by KOLLAGUNTA CHANDRASEKHAR, KSC Cardiology
Heart failure is a syndrome in which the heart is unable to pump enough blood to meet the body’s needs. This could be because the heart muscle is weak or because the heart is stiff and unable to fill properly.
Previously, it was thought that heart failure always meant a weak heart. We now realize, however, that more than 50% of patients admitted to hospitals in the United States with shortness of breath and heart failure have “normal function.” In these cases, the heart is stiff and is unable to stretch to accommodate the blood that it receives.
Understanding the Basics
Ejection fraction: The difference between the volume of blood in the heart after it fills (diastole) and the volume after it contracts (systole) is normal. This is the stroke-volume, the amount of blood that is pushed out per beat. If this is taken as a fraction of the volume of blood in the diastole, that percentage is the ejection fraction. Normal ejection fraction is greater than 50%. Less than 40% is reduced ejection fraction.
There are 4 kinds of heart failure: Heart failure with reduced ejection fraction (EF less than 40%), heart failure with midrange ejection fraction (EF 40-50%), heart failure with preserved ejection fraction (greater than 50%) and heart failure with improved ejection fraction (patient whose ejection fraction was reduced and now has improved with medications/treatment).
It was generally believed that a heart that was damaged could not recover and treatment of heart failure was basically a treatment of symptoms. Not anymore. Treatments with medicines and devices have improved outcomes significantly.
Heart failure management falls broadly into three columns.
1. Treatment of congestion: Congestion, filling up with fluid either in the lungs or in the legs, is the main symptom for which patients seek medical attention. This is treated by diuretics to remove fluid. The diuretics help with the symptoms, but they do not help the heart itself. Keeping the fluid status optimal is key to keeping the patient out of the hospital.
2. Treatment of the weak heart: There are many different classes of medications used to treat a weak heart and help it get better. 4 of these (the pillars) are absolute musts and need to be started as soon as feasible after diagnosis.
It used to be that doctors would try one medication at a time and gradually add others for weak hearts (HF with reduced EF). The main disadvantage of this was that it would take a good three months or more for patients to be on all of the medications needed.
3. Risk of cardiac arrest and sudden death: Patients whose EF remains low need defibrillators.
BIO: Dr. Kollagunta Chandrasekhar, better known as Dr. Sekhar (pronounced Shaker) has been practicing cardiology in Winter Haven for more than 25 years.