Is your heart weak? Let's learn about Systolic Heart Failure.

Do you sometimes feel short of breath? Do you feel tired even after doing a little work? Or do your legs swell? These could be signs that your heart is a little weak. Today, we will talk about this heart disease, 'Systolic Heart Failure'. Although this is a bit serious, it is a condition that can be controlled if recognized early and treated properly.

What is Systolic Heart Failure?

Simply put, your heart has four main chambers. The lower chamber on the left, called the left ventricle, pumps oxygenated blood throughout the body. It works like a water pump. Now, in this condition called systolic heart failure, the left ventricle becomes weak. That means it can't pump blood properly and efficiently.

What happens then? Imagine if the water motor is not strong enough, the water will not flow properly. Similarly, when the heart does not pump blood properly, fluid can accumulate in the lungs. That is when things like difficulty breathing and fatigue occur. Other parts of the body, especially the legs, ankles, and abdomen, may also swell . This is because the fluid in the body is not circulating properly.

So what is this Ejection Fraction?

Now let's talk about what Ejection Fraction (EF) is. This is called 'Ejection Fraction' in Sinhala. Although this is a bit of a medical term, it is easy to understand. Simply put, this is the percentage of how much blood your left ventricle pumps into the body when it beats once.

A healthy, well-functioning heart should have an EF value between 55% and 70% . This means that more than half of the blood entering the left ventricle of the heart is pumped out in one beat. However, if this EF value falls below 40% , it may be a sign of systolic heart failure. This means that the heart's pumping ability has decreased. That is why this condition is sometimes called 'Heart Failure with Reduced Ejection Fraction' (HFrEF) .

Who is more likely to develop this condition?

Systolic heart failure can affect anyone, but the risk increases with age. It is also more common in people with other heart conditions, such as a previous heart attack or high blood pressure.

What causes systolic heart failure (HFrEF)?

Systolic heart failure often occurs when the left ventricle of the heart is damaged by another disease. Think of it this way: the heart muscle is like a rubber band. It stretches and contracts. But if it is damaged, it cannot do that job properly.

Here are some of the main reasons that may affect this:

• Coronary Artery Disease: This is the most common cause. The arteries that supply blood to the heart (coronary arteries) become narrowed or blocked by fatty deposits, preventing the heart muscle from getting the oxygen and nutrients it needs. This causes the muscle to weaken.
• High blood pressure (Hypertension): When blood pressure is high for a long time, the heart has to work harder to pump blood. It's like pumping water into a blocked artery. Over time, this can cause the heart muscle to enlarge and eventually weaken.
• Previous Myocardial Infarction: A heart attack is when blood flow to a part of the heart is cut off, causing muscle cells to die. The dead area then becomes scarred, reducing the heart's ability to pump.
• Diabetes Mellitus: Diabetes can also damage blood vessels and directly affect the heart muscle.
• Abnormal Heart Rhythm: When the heartbeat is irregular, the heart is unable to pump blood efficiently.
• Heart Valve Disease: When the valves in the heart do not work properly, blood can flow backward or forward, which can put additional strain on the heart.
• Myocarditis: Inflammation of the heart muscle. This can be caused by things like viral infections.

This damage can cause scarring of the heart muscle, dilation, or stiffness of the ventricles. All of these things weaken the left ventricle and reduce EF. The good news is that in most cases, if the underlying cause is treated properly, the heart's function can be somewhat improved.

What are the symptoms of this condition?

Well, how do you know if you might have this problem? Here are some symptoms to watch out for:

• Shortness of breath (Dyspnea): You may have difficulty breathing, especially when exercising, climbing stairs, or even lying down in bed. If you need to sleep with two or three pillows at night, that is also a sign.
• Frequent fatigue and weakness: If you feel very tired even after doing tasks that were previously easy.
• Swelling in legs, ankles, and feet: This swelling can occur due to fluid retention. Sometimes the abdomen can also swell.
• Rapid or irregular heartbeat: If you feel a change in the way your heart beats.
• Persistent cough or wheezing: A cough that is especially accompanied by white mucus.
• Decreased ability to exercise.
• Nausea or lack of appetite.
• Chest pain: This could be due to a cause such as coronary artery disease.
• Dizziness.

If you have one or more of these symptoms, please do not ignore them and see a doctor. The earlier you recognize them, the easier it is to treat.

How do doctors detect this?

When you go to a doctor, he or she will run several tests to determine if you have systolic heart failure. The most important thing is to find out what the underlying cause is so that you can treat it properly.

This testing process typically includes the following:

1. Physical exam:

• The doctor will ask you about your symptoms (how long they have been present, how they feel).
• They ask about your past illnesses, such as whether anyone in your family has heart disease.
• A stethoscope is used to listen to the heart and lungs (to check for abnormal sounds and fluid in the lungs).
• Your blood pressure is measured.
• You will be weighed (to see if you have suddenly gained weight, due to fluid retention).

2. Blood tests (Blood work):

• These blood tests can check whether other organs (such as the kidneys and liver) have been affected by this weakness in the heart.
• Typically, things like `Albumin` (a type of protein), `Creatinine` (a measure of kidney function), and sodium and potassium (electrolytes) are measured.
• There is a special blood test called BNP (B-type Natriuretic Peptide). When the heart is stressed, the level of this BNP in the blood increases. This is very helpful in diagnosing heart failure.

3. Imaging tests of the heart:

• These tests can check many things, such as the shape and size of the heart, how thick the walls of the cells are, whether the valves are working properly, and whether there has been damage from a previous heart attack.
• Chest X-ray: To see if the heart is enlarged or if fluid has accumulated in the lungs.
• `Echocardiogram (Echo)`: This is the most important test. It is like an ultrasound scan of the heart. It can accurately measure the EF value. It can clearly see the functioning of the heart's chambers and valves.
• Electrocardiogram (EKG/ECG): A test that records the electrical activity of the heart. It can detect things like the rhythm and speed of the heartbeat, and signs of a previous heart attack.
• Sometimes, other specialized tests such as `Cardiac MRI`, `Cardiac CT scan`, `Cardiac Catheterization` (Angiogram), `Exercise Stress Test` or `Nuclear Exercise Stress Test`, `Multigated Acquisition Scan` (MUGA)` may also be performed.

How is this treated?

Okay, now let's look at how to treat this condition of systolic heart failure. There are several main goals of treatment:

• Reducing symptoms (such as shortness of breath, swelling).
• Stopping or controlling the heart from weakening further.
• Improving the quality of life.
• Helping to prolong life.

Treatment methods can be divided into several main categories:

1. Lifestyle changes

These are very important. It's not enough to just take medicine, you need to do these things on your side too.

• Limit salt intake: Salt (sodium) causes the body to retain excess fluid. This increases swelling and puts more strain on the heart. Reduce salt intake as directed by your doctor. Generally, it is not recommended to consume more than 1500-2000 milligrams of sodium per day.
• Limiting fluids: Some people are also told to limit the amount of water they drink per day. This is something you should discuss with your doctor and decide.
• Maintain a healthy weight: If you are overweight, try to lose weight. It is a good idea to weigh yourself daily. If you gain weight suddenly (a kilo or two in a day), it may be a sign of fluid retention. If this happens, tell your doctor .
• Avoid smoking: Smoking is very harmful to the heart and blood vessels.
• Limit or stop alcohol: Alcohol can also weaken the heart muscle.
• Exercise regularly: Talk to your doctor about what exercises are right for you. Start small and gradually increase your activity. Walking is a good exercise. It would be great if you could participate in a cardiac rehabilitation program.
• Reduce stress, rest well, and get enough sleep.
• Eat a healthy diet: eat vegetables, fruits, fibrous foods, and low-fat foods.

2. Medicines (types of medicines)

There are many effective medications available to treat systolic heart failure. These medications can improve your EF, symptoms, and overall heart function. Your doctor may prescribe one or more of these medications together.

• Beta-blockers: These improve heart function by slowing the heart rate, reducing the amount of work the heart has to do. They can help control blood pressure, reduce the risk of heart attack, and control irregular heartbeats.
• Angiotensin-Converting Enzyme (ACE) inhibitors: These control blood pressure, dilate blood vessels, and block stress hormones in the body, improving heart function over time.
• Angiotensin-II Receptor Blockers (ARBs): These are given to people who have side effects like cough from ACE inhibitors. They work in a similar way to ACE inhibitors.
• Angiotensin Receptor-Neprilysin Inhibitors (ARNIs): This is a relatively new, very effective class of drugs. These also reduce stress hormones, open blood vessels, and improve heart function.
• Aldosterone Antagonists (Mineralocorticoid Receptor Antagonists - MRAs): These reduce stress hormones and help the kidneys remove excess fluid and salt from the body. You need to be careful about your potassium levels when taking these medications.
• Diuretics (water pills): These quickly relieve symptoms (especially swelling and shortness of breath) by removing excess fluid and salt from the kidneys. When fluid is reduced, it is easier for the heart to pump blood.
• SGLT-2 inhibitors: These are originally a type of medication for diabetes. But later it was discovered that they are also very good for heart failure patients without diabetes. They excrete excess fluid along with sugar in the urine.

The most important thing is to take the medicine your doctor prescribes exactly, at the time and in the dosage prescribed. Never stop taking the medicine or change the dosage on your own.

3. Equipment and surgery

Some patients may not be able to control their condition with medication and lifestyle changes alone. They may need things like:

• ICD (Implantable Cardioverter-Defibrillator): A small device that detects a dangerous irregular heartbeat (arrhythmia) and delivers a small electrical shock to the heart to restore normal rhythm. This is implanted under the skin of the chest.
• CRT (Cardiac Resynchronization Therapy) / Biventricular Pacemaker: This device helps to correct the imbalance between the left and right chambers of the heart. This also improves the heart's pumping ability.
• Coronary Artery Bypass Grafting (CABG) or Angioplasty with stenting: Treat coronary arteries if they are blocked.
• Heart valve repair or replacement surgery.
• Heart transplant or LVAD (Left Ventricular Assist Device): These are the treatments most often considered for critically ill patients.

How can the risk of this condition be reduced?

"Prevention is better than cure," they say. So, there are things you can do to prevent or reduce the risk of developing systolic heart failure. Good health habits are the key.

• Eat a well-balanced, nutritious diet (less salt, less oil, more vegetables and fruits).
• Exercise regularly.
• Maintain a healthy weight.
• Avoid smoking completely.
• Limit alcohol consumption.
• If you have any medical conditions like high blood pressure, diabetes, or cholesterol, control them well. Follow your doctor's instructions carefully.
• Reduce stress and get enough sleep.

What expectations can you have while living with this situation?

Systolic heart failure is a chronic, long-term, serious condition. It may not be completely curable. However, with proper treatment and lifestyle changes, symptoms can be controlled and a good life can be lived.

The outcome depends on several factors:

• How severe the heart disease is.
• Your overall health and whether you have any other diseases (such as kidney disease, diabetes).
• How you respond to treatment.
• What is the main reason for this?

Therefore, it is very important not to be afraid or frustrated, but to follow the doctor's instructions exactly and adjust your lifestyle. Work together with your medical team.

When should you seek immediate medical attention?

If you experience any of these symptoms, you should seek medical help immediately, meaning as soon as possible :

• Sudden and severe chest pain.
• Sudden and severe difficulty breathing.
• Fainting or extreme weakness.
• Chest pain, dizziness, or shortness of breath with a fast or irregular heartbeat.
• Sudden swelling of the legs or weight gain.

What questions can you ask the doctor?

When you see your doctor, you can ask questions like these to better understand your condition:

• What is the exact cause of my systolic heart failure?
• What is my ejection fraction (EF) value? What does it mean?
• Has this condition affected my other organs (like kidneys, liver)?
• What treatments are right for me? What are the pros and cons?
• What are the most important changes I need to make in my lifestyle?
• What kind of food and drink should I eat and what should I avoid?
• What exercises can I do? How long should I do them?
• What should I not do?
• What are the possible side effects of this medication? What should I do if they occur?
• How often should I come for check-ups? When will my EF score be checked again?
• What should I do in an emergency?

The most important things we need to remember

Systolic heart failure is a serious, long-term condition in which the left ventricle of the heart is unable to pump blood properly. If you have any of these symptoms, please see a doctor. The earlier it is recognized, the easier it is to treat and the better the outcome.

By treating the underlying cause, taking the medication your doctor prescribes, and developing good lifestyle habits, you can help control your symptoms and live a healthy, active, and long-term life. Don't be afraid, stay strong! You are not alone, your doctors, family, and friends are all there to help you.

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