Dr Gokhale explains about signs and symptoms that cause heart failure. Seek emergency treatment if you experience any of the Heart failure symptoms.

1. Dr. Alla Gopala Krishna Gokhale
First Surgeon in Telangana & Andhra Pradesh to
do Heart Transplant, Lung Transplant & Minimal
Access Bypass Surgery
All About Heart Failure
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2. All About Heart Failure
 Heart Failure (HF) – a condition in which a weakened heart
can’t pump enough blood throughout the body. This leads to
reduced quality of life, frequent hospitalization and high
mortality. Although Heart Failure, like other heart ailments, has
been acquiring epidemic proportions in India in the recent past,
it has not received adequate public attention.
 Heart Failure usually can’t be cured, but thanks to advances in
technology and drug discovery, it can be effectively managed
and patients’ quality of life is improved. Coupled with
appropriate lifestyle changes, the inexorable progression of the
disease can even be arrested. Hence the importance of early
diagnosis and treatment.
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3. WHAT IS HEART FAILURE?
 Heart Failure does not mean that heart has stopped working or
is about to stop working. Heart Failure is a condition in which
the heart becomes so weak that it has trouble pumping a
normal amount of blood carrying enough oxygen and nutrients
to meet the body’s needs. While the word ‘failure’ sounds
alarming as it implies that the heart has suddenly stopped
working, the medical term actually describes a chronic
syndrome that typically develops slowly.
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4. SIGNS AND SYMPTOMS
 In the early stages, Heart Failure may not have any symptoms. In the
later stages, the patient may have severe symptoms because the
weakened heart is unable to pump enough oxygen-rich blood with each
contraction to satisfy the body.
 The most common symptoms are –
1. Difficulty in Breathing
2. Chronic Cough
3. Edema
4. Loss of Appetite
5. Fatigue
6. Rapid or Irregular Heartbeats
7. Mental Confusion or Impaired Thinking
8. Increase in Body Weight
9. Extreme Fatigue and Weakness
10. Cyanosis (blue color of skin), low blood pressure (hypotension), cold
sweating and gradual loss of consciousness are late features of CHF
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5. WHAT CAUSES HEART FAILURE?
 Heart Failure is caused by many conditions that damage the
heart muscle, including –
1.Coronary Artery Disease
2. Heart Attack
3. Cardiomyopathy
4. Strain on the Heart
5. High Blood Pressure (Hypertension)
6. Diseases of Valves of Heart
7. Diseases of Muscle of Heart
8. Birth Defects of Heart
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6. TYPES OF HEART FAILURE
 Heart Failure may be of two types – left-sided Heart Failure and
right-sided Heart Failure.
 Left-sided Heart Failure occurs when the left ventricle cannot
adequately pump oxygen-rich blood from the heart to the rest of
the body. The main symptoms include shortness of breath,
fatigue and coughing. There may also be lung congestion (with
both blood and fluid).
 Right-sided Heart Failure occurs when the right ventricle is not
pumping adequately, which tends to cause fluid build-up in the
veins and swelling in the legs and ankles. Right-sided Heart
Failure usually occurs as a direct result of left-sided Heart
Failure. It can also be caused by severe lung disease.
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7. TYPES OF HEART FAILURE
 Heart Failure is also defined in terms of the cardiac cycle. Systolic
Heart Failure means that the heart is unable to pump adequate
amounts of blood during its contraction. Lung congestion and swelling
(edema) of the lower extremities are typical symptoms of systolic
Heart Failure. Coronary artery disease, high blood pressure and
heart valve disease cause systolic Heart Failure.
 Diastolic Heart Failure refers to the heart’s inability to relax between
contractions and allow enough blood to enter the ventricles.
Symptoms may be identical to those of systolic Heart Failure.
Diastolic Heart Failure is often a precursor to systolic Heart Failure.
Coronary artery disease, high blood pressure and cardiomyopathy
cause diastolic Heart Failure.
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8. DIAGNOSIS
 There is no single test that can diagnose Heart Failure. The patient may have to
go some of the following tests–
1.ECG (Electrocardiogram)
2. Chest X-ray
3. BNP Blood Test
4. Thyroid Function Tests
5. Echocardiogram
6. Holter Monitor (Ambulatory Electrocardiography, EKG) Test
7. Nuclear Heart Scan
8. Cardiac Catheterization
9. Coronary Angiography
10. Ejection Fraction (EF) Test
11. Magnetic Resonance Imaging (MRI)
12. Positron Emission Tomography (PET) Scanning
13. Radionuclide Heart Scan
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9. TREATMENT
 Treatment for Heart Failures aims at –
1.Slowing its progression (thereby decreasing the risk of death and
the need for hospitalization)
2.Reducing symptoms (water retention, shortness of breath, etc.)
3. Addressing heart rhythm disturbances.
4. Improving the quality of life.
 Heart Failure is a chronic and progressive condition that can be
managed but rarely cured. Many people’s symptoms and heart
function will improve with proper treatment. In some cases, doctors
correct Heart Failure by treating the underlying cause.
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10. TREATMENT
 Treatments, or a combination of treatments, are selected based on
the type, cause and severity of Heart Failure and the overall health
and other factors such as age of the patient.
 Treatment may include –
1.Lifestyle changes.
2. Medications for Heart Failure and underlying causes, such as
coronary artery disease, heart valve disease, high blood pressure
and arrhythmias.
3. Surgical procedures including heart transplantation in extreme
cases.
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11. LIFESTYLE CHANGES
 If the Heart Failure has been diagnosed as mild, lifestyle changes along with
medication will be effective in slowing its progression. A patient should observe
the following dos and don’ts –
1.Eat a Healthy Diet
2. Exercise Regularly
3. Keep Blood Pressure Low
4. Monitor Symptoms
5.Maintain Fluid Balance
6. Limit Salt Intake
7. Take Medications as Prescribed
8. See the Doctor Regularly
9. Bed Rest
10. Stress Reduction
11.Others lifestyle changes that may reduce the symptoms of heart failure
include stopping smoking or other tobacco use, eliminating or reducing alcohol
consumption, and not using harmful drugs.
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12. MEDICATIONS
 Doctors usually treat Heart Failure with a combination of medications depending
on the symptoms. Several types of drugs have proved useful in the treatment.
The main medicines are –
1. Angiotensin-Converting Enzyme (ACE) Inhibitors
2. Angiotensin II (A-II) Receptor Blockers (ARBs)
3. Digoxin (Lanolin)
4. Beta Blockers
5. Diuretics (Water Tablets)
6. Aldosterone Antagonists
7. BiDil
8. Cardiac Glycosides (eg. Digoxin)
9. Other Medications – Nitrates for chest pain, a statin to lower cholesterol or
blood-thinning medications to help prevent blood clots may be given with Heart
Failure medications.
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13. SURGICAL TREATMENT
 Surgery is aimed at stopping further damage to the heart and improving its
function. Procedures include –
1.Heart Pumps
2.Pacemakers & ICDs
3.Coronary Artery Bypass Grafting Surgery
4.Coronary Stenting
5.Heart Valve Surgery
6.Infarct Exclusion Surgery (Modified Dor or Dor Procedure)
7.Cardiac Resynchronization
8.Heart Transplant
9.Cardiac Wrap Surgery
10.Enhanced External Counterpulsation (EECP)
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14. HOW IS ACUTE HEART FAILURE
TREATED?
 Acute heart failure is a condition when symptoms especially
breathlessness suddenly become severe and distressing and usually
requires admission to hospital. The primary cause for acute heart
failure is excessive collection of fluid in the lungs that interfere with
proper oxygenation of blood. It is treated with diuretic medicines that
are injected directly into the vein to help remove this excessive fluid. A
strong painkiller like morphine may be given to help reduce anxiety
and an oxygen mask to ease breathing.
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15. THANK YOU