2023-07-12 10:00:00
｜Interview]Dr. Ryu Jae-chun, a cardiologist
｜The number of patients with heart failure increases significantly with an aging society
｜Echocardiography is basic and essential for heart failure treatment
Heart failure is a functional or structural abnormality of the heart that causes problems with the pumping (expelling blood) function or filling (receiving blood) function of the ventricles. Symptoms such as shortness of breath, swelling of the legs, and fatigue appear together, and sometimes accompanied by crackles in the lungs and an increase in jugular venous pressure. The 5-year survival rate for heart failure is regarding 40% lower than for cancer in advanced heart failure. Learn more regarding heart failure with Director Ryu Jae-chun (Ryu Jae-chun internal medicine clinic).
Director Ryu Jae-chun, a cardiology specialist｜Source: Ryu Jae-chun Internal Medicine Clinic
Increased number of heart failure patients with an aging society
According to statistics released by the Korean Heart Failure Association, the prevalence of heart failure in Korea, which was only 0.77% in 2002, has tripled in 16 years to 2.24% in 2018, and the number of patients has increased significantly to 1.15 million. Director Ryu Jae-choon finds these causes in the aging population and the increase in the elderly population.
“As the average life expectancy has increased due to the development of medicine and the improvement of quality of life, it seems that the number of heart failure patients is increasing as the elderly population increases. In addition, the increase in ischemic heart disease patients is also one of the main causes worth paying attention to,” said Dr. Ryu Jae-choon. In fact, ischemic heart disease, a heart disease in which the coronary artery that supplies blood to the heart muscle is blocked, causing the heart muscle to die or not to exert its strength properly, is considered one of the leading causes of heart failure.
There are many different causes of heart failure. According to a paper published in the Journal of the Korean Society of Cardiology, a joint research team involving a number of universities including Konkuk University, Kyungpook National University, and Sungkyunkwan University, heart failure due to the above-mentioned ischemic heart disease (32.3%) was the most common, followed by cardiomyopathy (22.7%). , hypertensive heart disease (16.5%), and heart valve disease (13.5%) followed. Congenital heart disease, endocarditis, myocarditis, and other causes and underlying diseases were not clear in 15% of cases.
Echocardiography is essential for treatment and diagnosis
According to Dr. Ryu Jae-choon’s explanation, △left ventricular relaxation/contraction function △hemodynamics (measurement of pulmonary artery pressure and right ventricular pressure) △valvular structure and function abnormalities can be evaluated through echocardiography, △local wall motion disorder △pericardium and other structures Abnormality of △ The presence or absence of intracardiac shunt and congenital heart disease can be observed.
In particular, in order to diagnose heart failure with preserved ejection fraction, which accounts for 40% of all heart failures, echocardiography is used to find objective evidence of cardiac structural or functional abnormalities, such as left ventricular ejection fraction, abnormal left ventricular diastolic function, and increased left ventricular filling pressure, along with symptoms and signs of heart failure. It is important.
Dr. Ryu Jae-chun said, “The left ventricular ejection fraction measured by echocardiography is used as an index to measure the contractile function of the left ventricle. If the left ventricular ejection fraction drops below 40% on ultrasound, it is classified as heart failure with reduced ejection fraction and the ejection fraction is 50. If it is greater than 10%, heart failure with preserved ejection fraction is diagnosed.”
In addition, Dr. Ryu Jae-choon said, “The most important thing in heart failure treatment is to clearly diagnose and identify the causative disease. This is because heart failure treatment policies and effects vary depending on the cause and pathophysiology.” The role of echocardiography, which can accurately evaluate cardiac function and the prognosis of heart failure, is absolute.”
Heart failure treatment begins with finding the cause of the disease with echocardiography｜Source: Getty Image Bank
Management is important like a chronic disease…Constant medication is essential
Unfortunately, heart failure is not a curable disease. However, like chronic diseases such as diabetes and high blood pressure, symptoms can be controlled with steady management. In severe cases, medication may be required.
In the standard drug treatment for heart failure, diuretics, digoxin, and cardiotonic drugs are used to improve symptoms. To improve survival rate, four drugs, △renin-angiotensin system blocker △beta-blocker △aldosterone antagonist △sodium-glucose cotransporter 2 (SGLT2) inhibitor, are used. It is utilized.
Director Ryu Jae-choon said, “The most important part of heart failure treatment is improving the patient’s symptoms and improving the quality of life. The goal is to prevent dangerous situations such as hospitalization through periodic observation and management of the disease, reduce mortality, and prolong the patient’s life.” said.
In addition, he said, “Steady drug treatment is necessary to control symptoms. Even if symptoms improve noticeably following drug treatment and the ejection fraction of the left ventricle improves on ultrasonography, drug treatment should be maintained.” For this, it is necessary to treat the cause of the disease, take regular medications, stop smoking, stop drinking alcohol, eat a low-salt diet, control weight, exercise regularly and manage stress, etc.”
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