Heart Failure and Heart transplantation.
Heart Failure is major health problem all over the world. It means heart becomes so weak that it can not pump enough amount of blood to the body organs to function normally. As a result the organs like Lungs, Kidney, Liver, Brain etc. start failing and ultimately resulting in death if not treated timely. It can be a acute heart failure occuring suddenly or chronic heart failure which can progress over a period of months or years. There are various treatment options which we will discuss subsequently, heart transplantation is the most advanced and ultimate treatment option.
Heart's function can be broadly divided into two parts, one is contraction so that it will pump the pure blood to various organs and relaxation so that it will accommodate the returning impure blood. Heart failure can occur due to abnormalities in either of these functions. Contraction capacity decreases by weak heart muscles, most common cause is heat attack. Other causes are high blood pressure, diabetes ,inherited heart muscle weakness, excessive alcohol consumption, dietery deficiencies etc. Heart has four natural valves regulating blood flow in its four chambers, blockade or leakage in any of these valves can cause heart failure. Relaxation abnormality again can occur because of old age, high blood pressure, diabetes inherited muscle abnormalities etc. Apart from these common causes there are innumerous other causes of heart failure.
Patient suffering from heart failure will experience breathlessness which can be mild to severe, later phases patient will not be able to lie down straight because of shortness of breath. Profound weakness, fatigue may be experienced by the patient. They may develop swelling over legs initially and later phases whole body can get bloated up. In advanced heart failure other organs will get damaged kidney may fail so the urine output will decrease, liver will fail and jaundice will appear, ultimately brain starts getting affected and drowsy ness which may progress to unconsciousness. In advanced heart failure death will be inevitable if not treated aggressively.
As heart failure is a heterogeneous disease treatment of it is also varied. Most important is to treat the underlying cause if it is treatable e.g. treating blockages in coronary arteries by angioplasty or bypass surgery, proper treatment of blood pressure and diabetes, treating vitamin deficiency, abstinence from alcohol etc. Once it is taken care off oral medications are available to decrease the symptoms also to halt the progression of disease. Life style modifications like proper diet, exercise, proper rest lack of stress is of profound importance. In advanced HF heart become so weak that even after all this measures the symptoms may not go away completely, recurrent hospital admissions will be required many times advanced life support like ventilator, dialysis will be necessary. Eventually these modalities also will be ineffective and patients will succumb. Recent Advances are ventricular assist devices ( we can say partial or complete artificial heart) which are far from perfect and extremely costly, and last but not the least heart transplantation.
Heart transplantation is done in relatively young patients with advanced heart failure which we have discussed previously. Donor heart is taken from the brain dead but otherwise healthy donor. This surgery is done only in few tertiary care hospitals. In India recently many cardiac transplantations are being done due advances in medical facilities and awareness for organ Donation. At Apollo Hospital, Navi Mumbai till now we have done two successful heart transplantations.
Dr. Tamiruddin A. Danwade.
Consultant Interventional Cardiologist and Heart failure specialist,
Apollo hospitals, Navi Mumbai.
