In addition to aortic dissection, the other life-threatening ailment amma had was a weak heart.
I have heard, on numerous occasions, both patients and doctors using the term “weak heart”. Some doctors used this rather layman-ish term for amma too.
Between the two – her aortic dissection and weak heart – the aortic dissection seemed far more dangerous for me, perhaps because it was the lesser understood of the two. Besides, somehow, a weak heart doesn’t evoke the same fear as a long, gory tube that is hanging half-torn.
So, for a while, I too just kept parroting the term “weak heart” without much of a thought. Later, however, I read about it a bit out of curiosity.
So what exactly is a weak heart?
In a practical sense, a weak heart implies that the heart doesn’t pump blood well enough. Doctors technically call such a condition congestive heart failure (CHF) or simply heart failure.
The heart’s pumping can become inefficient owing to a variety of reasons.
The arteries in the heart (called coronary arteries) can get clogged resulting in poor pumping of blood within the heart which in turn damages heart muscles, as they now receive less oxygen. When these muscles are so severely damaged that they stop functioning all together, the result is a heart attack.
Heart muscles could also deteriorate more gradually with age or factors such as high blood pressure. High blood pressure makes the heart work harder, and this in turn weakens the heart muscles and/or enlarges the heart’s chambers. The efficiency of pumping decreases in parallel to such deterioration.
A heart may not pump well owing to the poor functioning of the valves located between the chambers of the heart.
There are a few other causes too for heart failure, but the above three are perhaps the most prominent.
As the muscles of the heart are far more important than muscles in many other parts of the body, these muscles have evolved such that they are able to pump blood powerfully and efficiently throughout our entire lifetime. 41
A key reason for the heart muscles to become weak is high blood pressure, and this was the case for amma too. When the blood pressure inside the arteries is too high, the heart needs to work harder as it has to now pump against this increased pressure. Over time, this causes the heart muscle to thicken (technically termed hypertrophy) and become less efficient at pumping. The part of the heart most affected by hypertrophy is the left ventricle as that is the portion that pumps blood to the rest of the body – through the aorta.
Given that she had a stroke in 2002 most likely owing to hypertension, it is a fair guess that she must have had hypertension for a few years by then, perhaps from around 1995 when she was about 55 years old. This high blood pressure likely started weakening her heart right from that time.
Owing to the effects of hypertension, amma had left ventricle hypertrophy which resulted in relatively poor functioning of this chamber. Given its importance, any dysfunction of the left ventricle is considered a life-threatening ailment.
Her left ventricle was able to pump out (eject) blood to the aorta reasonably well during the contraction of the heart – called the systole phase – but it was not doing a good enough job when it came to filling blood in the chamber during the relaxation phase – the diastole phase. 42 This condition, called Left Ventricular Diastolic Dysfunction (LVDD) is usually treated through medications, especially for old people. 43 In amma’s case, it was treated specifically through a combination of medications that control blood pressure and those that lower the fluid retention in the body and thus lessen the workload for the heart.
Her heart presented a few other challenges such as enlargement of some of its chambers – called cardiomegaly.
All the challenges amma had with her heart were owing to her hypertension that had been left untreated or poorly managed for many years.
Medications today can do wonders to keep weak hearts ticking. Up to the 1980s, those with weak hearts rarely lived beyond five years. Today, with medications and treatments, some experts opine that even those living with advanced heart failures could live 20 years with the right treatment and a bit of luck. 44
In addition to medications, what was needed for amma was a healthy lifestyle. As long as amma took these medications regularly and kept herself active but without over-exertion, her weak heart would be able to sustain her.
Even though she did tease her heart once in a while with some of her activities, her weak heart faithfully sustained her for many years, until arrived the day when it had to finally bid adieu.
41. Cardiac muscle is three layered – epicardium on the outside, myocardium in the middle and endocardium that contacts the blood in the heart. Among the three, it is myocardium, a specialized type of muscle tissue, that does the pumping action. A fairly unique muscle tissue, it contracts and relaxes involuntarily, and is responsible for keeping the heart pumping blood around the body
42. Ejection fraction refers to the percentage of blood (in volume) that the ventricle is able to eject to the aorta during systole (contraction). Amma had an ejection fraction of about 55 during the last ten years, which is at the lower end of the acceptable range, which is 50-70.
43. Surgery is possible for left ventricle dysfunction through implantation of what are called left ventricular assist devices (LVAD), but these are used only for select cases where the heart function has reached its end stages.
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