[Local Medical]Heart failure + diabetes are double fatal, controlling blood sugar and protecting the heart are indispensable

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Text◆Yang Qianni

People with ischemic heart disease, hypertension, and diabetes are at higher risk of developing heart failure. Studies show that diabetes increases the risk of heart failure by two times in men and five times in women.

For this reason, heart failure and diabetes are often labeled as the “fatal duo” because diabetes can lead to heart failure and heart failure can lead to diabetes.

(Kuala Lumpur News) Heart failure (heart failure) is a condition in which the heart cannot pump enough blood to supply the body’s needs. In some cases, some people’s hearts don’t fill with enough blood, some don’t have enough power to pump blood around the body, and some people have both problems at the same time.

Alcohol abuse and drug abuse damage heart muscle

Azmee Mohd Ghazi, deputy director of the Department of Cardiology and Consultant Cardiologist at the National Heart Centre, pointed out that heart failure is the leading cause of hospitalization in the United States and Europe, and mortality rates also increase with each return to the hospital.

“Nine million people in Southeast Asia suffer from heart failure;

The prevalence rates in Malaysia and Singapore are 6.7% and 4.5% respectively.

Compared to the United States (average age 75),

Southeast Asian patients develop acute heart failure at a younger age (54 years)

and have more severe clinical features,

There is a higher chance of using mechanical ventilation,

The length of admission was longer (6 days) and the in-hospital mortality rate was higher (4.8%).

The length of stay and in-hospital mortality of the former were 4.2 days and 3.0%. “

He said the causes of heart failure include ischemic heart disease, diabetes, hypertension and other heart conditions such as arrhythmia, cardiomyopathy, congenital heart defects or valvular heart disease.

Heart failure can also occur when the heart muscle is damaged or overloaded. It should be noted that heart failure does not necessarily occur when the heart muscle becomes weak, but when the heart muscle becomes stiff.

“Factors that can damage the heart muscle include alcoholism, drug abuse, AIDS, thyroid disease, too much vitamin E, and cancer treatments such as radiation or chemotherapy. In addition, getting older and being overweight also increases the risk of heart disease and diabetes, which can lead to heart failure. .”

“Over time, as the heart becomes unable to maintain the blood demands of the rest of the body and weakens, certain proteins and substances may be released into the blood. These substances can have toxic effects on the heart and blood flow and can lead to heart failure. Aggravated.”

Heart failure cannot be cured and requires lifelong monitoring

He said that ejection fraction (EF) is a measure of the heart’s ability to pump blood. It measures the percentage of blood pumped out by the left ventricle with each contraction of the heart. When the heart relaxes, the ventricles refill with blood.

“Heart failure can be divided into two categories based on left ventricular ejection fraction: Heart Failure with Reduced Ejection Fraction (HFrEF) and Heart Failure with Preserved Ejection Fraction (HFpEF) ).”

“The former is when the myocardium cannot contract effectively, and less blood is pumped out compared with a normal heart, which is characterized by enlargement of the ventricles and impairment of normal contraction and emptying; the latter is when the myocardium can contract normally, but the ventricles fail to fill enough of blood, less blood entering the heart than a normal heart, is characterized by the ventricles becoming stiffer or thicker and unable to relax and fill normally.”

He pointed out that the American College of Cardiology Foundation and the American Heart Association (ACCF/AHA) divide the development process of heart failure into four stages.

Stage A patients are at high risk for heart failure but do not have structural heart disease or symptoms of heart failure.

Stage B means you have structural heart disease but no signs or symptoms of heart failure.

Stage C means patients with structural heart disease and previous or current symptoms of heart failure. Stage D is refractory heart failure that requires special intervention.

He mentioned that the New York Heart Association (NYHA) classifies cardiac function based on the severity of the patient’s symptoms and limitations in performing physical activities:

Level I: No restrictions on physical activity, no symptoms such as fatigue, palpitations, or difficulty breathing (shortness of breath).

Level II: Mild limitation of physical activity, no symptoms at rest, but daily physical activity can cause symptoms such as fatigue, palpitations, and dyspnea (shortness of breath).

Level III: Physical activity is significantly limited and asymptomatic at rest, but slight physical activity causes symptoms such as fatigue, palpitations, and dyspnea (shortness of breath).

Grade IV: Symptoms of heart failure occur even at rest. Any physical activity increases discomfort.

“Heart failure is currently incurable. Patients must control the condition throughout their lives and adhere to treatment plans such as taking medications regularly and changing lifestyle habits to relieve disease symptoms, improve quality of life, increase heart function, prevent hospitalization and improve survival rates. Although It can be treated, but heart failure symptoms may gradually worsen, so patients need to monitor their condition closely.”

Prescription drugs required depending on type of heart failure

He noted that doctors generally prescribe medications based on the type of heart failure a patient has, its severity and their response to the medication. Common medications used to treat heart failure include:

◆Angiotensin-Converting Enzyme Inhibitor (ACEi) can lower blood pressure and reduce heart strain, and can also reduce the risk of future heart attacks.

◆Aldosterone antagonists cause the body to excrete excess sodium through urine. This reduces the amount of blood the heart has to pump.

◆Angiotensin receptor blockers relax blood vessels and lower blood pressure to reduce the burden on the heart.

◆Beta blockers can reduce heart rate and blood pressure to reduce the burden on the heart.

◆Digoxin can strengthen the beating of the heart and pump more blood.

◆Diuretics help reduce fluid buildup in the lungs and swelling of the feet and ankles.

◆Isosorbide Dinitrate (ISDN) or hydralazine hydrochloride can help relax blood vessels so that the heart does not have to work so hard to pump blood.

◆Angiotensin Receptor Neprilysin Inhibitor (ARNi) can relax blood vessels, making it easier for blood to flow, making it easier for the heart to pump blood to the body.

“About the hypoglycemic drug sodium-glucose co-transporters 2 (SGLT 2) inhibitor, it is a kind of hypoglycemic agent that inhibits the reabsorption of glucose in the kidneys and allows glucose to be excreted in the urine. The drug, which acts similarly to most prescription drugs used to treat heart failure, has been shown to be beneficial in patients with heart failure and is also well tolerated and has low side effects. Compared with some of the drugs commonly used today, SGLT 2 inhibitors The once-daily dosing regimen, which requires no dose adjustments, is also simpler.”

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