HEART AND FUNCTIONS

Heart is a muscular organ located just to the left of the breastbone and within the chest cavity. It has four chambers:

• Atria are the top two chambers that receive blood from the body or lungs.
• Ventricles are the bottom two chambers .The right ventricle pumps blood to the lungs to pick up oxygen and then the left ventricle, the strongest chamber, pumps blood to the rest of the body.

Valves help direct blood flow. As they open and close, the valves produce sounds that can be heard with a stethoscope. There are four valves in the heart. Every cell in the body needs oxygen to live and function. The role of the heart is to deliver the oxygen-rich blood to every cell in the body. The arteries are the pathways through which blood is delivered. The largest artery is the aorta, which branches off the heart and then divides into many smaller arteries. The veins carry the deoxygenated blood back to the lungs to pick up more oxygen, and return an oxygen-rich blood to the heart. The blood flows continuously through the circulatory system, and the heart muscle is the pump that makes it possible.

WHAT IS HEART FAILURE

Heart failure is the inability of heart muscles to adequately pump blood in the body. There may be many causes for such weakness of the heart muscles, e.g. high blood pressure, coronary artery disease, heart attack, diabetes, congenital heart disease or severe lung disease. As a result, the ability of the heart to pump blood is reduced and blood begins to back up in the chambers of the heart, which in return backs up in the lungs and body tissues. This results in fluid accumulating in the lungs (shortness of breath) and tissues (swelling). In addition, the vital organs receive less blood. The kidney reacts by retaining water and salt. Extra salt in the body causes further fluid retention.

DIAGNOSIS OF HEART FAILURE

The diagnosis of heart failure can often be made on the basis of medical history and physical examination. Laboratory investigation and cardiac tests like ECG and echocardiography not only help in the confirmation of diagnosis but also assist doctors in assessing the severity of the disease as well as in identifying the cause of heart failure. Heart failure may develop slowly over the period of several days or weeks (chronic) or suddenly that is the acute heart failure, which is also called pulmonary edema. Chronic heart failure may or may not require hospital admission, depending on how severe it is.

SIGNS AND SYMPTOMS OF HEART FAILURE

The warning signs of heart failure are:

• Shortness of Breath

  This is the result of collection of fluid in the lungs and is one of the most common and most overlooked symptoms. It can be felt while climbing stairs (where as previously you climbed them with ease) or you may awaken from sleep because of shortness of breath especially in lung diseases like asthma, but heart failure is one of the most significant causes that necessitates immediate attention.

• Persistent Cough or Wheeze

  Cough is a very common symptom, which we all experience off and on. Very often cough can be caused by mild respiratory infection, but if it persists and increases while lying down or is associated with pink frothy sputum, it may be the result of heart failure.

• Swelling (Edema)

  Swelling of the feet and ankles can be caused by a failing heart, resulting in poor circulation and excess fluid, which builds up in the body tissues. You can check for swelling by pressing on your ankle with your thumb and, if you leave a thumbprint it means that you have swelling. There are many other causes of edema and presence of edema does not always mean that you have heart failure. But if you have noticed new swelling, it is important to consult a doctor immediately.

• Weight Gain

  Excess fluid in the body can accumulate in the lower legs and abdomen (stomach). It will result in weight gain. It is easy to identify the swelling in the abdomen. You can detect this problem by weighing yourself daily and keeping a record of it. Note that weight gain alone is often not due to heart failure, but if associated with swelling, and/or shortness of breath, there is a high possibility that you could have heart failure.

• Loss of Appetite

  Although loss of appetite has many reasons, severe heart failure could be one. It may result from swelling of the liver and stomach and cause feeling of being full or sick with loss of appetite.

• Extreme Fatigue

  Fatigue occurs when your body needs more blood than your heart can provide. However, fatigue is not a specific sign of heart failure, and can be caused by a host of other reasons.

• Palpitation

  Many patients with heart failure may feel increased heart beating while resting or during minimal activity. The feeling may be as if the heart is racing or throbbing or is beating irregularly.

TREATMENT OF HEART FAILURE

Heart failure is a serious condition, and there is usually no cure for it. But in most cases, heart failure can be controlled by taking medications and making healthy changes in lifestyle, such as eating a healthy diet and doing moderate exercise. Treatment of heart failure is directed towards bringing the demand and supply of blood in the body into proper balance. There are three goals of treating heart failure:

• To reduce the overall workload of the heart.
• To improve the pumping action of the heart.
• To prevent sodium and water retention in the body.

We can achieve the above-mentioned goals through:

• Medications
• Diet
• Controlled physical activities.
• Education and counselling.

MEDICATIONS

Dioxin (Lanoxin)

This is one of the oldest medicines used in heart failure. It strengthens the heart muscles and enables the blood and oxygen to be pumped more forcefully and effectively to the body.

Caution

It is very important to take the exact amount of medication even if you are feeling better.
Inform your doctor if you have:

• Loss of appetite.
• Nausea and vomiting.
• A feeling of a fast or irregular heart beat.
• Change in your vision.

Diuretics

These medications are often called “water pills”. They assist your body in removing water and salt, which help to decrease the workload of your heart, lower the blood pressure and maintain weight.

Potassium (K+)

This is a mineral needed by heart muscles to contract and relax properly. Since some diuretics cause loss of K+, you may need to take food rich in potassium like citrus fruit and bananas. You may need to take potassium supplements as well. Check with your doctor if you need to take any special diet for this purpose. Call your doctor if you feel any weakness or muscle cramps.

Vasodilators (ACE Inhibitor and Angiotensin Receptor Blockers)

These medications relax your blood vessels and lower the blood pressure so that your heart does not need to work as hard. Caution: Lie down straight on the bed for five minutes after taking these medicines, to avoid dizziness. These drugs have been proven to increase survival in heart failure, therefore, you must continue to take these medicines regularly. Contact your doctor for symptoms of dizziness or cough.

DIET

You can help your heart work better by reducing salt intake. Generally you do not need to completely eliminate the use of salt in your food but by taking a low-salt diet, you can significantly reduce fluid retention or edema. You may also need to limit intake of liquids including water. Ask your doctor for any special instructions.

CONTROLLED PHYSICAL ACTIVITY

Controlled and monitored physical training certainly improves the ability of heart failure patients to lead more active and productive life. A well-structured cardiac rehabilitation programme can help you in this regard. Suggestion: Daily schedule of a patient recovering from a heart failure:

• Shorten your workday.
• Rest after meals to reduce the amount of work your heart must do while digesting food.
• Increase rest during times of emotional stress/illness.
• Nap during the day and do not nap too close to bedtime.
• Avoid eating just before going to bed.
• Ask your physician about the best time to take diuretics, so you will not need to go to the bathroom in the middle of the night.
• Use pillows to prop head for easy breathing
• Get a good night’s sleep.

PATIENT EDUCATION AND COUNSELLING

Proper knowledge and counselling of the patient provides the basis for compliance with the treatment and improved long-term healthy outcome.

SPECIAL INSTRUCTIONS

• Take all medications as directed by your doctor.
• Avoid taking extra salt and follow diet plan.
• Weigh yourself weekly and keep a record.
• See your doctor on follow-up day.
• Take proper rest.
• Stop smoking.

VISIT YOUR DOCTOR IF YOU HAVE

• Increased shortness of breath.
• Persistent dry cough with or without pinkish frothy sputum.
• Increase swelling on ankles.
• Sudden increase in your weight.
• Feeling of fullness or abdominal bloating.
• Rapid heart beat (palpitation).
• Extreme fatigue.