‘Pharmacology, healthy lifestyle only recourse to treating heart failure'

Time of India

08-05-2025

The coronary arteries supply blood to the heart. The heart squeezes blood by 'pumping' it to every nook and corner of the body. If blood flow gets suddenly interrupted owing to a blockage, you get an acute heart attack — myocardial infarction. But if the pump slackens, that is if the specialized myocardial muscles get enfeebled, in patches or as a whole, this is heart failure.Sudden death results from a massive blockade, but heart failure can be in different grades from mild to severe and presents with varying degrees of discomfort.Readers need to appreciate that angioplasty and bypass are mechanical procedures to amend the circulation, but the treatment to heart failure is purely pharmacological and healthy lifestyle.Unfortunately, chronic heart failure is a debilitating, symptomatic condition which repeatedly brings the patient to emergency, and except for juggling with drugs, there is little to offer.The tragic story of heart failure (measured on an echocardiogram as a reduction in ejection fraction (EF)), is that the first attack often is a signal of many events to come, which could successively dampen and worsen heart failure.The heart muscle of the ventricles contract and relax in symphony in a rhythmic fashion to eject blood. If this orchestra of the normal muscles is disrupted, then that segment of the limping ventricle gets handicapped and is unable to push out the blood from the heart.Usually following a heart attack, even after healing, the specialised heart muscle in the injured area gets replaced by fibrous not contractile tissue, which then results in inefficient ejection. The inadequately emptied ventricle then backs up, with lungs getting filled up and the patient becoming breathless.In acute accumulation of fluid (rare),the patient comes to emergency in a gasping state with inability to lie down. With mild compromise in heart function, the patient has gradual accumulation of backward congestion and gets mild breathing difficulty, swelling of feet and a dry cough. There is a huge burden of chronic heart failure patients who live a guarded, sometimes apprehensive, life depending on the degree of failure.While the normal EF is 55 to 60 percent (depending on age), values less than 40 require special attention.Commonly, heart failure is a complication post heart attack, but metabolic conditions like uncontrolled diabetes and anatomical distortions like heart valve disease, are also causes. Rarely, viral and severe body infections can also precipitate heart failure.When the heart cannot cope with the five litres of fluid in the body, like an overloaded vehicle, one needs to reduce the load and that is why diuretics (urine producing drugs) and fluid and salt restriction, is the order of the day.The patient himself feels the chest lighter with this, coupled with heart rate reducing drugs like beta blockers etc.It is only in the last two decades that drugs which help cardiac remodeling (Arni) and cardiac function (gliflozins, GLP analogues, finerinone, verquvo) have emerged and offered better hope.The use of this complicated but doable pharmacology (only in trained hands) has revolutionised the life expectancy of chronic heart failure patients.The prescription often gets obnoxiously long, for each of these new molecules play their trifling, but important, roles to deliver the punch.In patients with certain arrhythmias, a specialised pacemaker is seen to help heart failure. Of course, heart transplant is the ultimate option, but we have 'miles to go before we sleep'.Graduated activity, food supervision and weight reduction are mandatory pillars amid these new pawns which all add to treatment success.Until yesterday, regarded as a hopeless case, heart failure is now better understood with the "Sky Force" of new drugs. The recurrent heart "Raid too", can be tamed so that the "Dhadak too" can prosper.(Dr Hemant Thacker is a consultant physician & cardiometabolic specialist practising in Mumbai andJ affiliated to the TOI. Email:[e-mail])