Heart failure and attack are not same

In 1971, when Jim Morrison was found dead due to heart failure in a Paris apartment, at a young age of 27 years, it took the world by a storm. People woke up to the fact that even the young can die from heart failure, which was believed to be an ailment of the old.

Cut to 2017, George Michael died in his sleep and the cause of death was believed to be heart failure. The world took notice of it, again, but is that enough?

Over the last four decades, a grim reality has been staring at us: heart failure is growing at an unprecedented pace, but the awareness about it is as little as it was then.

Often confused with heart attack, the symptoms of heart failure are dismissed as “age related” or “just momentary, nothing major.” Heart failure is a debilitating and life-threatening condition, which impacts over six crore people worldwide.

One of the most common questions posed by heart failure patients when they are informed about their condition is “How can my heart fail? I drove to your clinic myself, went to work this morning and haven’t even suffered a heart attack!”

As cardiologists, it is important for us to educate patients and caregivers about the difference between heart failure and heart attack and that they are two different medical conditions.

While heart attack is a sudden and unexpected event resulting from blockage in the arteries supplying blood to the heart muscles, heart failure is a chronic and progressive condition in which the heart can’t pump enough blood to meet the body’s needs.

Heart failure is led by symptoms like shortness of breath and swelling. It can lead to an altered mental state. This condition is not painful, is not a severe process and does not lead to sudden death. Heart attack is usually critical and causes a lot of chest pain, which may lead to sudden death.

Since heart failure is a progressive condition, it is similar to other progressive diseases like cancer and chronic obstructive pulmonary disease (COPD). The stage of the condition depends on the extent of damage already done. The symptoms vary according to the different stages and hence, a patient must identify these in order to get the best treatment.

Note that heart failure is a condition when the heart does not contract or relax properly, and hence, it cannot pump enough blood around the body. That is why it often leads to blood backing up in the lungs making it difficult to breathe (left-sided failure) and blood backing into veins resulting in swollen legs and feet (right-sided failure).

Catch it in time

In most patients heart failure sees a gradual progression due to co-morbid conditions like chronic high blood pressure, ischemic heart disease etc, or due to drugs or alcohol abuse.

Lifestyle diseases like diabetes, obesity, smoking, depression, inherited heart disease such as cardiomyopathy where the heart muscle is damaged, hypothyroidism, faulty heart valves and heart arrhythmias which experienced as abnormal heart rhythms, that cause the heart to beat too fast, and thus work too hard, are other risk factors.

It is also important to note that a patient who has suffered a heart attack may eventually develop heart failure if the tissue damage due to the former was extensive.

The symptoms for heart failure include — shortness of breath, extensive fatigue, diminished ability to exercise,  build-up of fluid somewhere in the body, persistent cough or wheezing, lack of appetite, nausea, confusion, impaired thinking and increased heart rate.

The condition can be diagnosed by means of a thorough physical examination, diagnostics and a knowledge of the person’s medical history.

It is important to go for an examination as soon as one identifies or observes any of the symptoms in order to begin timely treatment and arrest its development.

Even though some crucial damage that has developed over time can’t be reversed, it can be managed, quite often with strategies like treating the underlying cause, lifestyle changes, addressing potentially reversible factors, mechanical therapies and medications. If there is no response to medical therapy, there are surgical options, including heart transplant.

Heart failure is a preventable condition if diagnosed in time. Timely detection would go a long way in improving the quality of life extensively.

(The writer is cardiologist, Manipal Hospital, Bengaluru)