What is heart failure?

What heart failure actually is and how to identify some of its common symptoms


George Michael. Photo: Reuters
George Michael. Photo: Reuters

Singer George Michael, 53, died in his sleep on Christmas Day. He had been battling multiple health issues, smoked incessantly, and his lungs had deteriorated. It is believed that the cause of death was heart failure.

The statistics show heart failure is a common, yet often ignored, non-communicable disease. According to a 2014 press release by the European Society of Cardiology, more than 26 million people worldwide are living with heart failure (yes, one can live with heart failure: It is a condition in which the heart can’t pump enough blood to meet the body’s needs). One in five people is expected to develop heart failure in their lifetime. The risk of death from heart failure is, in fact, comparable to the risk faced by patients with advanced cancer. “Still, people generally seem more afraid of stroke, advanced cancer or heart attack, and few can actually even identify the common symptoms of heart failure (severe breathlessness, swollen ankles, rapid weight gain, difficulty moving),” says Kenneth Thorpe, chair of the Partnership to Fight Chronic Disease, an internationally recognized organization of patients, providers and health policy experts committed to raising awareness of non-communicable diseases.

Dr Thorpe says there is an urgent need to increase awareness about the symptoms of heart failure. And for that, it is vital to understand what heart failure is.

Know it

Soon after Michael, actor Carrie Fisher died—there is still confusion about whether it was due to a heart attack, cardiac arrest or heart failure. “These terms are often used interchangeably, but they are different,” says Dr Thorpe.

Heart attacks are caused by the rupturing of hardened arteries. The mortality rate of a patient admitted to hospital after a heart attack is relatively low. Cardiac arrest, which happens when the heart stops beating entirely, or partially, leading to a severe dip in blood pressure, is usually fatal unless there is immediate intervention. There can be many causes, from blood clots in the lungs to a collapsed lung. Then there is heart failure, which means your heart is not functioning as well as it should. Pumping efficiency reduces greatly, so less blood and oxygen reaches other parts of the body.

In fact, a Slovenia-based study, published in 2014 in the journal Archives Of Medical Science, showed that one in three people mistook heart failure symptoms for normal signs of ageing. “The pumping function can be estimated by determining the ejection fraction, which refers to the amount of blood being pumped out of the left ventricle each time it contracts. This is tested with an echocardiogram, an ultrasound of the heart; if it dips below 40%, it indicates problems with the heart,” says Balbir Singh, chairman (electrophysiology and cardiac pacing) at Medanta—The Medicity in Gurgaon.

What leads to heart failure?

Heart failure can happen slowly, over time, as a result of chronic high blood pressure, high cholesterol or due to drug and alcohol use. “Diabetes, obesity, depression, inherited heart disease such as cardiomyopathy (damage to the heart muscle), hypothyroidism and heart arrhythmias (abnormal heart rhythms) are all risk factors,” says Nilesh Gautam, senior interventional cardiologist and head (preventive cardiology and rehabilitation), Asian Heart Institute, Mumbai. “A heart attack may lead to heart failure eventually too if the tissue damage is extensive,” he adds.

Death due to heart failure could be sudden, sometimes even during sleep, so it is important to catch it in time, says Dr Singh. Extreme fatigue, where even everyday activities seem exhausting, is a common symptom but not the only one. Symptoms for left-sided heart failure include breathlessness, panting (more acute when the patient is active or lying down) and foam-like mucus. Right-sided heart failure symptoms include swollen ankles and legs, and an enlarged liver and stomach. “This happens because as blood flow out of the heart slows down, blood that returns to the heart through the veins backs up, causing fluid accumulation in the tissues,” explains Dr Singh. Bilateral heart failure is when both sides of the heart are damaged; the symptoms include dizziness, nausea and loss of appetite—the digestive system receives less blood, resulting in problems with digestion and appetite.

There have been reports of increased chances of cardiac arrest and heart failure for endurance athletes, but Dr Gautam doesn’t believe this has to be true if they train properly. “It is, of course, important to get regular medical check-ups done and keep blood pressure and diabetes levels under strict control. Also, one must always train under supervision, know your body limits and never push too hard,” he adds.

It is time, then, to learn about heart failure and watch out for symptoms so that it can be arrested in time.

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