Heart ailments are the leading cause of mortality in India, due to key challenges in cardiac care like inadequate facilities, inaccessibility, and lack of awareness. According to The Global Burden of Disease (GBD) 2016 , cardiovascular diseases (CVDs) account for half of 6 million deaths due to non-communicable diseases (NCDs).

Ischemic heart disease  (IHD) is the leading cause of death in India with an increase of 53% from 2005. The disease is characterised by reduced supply of blood to the heart. It the main reason for heart failure in Indian patients.

Unfortunately, there is a lot of ambiguity around heart failure. Most patients either don’t understand the condition at all, or simply confuse it with heart attack, which is a pity as the statistics suggest that the incidence of heart failure is rising fast and evolving into a non-communicable disease of almost epidemic proportion. Since heart failure is a progressive disease it can easily turn into a costly and potentially fatal condition, if not controlled in time. 

In India, currently, there are 5.4 million estimated heart failure patients. A recent International Congestive Heart Failure (INTER-CHF) study, highlighted that the mortality rates in heart failure patients after one year of diagnosis are as high as 23% in India. The study also highlighted that heart failure patients in India are approximately 10 years younger than patients in US and Europe. The mean age of heart failure patients in India is 59 years.

Knowing Heart Failure

While a 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 (long-term) condition in which the heart can't pump enough blood to meet the body's needs. This simply means that the heart muscle responsible for the pumping action weakens or stiffens over time, failing to efficiently pump, leading to slower movement of the blood (and thus the oxygen and nutrients) through the heart and body. 

Slowly as the pressure in the heart increases, the kidneys respond by causing the body to retain fluid (water) and salt. This leads to fluid builds up in the arms, legs, ankles, feet, lungs, or other organs, the body becomes congested. That is why this malady is also known as Congestive Heart Failure. Heart failure can involve the left side (left ventricle), right side (right ventricle) or both sides of your heart. Generally, though it begins with the left side, specifically the left ventricle, which is the heart’s main pumping chamber.

Common reasons leading to heart failure are blocked arteries, heart attack, cardiomyopathy (damage to the heart muscles from infections or alcohol or drug abuse), or conditions that overwork and thus damage the heart like diabetes, high blood pressure, obesity, kidney disease or thyroid malfunction. In most cases heart failure does not have a single cause.

Symptoms

The signs and symptoms of heart failure develop over a period. The main symptoms to look out for are congested lungs, water retention showing up as swollen ankles, legs or abdomen, unexplained weight gain, increased night time urination, shortness of breath (dyspnea), loss of appetite, coughing up pink, foamy mucusreduced ability to exercise and excessive fatigue.Sometimes less blood supply to the brain can lead to dizziness or confusion. 

All these symptoms indicate a weakened heart, and are signals to visit a doctor. 

Diagnosis

The diagnosis for heart failure is carried out through a careful analysis of a person’s medical history, physical examination, and some laboratory tests like Echocardiogram (ECG) cardiac stress tests, heart catheterization and MRI of the heart. Sometime even the Ejection Fraction (EF) is used to measure how well your heart pumps with each beat.

Treatment

Today there are enough treatments available for heart failure. Lifestyle modifications, medications like beta blockers, ACE inhibitors, treatment of the causative causes (like high BP or diabetes). 

A new treatment protocol of heart failure and hypertension, uses sacubitril/valsartan, which is a combination of two existing blood-pressure-reducing medications. The drug has reduced the risk of dying from all cardiac causes by 20% and reduced hospitalizations due to heart failure hospitalizations by 21% 

Not all conditions that lead to heart failure can be reversed, but treatment can control the advancement of symptoms and help one live longer with improved quality of life.

The writer is president, Cardiological Society of India (CSI)