Heart failure clinic - Advanced heart disease / failure program

People who had a severe heart attack but not treated in time will have the weak and flabby heart because of loss of blood supply to heart muscle leads to death of muscles, eventually weak pumping results in effort intolerance, breathlessness, and short life span. Sometimes heart failure could be due to other reasons without any preceding event and silent. The heart failure population is steadily increasing in spite of so much advances and availability of health care services.

We find this is one important area still not yet addressed adequately by the medical fraternity, leads to poor exercise tolerance which limits their productivity and social life, eventually they become crippled. Patients often come only in advanced stages after a short duration of fatigue and breathlessness. Failing heart eventually limits the life span and making them to visit the doctor or hospital frequently. They may get sick enough quickly which requires frequent ICU admissions. We have an elaborate program to quantify the problem and rehabilitate accordingly. They will require frequent visits and adjustment of medicines for the better survival. The clinic even offers other therapies like cardiac synchronization therapy (CRT) which helps them to get a better relief for a while. We even initiate heart transplant work up once the heart exhausted enough not responding to medicines and other therapies. The clinic enrolls patients for regular programs to involve them in patient groups so that they can have a better understanding about their problems with shared knowledge. Also they are regularly involved in physical rehabilitation to promote good life style and reduced recurrent exacerbations of heart failure. Some time, they may require occupational counseling as well to be more productive and self-dependent with ongoing therapies. You should not neglect fatigue or difficulty in breathing lasting more than few days unless there is a reason for that like fever etc. Diagnosing the heart failure at early stages may help us to arrest at that point by identifying the inciting factor and correcting it. Even at times the reason is not known, the medications help the heart not to progress into late stages. We have specialists to care patients with advanced heart failure. It is a multidisciplinary care involving cardiologists, heart failure surgeons, heart failure nursing personnel, dieticians and physiotherapists. We provide a comprehensive care to increase longevity and to have a better quality of life.

The most common symptoms are,
1. Breathlessness on exertion
2. Fatigue
3. Swelling of legs and foot
4. Indigestion and bloating
5. Exercise limitation
6. Coughing on exertion
7. Coughing on lying down

There are risk factors which predispose or directly causes heart failure
1. Coronary Artery disease
2. Hypertension
3. Diabetes mellitus
4. High alcohol intake
5. Metabolic syndrome
6. Heart defects from birth
7. Drugs

There are tests to diagnose the heart failure reasons
1. Cardiac catheterisation
2. Echocardiogram
3. Cardiac MRI & CT
4. Nuclear imaging
5. Endomyocardial biopsy
6. Electrophysiological studies
7. 6 minute walk test
8. Cardio pulmonary exercise testing

Special treatments
1. Revascularisation for blocked heart vessels
2. Heart valve repairs
3. Correction of birth defects in children
4. Surgical ventricular restoration
5. Cardiac resynchronisation treatment (CRT)
6. Heart transplant
7. Ventricular assist device ( L-VAD)
8. Heart & lung transplant

Diet in heart failure patients

The patients are advised to restrict salt and water to feel better. As salt and excess water clearance is poor in these patients, it will accumulate and worsen the symptoms. But with regular medicines, patient can have near normal salt and water intake to have a better life quality as these drugs aid in excretion of excess salt and water. But they have to have a diet plan without much day to day variations as their drugs are adjusted to routine plan.
They can take routine balanced diet to match the minerals and electrolyte loss with fruits and vegetables. Calorie restriction might help in controlling the symptoms.

Exercise plan

Aerobics and walking gives better life quality and stabilising the symptoms but may require close monitoring in the initial stabilisation stage. We provide our rehabilitation services to start exercise programs for our patients in a gradual manner according to their heart failure status.

Heart failure care plan

We prepare a individual care plan based on their symptoms and other Conditions like diabetes and hypertension. It includes their diet, activity and exercise plan. They are advised to consult at regular intervals to monitor the heart function serially as well as to adjust the medicines according to their symptoms and blood reports. They need to adhere the schedule very closely to have a symptom free long term life and stabilise the failure. They are also counselled to report immediately to the clinic or family physician whenever any new symptoms or worsening of symptoms for early identification and management of worsening heart failure or treat other precipitating reason.

Frequently Asked Questions

What is cardiac resynchronisation therapy ( CRT)?
Cardiac re synchronisation therapy is implanting a battery under the skin to fire currents through wires which routed to different parts of heart such way that the contractions are more coordinated that results in better pumping and better blood flow in certain patients but not for all which will be analysed by their ECG. This improves the physical tolerance better for few years in failed heart with incapacitating symptoms. It also provides protection to the sudden irregular beating that happens as a life threatening event in severe heart failure patient.
Heart transplant, is a good option to end stage heart failure?

Heart transplant will provide good life by today’s standards as much as two decades. It would be a excellent option for those with advanced heart failure, most of them are crippled to bed and won’t survive beyond one or two years.

What are the risks of heart transplant surgery?

The risk is little higher than other heart surgeries but it is worth it when comparing the risk of life with the failed heart. Once after surgery you will be taking drugs to adjust your immune system to the new heart which may bear risk of some infection. First few months the immune suppression drugs and antibiotics need to be taken regularly. After few months those drugs are kept minimal. But you need to care yourself bit more after transplant so as to avoid contracting ew infections from others and from environment. This requires few simple measures like wearing face masks in crowded places, frequent hand washing etc to avoid airborne or contact related infections. Regular consultation at frequent intervals may be required in the first year of transplant to detect infections or immune related heart dysfunction early so that the medicines can be adjusted or short course of antibiotics are started. Neglecting any symptoms may bear serious consequences, even a minor symptoms unlike the normal population.

How long it takes to get a heart transplant done if am declared fit and listed?

It depends on the waiting list seniority and also donor organ availability which can’t be predicted.

What if the patient get sick before transplant?

They will be on maximum medications but sometimes resistance to drugs, further decline in heart functions, infections, stress and drug default could worsen the symptoms enough to stay in the hospital for escalation drugs or changing medicines. That may require life support systems for a while. If not recovering, the priority request is placed for heart transplant. Mechanical circulatory support can be started to circumvent the failed heart like ECMO as short term support or implanting a artificial mechanical pump by open surgery in the chest on the heart with power supply line was brought out to connect to batteries called left ventricular assist device ( L VAD).

What are the choices if the patient is not fit for transplant?

Conditions like, older age group or patient cannot take immunosuppressive treatment can be put on L VAD which is readily available except cost concerns.

What is L VAD?

These are all artificial pumps that is fit on the heart by surgery to pump blood forward. They unload the heart and give us normal blood flow to the body. It is powered by the batteries connected to driveline from the pump which is tunnelled to the skin. The patient carries the battery with them and charged daily. Sine the blood is pumped by metal surface they need to be on blood thinners to avoid to get clogged by a blood clot. Newer generation devices are having refined technology to minimise the complications and they provide event free life close enough to transplant. Since donor organ availability is limited which can be diverted to more younger population, these devices gives excellent opportunity to heart failure patients, better longevity and good physical ability to carry out routine and occupational activities as like normal individual. Also in acute crisis due to severe heart failure not responding to any support can be put on left ventricular devices as permanent option or to bridge them till they get a organ for transplant. We provide all these treatments through our clinic.

What are all the Complications of L VAD?

Driveline infections, clotting in the pump leads to pump failure or clots can can travel distally causing stroke and bleeding related to blood thinners, are few complications that can happen. But these complications are becoming less nowadays with newer refined design pumps.

What is ECMO?

ECMO is an artificial machine which draws blood from the patient and oxygen is infused then pumped into the body, so as it does replace the function of both heart and lungs together. There are various disease or conditions that affects the hear or lungs to an extent the survival is not possible without external support. ECMO provides this short term support from outside in an icu environment till the recovery of particular organ or till they put on permanent systems like heart transplant or L VAD in unrecoverable conditions.