Move ahead with Heart Failure

Heart failure, a growing medical threat across the globe, not only affects the heart but also the functioning of all the body parts. Individuals with heart failure often face various challenges in their day-to-day life like tiredness and exhaustion, shortness of breath, physical weakness, water logging in the body, frequent infections and mental depression. While it may be very frustrating for the affected person and the caregivers to try to overcome the disease, some simple lifestyle measures actually go a long way in improving the quality of life.

In this post, we would like to share with you the heart-warming story of Mr.S, an 84-year old gentleman, who is currently undergoing cardiac rehabilitation with us.

Mr. S is a retired LIC employee . He has had a medical history of diabetes, hypertension, heart attack, chronic kidney disease and heart failure (ejection fraction 40%). He was taking several medicines to keep his illnesses under control. He lived with his family which included his wife, son, daughter-in-law and grandchildren.

Right after our first interaction with Mr. S, we understood that he had multiple health issues and needed individual attention from the rehab team. His main complaints were breathlessness during physical activity, generalized weakness and inability to lead a normal life. He used a walking stick for support and was unable to climb even a few steps. His ambition was to be able to walk at least a kilometer without any hindrance and difficulties.

After ascertaining that Mr. S’s condition was stable, we started him on a personalized cardiac rehab program comprising of supervised exercise, health education, counseling and dietary advice. He visited our rehab centre two times a week and followed our advice for home exercising on the other days. The exercise sessions were very short to begin with. It consisted of a prolonged warm-up period followed by simple exercises like on-the-spot marching with support, and stepping up and down a step a few times, and some cool-down stretches. He needed frequent rests which we allowed.

Breathing exercises were taught to ensure proper breathing technique to help with his breathing difficulty. Education about his current health problems, red-flag signs to watch out for, exercise and its effects, healthy eating and ways to meet his nutritional requirements, role of medications and their importance and adherence to exercise on a long term basis was an integral part of his program.

The rehab team helped Mr. S set weekly health goals that were small but achievable. In spite of a few inter-current illnesses, Mr. S has made progress and is able to do more. He is now cycling continuously for 15 minutes and working with low-weight dumbbells to improve his strength, after a month of continued efforts.

Sometimes, it does take a longer time to see improvement but close monitoring, baby steps and constant encouragement are the keys to success. Mr. S feels that he still has a long way to go before being able to walk a kilometer but we know for sure that he is much nearer to achieving his goal than he was a month ago.

If you or your loved ones are suffering from heart failure, talk to your Cardiologist about cardiac rehabilitation as it is an approved and mandatory aspect of management in the current era.

Blood pressure and your heart

High blood pressure (BP) or ‘hypertension’ means that the pressure exerted by your blood on the inner walls of your blood vessels is higher than normal. It depends on several factors like pumping capacity of your heart, volume and viscosity of your blood, and state of your vessel wall.

You would have noticed an inflatable cuff from the BP apparatus fixed to your upper arm when someone wants to measure your BP. The electronic device measures your BP by a method called “oscillatory method” whereby inflation of the cuff to a high pressure followed by deflation allows blood flow in the artery in a cyclical pattern that is captured as BP by the device.

You must have heard the term “120 over 80”; this is nothing but the upper limit of normal BP in adults. The upper number denotes systolic BP (SBP) or the peak pressure in the arteries during contraction of the heart and the lower number is the diastolic BP (DBP) or the least pressure in the arteries when the heart is actually filling with blood from the veins. Apart from BP, your heart rate (number of times the heart beats in 1 minute) is also shown on the BP monitor. The normal heart rate in a healthy adult ranges from 60-80 beats per minute in a resting condition.

The most recent international guidelines for hypertension classify BP as Normal, Elevated and High as shown in this table:

If you have never had your BP measured earlier, now is the time! You should not wait for warning signs of hypertension because quite often there are none. That is exactly why hypertension is termed a “SILENT KILLER”. Diabetes (high blood sugar) and dyslipidemia (abnormal cholesterol level) are the other two Silent Killers. All 3 should be measured at least once every year to catch abnormalities early.

Prevalence and Types of hypertension

An article published in the Journal of Hypertension in 2014 estimated that 1 in 3 persons living in cities and towns and 1 in 4 individuals living in rural areas in India are hypertensive.

  • Primary hypertension is the most common type where there is no specific cause for the high BP. General preventive measures like reduced salt intake, high fiber diet, regular exercise and stress reduction techniques should be the first line of management in this case. Medications are often prescribed to control your BP, it is best to take them as advised by your doctor and not stop them on your own.
  • Secondary hypertension is less common and denotes that there is an underlying medical problem for the high BP like kidney disease, hormonal disorder, structural problem in the major artery leaving the heart or other cardiac diseases. Very high BP at the time of diagnosis, blood pressure not responding to medical management and presence of other health issues are clues to this type of hypertension. Appropriate treatment of the underlying cause will help to manage hypertension in this case.

Impact of hypertension on your heart and other systems

Your heart is constantly pumping blood and supplying oxygen and energy to each and every cell in your body through your arteries. The health of your arteries is a very important factor that determines the health of your heart.

  • Constant increased pressure of the blood flowing through your arteries can damage the inner wall and lead to hardening or stiffening – Atherosclerosis. This in turn can lead to heart attack, stroke and other serious problems. Another life-threatening effect of untreated high BP is Aneurysm or weakening and bulging of important blood vessels like those supplying the brain and the major blood vessel leaving the heart. Rupture of these bulging arteries can lead to instant death.
  • Heart failure is one of the common complications of high BP wherein the pumping capacity of the heart drops below normal. This is measured by an echo test and the symptoms are weakness, breathlessness and swelling of feet.
  • Chronic kidney disease is again very common in hypertensive individuals and is due to damage to the blood vessels supplying the kidneys. The kidney function gradually drops which is seen as rising urea and creatinine levels in blood and reduced urine formation.
  • If you have high BP, regular eye checks are a must because an increased pressure in all the arteries including the arteries of the eye is possible. This can lead to damage to the back of the eye called Hypertensive Retinopathy, which can impair vision.
  • Memory loss, dementia and cognitive impairment are neurological complications of hypertension.

With World Heart Day fast approaching (29 September), let us all take a pledge to know our blood pressure and keep it under control!



Getting to grips with heart failure

For someone who has suffered a heart attack, has gone through several tests and life-saving procedures and has a long list of medicines to consume, a diagnosis of heart failure can be depressing. It not only means more medicines and more investigations but also lesser ability to do the things they enjoy and a reduced quality of life. However, the outlook for individuals with heart failure is not so gloomy after all. In fact, if you read this post till the end, you will be convinced that there is so much one can do to manage heart failure better!

The term ‘heart failure refers’ to the inability of the heart to perform its work well. In other words, the heart is not pumping blood effectively leading to all the body parts getting lesser oxygen than they need. The causes of heart failure are:

  • Ischemic heart disease (coronary blocks/angina/infarction)
  • Hypertension
  • Valve problems of the heart
  • Cardiomyopathy (heart muscle weakness)

The complaints typically given by patients are excessive tiredness, breathlessness, reduced ability to do physical activities, swelling of feet, cough at nighttime and discomfort in lying down posture. The cough, swelling of feet etc are caused by accumulation of fluids in the lungs and extremities as a result of the poor pumping of the heart.

While an X-ray chest will often show an enlarged heart and an ECG will show electrical changes, the ejection fraction (EF, an important parameter measured during an echocardiogram) gives a clear indication to the doctor about the cardiac function. The EF in healthy adults is between 50-75%, which means that the normal heart pumps just over half the heart’s volume of blood with each beat. There are 2 types of heart failure based on whether the EF is preserved (50% or more) or reduced (less than 50%). Both types of heart failure can be managed with medicines, limiting fluid and salt intake, and a proper diet and exercise regimen.

How does exercise help heart failure?

This is a very important question and warrants a thorough explanation. When someone is newly diagnosed with heart failure, they will be prescribed specific drugs to help improve the cardiac function and to reduce the symptoms. The number and dosage of drugs will be adjusted in the ensuing days to weeks until the symptoms are under control and the vitals are stable. Simultaneously, there will be changes made to the dietary pattern and fluid intake to prevent the heart from getting overloaded. This is the right time to initiate cardiac rehabilitation and supervised exercise as it benefits the heart in the following ways:

  • Strengthens heart and cardiovascular system
  • Reduces your blood pressure
  • Helps manage your weight better
  • Improves your circulation and the way your body uses oxygen
  • Gives you more energy, which lets you be more active without getting tired or short of breath
  • Makes your muscles stronger and more toned
  • Prevents the heart failure from worsening
  • Graded exercise improves the conditioning of your heart and lungs and allows you to participate in social, physical and sexual activities like normal individuals

While aerobic exercises are a must, strengthening exercises and balance and flexibility exercises are ideal too. It is recommended that individuals with heart failure keep track of how they feel during the exercise session and even after the session. Any excess breathlessness, discomfort, sweating, palpitation, giddiness or disorientation has to be informed to the healthcare provider immediately. Proper warm-up and cool-down are mandatory before and after each exercise session to prevent complications.

The advantages of a cardiac rehab program are that in addition to an exercise expert, there is a dietician who helps plan the meals and fluid intake per day taking into account the various factors like cardiac, renal and metabolic function; and there is a counselor who takes care of the psychosocial aspects such as feeling depressed, unduly stressed or helpless.

So how often should the EF be measured in someone with stable heart failure? The echo test, ECG and blood investigations should be done yearly if there are no new complaints, and more frequently if the clinical condition demands it.