Heart failure

The Heart failure program provides management of advanced heart failure (both systolic and diastolic), i.e. End stage heart failure, included medical management and assessing for Advanced Device Therapy – CRT, ICD, LVAD and Heart transplantation.

The phenotype of Heart failure has multiple etiologies and not all heart failure behaves the same way, because nuances and subtleties involved in Advanced heart failure, she stresses the importance of the multi disciplinary, collaborative centric moreover Dr Yashoda points to the expertise in identifying the appropriateness and the optimal timing of therapeutic interventions. Fantastic technologies and therapies available, but there may not be in every patients best interest, it is essential to understand when therapies will or will not work, and when one has to move beyond there, perhaps to mechanical assist devices or heart transplantation for heart failure. If we wait too long we may have missed the opportunity to treat a patient but no one wants to resort to devices or transplantation before a patient absolutely needs it.

Dr. Yashoda Ravi, also intended in derouging good community heart failure management, involvement of patients & ease at primary health care, to improve Quality life of heart failure patients.

Symptoms

Heart Failure symptoms may develop slowly or may start suddenly. Heart Failure symptoms may include

• Shorten of breath with activity or when lying down
• Fatigue and weakness
• Swelling in the legs, ankle, feet
• Rapid or irregular heart beat
• Wheezing
• Cough that doesn't go away or bring up white or pink mucus with spots of blood
• Abdominal swelling
• Rapid weight gain due to fluid build-up
• Nausea and lack of appetite
• Difficulty concentrating or decreased alertness

Diagnosis of Heart Failure

To diagnose heart failure, your doctor provider examines you and also your symptoms and medical history and check to see if you have risk factors for heart failure such as Hypertension, Diabetes and Coronary Artery disease.

While examine your lungs and heart by a device stethoscope, as well as looking your neck veins & legs, abdomen for swelling.

Tests

Blood test – Specific blood test called NT-proBNP, in heart failure the level of this protein goes up

Chest X-ray – Can show fluids in the lungs and heart enlargement

Electrocardiogram (ECG) – Test records the electrical signal in the heart, it can show how fast or slow the heart is beating, as well as whether it is regular or irregular

Echocardiography– Sound waves create images of the beating heart. This test shows the size and structure of the heart, heart valves & blood flow through the heart, it measures ejection fraction is measurement of the percentage of blood leaving your heart each time it squeezes. An ejection fraction of 50% or higher is considered ideal, but you can still have heart failure even if number is > 50%

Exercise tests or Stress test – to look how heart responds to physical activity it is done only to exclude coronary artery disease, if needed

CT scan of the heart vessels – Uses X-ray to create cross sectional images of the heart

Cardiac MRI – This test uses magnetic fields and radio waves to create detailed images of the heart

Coronary Angiogram - This test helps spot blockages in the heart arteries. The interventional cardiologist inserts a thin flexible tube called a catheter into blood vessels, in the wrist or groin. it is then guided to the heart. Dye flows through the catheter to artery show up more clearly as X-Ray image and Video

Cardio Pulmonary Exercise Test – It adds important additional information to that provided by standard exercise test. In particular it provides precise determination of aerobic capacity. The cause if dysonoea with exertion and prognosis in particular with heart failure

Myocardial Biopsy – In this test a removal very small piece of the heart muscle for examination. This test may be done to diagnose certain type of heart muscle disease that causes heart failure.

During or after testing for heart failure, doctor may tell you the stages of diseases, staging help determine the most appropriate treatment. There are two ways to determine the stages of heart failure.

New York Heart Association (NYHA) classification

This system group heart failure at four categories by numbers. You may see normal numbers used for these category names.

• Class I Heart failure – There is no heart failure symptoms
• Class II Heart failure – Everyday activities can be done without difficulty, But exceeding cause shortness of breath or fatigue
• Class III Heart failure – It's difficult to complete everyday activities
• Class IV Heart failure – Shortness of breath occurs even at rest of this category, includes most severe heart failure.

American College of Cardiology / American Heart Association Classification

This stage based classification system uses letters A to D; it includes a category for people who are at risk of developing heart failure.

• Stage A – There are several risk factors for heart failure but no sign of symptoms
• Stage B – There is heart disease but no sign or symptoms of heart failure
• Stage C – There is heart disease and sign of symptoms of heart failure
• Stage D – Advanced heart failure required specialized treatment

Doctors use the classification systems together to help decide the most appropriate treatment option; your doctor can help you interpret your stage.