let's talk about heart failure

Severe left-ventricular systolic dysfunction. This is what I learned I had when I was at Samsung Hospital's ER that first night. But what does that mean, and is it a death sentence the way congestive heart failure is?

What I'm learning through my own research is that there are types of heart failure, but one can lead to another, so these types shouldn't be thought of as mere isolated categories but more as stages in a larger process, a bit like watching the train wreck that is cancer, which is infamous for having its own stages (as well as grades*).

This resource says the following about my condition:

Congestive heart failure (CHF) and heart failure are chronic progressive conditions characterized by a weakened heart that is unable to pump enough blood to meet the body’s energy needs.

Heart failure often refers to early-stage weakening of the heart without congestion. As the damage to the heart progresses, it causes fluid to build up in the feet, arms, lungs, and other organs, which is referred to as congestion, throughout the body. This stage of heart failure is called CHF.

CHF is normally what leads to death in months or years. My friend Bill Keezer, who passed away in his early 80s, had it. I don't have CHF, but from the above, it seems I'm on the path to eventually acquiring CHF, at which point the clock will be ticking if it wasn't before.

The above text from the website is accompanied by this cute image:

No swelling or sudden weight gain for me, but I have the rest of the symptoms.

I have everything but the sudden weight gain and the swelling of the extremities, and today (Wednesday, the Buddha's birthday, I mean) was a good example of "sudden fatigue or weakness": I slept for much of the day instead of doing all the cooking I'd hoped to do.

This resource talks in detail about the typology of heart failure. When the heart's pumping ability (ejection fraction) is weakened, this is systolic heart failure—what I have. When there's heart failure without this weakening (but with stiffened heart muscle), this is diastolic heart failure. Another way to break the heart-failure question down has to do with the course of the condition: acute or chronic. Acute heart failure appears suddenly, and often as a result of something like a heart attack. Chronic heart failure, which is what I have, arises as a result of a years-long condition like high blood pressure. Yet another way to classify heart failure is by which side of the heart is affected. My case is the more common one: left-sided heart failure. Specifically for me, the heart-muscle weakness is in the lower chamber of the heart, i.e., the ventricle, not the auricle (or atrium). Here's what the just-cited resource has to say about my condition:

Left-sided heart failure: The left ventricle of the heart no longer pumps enough blood around the body. As a result, blood builds up in the blood vessels that carry blood away from the lungs. This causes shortness of breath, trouble breathing or coughing – especially during physical exertion. Left-sided heart failure is the most common type of heart failure. It is usually caused by coronary artery disease (CAD), a heart attack or long-term high blood pressure.

While I might have CAD, my own heart failure is most likely because of long-term high blood pressure, the result of years of bad dietary and lifestyle choices. I started distance walking in 2017, and before that, I'd been an avid walker when I'd lived in Switzerland during the 1989-90 academic year. But I recall having regained weight after I came back from Switzerland, and it's possible that, with the bad habits I've had since 1990, my recent distance-walking habits may have started too late to save me.

I keep coming back to what the doc at the hospital had said. They insisted that my breathing problems, when I was admitted, had nothing to do with COVID. If I assume they were right, then there are some dark implications to tease out from that, the main one being that heart failure was likely already a deep-set problem by the time I went to the ER. What I don't understand is how the severe symptoms of heart failure manifested themselves after I had started staircase training this past January. Wouldn't it make sense that walking up 26 floors would strengthen my heart, not weaken it? I guess that's another question I'll have to ask the doc during my appointment on the 24th, especially as it applies to future training.

Tentative conclusion from all this: the clock is ticking already, and I may be on borrowed time. Will I make it to 60? I hope so, so that I can do that Camino de Santiago walk with my buddy Mike in five years. But there's a chance I won't make it, which is something I've long suspected. As I keep reading up on life with heart failure, I'll pass along whatever wisdom I find regarding how I can improve or at least maintain a certain quality of life.

For more info on prognosis, see here. Based on the stats, making it five more years seems very likely, but making it another ten years, not so much.

__________

*What's the difference between a stage and a grade with cancer? The stage has to do with time and progress: it's how far a given cancer has gotten in eating you up. If your ovarian cancer has gotten to stage IV, there's nothing more to be done. The grade has to do with how aggressive the cancer inherently is. When my mom was diagnosed with glioblastoma multiforme (GBM), we were told it was a grade 4 cancer, i.e., the most aggressive type in terms of growth and spread. That doesn't change over time.