Tarana Javadova, scientific secretary of the Institute of Cardiology of the Ministry of Health: It is very important to treat heart disease seriously

- Ms. Tarana, first of all, we would like to know what is heart failure?

- Heart failure is a clinical condition in which the heart fails to meet the oxygen demand of the body. The heart delivers blood to the cells of the body, but in case of heart failure, it cannot supply the cells with enough blood. Heart failure is a sign of decompensation of both acute and chronic diseases.

- How is the course of the disease?

- Heart failure has two types of course: acute and chronic. Acute heart failure develops from an hour to a day. This is caused by acute conditions: acute heart rhythm disorder, cardiac tamponade resulting from trauma, sudden rupture of one of the tendinous elements of heart valves, infectious myocarditis, pulmonary embolism, acute myocardial injury. Since the body is not ready for these pathological functional changes that occur in an acute course, the decompensation phase begins without the compensation phase of heart failure.
Chronic heart failure develops over a period of one month to several years. Since this process is slow and long, it is characterized by compensatory mechanisms of the body (thickening of the heart muscle, narrowing of blood vessels, increase in blood volume). This stage is called compensated heart failure. After the body's reserve capacity is exhausted, the decompensation phase begins, complaints such as edema and dyspnea (shortness of breath) appear. The symptom of shortness of breath begins to manifest itself prominently in a quiet state or during a slight load.

- What are the causes of the disease?

- Chronic heart failure can be caused by intracardiac and extracardiac causes. Intracardiac causes include:
• ischemic heart disease;
• uncontrolled high blood pressure;
• heart valve damage;
• congenital and acquired heart defects;
• myocarditis (inflammation of the heart muscle - infections that weaken the heart muscle;
• heart muscle diseases (cardiomyopathy);
• arrhythmias (disruption of heart rhythm);
• diseases of the pericardium (that is, the sac that surrounds the heart from the outside), etc.
Extracardiac causes include:
• amyloidosis (disruption of protein metabolism and accumulation of protein in various tissues);
• lung diseases (emphysema, sarcoidosis);
• endocrine pathologies (eg, increased activity of the thyroid gland (hyperthyroidism));
• severe anemia (blood loss);
• cardiorenal syndrome;
• systemic diseases, etc.

- Doctor, what worries people the most are complications related to vascular occlusion. Does heart failure occur at this time?

- Among the factors leading to heart failure, coronary artery pathology remains in the forefront. Of these, ischemic heart disease (also called coronary heart disease - acute and chronic coronary syndrome) is the most common cause of heart failure. At this time, the blood flow decreases as a result of narrowing of the coronary arteries that supply the heart muscle with blood and oxygen. In this case, the heart muscle cannot function normally. Heart failure can develop after a myocardial infarction (heart attack). During a myocardial infarction, the damaged heart tissue is replaced by scar tissue. The greater the area of heart muscle damaged and replaced by scar tissue due to a myocardial infarction, the weaker the heart's function.

- Is there a type of heart failure that is not easy to diagnose and is sometimes not diagnosed?

- There is a disease called peripartum cardiomyopathy (a heart failure during pregnancy or in the postpartum period (usually in the first month) that progresses with a decrease in the pumping fraction of the left ventricle), which, if not detected in time, leads to serious heart failure. In the absence of an alternative diagnosis, it is a diagnosis that should be considered in pregnant women/mothers presenting with symptoms of heart failure, especially in the last stages of pregnancy and in the first five months after delivery. In this problematic process, it is necessary to exclude other pathologies by carrying out a differential diagnosis. In this context, a pregnant woman/mother with severe shortness of breath must be referred to a cardiologist and examined.

- What are the causes of peripartum cardiomyopathy?

- Although the exact mechanism of the disease is unknown, various hypotheses have been identified regarding its etiology, including viral myocarditis, nutritional deficiency, autoimmunity, pathological response to hemodynamic stress, vascular dysfunctions, hormonal damage, and genetic predisposition.

- What other signs that are not taken into account can lead to the development of heart failure?

- Today, people who abuse alcohol chronically also have this condition, which is called alcoholic cardiomyopathy. Alcohol-induced cardiotoxicity leads to nonischemic dilated cardiomyopathy—heart failure—characterized by loss of cardiac contractile function and dilated ventricles.
I would like to mention that if the disease is diagnosed early and at the same time the consumption of alcoholic beverages is stopped, it is possible to restore heart function. The biggest reason that brings patients to the doctor in the first place is chronic fatigue. The patient cannot cope with the work he used to do comfortably. Edemas in the legs, waking up from suffocation when sleeping at night, shortness of breath during normal physical activity, drowsiness, foam in the stomach, accumulation of gas, increased heart rate as soon as you eat a little food will be observed.
Possible symptoms depend on the type of heart failure. Left-sided heart failure can cause shortness of breath.
Dyspnea usually worsens when the patient overexerts himself (for example, when he climbs a height or stairs, walks quickly) or when he lies in bed. Shortness of breath may be accompanied by coughing.
The main symptom of right-sided heart failure is swelling of the ankles and feet.

- How is the severity of heart failure assessed?

- Heart failure has the following degrees:
• Stage I - no restrictions on physical activity. Ordinary daily physical activity passes without symptoms such as shortness of breath, palpitations;
• Stage II - slight physical limitation in daily activities. To have no complaints in a calm state. Ordinary daily physical activity reveals symptoms such as shortness of breath, palpitations;
• Stage III - severe limitation in physical activity, but no complaints at rest. Slight physical activity immediately reveals symptoms such as shortness of breath, palpitations;
• Stage IV - symptoms such as shortness of breath and heart palpitations appear during slight physical activity or complete rest.

- Would you tell me about the treatment of heart failure...

- It is very important for patients to take treatment seriously. The patient should always be under the supervision of a doctor. In addition to drug treatment, the first things to pay attention to are:
• Diet
If you're overweight, losing weight can help reduce your risk of heart failure. Since salt causes fluid retention, minimize the amount of salt in your diet;
• Stop smoking
Chemicals in tobacco constrict blood vessels, making heart failure worse;
• Sports and physical activity
The intensity of sports or physical activity is determined individually by the treating doctor, depending on the patient's condition;
• Immunization
It is recommended that you get vaccinated against the pneumococcal bacteria that cause influenza and pneumonia every year.