Consultancy Corner: Managing heart failure

This problem is one of the most recognised but hidden problem in our country. A rough estimation of more than 3 million cases developing every year.

Not exactly. Heart failure was not diagnosed easily till now, unless patient was very sick or admitted in hospital. One of the reason is awareness among physicians and the general public is more now. Another is availability of simple blood tests for HF called HF biomarkers – one example is a blood test called NT PRO BNP in India.

Heart failure is a slow consequence of gradual loss of heart muscle function. This has many common causes - one example is a silent heart attack in diabetic patients. Since the process is slowly progressive the disease does not manifest externally in dramatic fashion for patient or even doctor to detect it. 

The early symptoms or signs of HF can be very subtle – like fatigue, mild shortness of breath or mild leg swelling. In sedentary Indian patients these are generally overlooked or passed off as other problems. Like some patients with breathless and wheezing can be passed off as asthma, mild leg swelling can be thought off due to vein stasis or due to medicines like amlodipine or due to diabetes.

There are only 2-3 sure ways for a physician to diagnose HF in its early stages. The easiest way is to get a blood test called NT PRO BNP done. Another is to get an Echocardiography – heart scan done. But NT RO BNP is not available in all diagnostic labs in India. For example, in a developed city like Chennai, this is available only in 50% of the large diagnostic chains and less than 25% of hospitals. 

Echocardiography for HF is also another difficult area and again, since this needs access to Cardiologist it not easily done outside metro cities. Another problem is all Cardiologists are not familiar with details of HF Echo.

Patients who are diabetics or elderly or who have undergone following procedures like bypass surgery or angioplasty or CRT device or pacemakers should suspect HF if they have shortness of breath, leg swelling or wheezing.

Yes. Surprisingly one of the most common association of HF nowadays is in Coronary disease. Patients who had angioplasty for previous heart attacks or bypass surgeries or had pacemaker/CRT devices implanted. This is only an association and has many causes. For example, re-block of an artery or graft after angioplasty or bypass surgery. This problem is more common in patients aged more than 40 years.  

There is a varied group of idiopathic illnesses called cardiomyopathies. Cardiomyopathy means degenerative disease of the heart muscle. This has multiple varies causes numbering in 100’s. For example, post child delivery, many young women develop a debilitating heart muscle disease called, post-partum cardiomyopathy. This can progress rapidly to death if not treated. Another reason is viral illness of heart muscle called myocarditis – can lead to dilated cardiomyopathy. Other causes are cancer chemotherapy drugs, alcohol abuse, familial causes etc.

One common early treatment, employed by physicians is to start patients on diuretics like Lasix. This just masks the illness by reducing leg swelling and body fluids. Diuretic treatment for HF, does not treat root cause of the problem. It increases chances of patient having a kidney dysfunction and causes low potassium and sodium levels in body. More depressingly diuretic use masks the external signs of the illness and gives patients a false sense of relief.