Cases of ‘old lady heart syndrome’ are on the rise
AS SHE strolled around the city of Petra, Sadhana Press expected to be overwhelmed by her surroundings. But all she could focus on was her breathlessness.
This wasn’t the first time the 61-yearold from Harrow, London, had found herself out of puff. For the past few months, she’d become increasingly breathless.
Initially she had blamed this on the fact she was overweight, but while on holiday in Jordan last March, the mother-oftwo realised it must be more serious.
Back home, her GP referred her for an echocardiogram (ECG), where ultrasound is used to examine the heart’s structure, and an angiogram, an X-ray where a special dye is injected into the blood to check the arteries of the heart.
The tests revealed that Press was suffering from heart failure. This occurs when the heart muscle becomes damaged and weakened, and blood is no longer pumped around the body properly.
This triggers breathlessness and fatigue, as well as swelling in the feet and ankles.
The most common causes of heart failure include high blood pressure, heart disease, a previous heart attack, heart rhythm disorders such as atrial fibrillation or faulty heart valves.
Treatments involve medications such as ACE inhibitors and beta blockers to lower blood pressure and regulate heart rate.
Press has a new type of heart failure that predominantly affects women, and unfortunately there are few treatment options. That is because this type of heart failure doesn’t cause the heart to become enlarged, as is typical, but instead causes it to stiffen and shrink.
With a healthy heart, with every heartbeat the two ventricles contract forcefully, propelling blood out to the body and lungs. This surge of blood is what we feel as our pulse. Between each heartbeat the ventricles rapidly relax, allowing them to fill with blood ready for the next heartbeat.
With heart failure, typically the heart muscle thickens in an effort to create more power to pump blood around the body. While this sounds helpful, the increase in size actually makes the heart less efficient, and so exacerbates symptoms.
Doctors often diagnose heart failure when a heart appears large on a scan. But doctors now know that not all cases cause the heart to enlarge.
In fact, in some cases the heart stays the same size or shrinks, explains Dr Alex Lyon, consultant cardiologist at the Royal Brompton Hospital in London.
These patients have a different type of heart failure, where the ventricles become stif f and can’t relax between beats. They’re unable to fill properly with blood, so less blood is pumped around the body.
The exact reason for this stiffening is unknown, but it’s thought that a mesh of scar tissue, triggered by damage from conditions such as high blood pressure, diabetes or obesity, forms between the muscle cells of the heart.
This stif fness causes the heart to appear smaller. And because it seems to affect women more than men some experts refer to it informally as “old lady heart syndrome”.
“It sums up the type of patient affected – female, over-70 and also often with a history of high blood pressure,” explains Richard Bogle, a cardiologist from St Helier Hospital in Epsom, Surrey.
Why this condition affects more women is unknown, though menopause may play a role as this triggers a drop in oestrogen, a hormone that helps protect the heart. The classic form of heart failure (previously known as systolic heart failure but now called heart failure with reduced ejection fraction – HFrEF) was thought to be by far the most usual, but doctors realise that this newer type may be much more common than once thought.
But despite warnings that the condition is on the rise, it may still not be diagnosed, says Bogle. “If you’re not a cardiologist interested or aware of this condition, you may just miss it.”
Lyon believes that patients with suspected heart failure should have their heart stiffness calculated by using an ECG to measure how much the heart contracts with each beat, as well as a blood test that tests for levels of a substance called natriuretic peptide, which helps give an indication of heart function. – Daily Mail