1. Why Sudden increase in heart failure for Indian Army Officers over 45
Advanced Heart Failure and Transplantation Program
Medical Director Cardiac Transplant Program 1

2. What is Heart Failure? Heart failure is NOT a heart attack
Heart failure means the heart is:
Weakened
Cannot pump enough blood to supply the
body’s needs
. . . Latest research shows that Indian Army officers over 45 years of age are getting heart diseases at an alarming rate!
At first the term “heart failure” can seem pretty scary. You may hear the condition described as an “enlarged heart,” a heart with a “little damage” or a “weak heart.”
Heart failure is often a misunderstood disease. Many people think of heart failure as a sudden event such as a heart attack. But in fact the two are not the same.
A heart attack usually results from blockage in the blood vessels that cut off the supply of blood to the heart. This means that the heart isn’t getting the blood and oxygen it needs, and that causes the sharp pains associated with a heart attack.
Unlike a heart attack, heart failure is not something that occurs suddenly, nor is it typically painful. Heart failure is a progressive weakening of the heart muscle. It is a chronic condition that develops slowly and gets worse over time.
Very simply, heart failure is a condition that occurs when your heart can not pump blood well enough to meet your body’s needs. This is generally because the heart muscle is too weak. Heart failure typically develops as a result of some sort of injury or damage to the heart muscle. The remaining healthy parts of the heart have to do the same amount of work as the whole heart to pump blood around the body. Those remaining healthy parts of the heart get more and more stretched out and weaker - almost like a stretched out balloon or rubberband. 2

3. Why 45 is important
Heart failure affects nearly 5 million people in India
50% men and 50% women
An estimated ½ million new cases are diagnosed each year
Expected to rise to 750,000 new cases by 2040
Related to aging population, better treatment of heart disease and risk factors, awareness
Over one million heart failure hospitalizations annually
Rising over past few decades
Accounts for over 80% admissions in people 45 and over
Heart failure is frighteningly common, but under-recognized. It affects nearly 5 million Americans.
As more people are surviving heart attacks, but being left with weakened hearts, heart failure is the only major cardiovascular disorder on the rise. There are about a half a million new cases diagnosed each year.
Heart failure is the most frequent cause of hospitalization in people age 65 and older.
An estimated $8-15 billion is spent each year on the costs of hospitalization due to heart failure, which is twice the amount spent for all forms of cancer combined.
However, the use of newer medications has been shown to decrease the risk of hospitalization and death due to heart failure. As awareness about heart failure grows, and more patients are diagnosed and treated early, we will likely see these numbers fall. 3

4. Systolic Heart Failure Diastolic Heart Failure
Types of Heart Failure: Difference Between
Systolic and Diastolic Heart Failure
(Click for each type)
Dilated
Systolic Heart Failure
Weakened pump
Relaxation ± abnormal
 Blood backs up
and overloads the heart
Thickened or stiff
heart walls
Diastolic Heart Failure
Normal ejection
Abnormal relaxation: Stiff or scarred
Won’t allow enough blood to fill the
heart before it squeezes
Aorta LA LV
Normal
Normal ejection (squeeze)
=Systolic function
Normal relaxation (filling)
=Diastolic function
Pg 238, Lilly 3rd edition

5. Simplified View of Heart Failure
(Click for each view)
Normal Heart
Development of
Heart Failure

6. What Causes Heart Failure? (Click for each view)
Heart failure results after injury to the heart due to:-
High blood pressure
Heart attack
Damage to heart valves
Diabetes
High cholesterol
Heart muscle disease: damage
from drugs, alcohol, or
infections
Congenital heart disease
Heart failure is not something you can catch from someone.
In a minute, we’ll talk about some of the common symptoms of heart failure. But before we do that, let’s start by reviewing the risk factors.
Muscle damage and scarring caused by a heart attack is among the greatest risks for heart failure.
Cardiac arrhythmia (irregular heartbeat) also increases heart failure risk.
Uncontrolled high blood pressure increases the risk of heart failure by 200 percent.
The degree of heart failure risk appears directly related to the severity of the high blood pressure.
People with diabetes have a two to eight-fold greater risk of heart failure than those without.
Women with diabetes have a greater risk then men with diabetes.
A single risk factor is enough to cause heart failure, but multiple risk factors greatly increases the risk.
Advanced age also adds to the potential impact of any heart failure risk.
If you have any of these risk factors you should consult your physician. 6

7. What Are The Symptoms of Heart Failure? (Click for each type)
Think FACES...
Fatigue Constant lack of energy
Activities limited Difficulty with everyday activities
Chest congestion Dry cough or producing white or pink blood- tinged phlegm
Edema or ankle swelling Swelling of the feet, ankles, legs, abdomen, or unexplained weight gain
Shortness of breath Breathlessness during activity, at rest, or while sleeping
Many people are not aware they have heart failure because the most common symptoms are often confused with normal signs of aging. Also, people often try to avoid symptoms by making lifestyle changes, such as taking the elevator instead of the stairs. Let’s review some of the warning signs of heart failure. An easy way to remember the symptoms is by using the acronym “FACES: F-A-C-E-S”
“F” stands for fatigue or tiredness. This fatigue is generally brought on by exertion, but in advanced stages of heart failure can occur even at rest.
“A” stands for activity becomes limited or reduced. You may experience an inability to exercise, feel weak or have trouble completing daily tasks.
“C” stands for chest congestion or cough.
“E” stands for edema or swelling in your ankles.
“S” stand for shortness of breath. Some people even wake up suddenly from sleep feeling the need to catch their breath.
If you suffer from any of these symptoms, you should consult your physician about heart failure or make an appointment with one of our physicians that specializes in treating this disease (include local information).
Additional symptoms: Lack of appetite, nausea, increased heart rate, irregular heart rhythm

8. How Severe is A Patient’s Heart Failure?
Dr measure the “ejection fraction” by echo
The fraction of blood that the heart pumps with every beat
Dr assess the patient’s symptoms
No or mild symptoms
Do symptoms limit activity? If so, how much?
HF: EF below 40%

9. HOW TO IDENTIFY, PREVENT AND TREAT HEART FAILURE?
(Click on heart to view 5 minutes live video stream)