Being diagnosed with heart failure is not the end of life it can be managed

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Many of us have seen our near and dear ones complaining of symptoms like chest pain or increased fatigue in day-to-day activities. Then a physician runs a few tests and diagnoses it as heart failure. This story repeats itself for many families across India. Heart failure is the gradual weakening of the heart muscle and is often confused with a heart attack. Due to lack of awareness about the disease, patients do not consult the doctors at the right time. Treatment begins too late, which often requires surgery resulting in various complications and at times becomes unmanageable. In India mortality rate is more than 20%, and patients here are ten years younger than the global average.

Beat Heart Failure – an initiative by The Times of India in partnership with Novartis aims to spread awareness as patients panic and bombard the doctor with endless questions when diagnosed with heart failure. To explain what it is, the primary signs and symptoms, the course of the disease, the management of the disease, life expectancy, and Covid19 impact on heart health and when to consult a doctor if a patient’s condition deteriorates at home, doctors from BLK-MAX Super-Speciality Hospital, New Delhi have joined the initiative –

Dr. Subhash Chandra (Chairman and HOD Cardiology)

Dr. Neeraj Bhalla (Senior Director Cardiology)

Dr. Ramji Mehrotra (Principal director and chief -CTVS Cardiothoracic Vascular Surgery).

“Our body is a great miracle, and our heart is designed to pump tirelessly from the moment even before we are born till the person dies. The first signs of life are recognised on the ultrasound by checking the fetal heart movement”, explained Dr Neeraj Bhalla. Our heart is a muscular pump that has to contract continuously. It receives and expels the blood. Many reasons may weaken it leading to heart failure, and often it is not easily reversible but can be controlled or managed.

To simplify heart failure, Dr Subhash Chandra gave an interesting analogy. Think of a mechanical pump in the house that drains supply from the municipality and puts it in the overhead tank. That tank distributes water in the kitchen and bathroom pipes. If the pump weakens, the stream of the water in the house is slow. The heart functions similarly. It collects blood from various body parts and sends it to the lung for oxygenation. The blood then comes back to the heart. Then it pumps oxygenated blood to all parts of the body. It is a muscle that may weaken due to various reasons. If this pump weakens, it results in multiple symptoms.

Whereas, when the flow of blood to the heart is blocked, that causes heart attack. The blockage is most often a build-up of fat, cholesterol and other substances, which form a plaque in the arteries that feed the heart (coronary arteries).

In India, significant causes of heart muscle weakening are coronary artery disease due to alcohol intake, erratic lifestyle, tobacco chewing causing premature heart attacks, genetic reasons, foods rich in high fats, diabetes. Other causes of heart failure can be viral fevers, rheumatic disorders or valvular disorders. The most common cause occurs when the heart’s blood supply is compromised due to blockages. It causes the heart to activate a compensatory mechanism where it starts beating slowly to preserve its muscle and not die.

“The heart is a muscle, and muscle is life. When a person has a heart attack, a part of the muscle dies if the arteries close for a long time. Therefore, it is necessary that emergent opening of the vessels during the attack preserves the heart muscle the best and prevents heart failure and subsequently the whole outcome of the patient. It is the golden hour after the cardiac attack that will determine the entire prognosis of the patient, whether he lives a crippled life or an active life. If not managed on time, it will gradually weaken the heart and progress heart failure”, Dr Ramji Malhotra elaborated further.

It is necessary to know how much the muscle functions to understand whether heart failure is reversible and if the person can lead an everyday life. After a heart attack, the doctor does an angioplasty, and an assessment of the functioning of the heart by an investigation called echocardiography (ECG). It will reveal the ventricular function of the heart and calculate ejection fraction (the efficacy of blood pumped by the heart).

An ordinary person does not understand the reason behind their symptoms and whether they should consult a doctor. Some of the signs and symptoms are:

1) Exertion-related breathing difficulty, which aggravates in advanced stages or at night. The person requires more than one pillow or lies on one side. The person can’t lie straight on their back.

2) Patient suddenly wakes up in the middle of the night gasping for breath, suffocative feeling while sleeping. It is a sign that tells the cardiologist that the patient may end up in an emergency.

3) Increasing fatigue and difficulty doing daily activities such as climbing stairs, gardening, sexual activity.

4) Swelling of feet or compensatory weight gain as the body tries to conserve fluid to increase the heart’s efficiency.

After a person is diagnosed with heart failure, they must contact their cardiologist regularly. There has been tremendous advancement in the treatment compared to two-three decades back. The mortality rate due to cardiac involvement has reduced by 50%. This progress has also improved the quality of life. Cardiologists suggest regular echocardiography. The cardiologist checks the ejection fraction and accordingly proposes further management that whether the symptom management requires medications or surgery. Planned treatment depends on the causes and extent of heart failure. The doctor suggests having an emergency kit at home for patients with low ejection fraction.

These days younger patients are seen more frequently in emergency wards with cardiac disorders. The pandemic has seen worsening heart health and increased cardiac deaths. Multiple external factors have precipitated this crisis further. Patients who have heart disease and recover from covid are more prone to cardiac death. Various studies have shown that Covid19 increases blood coagulability (blood thickening), pulmonary embolism, myocarditis, etc. Stress has also increased during this time. All these factors together contribute to the rise in heart disease.

A person with a history of Sars-cov2 should get a cardiac check-up, and people with associated comorbidities should constantly visit the doctor. People should take caution in resuming physical activities. After contracting Covid19, people must often see their doctors if symptoms persist and feel fatigued, observe a weight increase, swelling of feet, increased frequency of peeing, racing of heart or giddiness.

There are plenty of ways to manage heart failure. The first is living a healthier lifestyle regarding diet and exercise, controlling weight, avoiding smoking and drinking alcohol, and second is regular treatment. Medical science has made a lot of progress, and many treatment options are available too. Remember, heart failure is not a death sentence; it’s an opportunity to change the trajectory of your health.

To know more about how to manage heart failure, visit

Disclaimer:“The views and opinions expressed in the article by the panelists/experts are based on their independent professional judgement and are disseminated in public interest. These views should not be considered as a substitute for professional advice of a registered medical practitioner. The purpose of this article is not to promote any medical procedures or medication and/or recommend a certain doctor. For any specific health issues, please consult your registered medical practitioner.”


(This story has not been edited by THE WEEK and is auto-generated from PTI)