Understanding Heart Ailments And Its Treatments
“Identifying heart ailments at an early stage is of utmost importance as it can prevent emergency situations and save a life”
The Pumping Ability Of The Heart
The most important and common causes of heart failure is coronary artery disease, cardiomyopathy and hypertensive heart disease. Other systemic diseases like thyroid disease, anaemia and infections also cause heart failure. We need to understand that the heart is a pump. It pumps blood to the body to maintain circulation of oxygen, glucose and other nutrients. When the heart is diseased or unable to pump adequate amount of blood, it leads to heart failure.
When the heart is unable to pump, the endocrine system and angiotensin system gets activated causing salt water retention and an increased resistance of blood vessels in an attempt to correct the decreased blood flow to the organs. These attempts further deteriorate the pumping ability of the heart and increases the load on the heart resulting in a viscious cycle. The treatment of heart failure lies in correcting these bad effects so that the heart regains its function.
The Two Types Of Heart Failure
Acute Heart Failure
This is an emergency situation caused due to the sudden blockage of blood vessels that supply blood to the heart muscle. This results in severe breathlessness or death. The best treatment for this kind of heart failure is to open the blocked vessels by balloon treatment called primary or emergency angioplasty.
Chronic Heart Failure
The heart functions slowly resulting in breathlessness, leg swelling, weight gain, decreased working capacity and weakness. Patients may get up with breathing difficulty during nights and prefer to sit up than lie down. This condition is called orthopnea.
Heart Pumping Tests
Echocardiogram is the best test to know the pumping function of the heart. It also helps in identifying the cause of heart failure. The pumping function of the heart is expressed as ejection fraction (E.F), the fraction or percentage of blood pumped by the heart with each heartbeat.
Other tests that reveal the pumping function of the heart are radionuclide ventriculography (RNV) and angiogram. Angiogram also helps identify the blockage of blood vessels.
Dealing With Emergencies
In emergency situations, the patient needs oxygen, diuretics and medicines that improve pumping like dopamine and dobutamine. In chronic heart failure, apart from controlling hypertension, medicines that decrease the load on the heart like vasodilators, angiotensin inhibitors, diuretics, beta blockers are given.
Salt and water restriction is an essential part of heart failure treatment. Also, medicines which decrease cholesterol deposition in the blood vessels like statins are often used.
Treatments For Different Heart Ailments
- Definite treatments like angioplasty, open heart surgery, bypass grafts and valve replacements have changed the treatment of heart failure
- Latest treatments like cardiac resynchronization and cardiac transplantations are becoming more common
- Also, technology and medication that prevent organ rejection are becoming available
- Identifying heart ailments at an early stage is of utmost importance, as it can prevent emergency situations and save a life
- In patients with an enlarged heart, the electrical activity becomes slow, resulting in delayed electrical activity of the heart tissues, called left bundle branch block.
- If the ventricular activity is prolonged to 150 milliseconds or more, there is a delay in activation of various portions of the muscular activity of the left ventricle.
- This condition can be corrected with a specialized pacemaker therapy called Cardiac Resynchronization Therapy (CRT).
- In CRT, electrodes are kept in the left ventricle that stimulates the walls of the ventricle in a coordinated way. This therapy has become a very good alternative for cardiac transplantation.
- Another device often recommended is Intra Cardiac Defibrillator (lCD).
- When there is decreased pumping of the heart, missed beats can occur and may lead to ventricular tachycardia (VT), ventricular fibrillation (VF), cardiac standstill and death.
- The electrode of lCD delivers a shock to the heart automatically and corrects the disordered beating. It has become a very useful device in preventing these complications and sudden cardiac death.
Heart Failure Due To BNP/Sodium
Normally the hormone BNP or brain natriuretic peptide, is secreted by the heart muscle when it is stretched. In heart failure, due to increased pressure in the heart chambers, BNP is secreted in higher amounts. The level depends on the severity of heart failure with very high levels indicating poor prognosis. The levels also decrease with effective heart failure treatment.
More water is retained in the body than sodium resulting in water retention. This can cause drowsiness, weakness, stupor and convulsions. However, if sodium consumption is limited, it will help reduce the amount of extra fluid around the heart, lungs, and in the legs, as additional fluid in the body makes the heart work harder leading to increased blood pressure. Thus, treatment apart from salt restriction, includes restricted fluid intake.