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Centre For Heart Failure Management

In today’s time and world, with increasing stress levels and other factors, the prevalence of heart diseases has increased manifolds. And unfortunately, these heart related diseases often end in heart failure. This can have far reaching effects on the quality of life and also result in untimely death. But what most of us don’t realise is that heart failure can be prevented if recognised early.

At the Fortis Malar Heart Failure Centre, Chennai, our team of physicians are constantly engaged in the appropriate diagnosis and treatment of all heart related diseases. In many cases, medical treatment is often optional. What our team does is provide assistance in terms of optimising and personalising complete care for the patient.

The treating family physician, health assistant nurse and dieticians all ensure that patients with advanced heart failure receive the best in terms of Ventricular Assist Device, Pacemakers, Stem Cell and Heart Transplantation facilities.

Moreover, at Fortis Malar our patients receive personalised and individualised care from diagnosis to follow-up. The centre provides:

  • ECG
  • ECHO
  • TMT
  • Pro BNP/ Other biochemical tests
  • Cardiac Catherisation


1) What is Heart Failure? Is it the same as a heart attack?

Heart failure is quite different from a heart attack. It is not a disease by itself but an amalgamation of various signs and symptoms caused by a wide variety of disorders that include valvular, heart muscle, pericardial (covering layer of heart) and other non-cardiac (unrelated to heart) diseases. The onset and severity of the symptoms of heart failure depend on the nature of the underlying cardiac disease and the rate at which this develops.

2) How severe and life-threatening is Heart Failure?

The incidence of heart failure may be sudden (acute) or over a period of time (chronic). Heart failure can also occur when the heart retains its normal pumping capacity but where there is a failure to relax normally. This is known as diastolic heart failure. It can also occur due to poor pumping capacity of the heart, otherwise known as systolic heart failure.
It becomes an emergency when heart failure occurs along with angina or heart attacks, or with severe high blood pressure.

3) What are the symptoms of Heart Failure?

Most symptoms and signs of heart failure are caused by congestion and fluid collection in the lungs, legs, abdomen etc., and the inability of the heart to pump efficiently to meet the demands of the organs and tissues in the body. There could be breathlessness, which could be an exaggerated uncomfortable awareness of breathing.The description of this sensation includes:

  • Shortness of breath
  • Heavy breathing
  • Tightness in chest
  • Air does not go all the way down
  • Choking
  • Air hunger

These symptoms will be noticed during exertion in early stages of the disease but may occur later also, in the advanced stages. There could be breathlessness when lying down that will be relieved only on sitting up. Sometimes, patients state that they have to sleep on three or more pillows to feel comfortable at night. And then there could be Paroxymal Nocturnal Dyspnoea (PND) which usually starts 2 – 4 hours after the onset of sleep. Patients begin coughing and sweating with breathlessness, which is relieved only by getting out of bed.

Fatigue and impaired stamina are other prominent symptoms of heart failure. Patients may also report abdominal fullness, leg swinging, nausea and loss of appetite.

4) How does Heart Failure get diagnosed?

Heart failure is diagnosed based on the symptoms that the patient experiences and the signs observed during examination. This may include prominent neck veins, leg swelling, breathlessness, increased heart rate and respiratory rate, cold clammy hands and feet, enlarged liver, wheezing etc.

When heart failure is suspected, certain tests are carried out to ascertain its presence and cause. A blood test to assess BHP (Brain Natriuretic Peptide) is carried out. A result of more than 100 pg/ml, indicates a strong possibility of heart Failure.

ECG and Chest X-ray are also routinely done and an Echocardiogram (ECG) is carried out to reveal the functioning of the heart. A nuclear scan of the heart called MUGA scan accurately assesses the pumping efficacy of the heart. An evaluation for precipitating factors is also done, along with specific tests to rule out reversible causes such as metabolic or hormonal disturbances and infection.

5) What are the modalities of treating Heart Failure?

The treatment consists of removing the underlying cause, the precipitating factors and thereby containing the disease. General measures include rest, administration of oxygen, sedation, salt and fluid restriction. The treatment also includes administering drugs that will:

  • Decrease the fluid overload (Diuretics)
  • Decrease the filling pressures within the heart (Nitroglycerine)
  • Decrease the stress on the heart (Vasodilators)
  • Improve or strengthen heart muscle performance (Digoxin & Inotropes)
  • Improve or prevent adverse changes in the heart (ACE inhibitors and AT II blockers)
  • Improve survival, decrease the need for hospitalisation and prevent sudden death (B blockers)
  • Prevent Dysrhythmic (Antiarrhythmic agents)
  • Prevent blood clotting (antiplatelets and anticoagulants) which is the mainstay of drug treatment of Heart Failure.
  • Drugs to treat Hypertension, Diabetes and Coronary artery disease are also given as and when required.

Surgical treatment includes treatment for Ischemia (Coronary Artery Bypass Graft surgery), Valvular Disease Surgery to restore heart size and geometry and ventricular assist devices. Heart Transplantation is the last option.

6) Can pacemakers help in this condition?

The loss of synchronised contraction of the left and right ventricle of the heart can be rectified by implanting a pacemaker (triple chamber pacemaker). This improves the overall pumping efficacy of the heart by making the right and left sides of the heart contract in a synchronised manner. This Cardiac Resynchronisation Therapy (CRT) gives symptom relief and improves survival chances. Added to that, it also decreases the number of hospitalisations of the patient. However, heart failure management is complex.

It needs a multidisciplinary approach, which includes patient education, dietary advice, review by cardiologist, medication dose adjustment and home visits to ultimately deliver cost effective treatment to reduce morbidity and frequent hospitalisation.

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