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Even though it may sound like it, congestive heart failure does not necessarily mean that the heart has failed. However, heart failure is a serious condition where the heart does not pump blood around the body efficiently.
We depend on the pumping action of the heart to deliver nutrient- and oxygen-rich blood to every cell in the body. When cells are not nourished adequately, it is not possible for the body to function properly.

If the heart is weakened and cannot supply the cells with sufficient blood, the patient becomes tired and breathless. Everyday activities that were once taken for granted become challenging.

Heart failure is a serious condition, and there is usually no cure. However, with the right treatment, the patient can still lead an enjoyable, meaningful, and productive life.

According to the National Heart, Lung and Blood Institute, approximately 50.7 million people in the World have heart failure.

Heart failure, heart attack, and cardiac arrest
man experiencing a heart attack
Heart failure comes in many forms and has many causes.
Here, we explain some important terms:


Heart attack - this is death of heart muscle due to the blockage of a coronary artery. The heart muscle dies because it is starved of oxygen (because blood is not getting to it).
Heart failure - this means the heart muscle cannot pump blood around the body properly. It is not a heart attack.
Cardiac arrest - this means the heart stops, blood circulation stops, and there is no pulse.
Causes
Heart failure is caused by any conditions that damage the heart muscle. These include:

Coronary artery disease - the coronary arteries supply the heart muscle with blood. If these are blocked or the flow is reduced, the heart does not receive the blood supply it needs.
Heart attack - a sudden block of the coronary arteries; this causes scars in the heart's tissues and decreases how effectively it can pump.
Cardiomyopathy - damage to the heart muscle other than by artery or blood flow problems; for instance caused by drug side effects or infections.
Conditions that overwork the heart - for instance, valve disease, hypertension (high blood pressure), diabetes, kidney disease, or heart defects present from birth.
The following are risk factors for congestive heart failure; they may make it more likely:

Diabetes - especially diabetes type 2.
Obesity - people who are both obese and have diabetes type 2 have an increased risk.
Smoking - people who smoke regularly run a significantly higher risk of developing heart failure.
Anemia - a deficiency of red blood cells.
Hyperthyroidism - overactive thyroid gland.
Hypothyroidism - underactive thyroid gland.
Myocarditis - inflammation of the heart muscle, usually caused by a virus, leading to left-sided heart failure.
Heart arrhythmias - abnormal heart rhythms, they may cause the heart to beat too fast, creating more work for the heart. Eventually the heart may weaken, leading to heart failure. If heartbeat is too slow not enough blood may get out from the heart to the body, leading to heart failure.
Atrial fibrillation - an irregular, often rapid heart beat; patients with atrial fibrillation have a higher risk of hospitalization due to heart failure, a study found.
Emphysema - a chronic disease that makes it hard for the patient to breathe.
Lupus - the patient's immune system attacks healthy cells and tissues.
Hemochromatosis - a condition where iron accumulates in the tissues.
Amyloidosis - one or more organ systems in the body accumulate deposits of abnormal proteins.

Symptoms

The following are possible symptoms of heart failure:

Congested lungs - fluid builds up in the lungs and causes shortness of breath even when resting and particularly when lying down. It can also cause a hacking, dry cough.

Fluid retention - because less blood is being pumped to the kidneys, it can cause water retention. This can cause swollen ankles, legs, and abdomen. It can also cause weight gain and increased urination.

Fatigue and dizziness - because less blood is reaching the organs of the body, it can cause feelings of weakness. Because less blood is reaching the brain is can also cause dizziness and confusion.

Irregular and rapid heartbeats - to try and counteract the lack of blood being pumped with each contraction of the heart, the heart might pump more quickly.

Heart failure shares symptoms with other conditions, and if anyone has the symptoms, it does not mean they have heart failure.

However, anyone who experiences more than one of the symptoms should tell their doctor and ask for an evaluation of their heart.

People who have been diagnosed with heart failure should monitor their symptoms carefully and report any sudden changes to their doctor immediately.

Types
There are many different types of heart failure:

Left-sided heart failure
Left-sided heart failure is the most common form of congestive heart failure. The left side of the heart is responsible for pumping blood to the rest of the body. Blood backs up into the lungs as it is not effectively pumped away from the heart. This can cause shortness of breath and fluid buildup.

Right-sided heart failure
The right side of the heart pumps blood to the lungs where it collects oxygen. Right-side failure is, most often, caused by fluid build-up in the lungs due to left-side failure. Sometimes it can occur due to other conditions, including lung disease.

Diastolic heart failure:
This occurs when the heart muscle is stiffer than normal. Because the heart is stiff, it does not fill up with blood properly; this is known as diastolic dysfunction.

Because the heart does not fill up with blood, it cannot pass as much blood around the body as is necessary. This can occur on either side of the heart.

Systolic heart failure:
Systolic dysfunction describes the heart's inability to pump efficiently after filling with blood. It often occurs if the heart is weak or enlarged. This can occur on either side of the heart.

Diagnosis
Most people will initially see their doctor if they have symptoms. The doctor will discuss the symptoms with the patient. If the doctor suspects heart failure, he will recommend further tests, these may include:

Blood and urine tests - these will check the patient's blood count and liver, thyroid, and kidney function. The doctor may also want to check the blood for specific chemical markers of heart failure.
Chest X-ray - an X-ray will show whether the heart is enlarged. It will also show whether there is fluid in the lungs.
An ECG (electrocardiogram) - this device records the electrical activity and rhythms of the patient's heart. The test may also reveal any damage to the heart from a heart attack. Heart attacks are often the underlying cause of heart failure.
An echocardiogram - this is an ultrasound scan that checks the pumping action of the patient's heart. The doctor measures the percentage of blood pumped out of the patient's left ventricle (the main pumping chamber) with each heartbeat - this measurement is called the ejection fraction.
The doctor may also carry out the following additional tests:

Stress test - the aim here is to stress the heart and study it. The patient may have to use a treadmill or exercise machine, or take a medication that stresses the heart.
Cardiac MRI (magnetic resonance imaging) or CT (computed tomography) scan - they can measure ejection fraction as well as the heart arteries and valves. They can also determine whether the patient had a heart attack.
B-type natriuretic peptide (BNP) blood test - BNP is released into the blood if the heart is overfilled and struggling to function properly.
Angiogram (coronary catheterization) - a catheter (thin, flexible tube) is introduced into a blood vessel until it goes through the aorta into the patient's coronary arteries. The catheter usually enters the body at the groin or arm. A dye is injected through the catheter into the arteries. This dye stands out on an X-ray and helps doctors detect coronary artery disease (arteries to the heart that have narrowed) - another cause of heart failure.

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Sudden cardiac arrest is the abrupt loss of heart function, breathing and consciousness. The condition usually results from an electrical disturbance in your heart that disrupts its pumping action, stopping blood flow to your body.

Sudden cardiac arrest differs from a heart attack, when blood flow to a part of the heart is blocked. However, a heart attack can sometimes trigger an electrical disturbance that leads to sudden cardiac arrest.

If not treated immediately, sudden cardiac arrest can lead to death. With fast, appropriate medical care, survival is possible. Giving cardiopulmonary resuscitation (CPR), using a defibrillator — or even just giving compressions to the chest — can improve the chances of survival until emergency workers arrive.

Sudden cardiac arrest care at Mayo Clinic

Symptoms
Sudden cardiac arrest signs and symptoms are immediate and drastic and include:

Sudden collapse
No pulse
No breathing
Loss of consciousness
Sometimes other signs and symptoms occur before sudden cardiac arrest. These might include:

Chest discomfort
Shortness of breath
Weakness
Palpitations
But sudden cardiac arrest often occurs with no warning.

When to see a doctor
See your doctor promptly if you have episodes of:

Chest pain or discomfort
Heart palpitations
Rapid or irregular heartbeats
Unexplained wheezing
Shortness of breath
Fainting or near fainting
Lightheadedness or dizziness
If you're currently having these symptoms, call 911 or emergency medical help.

When the heart stops, the lack of oxygenated blood can cause death or permanent brain damage in minutes. Time is critical when you're helping an unconscious person who isn't breathing.

If you see someone who's unconscious and not breathing normally, do the following:

Perform CPR. Quickly check the breathing. If the person isn't breathing normally, begin CPR. Push hard and fast on the person's chest — at the rate of 100 to 120 compressions a minute. If you've been trained in CPR, check the person's airway and deliver rescue breaths after every 30 compressions.

If you haven't been trained, just continue chest compressions. Allow the chest to rise completely between compressions. Keep doing this until a portable defibrillator is available or emergency workers arrive.

Use a portable defibrillator, if one is available. It will give you step-by-step voice instructions. Continue chest compressions while the defibrillator is charging. Deliver one shock if advised by the device and then immediately resume CPR, starting with chest compressions, or give chest compressions only, for about two minutes.

Using the defibrillator, check the person's heart rhythm. If necessary, the defibrillator will give another shock. Repeat this cycle until the person recovers consciousness or emergency workers take over.

Portable automated external defibrillators (AEDs) are available in many places, including airports, casinos and shopping malls. You can also purchase one for your home. AEDs come with built-in instructions for their use. They're programmed to allow a shock only when appropriate.

Causes
A problem in your heart rhythm (arrhythmia) — the result of a problem with your heart's electrical system — is the usual cause of sudden cardiac arrest.

The heart's electrical system controls the rate and rhythm of your heartbeat. If something goes wrong, your heart can beat too fast, too slowly or irregularly (arrhythmia). Often these arrhythmias are brief and harmless, but some types can lead to sudden cardiac arrest.

The most common heart rhythm at the time of cardiac arrest is an arrhythmia in a lower chamber of your heart (ventricle). Rapid, erratic electrical impulses cause your ventricles to quiver uselessly instead of pumping blood (ventricle fibrillation).

Heart conditions that can lead to sudden cardiac arrest
Sudden cardiac arrest can happen in people who have no known heart diease. However, a life-threatening arrhythmia usually develops in a person with a pre-existing, possibly undiagnosed heart condition. Conditions include:

Coronary artery disease. Most cases of sudden cardiac arrest occur in people who have coronary artery disease, in which your arteries become clogged with cholesterol and other deposits, reducing blood flow to your heart.
Heart attack. If a heart attack occurs, often as a result of severe coronary artery disease, it can trigger ventricular fibrillation and sudden cardiac arrest. Also, a heart attack can leave scar tissue in your heart. Electrical short circuits around the scar tissue can lead to abnormalities in your heart rhythm.
Enlarged heart (cardiomyopathy). This occurs primarily when your heart's muscular walls stretch and enlarge or thicken. Then your heart's muscle is abnormal, a condition that often leads to arrhythmias.
Valvular heart disease. Leaking or narrowing of your heart valves can lead to stretching or thickening of your heart muscle. When the chambers become enlarged or weakened because of stress caused by a tight or leaking valve, there's an increased risk of developing arrhythmia.
Congenital heart disease. When sudden cardiac arrest occurs in children or adolescents, it can be due to a heart defect that was present at birth (congenital heart disease). Adults who've had corrective surgery for a congenital heart defect still have a higher risk of sudden cardiac arrest.
Electrical problems in the heart. In some people, the problem is in the heart's electrical system itself instead of a problem with the heart muscle or valves. These are called primary heart rhythm abnormalities and include conditions such as Brugada's syndrome and long QT syndrome.
Risk factors
Because sudden cardiac arrest is so often linked with coronary artery disease, the same factors that put you at risk of coronary artery disease can also put you at risk of sudden cardiac arrest. These include:

A family history of coronary artery disease
Smoking
High blood pressure
High blood cholesterol
Obesity
Diabetes
A sedentary lifestyle
Other factors that might increase your risk of sudden cardiac arrest include:

A previous episode of cardiac arrest or a family history of cardiac arrest
A previous heart attack
A personal or family history of other forms of heart disease, such as heart rhythm disorders, congenital heart defects, heart failure and cardiomyopathy
Age — the incidence of sudden cardiac arrest increases with age
Being male
Using illegal drugs, such as cocaine or amphetamines
Nutritional imbalance, such as low potassium or magnesium levels
Obstructive sleep apnea
Chronic kidney disease

Stem cells may potentially be used as a “one-and-done” approach to restore function in people with heart-failure, a study has found. Reported in the journal Nature Biotechnology, the study showed human stem cell treatment can possibly return the hearts’ functioning to better than 90 per cent of normal in macaque monkeys with heart attacks. Heart-failure that causes nearly 10 million deaths worldwide, is a condition caused by lack of blood flow. The stem cells will help “form new muscle that will integrate into heart so it may pump vigorously again,” said Charles “Chuck” Murry, Professor at the University of Washington.

“Our findings show that human embryonic stem cell-derived cardiomyocytes can re-muscularise infarcts in macaque monkey hearts and, in doing so, reduce scar size and restore a significant amount of heart function. This should give hope to people with heart disease,” Murry said. For the study, the team induced experimental heart attacks in macaque monkeys.

Two weeks later, the researchers took heart cells that they had grown from embryonic human embryonic stem cells and injected them into and around the young scar tissue. Each animal received roughly 750 million of these human embryonic stem cell-derived cardiomyocytes. At four weeks after treatment, the ejection fraction in the treated animals rose to 49.7 per cent, about half-way back to normal, as compared to the untreated control animals, which remained unchanged at about 40 per cent. MRI scans showed that new heart muscle had grown within what had been scar tissue in the treated hearts, while no new muscle was seen in the untreated animals.

Moreover, the human heart cells had also formed new muscle tissue in the damaged region. The new muscle tissue had replaced 10 per cent to 29 per cent of the scar tissue, integrated with the surrounding healthy tissue and developed into mature heart cells, the researchers said. Murry said that the research aims to develop a treatment that could be given to people shortly after a heart attack to prevent heart failure.

Because heart cells are long-lived there should be no need for additional treatments, he said. The transplanted stem cells would also be genetically altered to reduce the risk of immune rejection, which often complicates organ transplantation. “What we hope to do is create a “one-and-done” treatment with frozen “off-the-shelf” cells that, like O-negative blood, can go into any recipient with only moderate immune suppression,” Murry said.

According to the British Heart Foundation, more than half a million people in the UK are living with heart failure. It is a condition wherein the heart is incapable of pumping adequate amount of blood in the body. One of the most common reasons behind a heart failure is weakened heart muscles. Some of the symptoms that you can easily spot to determine risk of heart failure include shortness of breath, swelling in feet, ankles, stomach and lower back.

One may also feel excessively exhausted. Heart failure can also be caused by heart attack, high blood pressure, alcohol consumption, arrhythmia (irregular heartbeats) among others. The condition is usually diagnosed by running a tests like blood tests, ECG, ECHO, chest x-ray, and a coronary angiogram.Managing Heart Failure

"A combination of medication and lifestyle changes will hopefully help you continue to do the things you enjoy, by helping you manage your symptoms and keeping your condition as stable as possible," British Heart Foundation. Patients of heart failure are usually advised to cut down their salt intake and keep blood pressure level in control.
A new study published in the journal Science Advances points at the ability of a certain protein in helping people with heart failure.

The protein is derived from the contractile machinery of the cardiac muscle cells that keep the heart pumping. This protein may help the heart contract in the event of stress. Most cases of heart failure have dysregulated complex cell signaling pathways. The team tried overcoming the problem by directly targeting proteins that help heart muscles contract.

"Phosphorylation of MyBP-C enhances both the magnitude and rate of cardiomyocyte contraction, which at the whole heart level translates to enhanced systolic left-ventricular pressures, and ultimately cardiac output. Our findings show that a specific amino acid on MyBP-C, serine 302, can be directly targeted to enhance the rate and magnitude of cardiac pump function, which would be of benefit to a large number of heart failure patients," Julian E. Stelzer, PhD, associate professor in the department of physiology and biophysics, Case Western Reserve University School of Medicine.

Myosin binding protein-C (MyBP-C) is a modifying protein that was found to have significantly enhanced the cardiac output in mouse models. It was concluded that the protein can also be specifically targeted to modulate heart function in humans. Therefore, experts suggest developing drugs that help phosphate molecules bind to serine 302 on MyBP-C. Such drugs can markedly improve cardiac output in people with heart failure due to reduced pumping capacity.

Researchers demonstrated their findings in several models, including isolated cardiac muscle fibers and intact mouse hearts. In the intact heart, phosphorylation of serine 302 increased the rate and magnitude of pressure development, and therefore cardiac output, but this effect was abolished in mice with modified serine 302 MyBP-C," said Mamidi. "Therefore, our studies have identified a critical downstream target of stress signaling that can modulate cardiac output in vivo."

High protein diet have always enjoyed a lot of popularity among fitness conscious folk. Many people who are looking to shed some weight are recommended a high protein diet. But is it really healthy, asks a new study. According to this study, a high-protein diet could increase the risk of heart failure in middle-aged men.

However, proteins from fish and eggs were not associated with heart failure risk in this study. “As many people seem to take the health benefits of high-protein diets for granted, it is important to make clear the possible risks and benefits of these diets,” said Jyrki Virtanen, study author.

Protein is found in foods such as meat, poultry, dairy products, seafood, beans, peas, and nuts, and it is considered essential for healthy bones, muscles, and skin.

Method for study

Researchers studied 2,441 men, age 42 to 60, at the study’s start and followed them for an average 22 years. Overall, researchers found 334 cases of heart failure were diagnosed during the study and 70% of the protein consumed was from animal sources and 27.7% from plant sources.

Higher intake of protein from most dietary sources was associated with slightly higher risk. Only proteins from fish and eggs were not associated with heart failure risk in this study, researchers said. Earlier, a high protein diet was said to have increased the risk of heart failure among older women. Before this a number of studies have said that high protein diet actually helps boost metabolism, help in muscle building and aid weight loss.

Conclusion of the study

It was found that the risk among middle-aged men was 33% higher for all sources of protein, 43% higher for animal protein, 49% higher for dairy protein and 17% higher for plant-based protein. So, what’s the ideal amount? Unfortunately, this topic still needs more research to ascertain that.

Dr. ATUL KALE
Dr. ATUL KALE
MS/MD - Ayurveda, Ayurveda Neurotologist, 15 yrs, Pune
Dr. Sandeep Mengade
Dr. Sandeep Mengade
BAMS, Family Physician General Physician, 17 yrs, Pune
Dr. Vinod Shingade
Dr. Vinod Shingade
BHMS, General Physician Homeopath, 10 yrs, Pune
Dr. Rekha Pohani
Dr. Rekha Pohani
Specialist, Dietitian dietetics, 13 yrs, Pune
Dr. Prashant Wankhede
Dr. Prashant Wankhede
MS/MD - Ayurveda, Pune
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