Heart failure without symptoms? Recognising early stages that go undetected

Hyderabad: Heart failure, a condition often associated with debilitating symptoms and frequent hospital visits, has a silent precursor that is being increasingly recognised in medical circles—Asymptomatic Left Ventricular Systolic Dysfunction (ALVSD).

Experts warn that this early stage of heart failure, classified as Stage B, often goes unnoticed but can lead to severe outcomes if left unmanaged.

“Asymptomatic heart failure is more common than we realise and the ageing population, coupled with lifestyle factors, is contributing to this rise,” said Dr C Rajiv, a cardiologist in Hyderabad.

What is asymptomatic heart failure?

Heart failure is a progressive condition categorised into four stages:

• Stage A: High risk of developing heart failure.

• Stage B: Structural heart disease without symptoms (asymptomatic).

• Stages C/D: Structural heart disease with symptoms like breathlessness or fatigue.

Stage B, or ALVSD, occurs when the heart’s left ventricle shows reduced systolic function, even though patients do not experience visible symptoms. “It’s like a ticking time bomb. Patients may feel fine but could still be at high risk for future heart failure,” explained Dr Rajiv.

Why does it happen?

Several factors are contributing to the rise in ALVSD cases:

1. Lifestyle changes: Sedentary lifestyles, unhealthy diets and rising rates of obesity and diabetes are major culprits.

2. Aging population: The risk of developing heart issues increases with age.

3. Lack of awareness: Many people ignore risk factors like hypertension or elevated cholesterol, which can silently damage the heart over time.

Dr Rajiv highlighted, “Most patients with early-stage heart failure have underlying conditions like diabetes, hypertension or a history of heart attacks. These conditions damage the heart gradually, even if the patient feels no symptoms.”

How is it detected?

Detecting ALVSD is challenging because it is asymptomatic.

The condition is typically identified through advanced imaging techniques like echocardiography. “Echocardiograms are crucial for spotting abnormalities in heart function before symptoms appear,” said Dr Preeti Menon, a specialist in cardiac imaging.

Tests focus on the heart’s ejection fraction (EF)—a measure of how effectively the heart pumps blood. However, EF alone may not provide the full picture. Doctors are increasingly looking at diastolic function and other cardiac cycle parameters to detect early issues.

What are the preventive measures that can be taken?

Preventing ALVSD involves addressing underlying risk factors early. Experts recommend:

1. Routine health checks: Regular monitoring of blood pressure, cholesterol and sugar levels is vital.

2. Adopting a healthy lifestyle: Eating a balanced diet, exercising regularly, and avoiding smoking can significantly reduce the risk.

3. Managing chronic conditions: Properly treating hypertension, diabetes, and other conditions can prevent heart damage.

“Lifestyle changes can delay or even prevent the onset of asymptomatic heart failure,” advised Dr Rajiv. “Simple steps like reducing salt intake, controlling weight, and walking for 30 minutes daily can make a big difference.”

What are the risks of ignoring the condition?

If left untreated, ALVSD can progress to symptomatic heart failure, where patients experience severe fatigue, breathlessness and fluid retention. “By the time symptoms appear, the damage is often extensive, making treatment more complex and less effective,” warned Dr Menon.

Early intervention, including the use of medications like ACE inhibitors and beta-blockers, has been shown to improve outcomes in ALVSD patients.

A call for awareness

As the prevalence of ALVSD rises, experts urged people to take proactive steps. “Heart failure doesn’t happen overnight. By understanding and addressing the early signs, we can prevent severe complications and improve quality of life,” said Dr Rajiv.