Heart Failure

Heart failure is associated with a pathologically reduced pumping capacity of the heart. Here you can find out more about symptoms, causes, and therapy for heart failure. Heart failure, also commonly known as heart failure or cardiac muscle weakness, is a disease of the heart that is associated with a pathologically reduced pumping capacity. The heart is too weak to pump enough blood around the body. Heart failure occurs less often, even with normal or even increased pumping capacity – namely when the heart can only insufficiently fill with blood. In any case, weakness, tiredness, and shortness of breath are the result. Heart failure often develops over a long period of time (chronic heart failure), but it can also appear suddenly as acute heart failure, for example in the event of a heart attack. Heart failure is divided into different degrees of severity depending on the severity of the symptoms.

The Cardiac Output at a Glance

The heart with its pumping function is the motor for blood circulation. The incoming (used up) blood from the veins reaches the right ventricle via the right atrium. From there it goes on to the lungs. In the lungs, the blood is enriched with fresh oxygen and returns to the heart, but this time to the left heart area. It flows through the left atrium into the left ventricle and from there is pumped into the arteries. If the right ventricle is affected by heart failure, cardiologists speak of right ventricular failure and the left ventricle of left ventricular failure. If both heart chambers are affected by heart failure, this is a global insufficiency. The symptoms vary depending on the type of heart failure.

Doctors separate the symptoms of heart failure into those of right heart failure and those of left heart failure.

Symptoms Of Left Heart Failure

In left heart failure, the left heart can no longer pump enough blood into the body. This results in reduced resilience and physical weakness, and rarely too low blood pressure.

In addition, the blood backs up in the lungs. Sometimes the liquid components of the blood (especially water) are pressed out of the blood vessels into the lungs: water accumulates in the lungs, causing pulmonary edema. This leads to shortness of breath and a cough. As the disease progresses, breathing difficulties increase so much that those affected can hardly breathe while lying down. This is why they typically sleep with their upper bodies elevated or sitting completely. The following usually applies: the higher the mountain of pillows at the head end, the more pronounced the left heart failure. Long-term and severe blood backlog in the lungs can also develop right heart failure and global insufficiency.

Symptoms of Right Heart Failure

Right heart failure can develop from left heart failure, but it can also develop without a previous left heart failure. The latter is the case when the right heart is no longer able to take in enough blood from the body and pump it into the pulmonary circulation. In this case, the blood backs up in the venous system of the body. This increases the pressure in the veins.

The following symptoms are typical for right heart failure:

Heavy and swollen legs due to edema: With strong and sustained pressure, the liquid components of the blood are pressed out of the blood vessels into the body tissue: water is stored in the tissue, causing edema. This water retention occurs primarily in the lower legs, ankles, and feet. The consequences are, among other things, heavy and swollen legs. Typically, stockings or socks leave dents in the skin. As the disease progresses, the blood can also back up in the neck veins and in the veins at the base of the tongue. Thick vein cords are then visible on the neck and base of the tongue.

Frequent nocturnal urination: The stored water often leads to weight gain. Another typical symptom is urination at night (nocturia). Right heart failure patients have to go to the toilet several times during the night. The reason for this is as follows: When the body is upright, there is a large gap between the legs and the heart, not when sleeping in a horizontal position. When lying down, the heart can transport the stored water to the kidneys more easily. From there it is excreted in the urine. Furthermore, the kidneys are better supplied with blood when the body is in a horizontal position, which makes their work easier and also improves the nocturnal excretory function.

Body water retention: With pronounced and persistent right heart failure, the water is not only deposited in the legs and feet. The backlog of blood in front of the heart leads to generally increased venous pressure and further water retention. If water collects in the abdominal cavity, doctors speak of ascites. Often the blood also backs up in the abdominal organs. This leads to an enlarged and painful liver (congested liver), congestive gastritis develops in the stomach with loss of appetite and flatulence. If water collects in the gap between the pleural leaves (i.e. between the lungs and the pleura or pleura), pleural effusion occurs. This causes shortness of breath and throat irritation.

Heart Failure

Symptoms Of Global Insufficiency

If both parts of the heart are affected, doctors speak of a global heart muscle weakness, global insufficiency. Global insufficiency combines symptoms of left and right heart failure.

Heart shock – the most dangerous form of heart failure

The most dangerous form of heart failure is cardiac shock, medically known as cardiogenic shock. Sufferers of cardiogenic shock have severe shortness of breath and are cold sweaty, the hands and feet are cool and the pulse is racing. In the worst case, the consciousness becomes cloudy.

Acute and chronic heart failure

Doctors differentiate between acute and chronic cardiac weakness according to the course. Acute heart failure develops over hours to days. The chronic form, on the other hand, develops over the course of months to years. H4: Classification of heart failure according to NYHA Heart failure is differentiated depending on its severity. Doctors differentiate between two classifications, the American Heart Association (AHA) classification, and the New York Heart Association (NYHA) classification. The NYHA classification is more common in Germany. According to NYHA, there are 4 stages of heart failure:

    • Stage I: no complaints, normal physical resilience
    • Stage II: discomfort with heavy physical exertion
    • Stage III: complaints even with light physical exertion
    • Stage IV: discomfort in all physical activities and at rest.

Causes

The causes of heart failure are complex. The heart’s pumping capacity depends on several factors: the strength of the heart muscle, the heart rate, and the resistance in the bloodstream. Disorders of all three factors can be responsible for heart failure.

The following diseases can cause heart failure:

    • constricted coronary arteries (coronary heart disease, short CHD)
    • Heart attack, heart valve defects (for example mitral valve insufficiency), cardiac arrhythmias as well as heart inflammation and pericardial effusions
    • Hypertension (high blood pressure) and increased blood volume in the body
    • hormonal diseases (e.g. hyperthyroidism)
    • metabolic diseases (e.g. overweight or obesity)
    • severe anemia or an increased blood requirement with a high fever
    • Vitamin D deficiency.

Examination

The doctor makes the diagnosis of heart failure based on the symptoms and previous or concomitant illnesses. Laboratory examinations, an ultrasound examination of the heart, and a cardiac catheter examination are usually carried out to ensure this. X-ray examinations and magnetic resonance imaging (MRI) also help with the diagnosis.

Treatment

Drug therapy for heart failure aims to treat the underlying disease. In addition, drugs that relieve the strain on the heart or strengthen the heart muscles are used. The following recommendations apply to the severity levels according to NYHA:

    • Stage I: ACE inhibitors such as captopril, enalapril, lisinopril, fosinopril, trandolapril or ramipril. If ACE inhibitors are not tolerated, drugs from the group of AT1 receptor antagonists such as candesartan, losartan and valsartan are an alternative.
    • Stages II to IV: Combination of ACE inhibitors with other drugs such as beta-blockers (e.g. carvedilol, metoprolol, and propranolol) or dehydrating agents (including bumetanide, furosemide, hydrochlorothiazide piretanide, spironolactone, and triamterene). In addition, cardiac glycosides are used to strengthen the heart (e.g. beta-acetyldigoxin, digoxin and digitoxin or metildigoxin).
    • Nitro-based vasodilators (such as glycerol trinitrate, isosorbide mononitrate, isosorbide dinitrate, or molsidomine) can improve the blood and oxygen supply to the heart. They also relieve the heart’s pumping function. The active ingredient chlortalidone from the group of thiazide diuretics has antihypertensive and dehydrating effects.

Operative Therapy

Surgery may also be an option to treat heart failure. This can be, for example, the implantation of a pacemaker or a defibrillator (cardiac shock). In very severe cases, a heart transplant must be considered. However, the doctor decides on the need for these therapeutic measures on an individual basis.

Therapy Of Incipient Cardiac Insufficiency

The doctor will recommend a healthy lifestyle and physical activity for the treatment of emerging or mild heart failure. He will advise overweight people to lose weight. Smokers should quit the vice. Furthermore, alcohol consumption must be reduced to a minimum. In the Special Heart-Healthy Living you will find a multitude of suggestions with which you can keep your heart healthy or support the treatment of heart failure in a meaningful way.

Self-Help Against Heart Failure

You can improve symptoms of mild heart failure by adopting a healthy lifestyle with plenty of exercises. Regular physical activity has a strengthening effect on the heart. Before cardiac patients do exercise, however, they should ask a doctor for advice. Special cardiac sports groups (or coronary sports groups) are particularly recommended. Your health insurance company will be happy to inform you about offers in your area.

Self-Medication For Heart Failure

Self-medication in the case of heart failure with over-the-counter medication may only take place after a medical consultation. If you have a doctor’s permission, there are two groups of active ingredients that you can use for heart failure:

  • heart-strengthening herbal ingredients made from hawthorn, adonis herb, lily of the valley herb, sea onion, and oleander leaves
  • Circulatory stimulants such as moxaverine and plant ingredients from camphor, real daphne, and rosemary.

Prevention

    • Reduce excess weight and eat a fresh and balanced diet.
    • Eat a diet with as little salt as possible (less than 3 grams per day).
    • Avoid excessive alcohol consumption.
    • Quit smoking.