The importance of a healthy heart is undeniable, yet now more than ever, due to high cholesterol diets, coupled with stressful lives and a lack of exercise — has resulted in heart disease killing more people than the various cancers, combined.
Due to several variables, there are times when the organ does not function at an optimal level; this is where medical experts such as Dr Mohamed Khan step in.
The doctor highlights, one of the health-related issues associated with this organ is heart failure — explaining, it is a condition in which the heart does not pump or fill with blood well.
Going on to add, “This causes the heart to lag behind in its job of moving blood throughout the body. This can lead to symptoms such as swelling, trouble breathing, and feeling tired.”
Dr Khan explains, what many people do not realise is that there are two main types of heart failure.
● In heart failure with preserved ejection fraction, the heart is too stiff. When the heart pumps, it doesn’t relax and fill with blood normally. This type of heart failure is also known as “diastolic heart failure”.
● In heart failure with reduced ejection fraction, Dr Khan stresses the heart is too weak —thus when the heart pumps, it doesn’t squeeze normally. He says this type of heart failure is known as “systolic heart failure”.
The term “ejection fraction” (or “EF”) is not a term which a non-medical professional is familiar with. According to Dr Khan, this is the amount of blood the heart pumps out with each heartbeat. “People with “heart failure with preserved ejection fraction” have a normal (or almost normal) EF,” he elaborates.
People with the other type of heart failure, “heart failure with reduced ejection fraction,” have an EF that is lower than normal.
When looking at the warning signs of heart failure, Dr Khan states there are symptoms to look out for. These symptoms can include:
● Trouble breathing: At first, people might have trouble breathing only with activity. Over time, they can also have difficulty breathing at rest or when lying down.
● Swelling in the feet, ankles, legs, or belly
● Feeling tired
If you suspect you might have any signs of heart failure as listed above, Dr Khan explains, your doctor or nurse will ask about your symptoms, do an exam and order some of the following tests:
● Blood tests
● Chest X-ray – This test can show if there is fluid in the lungs. It also shows the general shape of the heart and large blood vessels in the chest.
● Electrocardiogram (also called “ECG”) – This test measures the electrical activity in the heart.
● Echocardiogram (also called an “echo”) – This test uses sound waves to create a picture of the heart as it beats.
● Stress test: During this test, a doctor records your ECG while you exercise on a treadmill or bike, or will administer medication to make the heart pump faster.
● Cardiac catheterisation (also called “cardiac cath”) – During this test, the doctor puts a thin tube into a blood vessel in your leg or arm. Then he or she moves the tube up to your heart. When the tube is in your heart or blood vessels, he or she will take measurements. The doctor might also put a dye that shows up on an X-ray into the tube. This can show if any arteries in your heart are narrowed or blocked. This part of the test is called “coronary angiography”.
When it comes to the treatment of heart failure, Dr Khan explains that treatment involves several medications and steps to enhance your heart’s health.
He elaborates further on the matter, explaining, “Doctors can use different types of medicines to treat your heart failure. The right medicines for you will depend on your symptoms and other medical conditions. Some medicines will reduce your symptoms, such as swelling or trouble breathing. This will help you feel better and be more able to do everyday tasks.”
If an individual has fluid on their lungs or swelling in their legs, Dr Khan adds the patient’s doctor might prescribe a “diuretic” (water pill) to help with these symptoms.
“Your doctor might also prescribe a medicine called a mineralocorticoid receptor antagonist. This helps the body get rid of extra salt and fluid — while also allowing the body to hold onto a mineral called potassium, a vital mineral required by the body to function normally. A mineralocorticoid receptor antagonist might also protect the heart from harmful hormone effects that happen in heart failure.”
If a person has high blood pressure, Dr Khan goes on to explain their doctor might prescribe medicines to control it. Saying, “If you have a heart rhythm problem called “atrial fibrillation,” your doctor might prescribe medication to control your heart rate.”
It is noted; that it is paramount to take your medicines every day, even if you feel well. It is also required to tell your doctor or nurse if you can’t afford your medicines or if they cause side effects. There are often ways to help with these issues.
Dr Khan adds another essential aspect of caring for your heart’s health, is treating your coronary heart disease (if you have it). He explains, “In coronary heart disease, the arteries that bring blood to the heart get clogged. Treatment can include medicines, a procedure to unblock a clogged artery or surgery.”
When referring to the above, it is undeniable that treatment is of the utmost importance. However, in modern-day society, some prefer a holistic approach to caring for their hearts.
But when compared to holistic approaches in treating heart failure, how does alternative medication compare?
Dr Khan emphasises, “Due to the limited data to support some alternative treatment options; these cannot be blanketly recommended without consulting with your physician. Treatment strategies can be individualised, taking into account individual circumstances, and the safety profile of these treatments.”
He also stresses that there is no replacement for maintaining a healthy lifestyle — adding, it is vital to be involved in your management, rather than just being a silent bystander.
The doctor looks at heart failure self-management, stating that effective care includes patient education and support to promote self-management.
He elaborates even further by saying self-management includes medication management, daily monitoring of signs and symptoms (including daily weight monitoring to detect fluid accumulation) and lifestyle modification.
Lifestyle modification is primarily based upon observational studies and physiologic rationale:
● Cessation of smoking
● Restriction of or abstinence from alcohol consumption.
● Based on expert opinion and limited evidence, Dr Khan advises patients to restrict sodium intake to 3 g/day. This level of sodium restriction is likely sufficient. A more restrictive sodium intake is not practical for many patients, and there is limited evidence that a more restrictive intake can be harmful.
●We advise restricted fluid intake (eg, 1.5 to 2 L/day) only in patients with refractory disease.
●Avoidance of obesity.
With medical practitioners making it their mission to care for patients, what are the latest scientific breakthroughs in treating various heart conditions?
Dr Khan states that over and above the standard medical therapy, there are now medical devices that have shown to improve heart failure in certain patients. These he says includes:
● An implantable cardioverter-defibrillator to immediately manage patients who develop arrhythmias. Arrhythmias are common in advanced heart failure and are a common cause of death.
● Cardiac resynchronisation therapy (CRT) with biventricular pacing is indicated in selected patients. This therapy allows for a more synchronised cardiac contraction and thereby improving cardiac output. This translates into improved symptoms.
As Dr Khan highlights the importance of following the accredited medical treatments and lifestyle improvements — it is imperative to visit your local GP if you suspect or show signs of a heart condition.