Mr X, a healthy man just 50 years old, suddenly developed breathlessness while in office and was rushed by colleagues to the hospital. He had recovered from Covid-19 just eight weeks ago, hence, it was presumed that he had developed some lung complication. But investigations revealed that he had acute heart failure. He recovered after treatment.

Middle aged and elderly people sometimes develop sudden breathlessness, which apparently looks like sudden pneumonia or any lung problem. But in many cases, it is due to sudden heart failure. 

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, etc., can cause acute cardiac failure. 

A person may be having breathlessness on exertion for sometime, which may suddenly become severe someday. He may be stable and develop breathlessness suddenly one fine day on moving. It can occur after midnight, forcing him to get up and sit straight. This happens due to fluid accumulating in the lungs, due to acute heart failure in supine position. Around midnight, there is surge in chemical mediators in the body, due to its biological clock, which can suddenly raise blood pressure and cause heart failure.

Along with breathlessness, there may be cough with expectoration, which may be blood mixed, hence frightening. The manifestations are somewhat similar to Bronchial 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 due to heart failure, once the person gets sick, he keeps on deteriorating unless treated. The symptoms are not related to climate changes.

One can 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 develops acute heart failure, it tends to become repetitive and then chronic over time. Strong suspicion is needed to diagnose acute heart failure. Untreated, after months, peripheral signs develop 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 initiated 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 lifestyle changes and medicines to prevent development of acute cardiac failure.

Healthy lifestyle 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, deep fried substances, red meat etc. should not be part of regular diet.  Fish in diet, is very useful to keep heart healthy. Regular physical exercise prevents obesity. Physically 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 internal medicine

rachna212002@yahoo.co.uk