Many of us blithely seem to remain oblivious of the vulnerability that our lifestyle choices in everyday routine expose our health to avoidable consequences. Negligence and ignorance by a large group of people are significant contributors to heart failure.

Healthy habits such as exercising, sensible eating, and getting regular health check-ups will keep us as fit as a fiddle. There has been a steady rise in smoking, obesity, diabetes, hypertension, especially in metropolitan cities. These factors often have an adverse impact on our heart and cause gradual weakening of heart muscle, known as heart failure. It is essential to see the genesis and significant impact of heart failure due to a rise in mortality to more than twenty per cent if left untreated.

"To identify, manage and treat heart failure, which affects a little over 1% of India's population, mass awareness initiatives like this one are crucial. Cardiology & Cardiovascular Sciences is a Centre of Excellence at Fortis Healthcare, and expert doctors at our facilities across the country offer treatments and care in line with international benchmarks. As knowledge partners in the Beat Heart Failure campaign, they have touched upon several minute aspects of heart failure from medical management to surgical interventions, focusing on empowering people with easy-to-understand information." Mr Anil Vinayak, Group Chief Operating Officer, Fortis Healthcare.

Beat Heart Failure, an initiative of the Times of India in partnership with Novartis, is a nationwide drive to raise awareness about heart failure, its causes, diagnosis, risk factors, management and treatment. The campaign in association with leading Indian hospitals and their top cardiovascular experts has emphasized the role of self-discipline besides the critical role of doctors to reverse the curse of poor outcomes of heart failure. In this endeavour, one such discussion was conducted with the following doctors of Fortis Hospital, Kolkata -
Dr Shuvanan Ray - Director - Interventional Cardiology
Dr KM Mandana - Director CTVS

The heart is a chamber that is never empty, and it pumps blood to the whole body. The blood that enters the heart is the inflow, and the blood that exits the chamber is the ejection fraction remarked Dr Mandana. In a normally functioning heart, the ejection fraction is above fifty per cent. If the ejection fraction falls because the heart cannot pump according to the body's requirements, it is known as heart failure. The heart has two functions- to receive blood, and the second is to pump blood. Heart failure is generally seen to be occurring either due to reduced ejection fraction or on account of preserved ejection fraction, added Dr Ray.

Heart failure with reduced ejection fraction presents, when the heart muscles are weak, and pumping of the blood by the heart falls short of the need of our body. The second type of heart failure with preserved ejection fraction happens, where the compliance of the heart is weak, and the blood received by the heart is low. This is generally seen in elderly individuals and is difficult to manage. Heart failure with reduced ejection fraction is usually seen in developing countries because of mismanagement of acute coronary syndrome.

Heart failure is a clinical syndrome where the patient presents with multiple symptoms. Common symptoms are shortness of breath, respiratory distress at night, swelling of the feet, face & abdomen, and weight gain. The patient will complain of gradually increasing fatigue that was not present earlier, reduced exercise tolerance and difficulty in climbing stairs. The heart is a powerful organ and can tolerate considerable mismanagement without any visible symptoms, commented Dr Mandana. Heart attack, acute coronary syndrome, or heart failure is preventable and reversible if detected and treated promptly.

Notwithstanding the tremendous endurance of heart muscles, people tend to overlook body signals while performing daily activities, even with thirty per cent of ejection fraction. Beyond a point, as the heart's workload increases further and symptoms intensify, the person finds it difficult to function. Often, it is seen that the angiography is normal in such cases, but still, symptoms persist. The cardiologist then will think about dilated cardiomyopathy, as the heart compensates and increase in size to commensurate with the body's requirement.

An acute coronary syndrome is the vascular derangement of the heart. The heart has the most efficient muscles due to continuous blood supply via arteries. If the arteries supplying blood to the heart suddenly block, this results in decreased supply of oxygenated blood to the heart muscles. This is a reversible stage known as the hibernating myocardium. As the disease progresses, the heart muscles suffer irreversible damage and die.

Like, when the muscles in the body fatigue, we feel cramps, similarly, when the coronary arteries are blocked in any proportion, the heart must work extra, and we feel cramps in our chest, known as angina. The pain can also be felt as heaviness or pain in other parts of the body such as the jaw, upper limbs, or the patient can have uneasiness in the chest or discomfort during exertion. Any lingering pain or discomfort during exertion or walking, which was not felt earlier, is a strong indicator of an acute coronary syndrome. It encompasses all the symptoms of heart attack and pre-heart attack. Some patients may feel chest pain in an irregular pattern, and it may occur at rest which is known as unstable angina.

Heart failure is a disabling disease in any age group, and genetically, Indians are more prone to heart diseases. The concerning fact is that in India, people 10 years younger than the global average have presented with heart failure. Hence, it has become essential to tackle the five commandments of rising heart disease in Indians i.e., the rise in smoking, alcohol intake, obesity, diabetes, and hypertension. The biggest killer is obesity. Obesity is an increase in body weight or body shape. With obesity, the person is a candidate for diabetes, hypertension, and eventually acute coronary syndrome.

The acute coronary syndrome can begin even in childhood. If a child is under-weight at the time of birth and then in the early years may become overweight, then it is possible that the child possesses a thrifty gene and is a probable candidate for atherosclerotic diseases. It is easier to reverse heart failure in the acute stage. This is where heart failure clinics come in. Tertiary care doctors try to understand the cause behind the symptoms, treat them, and reduce the risk factors. They have a team of specialists, cardiologists, counsellors, dietitians, and work on holistic management of heart failure.

Depending on the symptoms, various treatment options are available. Medications throughout life, support the heart muscles and decrease the load. Doctors recommend coronary artery bypass graft or bypass surgery to reverse the lowered ejection and increase the supply. Various devices are now available for supporting the function of the heart. The best option is a heart transplant, if there is no relief to the patient despite all options, to live everyday life.

Heart failure is an unfortunate situation, but all hopes are not lost. People should be aware of warning signs and visit a doctor for a regular check-up. People need to watch their obesity and body shape, especially fat accumulation around the girth, increasing the belt size of a person. Exercising is critical from early childhood. A healthy and modest lifestyle will make your heart happy.