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Understanding Heart and Heart Failure

Understanding heart and its function

Heart

Heart is basically a pump which pumps blood to all parts of our body. It works all day along. Heart having the size of our fist is located between the two lungs nearly in the middle of the chest, towards the left side and weighs about 250-300 grams. The heart beats more than 100000 times a day, pumping more than 350 liters of blood every hour into a 90000 km longblood vessel network.

Heart has four chambers and four valves. Two on the left side and two on the right. Two upper chambers are known as atria . The two lower chambers are the ventricles.

Four valves which acts like doors keeps the blood moving in the right direction. Valve seen between Atria and Ventricle are Atrio-Ventricular valves. The Atrio-ventricular valve seen on the left side is mitral valve and on the right side is tri-cuspid valve.

Each ventricle pushes blood to the main blood vessels. The main blood vessel situated in right side is the pulmonary artery and on the left side is aorta. Semi-lunar valves acts as a door between ventricle and the main blood vessel. Semi lunar valve in right side is pulmonary valve and in left side is aortic valve.

Right atrium receives de-oxygenated blood from different parts of our body. When the blood has filled in the right atrium, the tri-cuspid valve opens to allow the blood to flow and fill the right ventricle. Then right ventricle contracts and the tri-cuspid valve closes (which prevents the backward flow of blood in the right atrium) where as pulmonary valve opens and blood get pumped from right ventricle to pulmonary artery. This blood pass through the capillary blood vessel network in the lungs and become oxygenated. Oxygenated blood then reaches left atrium and flows to left ventricle when mitral valve opens. From left ventricle blood gets pumped into the aorta, through the opened aortic valve from where blood flows to different parts of body.

What is Heart Failure?

The inability of heart to pump enough blood is called heart failure. Either the heart doesn't fill with enough blood or the heart can't pump enough blood to the rest of the body to satisfy its metabolic needs.

Heart failure is of two types.

  1. Pumping function of the heart is impaired- called HFrEF or Heart failure with reduced ejection fraction. Ejection fraction or EF is a measure of the pumping function of the heart. Normally it is more than 60%. In HFrEF or Systolic heart failure the EF is less than 40%.
  2. Pumping function is normal (EF more than 50%) but filling of blood into the heart is impaired. Thsis is called heart failure with preserved ejection fraction – HfpEF. When the EF is between 40 and 50% the recent classification puts it as HfmrEF or heart failure with mid range ejection fraction.

Epidemiology of Heart failure

In India there are 15-20 million patients with Heart failure approximately (based on few assumptions)

The data from the Trivandrum heart failure registry and Indian National Heart Failure registry shows that

  1. Indians develop heart failure 10-15 year earlier than patients from the western world – USA and Europe. Males predominate with 70% of the patient population
  2. Sicket Patient have bad outcode : 30% mortality at one year, 60% mortality at five years.
  3. Mortality higher than many common cancers like breast or colon

Symptoms of heart failure

Heart failure signs and symptoms may include:

  • Shortness of breath
  • Fatigue and weakness
  • Swelling of your ankles and feet
  • Palpitations - Rapid or irregular heartbeat
  • Reduced urine output
Donot decide that you have heart failure as these symptoms may be of other reasons. Please contact your local physician

Risk factors for developing heart failure

Conditions which lead to or predispose to the development of heart failure.

  1. Heart attack related heart failure - Coronary artery disease (due to blocks in coronary arteries – leading to heart attacks and related diseases) is the most commonest cause of heart failure in India. 70% of the heart failure in India is due to Coronary artery disease.
  2. Dilated cardiomyopathy - The heart muscle become weaker and get thinned and the pumping function of the heart is impaired in this condition. This is the second most commonest cause of heart failure in India (15%). This may be sequel or after-effect of a viral infection of the heart (called as myocarditis).
  3. Valvular heart Disease - Third commonest cause of HF(6%). Valve leaks or block (stenosis) of the valves can affect the smooth blood flow in the heart. In India, the commonest cause of valve problem is Rheumatic Heart Disease.
  4. High Blood Pressure/Hypertension - One of the commonest cause of heart failure with preserved ejection fraction – HfpEF is uncontrolled blood pressure. Because of the high BP, the heart muscle gets thickened and it becomes difficult for the heart to get filled.
  5. Diabetes Mellitus - Can lead to myocardial(heart muscle) dysfunction or can redispose to coronary artery disease(heart attack).
  6. Congenital heart disease / Birth defects of the heart (eg: hole in the heart etc ) - If not treated on time in childhood can develop heart failure later in life. If the hole is large heart failure can develop in childhood itself.
  7. Hypertrophic Cardio Myopathy - This is a peculiar type of heart muscle disease where the muscle gets unusually thickened due to genetic predisposition. This leads to impaired filling of the heart and lead to HFpEF.

How is heart failure treated?


Heart failure can be managed very effectively in almost all cases and the patient improves symptomatically and most of the patients can go back to a near normal life.

The treatments include:

  1. Medicine to strengthen heart, to give the heart some rest and to help body get rid of excess fluids.
  2. Rest may be required in the initial stages, but gradual resumption of physical activity is advised.
  3. A low-sodium (salt) diet(less than 5gm of salt per day).
  4. Restrictions of fluid intake 8-10 glasses (1.5 - 2 litres) of water daily.
  5. Lifestyle modifications.
    • Tobacco cessation
    • Abstinence from alcohol
    • Regular graded physical activity as advised by the physician
    • Normal healthy diet as advised by your doctor.
  6. Surgery, angioplasty or cardiac devices may be needed in some cases and will be advised by your doctor
Never stop taking your medication or change the dose without talking to doctor.

What can I do to manage my heart failure?


  • Follow doctor's advice.
  • Quit smoking, if you smoke.
  • Take medicines exactly as prescribed and never stop the medication without doctor's advice.
  • Daily Weight checking for weight gain - if there is 2-3 kg increase in a week, please inform your HF Clinic or doctor.
  • Track your daily fluid intake and limit to 1.5 – 2 L per day.
  • Monitor your blood pressure at least weakly if possible.
  • Total abstinence from alcohol.
  • Eat a heart-healthy diet that's low in salt and saturated fat.
  • Be physically active, to the level as advised by your doctor.
  • Get adequate sleep.
  • Regular hospital check-up, regular check-up of blood as advised by your doctor periodically.
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    • Prof. Dr. Harikrishnan S Principal Investigator Professor of Cardiology Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum - 695011 Mobile : +91 9895125101 Office : 04712524457 drharikrishnan@outlook.com
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