alcohol
•Manage stress
•Get vaccinated for the flu and pneumonia, as these infections can make heart failure worse
Regular follow up visits to your treating doctor is very important to prevent emergency hospitalisations.

Managing other health problems is the best way to lower your risk:
•Control high blood pressure, diabetes, and cholesterol
•Quit smoking and alcohol
•Balanced exercise and diet
•Get regular check-ups—especially if you have risk factors

Dr. Girish B Navasundi, MBBS, MD, DNB, Senior Consultant, Interventional Cardiology, Apollo Hospitals, Bannerghatta Road, Bengaluru

This article is intended for educational and informational purposes only and should not be interpreted as medical advice. It is not a substitute for consultation, diagnosis, or treatment from a licensed healthcare provider. Always seek the guidance of a qualified medical professional with any questions you may have regarding your health or a medical condition.