The coronavirus pandemic has put senior citizens in a fix. They tend to ignore subtle signs of deterioration in their health. By the time the patient and family decide that medical treatment is needed, it is often too late.

Heart failure is a disease that can set in with few complaints, a sudden gain of 2-3 kilos (not really all that much), fatigue, an irritating cough, sleep disturbances, breathlessness on exertion, irregular heartbeat, palpitations, and sometimes, chest pain.

The heart begins to fail when its pumping action becomes inefficient. This can occur because the heart muscles are stiff, weak or damaged, the covering of the heart prevents it from expanding and contracting entirely, or high blood pressure interferes with the pumping action. It may be because the valves in the heart become faulty, so that instead of propelling the blood outward with each pumping action some of it returns. This can also occur if the heart valves are congenitally faulty.

The heart muscles can respond to infections (usually viral) with inflammation and damage called myocarditis. Some medications, alcohol and tobacco can also damage the muscles as can chronic illnesses such as uncontrolled diabetes, hypertension and thyroid diseases. Sudden blood clots, especially in the lungs, can also cause the heart to fail.

The human heart beats regularly because of the regulated flow of electrical currents through its conducting system. This can become deranged with heart failure and cause abnormal rhythms and even death. Fluid retention can occur because of the poor pumping action, leading to enlargement of the liver and kidney failure.

Most of the time, the signs of heart failure such as throbbing veins in the neck, swollen feet, high blood pressure, a distended abdomen and congestion in the lungs can be picked up on physical examination. To determine the precipitating cause for heart failure and evaluating it blood tests, a chest X-ray, ECG, sometimes a treadmill test and then a cardiac echo test, CT or MRI may be required.

Heart failure is classified according to symptoms: class 1 is an asymptomatic person; in class II, fatigue comes on only with exertion and is not present at rest; in class III cases, daily activities become burdensome while in class IV, the person is in a permanent state of difficulty even while at rest.

Any diseases contributing to heart failure should be aggressively treated. There are several medications to remove fluid from the body and improve the functioning of the heart. It is possible to lead a fairly normal life with regular medication. If the electrical system of the heart is a problem, then a pacemaker may be required.

Lifestyle modifications can help delay the onset and prevent the progression of heart failure.

• Walk, jog, run, swim or cycle for 40 minutes a day
• De-stress with 10 minutes of yoga and 10 minutes of meditation
• Do not smoke or drink
• Ask your doctor whether any of the prescribed medications you are taking have any harmful side effects on the heart. Even OTC painkillers such as diclofenac and aceclofenac can cause problems if taken for a long time
• Keep lifestyle diseases such as diabetes and hypertension under control
• Correct anaemia and thyroid problems
• Do not stop any heart medication without consulting your physician.

The writer is a paediatrician with a family practice at Vellore and the author of Staying Healthy in Modern India. If you have any questions on health issues please write to yourhealthgm@yahoo.co.in