Q I am a 58-year-old man and I've been overweight for many years.
I've been suffering from heart failure for the last two years.
I had an emergency operation after a heart attack and part of my heart muscle was cut away.
My ejection fraction is now below 50 per cent.Will my heart failure become worse?
I also cannot drink a lot of water and I am thirsty all the time.
What can I do to get my ejection fraction up and be able to drink normally? I am now no longer overweight.
A It appears that you had a heart attack during which a portion of the heart muscle was damaged.
This damaged segment of the heart wall weakened and scarred after the heart attack and eventually stretched into an out- pouch called a left ventricular aneurysm.
This is a rare complication of a heart attack and usually occurs only in cases where the damage is extensive.
When a heart or left ventricular aneurysm develops, further complications can set in, such as heart failure, dangerous clot formation inside the aneurysm or abnormal heart rhythms.
One treatment to prevent these complications from occurring is to surgically cut away and remove the scarred and damaged heart tissue that forms the wall of the aneurysm or outpouch and stitch back together the surrounding healthy heart muscle.
However, heart failure can still be a problem after this procedure because the heart function may have been compromised even before surgery, due to extensive heart muscle damage from the initial heart attack.
A normal heart will push out more than 50 per cent of the blood volume it contains during each contraction.
This is called the left ventricular ejection fraction. A left ventricular ejection fraction (LVEF) of 50 per cent or more is considered normal and a LVEF of less than 40 per cent is considered reduced.
A LVEF of 40 to 49 per cent is considered mid-ranged.
Typical symptoms of heart failure include shortness of breath (usually on exertion, but in acute episodes, can occur at rest), swelling of both ankles or legs, general lethargy, breathlessness on lying flat, and waking up in the middle of the night unable to breathe.
Although individuals vary, patients with poorer heart function or lower LVEF will be more likely to be incapacitated with symptoms, have more frequent hospital admissions and a higher risk of dying than someone with a better heart function or higher LVEF.
New major advances in the treatment of heart failure in the last few years have proven to prolong and improve the quality of life of patients with heart failure.
In your case, there is no reason why your heart would progressively fail. It is certainly possible to stabilise or even to improve your heart function.
The mainstay of treatment for heart failure is drug therapy. This includes medications to reduce congestion, alter neuro-hormonal imbalances and reduce the heart rate, which, taken together, would improve the symptoms and long-term outcome for patients.
Other therapeutic options which are suitable for some patients include pacemaker devices to resynchronise heart contraction or to deliver an electrical shock in the event of rhythm abnormalities, which some patients with heart failure are prone to.
In addition to ensuring that you take the medications prescribed by your doctor (and to discuss with your doctor first before you take any new drugs, such as painkillers), you can also take healthy- heart lifestyle measures.
You have done well to reduce your weight. Regular exercise, monitoring your blood pressure and having enough sleep are important.
If you have severe heart failure, your doctor may advise you to reduce your fluid intake to 1 to 2 litres a day and to reduce your salt intake to less than 6g a day.
If this is difficult for you to maintain, check with your doctor to see whether a less restrictive regimen is possible and safe for you.
Dr Tan Kok Soon
Senior consultant cardiologist at Tan Kok Soon Heart Specialist Clinic at Mount Alvernia Hospital.
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