Blood pressure is the force of blood pushing against blood vessel walls. Blood pressure is measured using two numbers: The first number, called systolic blood pressure, measures the pressure in your arteries when your heart beats. The second number, called diastolic blood pressure, measures the pressure in your arteries when your heart rests between beats. Hypertension (high BP) means either or both of systolic BP (SBP) and diastolic BP (DBP) are beyond normal limits.
Is it necessary to treat High blood pressure?
It is true that blood pressure increases with ageing. Many people express concern regarding target BP levels and need of treatment. Historically, as late as 1950s, the cardiologists and physicians considered the elevated blood pressure to be necessary for adequate blood supply to vital organs. Hence blood pressure with ageing is called as “Essential Hypertension”.
But the concept was proven to be wrong. Untreated hypertension is lethal, often a “silent killer.”
Hypertension can cause:
Bleeding within the brain (Hemorrhagic stroke)
Blockage of heart vessels (Heart attack)
Blockage of brain vessels (Ischemic stroke)
Loss of vision
Heart failure
Kidney failure
Memory loss (Dementia)
Symptoms of hypertension:
Patients with hypertension are usually with out any complaints. Hence it is a silent killer. It is advised to monitor BP at regular intervals. People with very high blood pressure or sudden rise of blood pressure can have symptoms. It is not advisable to wait for the symptoms.
When to treat?
Current guidelines defined normal blood pressure as SBP < 120/ DBP <80 mm Hg. Blood pressure of more than SBP of 140 (or) DBP of 90 mm Hg requires medication. Blood pressure of 120-140 mm Hg SBP (or) 80-90 mm Hg DBP needs lifestyle modification. Need of medication must be individualized according to their 10 yrs heart disease and stroke risk.
Blood pressure is measured as you move around, living your normal daily life. Usually measured for up to 24 hrs. A small digital BP monitor is attached to belt around your waist and connected to a cuff around your arm. You can even sleep with it on.
How to prevent? / control by lifestyle modification?
Heart is a muscle that pumps blood around your body, delivering oxygen and other nutrients to all your cells.
• There are four chambers in the heart – two on the right side and two on the left side.
• Blood from your body enters the right side of your heart. From here, the heart pumps the blood to the lungs, where the blood takes up oxygen.
• Oxygen-rich blood then enters the left side of the heart. From here it is pumped through the aorta (the largest artery in the body) to all parts of your body.
• There are four valves inside the heart, to make sure that the blood flows in the correct direction.
What is heart failure?
Heart is a powerful muscle that delivers blood and oxygen around our body through a regular pumping action. ‘Heart failure’ is the term we use to describe a set of symptoms that occur when your heart fails to deliver as much blood and oxygen around our body as it should.
The term ‘heart failure’ can sound frightening, so it might be more helpful to think of it as: ‘My heart is not functioning as well as it should and needs treatment to support how it works.’
What causes heart failure?
Heart failure can be caused by one or more conditions.
The most common causes are:
• Heart attack
• High blood pressure
• Cardiomyopathy (a disease of the heart muscle)
• Problems with the heart valves
Heart failure can also be caused by:
• A viral infection affecting the heart muscle
• Excess alcohol or recreational drugs
• An abnormal heart rhythm (arrhythmia)
• Some chemotherapy medications
• Congenital heart problems (heart problems you are born with)
• Thyroid gland disease
• Anaemia (low haemoglobin)
Sometimes we just don’t know what the cause is, but the important thing is to treat your condition and control your symptoms. This will help you have the best possible quality of life and improve your life expectancy.
What are the symptoms of heart Failure?
The main symptoms are:
Shortness of breath when you are resting or being active
Swelling of your feet, legs, ankles, abdomen (tummy area), or in the small of your back
Fatigue (feeling unusually tired and weak).
feeling lightheaded
The symptoms happen because your heart muscle is not pumping as well as it should. This can cause a build-up of fluid that backs up into your lungs – it’s sometimes called congestion. Your kidneys can end
up retaining salt and water. This extra fluid can cause swelling in your ankles, feet or legs or in the small of your back (oedema) or in your abdominal area (ascites). The extra fluid can also cause sudden weight gain. Heart failure can also cause unusual tiredness and weakness (fatigue) because your heart can’t deliver enough blood and oxygen to the muscles in your body.
If any of these symptoms mentioned are new, or getting worse, you should consult your doctor as soon as possible. If the symptoms are very bad or if you feel very ill and you are frightened, you need hospitalization.
What are the tests that I need to undergo?
After the physical examination, your doctor may also order some of these tests:
Blood tests. Blood tests are done to look for signs of diseases that can affect the heart.
Chest X-ray. X-ray images can show the condition of the lungs and heart.
Electrocardiogram (ECG). This quick and painless test records the electrical signals in the heart. It can show the timing and length of the heartbeats.
Echocardiogram. Sound waves are used to produce images of the heart in motion. This test shows the size and structure of the heart and heart valves and blood flow through the heart. An echocardiogram can be used to measure ejection fraction, which shows how well the heart is pumping and helps classify heart failure and guides treatment.
Cardiac computerized tomography (CT) scan / Magnetic resonance imaging (MRI). These tests are done to know about the condition of heart muscle, structural abnormalities of heart and blockages in coronary arteries.
Coronary angiogram. In this test, a thin, flexible tube (catheter) is inserted into a blood vessel and guided to the heart arteries. A dye (contrast) is injected through the catheter to make the arteries show up more clearly on an X-ray, helping the doctor spot blockages.
Myocardial biopsy. In this test, a doctor inserts a small, flexible cord into a vein in the neck or groin, and removes very small pieces of the heart muscle for examination. This test may be done to diagnose certain types of heart muscle diseases that cause heart failure.
How is the heart failure treated?
Medication:
In order to treat your heart failure and keep it under control, you may have to take a combination of many different medications. Your doctor may need to change the dose of your medication or give you a different one from time to time, depending on your condition and symptoms.
1. Keep track of the medications you are taking
2. Understand what your medications are for
3. Take your medications properly.
Surgery and other treatments:
If your heart failure is caused by heart valve disease, you may be able to have an operation to repair or replace the affected valve. If you have angina (chest pain) which has been caused by coronary artery ( blood vessel of heart) disease, then an angioplasty and stent or coronary bypass surgery may be an option for you. These treatments may help to improve your heart failure symptoms.
Some people with heart failure will benefit from a pacemaker or implantable cardioverter defibrillator (ICD), which helps to improve the pumping action of the heart.
Pacemaker
Having a pacemaker implanted can improve the strength, rate and rhythm of your heartbeat. This can help to improve the pumping mechanism of your heart.
Cardiac synchronization therapy (CRT)
If your symptoms of heart failure are severe, they may be caused by the bottom chambers of the heart (the ventricles) beating out of time with each other. You may then benefit from having a treatment called cardiac resynchronization therapy (CRT). This is where a certain type of pacemaker called a ‘bi-ventricular pacemaker’ is implanted to help co-ordinate the contractions of the heart muscle and help it pump better.
Implantable cardioverter defibrillator (ICD)
If you have heart failure and you’re at high risk of life-threatening heart rhythms and dying suddenly, your doctor might recommend that you have an ICD implanted. An ICD is similar to a pacemaker but, if you were to suffer from a dangerousheart rhythm, the ICD would give your heart an electrical shock to help restore a normal heart rhythm.
Some ICDs can also work as a pacemaker. So, if you need a pacemaker and an ICD, you would
need only one device with both functions.
Ventricular assist device (VAD)
A ventricular assist device (VAD) — also known as a mechanical circulatory support device — is an implantable mechanical pump that helps pump blood from the lower chambers of your heart (the ventricles) to the rest of your body. A VAD is used in people who have weakened hearts or heart failure.
Cardiac transplantation
Cardiac transplantation is the surgical placement of a healthy heart from a human donor into the body of a person whose own heart is badly diseased. Heart transplant is a treatment that’s usually reserved for people whose condition hasn’t improved enough with medications or other surgeries.
While a heart transplant is a major operation, your chance of survival is good with appropriate follow-up care.
Can heart failure be cured?
When heart failure is caused by an underlying problem that can be treated, such as heart valve disease, uncontrolled high blood pressure or anaemia, your heart failure symptoms may go away or be reduced, and your heart muscle could return to normal.
However, in most cases heart failure is caused by a heart attack when part of your heart muscle becomes damaged or dies. Many people make a good recovery after a heart attack. However, sometimes your heart can become less effective at pumping blood around your body, causing the symptoms of heart failure. While you can control and manage these symptoms, your heart failure cannot be cured. With good management of symptoms, and the right treatment, many people with heart failure can lead a full and active life.
How to lead a good quality life ?
Lifestyle changes recommended!
By choosing a healthy lifestyle and taking medication regularly, persons with heart disease can improve quality of life as well as lead a fuller life. Following steps are mandatory for the patients with reduced pumping efficiency of heart (heart failure).
10 commandments to improve failing heart
Healthy diet:
Diet should be low in saturated fat, trans fat, cholesterol and sodium.
Salt
Sodium is a critical issue for patients with heart failure. A high sodium intake can cause fluid retention and therefore contribute to edema. Fluid accumulation puts more strain on the heart and can lead to shortness of breath. Salty foods cause the body to hold on to fluids contributing to congestion. Most people consume much more salt than they need. Salt (sodium) is required by the body, but only in small amounts. Try to keep your sodium intake to no more than 2 grams per day. Do not add salt to your food. Also, avoid sources of “hidden” salt (pickles, preserved foods).
Cholesterol High blood cholesterol levels have been linked to coronary artery disease, the leading cause of heart failure. A diet high in saturated fats leads to a high level of LDL or “bad” cholesterol. If you are at risk for coronary artery disease, reduce your intake of saturated fats such as those found in red meats and whole milk products and reduce cholesterol levels by limiting egg yolks and animal products. Vegetables, fruits, fish and toned milk are advisable.
Potassium and magnesium are important minerals in the diet. Diuretics used to get rid of excess fluid may deplete your body of these nutrients. It is advisable to take foods rich in them like bananas, nuts, potatoes.
Physical exercise:
Exercise is a great way to strengthen the heart and cardiovascular system since aerobic exercise trains the heart to beat more efficiently. With training, the heart pumps out more blood per beat and the heart rate decreases. Furthermore, muscle strengthening can improve the utilization of oxygen by the body for any given level of heart failure. Persons with heart failure should always check with doctor before beginning any exercise routine.
Doctor will advise regarding amount of exertion and type of activities advisable as well as restricted. Light to moderate aerobic activity is useful in preventing progression of heart failure. Activities to try including walking, Cycling and swimming. Avoid exercises that require quick bursts of energy. Start slow and increase the length or intensity of your activity as you feel up to it. Listen to your body and stop exercising if you experience shortness of breath, dizziness, chest pain, nausea, or a cold sweat. Exercise for 30 minutes a day on at least 5 days per week.
Maintain weight:
Obesity is a risk factor for hypertension, stroke, heart disease, and diabetes. Excess weight puts extra strain on the heart. The heart has a harder time delivering the excess needs for oxygen to tissues of the body. Losing weight can help you feel better and help your heart function better too. Obesity can be assessed by calculating body mass index which takes height and weight into consideration. An optimal body mass index (BMI) is between 18.5 and 25.
Sudden weight gain or weight loss can be a sign that you may be developing heart failure or that your heart failure is progressing. Weigh yourself at the same time each morning, preferably before breakfast and after urinating. Notify your healthcare professional if you gain three or more pounds in one day, five or more pounds in one week as this may be due to fluid retention. Alternatively, excessive weight loss may be a concern if you have advanced heart failure. If you are consistently losing weight, check with your doctor or a registered dietician for a healthy plan for gaining weight.
Quit tobacco consumption/smoking:
Tobacco consumption in any form (cigarette/beedi/cigar/ghutka/snuffing) is equally hazardous and most common cause of heart attack. Each puff of nicotine from tobacco smoke temporarily increases heart rate and blood pressure, even as less oxygen-rich blood circulates through the body. Smoking also leads to clumping or stickiness in the blood vessels feeding the heart. People who quit smoking are more likely to have their heart failure symptoms improve.
Avoid alcohol:
Alcohol can depress the contraction function of the heart. If you drink alcohol, do so in moderation. This means no more than one to two drinks per day for men and one drink per day for women. In more serious situations of heart failure, you should avoid alcohol altogether.
Managing stress:
Although we cannot eliminate stress from our lives, we can control it. Stop activities that make you feel unwell, and do not limit activities that you really enjoy. Yoga and meditation will be helpful.
Monitoring BP/glucose:
Fluctuations of them will precipitate heart failure. Hence regular monitoring is required. Research has shown that monitoring blood pressure at home can be helpful in addition to regular monitoring in a healthcare provider’s office. Chart your blood pressure to provide information on what is happening with your blood pressure over time and help eliminate false readings.
Fluid restriction:
Heart failure leads to fluid retention in the body. Hence diuretics are usually advised to get rid of extra water and sodium and reduce their heart’s workload. Amount of liquid to drink every day varies person to person and will be decided by treating doctor.
Avoid or limit caffeine:
Consume only a moderate amount of caffeine per day, no more than a cup or two of coffee
Comfort tips Two of the most common symptoms of heart failure are shortness of breath and edema. Some patients find it easier to breathe at night if they sleep with a couple of pillows behind their backs. Also, support stockings may help alleviate edema in the ankles and legs during the day. Make sure that the elastic is not so tight that it restricts your circulation.
Making these changes is easier said than done.
Dealing with new restrictions and responsibilities is challenging but working these changes into your daily routine can make a real difference.
