Prevent Heart Failure.

The best way to prevent heart failure is to:

Lower your risk of getting heart disease by making lifestyle changes.

Control certain health problems, such as high blood pressure and diabetes.

 

To reduce your risk:

 

Don’t smoke. If you smoke, quit. Smoking greatly increases your risk for heart disease. Avoid secondhand smoke too.

Lower your cholesterol. If you have high cholesterol, follow your doctor’s advice for lowering it. Eating a heart-healthy diet-such as the TLC diet -exercising, and quitting smoking will help keep your cholesterol low.

Control your blood pressure. High blood pressure raises your risk of getting heart disease and heart failure. Exercising, limiting alcohol, and controlling stress will help keep your blood pressure in a healthy range.

Get regular exercise. Exercise will help control your weight, blood pressure, and stress. Controlling these things will help keep your heart healthy. Try to do activities that raise your heart rate. Aim for at least 2½ hours of moderate exercise a week. One way to do this is to be active at least 10 minutes 3 times a day, 5 days a week. Talk to your doctor before starting an exercise program.

Control diabetes. Take your medicines as directed, and work with your doctor to make a diet and exercise plan to control diabetes.

Limit alcohol. If you drink alcohol, drink moderately. This means no more than 2 drinks a day for men and 1 drink a day for women. Heavy consumption of alcohol can lead to heart failure.

 

via Heart Failure-Prevention.

Common painkillers linked to heart, stoke and gastrointestinal risks!

Do you think twice before popping in a painkiller analgesic  in your mouth. If no, read this!

A recent meta-analysis was done to study the effects of analgesics like ibuprofen, diclofenac and coxibs on heart risks, stroke risk, and gastric bleeding risks.

The meta-analysis included  280 randomized trials of analgesics (non-steroidal, NSAID)  versus placebo  with 124 513 participants, 68 342 person-years. It also included 474 trials of one NSAID versus another NSAID 229 296 participants, 165 456 person-years. It was published recently in the Lancet.

The main outcomes were major vascular events like heart attacks, stroke, or vascular death and  gastrointestinal complications like perforation, obstruction, or bleed.

Findings

Major vascular events like heart attacks and strokes were increased by about a third by all the analgesics like coxib, diclofenac.  Ibuprofen also significantly increased major coronary events. Compared with placebo, of 1000 patients allocated to a coxib or diclofenac for a year, three more had major vascular events, one of which was fatal.

Naproxen did not significantly increase major vascular events.

Heart failure risk was roughly doubled by all NSAIDs.

All NSAID regimens increased upper gastrointestinal complications like bleeding and perforation.

The vascular risks of high-dose diclofenac, and possibly ibuprofen, are comparable to coxibs, whereas high-dose naproxen is associated with less vascular risk than other NSAIDs.

 

Although NSAIDs increase vascular and gastrointestinal risks, the size of these risks can be predicted, which could help guide clinical decision making

 

In view of the above findings it would be advisable not to pop in a pain killer for mild aches and pains. Patients who need pain killers for chronic pain should take them strictly under medical supervision. 

 

via Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials : The Lancet.

Drugs for the weak heart!

ImageWeak Heart is a condition caused by weakness of the heart muscle where in the heart is unable to pump blood to meet the daily requirement of the body.

This condition in medical terms is called Cardiomyopathy or Left ventricular (LV) dysfunction.

This condition causes breathless on exertion initially and then breathlessnes at rest in the late stages. One is unable to sleep supine at night due to the breathlessness. It may be associated with cough and swelling of the feet. This clinical condition is called Heart Failure.

The condition is diagnosed by carrying out an Ultrasound of the heart to know its pumping function. This test is also called 2D-Echocardiography.

 

There are some important medications which patients need to take:

1. Diuretics: These are drugs given either orally or intravenously. These act on the kidneys by flushing water and electrolytes from the body. By flushing out water from the body, these drugs reduce the congestion in the lungs and thereby reduce breathlessness. They also cause reduction in the swelling in the feet. This causes increase in the urine output. Thus, these drugs are advised to be taken in the mornings. 

The common ones used are Furosemide, Spironolactone, Amiloride, Triamterene etc.

These can cause electrolyte imbalance and dehydration and so the therapy need to be monitored.

These drugs are recommended to patients in heart failure who are breathless and develop swelling of the feet. They relieve patients of their symptoms but are not found to reduce the  long term mortality.

 

2. ACE Inhibitors. This is a class of drug which acts by blocking the conversion of angiotensin I to angiotensin II. They, therefore, lower arterial resistance and increase venous capacity; increase cardiac output. They reduce the cardiac mortality in the long run and are recommended in all patients with heart failure and LV dysfunction.

The common ones used are Enalapril, Captopril, Ramipril and Perindopril. These drugs can cause increased potassium levels in the blood and can cause dry cough in come patients. If a patient in unable to tolerate the drug due to dry cough, they can be substituted with ARBs. ARBs (angiotensin receptor blockers) are similar drugs but tend to be more expensive.

They are recommended for all patients with LV dysfunction and/or heart failure as they reduce long term mortality.

 

3. Beta-Blockers: This is a class of drug which reduces sympathetic over-activity. Thereby, they reduce the heart rate and blood pressure, thus giving the heart much needed rest to recover. 

The drugs approved for this condition are Metoprolol,  Bisoprolol and Carvedilol. These drugs need to be started in very small doses and then increased carefully as some of the patient may encounter worsening of their symptoms. Majority of the patients tolerate them well. They need to be monitored for the side effects like bronchospasm and slow heart rate.

They are recommended for all patients with LV dysfunction and/or heart failure as they reduce long term mortality.

Now you know what to take if someone suffers from LV dysfunction or heart failure. 

Take care!

Heart Failure

Introduction:

Heart Failure (HF) continues to be a major heart problem and an important cause of hospitalization in India. The number of patients with HF has been gradually increasing due to improving life span of patients and improved survival after heart attacks in the last few years. More patients are being saved from heart attacks due to better availability of drugs and immediate revascularization of the blocked vessels. Though this is heartening news, the number of patients with poor heart function has been increasing all over the country.

What is Heart Failure?

Heart Failure does not mean that heart has stopped working or is about to stop working. HF 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.

 

What causes HF?

HF develops either as a result of (1) damage to the heart muscle (which could be caused by coronary artery disease,  infection or toxic exposure to chemicals such as alcohol and drugs) or (2) when too much strain is placed on the heart because of years of untreated high blood pressure or an abnormal heart valve.

 

What is the commonest cause of Heart Failure/ heart muscle damage?

The commonest cause of HF is coronary artery disease where in the blockages of the coronary arteries cause damage to the heart muscle thereby reducing the pumping of the heart. The loss of pumping function of the heart is directly related to how fast the patient seeks treatment for a heart attack. Patients who receive treatment within one hour of onset of chest pain due to a heart attack do well as the heart muscle is salvaged from further damage due to early intervention in the form of drug treatment or angioplasty. Damage to the heart muscle due to drugs, alcohol or infections is the second common cause of HF.

 

What do the patients complain of?

The commonest symptom is shortness of breath, also called dyspnea, which is caused by accumulation of fluid in the lungs due to failure of the left side of the heart.

Swelling of feet, ankles, legs and abdomen due to accumulation of fluid is caused by failure of the right side of the heart.

Chronic cough, loss of appetite and fatigue are some of the symptoms which patients experience.

Some of the patients may complain of palpitations which may be caused by irregular heart beats.

 

Diagnosis of HF:

Patients are mostly diagnosed by their physicians due to their typical symptoms and then advised to undergo tests like Electrocardiogram, Echocardiography and Coronary angiography.

  1. The Electrocardiogram (ECG) give information about the rhythm of the heart, any electrical disturbance of the heart and also if the blood supply is less.
  2. The Echocardiography is the sonography of the heart wherein its imaged and the pumping of the heart is studied. It’s the most important test to diagnose heart failure. It gives the physician information on heart pumping, the function of the valves and leaks across the valves. The pumping of the heart can be quantified as Ejection Fraction (EF) which is normally in the range of 55-65%. Any decrease in EF below the normal range suggests some weakness of the heart muscle and needs to be investigated further. Patients with EF lower that 35% entail more risk of sudden death and heart failure hospitalizations and need more specialized treatment.
  3. Coronary angiography: is necessary to diagnose blockages in the coronary arteries which would need subsequent correction by either angioplasty or bypass surgery.

 

Risks of Heart Failure:

Patients with HF are at high risk of Sudden Cardiac Death and recurrent hospitalizations due to heart failure episodes. The patients at most risk are the ones with an EF of less than or equal of 35%. HF patients keep getting admitted in hospitals due to recurrent dyspnea which need to be treated with intravenous medications.

 

Devices in Heart Failure:

There are 2 devices which can be used in HF treatments (1) Cardiac Resynchronization Therapy and (2) Implantable Cardiac Defibrillator

 

 

Summary:

Patients with heart failure are at risk of dying from progressive heart failure and sudden cardiac arrest. This can be now corrected and treated effectively by implanting devices (namely CRT and ICD respectively). However, these patients need to be carefully evaluated and selected by the cardiologist before undergoing these procedures so as to ensure maximum benefit.

 

 

Devices for Heart Failure

Devices for Heart Failure:

 

There are 2 devices which can be used in HF treatments (1) Cardiac Resynchronization Therapy and (2) Implantable Cardiac Defibrillator

 

(I) Cardiac Resynchronization Therapy:

The heart is made of 2 upper chambers called atria and 2 lower chambers called ventricles. An electrical system controls the synchronized pumping action of these chambers. The atria contract first followed by the 2 ventricles. The 2 ventricles contracts simultaneously to as to ensure optimal pumping of blood to the body and lungs. However this synchronized contraction (Synchrony) is lost between the atria and the ventricles and also between the 2 ventricles. This dys-synchrony leads to further less effective contraction of the heart thereby reducing thereby aggravating the heart failure. This Dys-synchrony can be easily diagnosed by the Physician with the help of the electrocardiogram and the echocardiogram.
CRT is designed to correct this dys-synchrony between the upper and lower chambers of the heart and also between the 2 lower chambers. This ensures simultaneous contraction of the 2 lower chambers thereby improving the contractions. In this procedure, a pacemaker (the size of a pager) is implanted just below the skin in the upper chest region and 3 wires (leads) are inserted into the heart to deliver electrical therapy. The 3 leads are positioned in the right upper, right lower chambers and the left lower chambers. The CRT device simultaneously stimulates the left and right ventricles and restores a coordinated, or “synchronous,” squeezing pattern. This reduces the electrical delay and results in a more coordinated and effective heart beat.

Who needs the CRT?
According to the Heart Rhythm Society, the ideal candidate for a CRT device is someone with:

  1. Moderate to severe heart failure symptoms, despite lifestyle changes and medication
  2. A weakened and enlarged heart muscle
  3. A significant electrical delay in the lower pumping chambers.

How effective is CRT?

There have been around 8-9 clinical trials involving around 5000 patients. Clinical studies demonstrate modest improvements in exercise tolerance, heart failure severity, and quality of life in most patients. Almost two-third of the patients implanted with the device benefit in their symptomatic status and also have decrease in the number of hospitalizations over the next few years. Improvement may happen quickly, but sometimes it can take several months.

(II). Implantable Cardiac Defibrillators (ICD)

ICD is a device designed to shock the heart out of a dangerous life threatening rhythm. The device is similar to the pacemaker and is the size of a pager. It is implanted below the skin in the upper chest and is then connected to a wire (lead) which monitors the heart rhythm 24 hours. Whenever it detects a dangerous heart rhythm, it delivers an internal shock to the heart and restores the normal rhythm.

Who needs ICD? Who is at risk of developing dangerous heart rhythm?

Dangerous heart rhythms can cause Sudden Cardiac Arrest which can cause instant death. Patients most at risk are those with compromised heart function (Ejection fraction < 35%). These patients if symptomatic need to undergo an ICD implantation so as to reduce their risk of dying from sudden cardiac arrests.

How effective is ICD?

There have been around 6 clinical trials involving around 3000 patients. Clinical studies demonstrate modest reduction in the death rates due to sudden cardiac arrest and have been life-saving in the majority of the patients.

Summary:

Patients with heart failure are at risk of dying from progressive heart failure and sudden cardiac arrest. This can be now corrected and treated effectively by implanting devices (namely CRT and ICD respectively). However, these patients need to be carefully evaluated and selected by the cardiologist before undergoing these procedures so as to ensure maximum benefit.