Heart attacks, major public health issue

Heart failure is a progressive disorder of the heart that has become a major health issue in our society due to various contributing factors. Heart failure carries immense social burden, and, therefore, there is a need to make the common man aware of the symptoms of the disease and understand the medical management available to-day.

To define heart failure in basic terms it is the death of the functioning heart muscle. Heart fails to deliver the required amount of blood to the body needs. The heart is a living pump as big as one’s fist. It pumps five litres of blood per minute or around 280 litres an hour; it beats at the rate of 72-90 per minute. In heart failure, the heart of the patient fails to pump the required amount of blood resulting in building up of pressure in the heart chambers causing breathlessness and lung congestion.

Many assume that they are suffering from respiratory illness and live with this burden. Many patients have flu–like symptoms that is cough and cold and get treated for the same. Required tests need to be done to rule out suspicion of heart failure. India forms 16% of the world population. Statistics show 25% of Indians suffer from coronary heart disease, 120 million are hypertensive and a large number suffer from rheumatic heart disease.

By 2020, cardiovascular disease will be major cause of morbidity and mortality in India. On an average, Indians, aged 56 yrs, are affected with heart failure as compared to the world wide population. Mean age of these overseas patients is 73 years. Heart failure is on rise worldwide, the prevalence is highest in patients above the age of 65 and rises to 10-20% among the people above 70 years of age.

Mortality in heart failure is  still high even with the best of treatment available. Though the symptoms of heart failure stabilised with treatment and may seem that patients are doing well, there is a complex neuro-hormonal imbalance influencing the progression of the disease. This mechanism is addressed recently on understanding the pathophysiology of heart failure and its management.

Heart failure, a devastating disease, is the end stage of all cardiovascular diseases, mortality rate is higher as compared to the west. Early diagnosis and instant management of heart failure had become a challenging health priority. Effective treatment and comprehensive management lead to better lifestyle and longevity among heart failure patients.

Dilated heart
How heart failure occurs? Heart muscle (left ventricle) loses its efficiency to pump blood effectively due to loss of power, shape and size. Left ventricle has a built in size, shape, pressure (like car tyre pressure). Any alteration will result in a dilated heart and inefficiency leading to heart failure symptoms. Myocardial infarction (heart attack), valve disease, hypertension and other conditions damage the heart muscle leading to heart failure.

How do we know our heart is safe? You need to consult a heart specialist and undergo particular tests like blood test, x-ray, ECG and heart scan (echo) to clear the doubt. Echo will measure the heart size, power and valve status to give a clear picture about your heart. You could call it a “Heart Failure Clearance Certificate”. What next if I have a heart failure? Currently, there are novel drugs available for the treatment of heart failure. Water tablets remove congestion in the lungs. Drugs are available to improve heart function. Ischaemia burden and blood thinners to prevent blood clots in the coronary vessels.

Recently, a new drug was approved by the Federal Drug Administration, USA. European society of cardiology and American college of cardiology have recommended this novel drug and it has been in use for over a year in the west. The results are encouraging. In India, the same drug has been released recently. Combination of these drugs have improved, symptoms, quality of life and longevity.

(The writer is Consultant Cardiologist, Dr Malathi Manipal Hospital, Jayanagar, Bengaluru)

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