Experiencing shortness of breath, even when lying down? Or feeling weak, tired or dizzy and having a racing pulse without a hottie in sight?

You might want to get your heart checked.

Padmini K. Muthusamy had all those symptoms and more. She was constantly feeling listless and grew weaker by the day.

“I was not able to do my normal routine activities, especially house chores.

“I was easily tired but did not take it seriously. I would gasp for air most of time and I thought it was my asthma problem since I had asthma during my childhood,” she recalls.

At night, she would cough and throw up while trying to sleep. Her legs had also begun to swell.

Thinking it was just the common cough, her husband whisked her to the clinic.

Padmini, 56, was treated for asthma, and for a while, she felt better, but the symptoms reappeared with a vengeance within weeks.

heart failure

Padmini is thankful she was correctly diagnosed and has a better quality of life now. Seen here are her husband Perumal Samy and their daughters Muhambigai (right) and Vigneswary.

One night, she was struggling to breathe, and this time, hubby rushed her to the hospital, where she was eventually diagnosed as having heart failure.

Life has never been the same since the diagnosis six months ago.

“Bit by bit, I got better. After the treatment and follow-ups, I’m feeling quite well now and am able to do some light work. But, I cannot exert myself,” says Padmini, thankful to have survived those difficult moments.

Timely intervention saved Padmini’s life, but alas, there are many in her shoes, clueless about their condition and walking around like time bombs.

What is heart failure?

Heart failure is a serious medical condition where the heart does not pump enough blood around the body as well as it should due to the weakening of heart muscles over time.

The limited blood supply causes scarring of the heart muscles, so the organ is unable to contract efficiently.

Basically, the heart can’t deliver enough oxygen and nourishment to the body to allow it to work normally, and may cause you to feel tired or fatigued.

It also means that you cannot eliminate waste products properly, leading to a build-up of fluid in your lungs and other parts of your body such as your legs and abdomen.

Although it is called heart “failure”, it doesn’t mean that your heart is about to stop working, but rather, your heart is having difficulty meeting the demands of your body, especially during physical activity.

The rate of heart failure is higher in South-East Asia compared to the rest of the world.

Your risk of developing heart failure is higher if you have vascular risk factors such as hypertension, obesity and diabetes.

Malaysia’s “sick” nation status, a result of alarming obesity rates, combined with lack of exercise, unhealthy eating habits, smoking and a lackadaisical attitude – are all contributing towards this increase in patient numbers.

‘The beginning of the disease is so slow that you might suddenly develop exercise intolerance,’ says Prof Carsten.

“Patients often have no symptoms or only show symptoms after some time. This is not like a heart attack. The beginning of the disease is so slow that you might suddenly develop exercise intolerance,” says Prof Carsten Tschöpe, vice director of the department of cardiology at Campus Virchow Clinic, Universitaetsmedizin, Berlin, Germany.

Serious misconceptions and knowledge gaps exist around heart failure, and consequently, a large number of premature deaths still occur.

“Heart failure has a crippling impact on patients’ lives, as often they are not equipped with the knowledge about the disease and proper management of the condition. The most common symptoms – breathlessness, fatigue and swollen ankles – which can vary from person to person, are often mistaken as signs of ageing or being unfit rather than being associated with the heart.

“Better recognition and understanding of the symptoms would prompt people to seek treatment at an earlier stage, leading to more accurate diagnosis, decreasing the risk of hospitalization and improving survival rates,” says Prof Carsten.

Heart failure in this region also occurs at a younger age and is characterised by more severe clinical features.

Asian patients with stable heart failure have also been shown to be at least a decade younger than European patients.

Many people do not know that heart failure is deadlier than some types of cancer, says Dr Aizai.

Datuk Dr Aizai Azan Abdul Rahim, chief clinical officer and senior consultant cardiologist at Institut Jantung Negara (IJN) says, “Many people do not know that heart failure is deadlier than some types of cancer, and Malaysia has a high prevalence of cardiovascular disease that can lead to heart failure.

“Malaysians mistakenly think that it only affects the older generation, but in fact, the mean age of Asians is strikingly low.

“Heart failure is an important cause of hospitalization here, accounting for about six to 10% of all acute medical admissions. Moreover, half of the hospitalised heart failure patients may die within five years.”

Both doctors were speaking at a recent media workshop on heart failure.

Age is not a factor

Heart failure is a major and growing public health problem in Malaysia.

It can develop at any age but becomes more common as age increases.

Worldwide, around 1% of people under 65 years of age have heart failure; this increases to 7% for 75-84 year olds, and up to 15% in people older than 85.

It is the most common cause of hospitalization in patients over 65 years of age.

Symptoms include shortness of breath, rapid heartbeat, loss of appetite, swelling in the ankles, legs and abdomen, tiredness, sudden weight increase and frequency of urination.

In Malaysia, the prevalence of heart failure varies between three to 20 per 1,000 population, although in persons over the age of 65 years, it could be as high as 100 per 1,000 population.

Dr Aizai says, “It affects people in the prime of their lives as heart failure tends to strike in the productive years and this puts a lot of burden on healthcare costs. In IJN, 20% of non-elective admissions are due to heart failure. The local figures are probable underestimated.”

However, even though heart failure is a chronic condition with no cure, it can be effectively managed.

“You should have your first full medical check up at 40 if you have a strong family history of non-communicable diseases. We should also look at food and genetic components.

The diagnosis of heart failure is purely based on symptoms though there is a blood test now. There is also a wide overlap of symptoms with the common flu and asthma,” says Dr Aizai.

Prof Carsten explains, “General practitioners must take the patient’s history and do an electrocardiogram. When the heart failure patients become sick, their heart first tries to heal itself by secreting a hormone called B-type natriuretic peptide (BNP).

You can do a BNP test to measure how much of it is in your blood. If you heart has tried to heal itself by using this compensatory mechanism, there will be an increased amount of BNP in your blood. It’s different from a heart attack test.”

Heart failure treatment

Treatment for heart failure depends on the type and severity of the condition, but medication is the backbone, along with lifestyle modications, especially light exercises.

“The cocktail of pills heart failure patients have to take is about 10 to 12 a day! Yet, despite medication, disease progression can only be slowed down. About 20 years ago, doctors said you shouldn’t do anything physical to aggravate the condition, but now, physical activity has been proven to heal the sick heart.

“All you need is 20 minutes three times a week, but not high intensity. You should reach only 70% of your maximum heart rate. If you work harder, it is possible for the symptoms to recur,” says Prof Carsten.

“Patients with this condition often say they have good days and bad days. A general tip is to pace yourself throughout the day – remember your energy battery,” concludes Dr Aizai.

So take note – if you’re always tired, it’s not that you’re getting older. It could signal a problem with your heart.