Khaas Baat : A Publication for Indian Americans in Florida
Health & Wellness

Controlling Heart Failure and Living Longer
New Treatments Brighten Future for Heart Failure Patients – Part II

Dr. M. P. Ravindra Nathan

By M. P. Ravindra Nathan,

Heart failure (HF) affects people of all ages – from children and young adults to the middle-aged and elderly. More than half of those who develop HF die within five years of diagnosis if not treated properly and in a timely fashion, hence the importance of early diagnosis. The good news is that HF is almost always manageable. With proper medications and interventions, you can ease your heart’s workload and your worry. But first you need to understand some of the clinical symptoms and warning signs of HF, so an early diagnosis can be made to initiate prompt management.

Often, HF may develop gradually and many mistake the early symptoms as part of the aging process. So, pay close attention to any new symptoms or signs that you notice in your body. The symptoms primarily result from a) Fluid retention or congestion in the various parts of the body because of heart’s inability to pump out the blood b) From decreased amount of good or oxygenated blood circulating, again from the pump failure.

The common symptoms include shortness of breath, especially on exertion, swollen feet, ankles, leg and even abdomen, weight gain, unusual fatigue or weakness and lack of appetite. Some may complain of chest pain or discomfort, especially on exertion most likely related to underlying coronary heart disease. Many have difficulty in sleeping because fluid tends to gravitate into the lungs from the legs on lying down. Some will wake up in the early hours of the morning gasping for breath, a condition called ‘acute pulmonary edema’ necessitating urgent hospitalization and they dramatically improve as soon as the treatment is started. Occasional symptoms include dizzy feeling, confusion and lack of appetite.

How do you diagnose heart failure?

Your doctor may order blood tests to assess your general health, presence of anemia that can precipitate or aggravate HF, status of blood glucose levels, kidney function and also for any precipitating factors like a heart attack. One test called BNP (B-Type Natriuretic Peptide) that measures the levels of BNP, a special marker in the blood, is helpful to diagnose HF and to determine its severity. BNP is a protein secreted by the heart in response to excessive stretching of the heart's muscle cells that occurs in a failing heart. A chest X-ray is helpful to detect the presence of fluid in the lungs and also to see if heart is enlarged. Another test, an ‘echocardiogram’, is important to assess the function of the heart muscle, enlargement of its chambers and status of the intracardiac valves.

One specific cardiac parameter we look at is ‘ejection fraction’ (EF) of the heart, a measure of how much blood the left ventricle pumps out with each contraction – normal being 55-75% and a reduction in the EF is often seen in HF. Of course, there is a type of heart failure called HF with normal (or preserved) EF. A stress test is helpful to evaluate your functional performance and evidence of coronary artery disease. In addition, many would need a full heart catheterization to evaluate the status of the coronary arteries and to see if ‘ischemia’ (decreased coronary blood flow) is the primary cause for HF.

What are the causes of heart failure?

Often, HF is the end stage of other forms of diseases affecting the heart or those that originate within the heart itself. The main causes include:

  1. High blood pressure (hypertension). Untreated or poorly treated hypertension can lead to thickening of the heart muscle leading to its failure. Early detection and treatment will prevent this complication.

  2. Diabetes Mellitus Type 2, a common problem, results in accelerated atherosclerosis of both the larger and small coronary arteries, resulting in weakening of heart muscle in addition to heart attacks.

  3. Coronary artery disease: A common problem among Indians leading to a variety of heart problems, including HF and sudden death.

  4. Heart valve disorders (including rheumatic heart disease common in tropical countries). If you have been diagnosed to have a heart murmur, pay close attention since it may indicate the presence of a narrow or leaky valve.

  5. Obesity and alcohol usage in excess for a prolonged period – both common problems in our practice, are important causes.

  6. Cardiomyopathy (primary disease of the heart muscle) often of unknown cause is another reason for HF.

Other causes include heart arrhythmias, congenital heart disease and sometimes viral infections too.

To be continued …

M.P. Ravindra Nathan, M.D., is a cardiologist and Emeritus Editor of AAPI Journal. For further reading, “Second Chance - A Sister’s Act of Love” by Dr. Nathan from Outskirts Press, can be found at www.amazon.com


Beyond 2020!


Wish you all a very Happy New Year!

This New Year is indeed special not only for eye care specialists like ophthalmologists, optometrists, opticians and every level of eye care providers but even marketing companies are having a field day using the 2020 phrase for all consumables, from vision products to detergents.

So what really is 2020? The most common usage of this rate is in measuring vision.

If your visual acuity is determined to be 20/20, you see at 20 feet what a person with normal vision sees at 20 feet. If you have 20/40 vision, you see at 20 feet what a person with 20/20 vision would see at 40 feet. And, if you're one of the lucky ones (e.g., 20/15), you can see at 20 feet what others would have to move closer (15 feet) to see. Your visual acuity is an important measure of your vision

My concept of Beyond 2020 goes beyond this often considered perception of perfect vision. Because 20/20 according to me is not perfect vision. There is more!

Being born with 20/20 vision (2 lines better than 2020), I have always aspired in my patients to achieve that outcome of beyond 20/20 whether it is with 23 different custom-designed Lasik or cataract surgery techniques or even when reversing complications while encouraging fellow eye surgeons worldwide to fight for more. In fact, a decade ago, while speaking at the world conference for eye surgeons in Berlin, Germany, I had made a slogan “2010 vision in the year 2010.”

Though this should surely not be a guarantee of any sorts, especially since many aspects, including the patient’s own vision potential will decide where they land, at least I want every eye surgeon to try.

Seeing beyond 20/20 vision obviously has its perks as someone with better vision will always be at an advantage at every level of life, personal and professional. There is no currency more valuable than vision and who then if given a choice would not want to be wealthier in this regard.

With so many aspects of our vision errors (contrast sensitivity, night vision, stereopsis, fusion and 3-D) to be corrected besides the usual nearsightedness, farsightedness, astigmatism and reading vision, we need to ensure that all of these imperfections are addressed by custom- designed Lasik or cataract surgery to each patient rather than line them up for a “cookie-cutter” experience on a conveyer belt of mediocrity.

X-ray vision and super-optimized vision will soon be a reality, we are on our way.

In addition to vision, my concept of “beyond2020” also is a pun intended that we need to carry our aspirations and goals (vision) to beyond 2020, not only in time but also by setting the bar higher for ourselves.

Let’s not get shortsighted (myopic) in our approach to life or its abundance. Let’s be more thankful, more appreciative, more optimistic and more understanding of each other and most importantly of our own potential that we must tap into so we reach our vision and life vision goals. Beyond 2020!

Arun C. Gulani, M.D., M.S., is director and chief surgeon of Gulani Vision Institute in Jacksonville. He can be reached at gulanivision@gulani.com or visit www.gulanivision.com

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