When the heart is struggling

Risposta: The heart is an extraordinarily efficient pump. Every day it beats around one hundred thousand times and pumps over 7,000 litres of blood into the circulation, ensuring that all the organs are supplied with oxygen and nutrients. When this pumping capacity decreases, the body activates a series of compensatory mechanisms which, at least initially, can mask the problem. This is why it is important to recognise the early signs of reduced function in the left ventricle, the heart’s main pumping chamber.

The most common symptom is dyspnoea, i.e. difficulty breathing. Initially, it only occurs during physical exertion, such as climbing a flight of stairs or walking uphill. However, as heart function deteriorates, shortness of breath may also occur during very mild activities or even at rest.

Another characteristic sign is the appearance of peripheral oedema, particularly around the ankles and in the pretibial region. In more advanced cases, applying gentle pressure with a finger to the leg leaves a small indentation for a few seconds – the so-called pitting oedema – which is indicative of fluid retention.

One of the earliest and least well-known symptoms is nocturia, that is, the need to get up once or more during the night to urinate. When the patient lies down, the fluid that has accumulated in the legs during the day re-enters the bloodstream and is excreted by the kidneys. This symptom, too – particularly if it is a new development – should not be underestimated.

As the disease progresses, another typical symptom appears: the inability to sleep lying completely flat. Many patients start using two or three pillows to breathe more easily; in the most advanced cases, they are forced to spend the night in a semi-seated position or even in an armchair.

The good news is that reduced heart function can now be detected at an early stage using simple and widely available tests. An electrocardiogram can provide the first clues, an echocardiogram allows the heart’s pumping function to be measured directly, whilst a blood test for NT-proBNP – a protein produced by the heart when it is under stress – is a valuable screening test. Recognising these warning signs means reaching a diagnosis before full-blown heart failure develops and starting treatment promptly – treatment which is now increasingly effective – with the aim of slowing the progression of the disease, improving the patient’s quality of life and reducing the risk of cardiovascular complications.