"Straight from the heart.....about the a heart surgeon"

All you need to now about heart failure...


The heart supplies pure blood to the whole body and ensures that the well-being of all organs and tissues.

In heart failure, there is inability of the heart to adequately pump or receive blood, leading to an imbalance of the supply to and needs of organ tissues.

Two important functions of the heart are described as 'systolic function' and 'diastolic function'.

Systolic function indicates the efficiency of the heart muscle pump to eject blood to the body by contracting appropriately. An indicator of this systolic function is called as LVEF (left ventricular ejection fraction). This is noted on 2D echocardiogram and is usually more than 55%. In systolic heart failure, this value is usually less than 40%.

Diastolic function indicates the efficiency of the heart pump to relax appropriately to ensure its complete filling. In diastolic heart failure with preserved ejection fraction, the LVEF is more than 50%.

Heart failure is majorly of three types -                                                   

HFrEF: heart failure with reduced ejection fraction. LVEF < 40%                                

HFmrEF: heart failure with mid-range ejection fraction. LVEF < 40 - 49%                     

HFrEF: heart failure with preserved ejection fraction. LVEF > 50%

Commonly encountered symptoms of heart failure are breathlessness (usually on exertion or after lying down flat), fatigue, tiredness, chest pain, palpitations (feeling of the heart beating fast), weight loss or gain.

There are four stages of heart failure - A, B, C, D - as defined by the American Heart Association & American College of Cardiology.                                                     

Stage A - no symptoms, no structural heart disease. But, presence of risk factors like high blood pressure, diabetes, obesity, low HDL (good cholesterol), high triglycerides (seen in blood lipid profile), blocks in arteries and family history of weak heart (cardiomyopathy).

Stage B - no symptoms. But, presence of structural heart disease like previous heart attack, deformed valve, thickened heart muscle or low LVEF.

Stage C - presence of both, symptoms and structural heart disease.

Stage D - severe symptoms at rest despite appropriate medicines at highest recommended or tolerated doses.

It is very important to prevent progression from stage A to B, B to C, and so forth because there is no coming back from the next stage to the previous one.

Regular blood tests need to be done to evaluate status of all organs (kidney, liver, thyroid,etc), blood elements, blood clotting systems,etc.

Some specific heart failure blood tests like BNP / Pro-BNP, hs-cTnT, sST2  will also be done. 

Microalbuminuria ( albumin level in urine) is also a good urine test in diagnosis of heart failure.

Heart specific tests are 12 lead ECG, echocardiogram, 24 hour holter study, CMR, CAG, cardiac catheterization and at times an endomyocardial biopsy.

Treatment in various stages:

Stage A - keep under control BP (120-130/80-90), blood sugar (HbAIC less than 7), bad cholesterol (less than 100), good cholesterol (more than 40), triglycerides (less than 180), weight (BMI around 25). Cease smoking and alcohol consumption. Medicines (ACEI / ARB) as advised.

Stage B - all measures as in stage A + Medicines (ACEI / ARB + Beta blocker) as advised.

Stage C - all measures as in stages A and B + Medicines (body water reducing pills - diuretic + ACEI / ARB + Beta blocker +/- digoxin, ARB, AA, hydralazine) as advised + pacing of both heart pumps (biventricular pacing) and shocking devices (ICD), in selected patients.

Stage D - heart transplant / VAD (temporary or permanent mechanical device support in the heart) / long term IV drug support (chronic inotropes) / compassionate end-of-life care / hospice



Heart failure workup

     6 Minute Walk Test

                Cardiopulmonary exercise testing

   Right heart catheterization


   EMBx - endomyocardial biopsy