A talk with Dr Lim Choon Pin on heart failure
What is heart failure?Heart failure is a condition when heart does not pump blood efficiently. As a result, the body's vital organs such as the brain, kidneys or liver do not receive adequate nutrients and oxygen. Common causes include coronary artery disease (blocked heart arteries), heart rhythm problems, heart valve problems or holes in heart can result in heart failure.
What are common signs and symptoms of heart failure?
Commonly experienced symptoms include shortness of breath (dyspnea) when you exert yourself or when you lie flat, fatigue and weakness, swelling (edema) in your legs, ankles and feet. You may also experience abdominal bloatedness and loss of appetite.
More serious symptoms include severe shortness of breath even at rest and coughing up of pink and foamy sputum.
What are the types of heart failure?
There are many different classifications of heart failure. The most common classification is based on the strength of the pumping function of the left-ventricle of the heart (ejection fraction). In a normal heart, 50 to 70% of the blood is pumped out of the left ventricle with each contraction. Heart Failure with Reduced Ejection Fraction (HFrEF) refers to patients who have heart failure and the ejection fraction of the left ventricle is less than 50%; this means that the heart's pumping function is weak. Heart Failure with Preserved Ejection Fraction (HFpEF) occurs in patients with heart failure symptoms when more than 50% of blood is pumped out of the left ventricle with each contraction; in this case heart failure occurs because the heart muscle is stiff.
Can a patient have heart failure without being aware of it?
Yes. Some patients are not aware that they have heart failure until they have advanced disease. Young patients often have a lot of reserve, hence tend not to feel ill until the symptoms are serious. The second group is the elderly people. They often think that feeling breathless is part of aging and do not seek medical attention. The third group is the obese and those who lead sedentary lifestyle; they do not exert themselves much, hence may not experience symptoms of breathlessness.
What are risk factors for heart failure?
Generally, patients with cardiovascular risk factors such as diabetes, high blood pressure, high cholesterol and obesity have an increased risk of developing heart failure when compared to people who do not have these conditions. Heavy alcohol and cigarette smoking are adverse lifestyle habits that can also lead to heart failure. Patients with underlying heart conditions such as coronary artery disease, rhythm problems, valve diseases often go on to develop heart failure. There are also some inheritable genes that can lead to higher risk of heart failure within the family.
Is smoking related to heart disease?
Yes, smoking can both directly and indirectly lead to heart disease. It may affect people differently and to varying degrees because of the different genetic makeup in each of us. Smoking damages the lining of your arteries, leading to a build-up of fatty material (atheroma) which narrows the artery. This can cause angina, a heart attack or a stroke. Nicotine and other harmful substances also cause your blood pressure and heart rates to increase, and the stress hormones concentrations in your body to rise, leading to increased stress on our hearts.
What are the treatment options?
Treatment of mild heart failure involves simple lifestyle modification and medications. In terms of lifestyle, we recommend reduced intake of salt to less than 1.5 g per day. Depending on the severity of a patient's heart failure and the presence of other conditions such as kidney or liver disease, we generally recommend limiting each day's fluid intake to between 1 to 2 litres. Stop smoking and reduce alcohol intake to reduce further damage to the heart. Regular exercise is also good for heart.
Medications can help stabilize the condition. It helps control heart failure symptoms, reduce the need to be hospitalised and improve survival rates.
What is the advanced treatment for heart failure?
Heart transplant is the ideal treatment for a patient with severe heart failure. It is generally performed for the end-stage of heart failure when other medical or surgical treatments have failed. However, it involves legislation and government policies and a comprehensive transplant programme.
Ventricular assist devices are artificial heart pumps that are surgically implanted to help support the pumping function of a weak heart. The pump is implanted into the apex of the heart inside the chest through an open heart surgery. A set of wires connects the pump to batteries outside of the body. This pump helps deliver blood to the rest of the body, significantly relieving heart failure symptoms, improving quality of life and survival of heart failure patients. With some limitations, the patient can still lead a relatively normal life.
At what age should people begin paying attention to heart health?
We should all start paying attention to heart health from a young age, as early as 20s. After all, prevention is better than cure. People with a family history of heart disease should start going for screening tests from 5 to 10 years before the age of onset of heart disease in the affected family member. These tests include blood tests to check for cardiovascular risk factors like diabetes, blood pressure and cholesterol. An active lifestyle and abstinence from smoking is strongly recommended.
Do heart diseases have any link to gender?
Yes, males are more prone to developing coronary artery disease. Studies suggest that females are protected by the oestrogen hormone. After menopause, the risk for heart disease is the same for both genders.
We recommend healthy diets low in sugar, salt and saturated fats. We should all eat more fruits and vegetables. Foods high in omega 3 fatty acids may also help in the prevention of heart diseases.