Heart failure is a serious illness at any time. Therefore, the very mention of such a diagnosis by the doctor gives rise
to a great deal of understandable alarm. In medical parlance, heart failure is said to be present when the heart is not able to pump enough blood to meet the requirements of the body. Contrary to a popular belief, it does not indicate “stoppage” of the heart beat. The usual symptoms are shortness of breath (initially with increased effort progressing in time to appear even at rest; some
patients may be woken up at night with shortness of breath), cough (sometimes with frothy sputum), palpitations, swelling in the legs, weakness, loss of appetite, disturbed sleep, confusion or impaired memory, etc. Of course, a number of other conditions may mimic heart failure which is why a doctor needs to be consulted at the earliest. There are, however, a small number of patients of heart failure in whom the cause cannot be found or removed whether for technical reasons or because of an uncertain or unacceptable risk of definitive
treatment. These patients require treatment on a long-term basis. The first line of treatment for these patients is with drugs, usually a combination of various medicines. Treatment inevitably is life long. Of these, a small number of patients may not respond to treatment or stop responding to treatment after having been suitably controlled for short or long periods. It is this small number of patients in whom medical treatment fails to provide sufficient relief in spite of the best efforts with medications (under the supervision of experts). For such patients there is only one procedure that can possibly offer a cure and that is cardiac transplantation. There are many logistic and technical reasons why this procedure cannot be offered to more than a very small number who could be possible beneficiaries (constraints of space do not permit a detailed consideration of these). The next best solution that has the potential of providing sustained relief but is still an experimental procedure is that of seeding in the heart very special cells called “stem cells” taken from the patient himself. This treatment is not available as yet for patients but is mentioned because it has been receiving media coverage. Incidentally, one of the institutions engaged in researching the subject is the PGI, Chandigarh. The next option is a surgical procedure that tries to reconstruct the major chamber of the heart (the left ventricle) in an attempt to restore the geometry of the chamber as close to normal as possible (the Batista operation). The procedure, however, carries a substantial risk with uncertain benefits. It has been known for several years that the sequence of activation of heart muscle plays an important role in ensuring optimum function of the heart. Some patients at an advanced stage of heart failure may also show abnormal spread of the normal electrical activity that controls the sequence of activation of the heart. About 15 years ago a new procedure was attempted to try and restore towards normal, as far as possible, the sequence of electrical activation of the heart. This procedure, known as Cardiac Resynchronization Therapy (CRT), has come to gain acceptance all over the world because it provides some relief in symptoms to these patients. It, however, cannot be called a miracle treatment since it does not offer a cure for the disease. It does not supplant medical treatment but may supplement it. A recent dissertation estimates that only about 4 per cent patients of heart failure would be eligible for treatment with CRT according to the currently accepted criteria. Unfortunately, about a third of the patients who are offered the treatment may not show significant improvement. Even in those who do, improvement in symptoms is estimated at 24 per cent.