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Heart failure is a chronic condition which occurs when the heart is unable to pump blood sufficiently to meet the metabolic demands of the tissues in the body. A weakened heart results in inadequate blood supply to the cells leading to fatigue, shortness of breath and other symptoms of heart failure. Advanced heart failure means the condition has progressed to where traditional therapies and symptom management are no longer working. Patients with advanced heart failure (HF) may experience severe symptoms that hinder their daily living. Some common causes for heart failure include diabetes, valve disease, congenital heart disease, hypertension, heart attack or coronary artery disease, family history of the disease, an enlarged or infected heart.
At what stage should one consult a doctor for advanced heart failure?
A patient should consult a doctor when they start experiencing chest pains that are sudden, severe, unexpected, and come with shortness of breath, sweating, nausea, or weakness. One should also monitor their heart rhythm and be aware of abnormally fast heart beats, especially if you are short of breath that it is not relieved by rest. Sudden weakness or inability to move your arms or legs, severe headaches and sudden fainting spells are also major warning signs.
How can advanced heart failure be treated across stages and what are the treatment options?
Heart failure develops over time as the heart’s pumping action grows weaker, the body tries to compensate for this with hormonal and other mechanisms. The New York Heart Association classifies this into 4 stages (NYHA Class 1-4), and the treatment varies at each stage. This is because once a patient has progressed to the next stage, it cannot be reversed i.e., once they progress to Stage C, they cannot go back to Stage B or A. While in the initial stages of heart failure, lifestyle changes along with medication can help manage the condition, in case of advanced heart failure, treatment options such as LVAD procedure or a heart transplant along with therapy are necessary for the patient. LVAD (left ventricular assist device) helps the left ventricle (main pumping chamber of the heart) pump blood to the rest of the body. It is a feasible and safe option for management of the condition.
Is LVAD (left ventricular assist device) a more lucrative option for patients with advanced heart failure compared to a heart transplant? Please explain
A LVAD is a safe and accessible option for patients with advanced heart failure. Due to persistent shortage of donors and other challenges in undergoing a heart transplant, LVADs have been used as bridge to heart transplant. A LVAD also requires fewer consultations post treatment. Further, a study conducted by the NCBI has shown that there are no differences between a heart transplant and LVAD for patients with regards to late mortality. The two-year outcome of a LVAD is comparable to that of a heart transplant.
Are patients above 50-65 advised for a LVAD?
1. Previous Cardiac surgery REDO patients2. Patients with high HLA antibodies levels3. Frail patients and unable to tolerate Immunosuppression drugs.4. Patients with higher Pulmonary pressures or kidney disease5 As Bridge to Transplant and Candidacy for Heart Transplant
How living with a LVAD can affect the daily routine of the patients?
A LVAD device helps a patient lead a more active life. It becomes a new way of life. While it may take some time to get used to having a LVAD, but it also improves the patient’s strength and ability to participate in activities they were not able to previously. Post treatment, a patient must follow the below mentioned precautions:
o Monitor your weighto Eat a healthy and well-balanced dieto Lead an active lifeo Avoid stresso Get plenty of sleepo Seek medical consultation regularly and be on the lookout for symptomso Avoid excessive physical strain
The author is a senior consultant and clinical lead of heart failure and Transplantation, MGM healthcare, Chennai. Views expressed are personal.
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