Let’s Have a Heart-to-Heart: The Signs & Symptoms of Heart Failure

Your heart really IS the most powerful muscle in your body. It keeps blood flowing through a vast network of vessels — as long as 75,000 miles! Now that's a lot of ground to cover! With each beat, it squeezes out a powerful burst of blood — 70 millilitres at a time. Over a lifetime, that adds up to thousands of gallons, all delivered with enough force to keep your body healthy and active.

So, what happens when the heart muscles become weak and begin to fail? As it struggles to pump blood efficiently, it leads to a cascade of effects within your body. Around 8-10 million people in India are living with chronic heart failure. This is a growing concern, especially because it tends to affect people at a younger age in India than in other parts of the world. The good news is that early detection and management can make a big difference. Let’s begin by understanding what heart failure is.

Heart failure isn't what it sounds like. It doesn't mean your heart stops working completely. Instead, it describes a condition where the heart muscle weakens and can't pump blood as efficiently as it should. Various factors can cause this, ultimately leading to cardiac insufficiency. This simply means your heart is unable to meet your body's demands for oxygen-rich blood.

What are the different types of heart failure? There are different ways this weakness can manifest:

• Left ventricular failure is the most common type, affecting the left ventricle, the heart's main pumping chamber that sends blood throughout the body.
• Right ventricular failure happens when the right ventricle, which pumps blood to the lungs, weakens.
• Congestive heart failure refers to fluid buildup in the lungs and other parts of the body due to heart failure.

To understand the severity of heart failure, doctors use a classification system from I to IV  developed by the New York Heart Association (NYHA). 

• NYHA Class I  (At High Risk): You don't experience any symptoms of heart failure at rest, but you may have a risk factor like high blood pressure or a previous heart issue.
• NYHA Class II  (Mild Symptoms): You may experience fatigue or difficulty breathing when engaging in physical activity but not when you are at rest.
• NYHA Class III  (Moderate Symptoms): Shortness of breath and fatigue make daily activities challenging, even when resting.
• NYHA Class IV  (Severe Symptoms): This is the most severe class, with significant limitations on daily activities and frequent episodes of shortness of breath, even while resting.

But how can we avoid developing NYHA Class IV Heart failure? Can congestive heart failure be detected early?

Ravi, a 58-year-old banker, was happy with his morning walks and fairly controlled diet. His routine kept him feeling good even after his heart attack 10 years ago. But over the past few months, things had changed. Even climbing a flight of stairs left him breathless upon reaching the top. He dismissed this as part of getting older. Then came the night sweats and the constant need to use the restroom. The cough that wouldn't go away started to worry him. Finally, after waking up in the middle of the night gasping for air, Ravi knew something was seriously wrong.

Are these simply weak heart symptoms? Or are they more specific signs of congestive heart failure? A visit to the doctor resulted in being diagnosed with chronic heart failure.

Heart failure often creeps up slowly. What are the possible signs that you may be dealing with heart failure?

• Shortness of breath (dyspnea): This is a hallmark symptom of heart failure. You might experience difficulty catching your breath, especially during activities or while lying at night.
• Fatigue and weakness: Feeling constantly tired and lacking energy is another red flag. Simple tasks that used to be easy may become overwhelming.
• Swelling in the legs, ankles, and feet (oedema): Fluid buildup due to impaired blood flow can cause swelling, particularly in the lower extremities.
• Rapid or irregular heartbeat (palpitations): Your heart might feel like it's racing, fluttering, or skipping beats.
• Persistent cough or wheezing: As fluid accumulates in the lungs, you might develop a persistent cough or wheezing due to congestion.
• Increased need to urinate at night (nocturia): When the body tries to get rid of excess fluid at night, you may experience a frequent urge to urinate.

Heart failure doesn't develop in a vacuum. Some of the most common diseases that weaken heart function include:

• Coronary Artery Disease (CAD) occurs when blood vessels become clogged with plaque, restricting blood flow and damaging the heart muscle.

“When undiagnosed and therefore untreated, this can lead to complications such as heart attacks (Myocardial Infarction), which can further be complicated by heart failure and sudden death,” says Dr Alok Shah, MBBS, DNB, DM — Cardio, a cardiologist in Mumbai affiliated with Breach Candy, Saifee, Wockhardt, and Bhatia Hospital.

• Chronically high blood pressure (hypertension) forces the heart to work harder over time, eventually leading to strain and potential failure.
• Uncontrolled diabetes can damage blood vessels and weaken the heart muscle.
• Bearing excess weight significantly burdens the heart. It’s forced to pump blood throughout the body with much more effort, thereby raising the risk of its failure.
• Cardiomyopathy enlarges the heart's walls — making them thick or stiff, hindering the heart’s pumping ability.
• An infection can sometimes infiltrate the heart muscle, causing inflammation (myocarditis) and weakening it.
• Birth defects (congenital heart disease) affecting the heart structure — like the walls or valves — can predispose someone to heart failure later in life.

Your genes play a part in your heart failure risk. Since you inherit genes from your parents, a family history of the condition can be a red flag. Having a parent with heart failure bumps up your risk by a significant 70% compared to someone with no family history. Even siblings with heart failure can increase your risk by about 40%. Conditions like dilated cardiomyopathy and high cholesterol levels are inherited conditions that damage your heart and may lead to heart failure in the future.

Heart failure diagnosis isn't a one-size-fits-all approach. Doctors use a combination of tools to paint a complete picture.

A common question is: Does congestive heart failure show up in tests? While lab tests do not give a definitive answer, they can offer clues. Doctors may conduct a few tests that measure specific hormone levels that become elevated in response to heart strain, potentially indicating heart failure. Other tests recommended will allow doctors to:

• Identify Left Ventricle Ejection Fraction (LVEF), which measures how well your left ventricle pumps blood with each beat. A reduced LVEF (below 50%) often indicates heart failure.
• Differentiate Preserved EF (HFpEF) vs. Reduced EF (HFrEF). A preserved EF means the heart muscle contracts normally but might be stiff, hindering blood flow. Reduced EF indicates weak heart muscle contractions.

Heart failure can be a daunting diagnosis, so it’s natural to wonder: how long can a person live with congestive heart failure?

Approximately 50% of individuals diagnosed with congestive heart failure have a five-year survival rate, and 30% live for 10 years. Survival rates significantly depend on the condition's severity, the patient's general health, and how well they follow their treatment plan. So, how can you prevent heart failure from getting worse?

The good news is that you have the power to influence the course of your heart failure journey. Adopting healthy lifestyle changes and working closely with your doctor can significantly slow its progression and improve your quality of life.

A heart-healthy lifestyle is your best defence. This involves nourishing your body with healthy fruits, vegetables, and whole grains while restricting harmful fats and too much sodium.

Regular exercise, even moderate activity most days of the week, strengthens your heart and improves blood flow. Controlling your body weight takes the pressure off your heart, and quitting smoking is a game-changer for your overall health.

Don't underestimate the power of relaxation! Recent studies show that yoga, meditation, and deep breathing reduce stress and improve quality of life.

“Patients who practised yoga on top of taking their medications felt better, were able to do more, and had stronger hearts than those who only took drugs for their heart failure,” said Dr Ajit Singh, Manipal Academy of Higher Education, India, ICMR. “The results indicate that yoga may serve as a useful complementary therapy for individuals with heart failure.”

Heart failure doesn't have to be a life sentence. With a healthy lifestyle and proper treatment, you can manage it and live a full life. Talk to your doctor if you experience any symptoms — early detection is key!