Middle aged and elderly people sometimes develop sudden breathlessness, which is confused with bronchial asthma, because lungs are congested. But this is mostly due to sudden heart failure and precise treatment is delayed due to the confusion.

Certain conditions put strain on the left ventricle(heart chamber pushing blood to whole body), which then becomes prone to sudden failure after a time.

Hypertension is the most common such condition. Because of increased resistance in the peripheral vessels, the left ventricle has to pump blood with greater force and becomes sluggish over a period of time resulting in failure.

Coronary artery disease is also a major cause for acute heart failure. Abnormalities of the valves of the heart, can cause acute or chronic left ventricular failure. Disease of the cardiac muscle, whether due to infection or metabolic conditions like uncontrolled diabetes, uremia due to renal failure, among others, can cause acute cardiac failure.

A person may be having breathlessness on exertion for sometime, which may suddenly become severe someday. He may also be stable and develop breathlessness suddenly one fine day after moving or after midnight forcing him to get up and sit straight.

There is associated cough with expectoration, which may be bloody, frightening to the person. These symptoms are very similar to bronchial asthma, hence it is also called "cardiac asthma”. The two can be differentiated only by the fact that bronchial asthma is episodic and in between the person is mostly normal. In bronchial asthma, there is a definite relation of symptoms to climate changes or exposure to allergy producing substances. But in cardiac asthma, once the person gets sick, he keeps on deteriorating unless treated. The symptoms are not related to climate changes.

One may also have palpitations which occur due to the over activity of the failing heart to maintain circulation.

Due to poor perfusion of vital parts and , disturbed sleep the individual starts feeling tired very easily. Loss of appetite adds to the sickness.

Usually, once somebody has acute heart failure, it tends to become chronic after some episodes. Strong suspicion is needed to diagnose acute heart failure. Like chronic heart failure, it does not produce peripheral signs like swelling of the feet and body and enlargement of the liver. Diagnosis is confirmed by X-ray chest, electrocardiography, echocardiography and other imaging techniques.

If treatment is started early, the functioning of the heart can improve to a great extent. Treatment of the underlying cause also helps in improvement of the condition.

It is imperative to keep conditions like hypertension and diabetes very well under control with life style changes and medicines to prevent development of acute cardiac failure.

Healthy life style helps to keep the body as well as heart healthy. Diet should include plenty of fresh vegetables, fruits, whole grains and nuts. Food substances with high fat content like margarine, cheese, deep fried substances, should not be part of regular diet. Among meat products, fish is very useful to keep heart healthy.

Regular physical exercise prevents obesity. Physical and mentally one should be relaxed. One should also quit smoking and alcohol to prevent damage to the heart.

Once heart failure starts, it is prudent to take the prescribed medicines regularly to avoid further extension of the problem.

Dr. Rachna Pande is a Specialist in internal medicine-Ruhengeri Hospital

E-mail: rachna212002@yahoo.co.uk