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.

Living With A Healthy Heart

Living With A Healthy Heart – Heart Failure, Infarction, Stroke

With a healthy heart, you open the horizon for a life without a heart attack, heart failure, or stroke. The best thing to do is to start right away. Cardiovascular diseases are by far the most common cause of death in Germany. More than 200,000 women and men die as a result of heart attacks, strokes, and heart failure alone. Many – some experts say almost all – of these people could still be alive if they had taken a little precaution – by living with a healthy heart. It’s a lot easier than most people think.

More Than 200,000 Heart Deaths Per Year

Before we get to the precautionary recommendations, a few more depressing figures about the current state of German heart health. 300,000 Germans experience a heart attack every year – around 60,000 women and men do not survive it. 270,000 suffer a stroke – around 100,000 of them die within the first year. And 70 percent of the survivors remain disabled in the long term – many of them are dependent on a nursing home. In addition, around 50,000 Germans die every year as a result of cardiac insufficiency (in almost 600,000 cases). Many cardiovascular diseases are preventable About 90 percent of all heart attacks are preventable, writes Dr. Norbert Smetak, the chairman of the Federal Association of Resident Cardiologists on the website for the German World Heart Day (September 29, 2015). He would like people to take more responsibility for their health and take advantage of the opportunities provided by prevention.

Live With A Healthy Heart

To live with a healthy heart – to some people that sounds a lot like asceticism and exertion. It is relatively easy to reduce the risk of high blood pressure, heart attack, stroke, or heart failure. The focus is on exercise, nutrition, the conscious use of luxury foods, and regular medical checks. Movement keeps the heart fit No matter what age and no matter what medical history: Our body is designed so that we can move. The movement clearly activates the body’s self-healing powers. Movement is essential for targeted preventive care – and it even speeds up healing after serious illnesses. While exercise cannot heal a seriously ill heart, it does improve the prospects for longer life. Privatdozent Dr. med. Friedhelm Späh told the German Heart Foundation: “Regular physical activity leads to a considerable decrease in mortality, especially for people over 65.” It also improves the quality of life in many ways. Nobody needs to do sports to strengthen their heart and circulation. Just 20 minutes of exercise in the fresh air a day can help you live a healthy life, whether it’s a walk, a short bike ride, or a few laps in the swimming pool.

Living With A Healthy Heart

Pay Attention To The Diet

Regularly fresh fruit and vegetables not only enrich the menu, they also taste good and, with their vitamins and trace elements, promote heart health and the immune system. A sedentary lifestyle and obesity are the most important risk factors for cardiovascular diseases. Living with a healthy heart means avoiding or reducing excess weight. Strict diets do not help. As a rule, they only lead to the yo-yo effect. What you lose in months with great abstinence is usually back on in a few weeks after the diet. Sustainable weight loss is especially successful if you change your diet so that you like to eat this way over the long term. A low-calorie mixed diet with lots of fresh regional and seasonal foods, preferably fruit and vegetables, is ideal. Even low-fat meat is not taboo – just in moderation. Whole grain products are a useful addition to the fresh menu. They make you feel full in the long term – and through dietary fiber and trace elements, they promote digestion as well as the metabolism and the immune system.

Check-Up Every Two Years

If you exercise enough, eat a healthy diet, and are of normal weight, the risk of heart attack, stroke, heart failure or high blood pressure is dramatically reduced. If you now have your family doctor checked you up every two years, the chances of a long, heart-healthy life are particularly good. Men and women from the age of 35 are also entitled to a check-up every 2 years with statutory health insurance. Among other things, you should have your blood lipid levels checked. Because elevated cholesterol levels can increase the risk of cardiovascular disease. The main concern is atherosclerosis, which leads to constricted or brittle blood vessels. Do not postpone a visit to the doctor in the event of acute symptoms A heart-healthy life also includes going to the doctor in the event of heart or circulatory problems without a clearly identifiable or known cause.

Typical signs of cardiovascular disease are, for example:

    • Pulse irregularities with no apparent cause
    • recurring pain in the heart area
    • unusual spells of dizziness
    • inexplicable inefficiency
    • decreased resilience
    • pronounced fatigue
    • shortness of breath
    • increased sweating
    • swollen legs
    • severe weight gain for no explainable cause

The heart benefits from serenity – you too!

“This is dear to my heart” or “It breaks my heart” – we call the heart the seat of our feelings. Even if this is not anatomically correct (feelings arise through mental evaluations in the brain), these sentences show an important connection. Our heart is very sensitive to stress. No wonder: stress is a defense reaction that puts the body in a state of alarm. We drive at full throttle, so to speak – and even the best engine cannot withstand that in the long run. The most pleasant side of a healthy-hearted life looks like this: Let your legs – and your soul – dangle more often. Just do what you enjoy doing. So that you can enjoy your heart-healthy life to the full for a long time. And as at the beginning of this article, something that you have known for a long time with some certainty: Smoking and excessive alcohol consumption is harmful to the heart and health. Not that we are accused of forgetting.

What Is Right Heart Failure?

Sometimes we can recognize warning signs of our body in everyday things: the otherwise super-fitting elegant loafers have to be exchanged for extra-wide health shoes from the medical supply store? The responsible swollen feet can be a first symptom of right-sided heart failure, also called right heart failure. What happens to this form of heart failure in the body and how to recognize Right Heart Failure, read now.

Symptoms of Right Heart Failure

Simply put, in right heart failure, the right half of the heart is no longer working properly. This is often the result of advanced left heart failure. If the two forms come together, it is also called global heart failure. When it comes to the chronic form, the symptoms of heart failure can go unnoticed for a long time right. Common signs of right heart failure include:

    • Rapid weight gain and swollen ankles and feet indicate water retention in the tissues. If you press your finger on the thickened area, a dent remains that can last for several minutes.
    • Caution: A thrombosis (blood clot) can also cause swelling in the leg. In contrast to this disease, in case of right heart failure, however, both legs or feet are always swollen. A thrombosis must be treated immediately.
what-happens-with-heart-failure-on-the-right
What happens with heart failure on the right?

Right heart failure is a weak pumping of the right half of the heart, which is responsible for the transport of oxygen-poor blood to the lungs. Normally, the right half of the heart works like this:

    1. Low-oxygen blood from the upper and lower half of the body flows into the right atrium.
    2. From the right atrium, the blood enters the right ventricle.
    3. The spent blood flows from the right ventricle into the lungs, where it is enriched with oxygen. This is called “small blood circulation”.
What happens if the right half of the heart is weakened?

This is simply explained: In right heart failure, more blood flows out of the systemic circulation than the impaired, right ventricle can carry on to the lungs. There is a backlog of spent blood in front of the right atrium, which can reach into the legs or neck. Sufferers suffer from swollen legs and thickened veins. In addition, this can increase the pressure in the veins so much that the liquid components of the blood are pressed into the surrounding tissue. This causes water retention (edema) in the feet, abdomen or other parts of the body.

Diastolic Dysfunction Heart Failure, Diagnostics, and Treatment

Diastolic cardiac insufficiency exists when signs and symptoms of heart failure are present, but the left ventricular systolic function is still preserved (ejection fraction above 45%). It is important to differentiate the diastolic from the systolic heart failure so that it can be optimally treated.

The incidence of diastolic heart failure increases with age; in about 50 percent of elderly patients with heart failure, there is isolated diastolic dysfunction, write Chhabi Satpathy and colleagues in the American Family Physician. If diastolic dysfunction is diagnosed early and adequately treated, the prognosis is better than for systolic dysfunction.

Diastolic heart failure is clinically and radiologically indistinguishable from systolic heart failure. However, if there is a normal ejection fraction and an abnormal diastolic function with signs and symptoms of heart failure, diastolic heart failure can be diagnosed. Unlike systolic, diastolic heart failure can occur in isolation. Common causes of diastolic dysfunction include cardiac ischemia, hypertension, aging, obesity and aortic stenosis. Rarely, the disorder is caused by myocardial diseases such as cardiomyopathy, storage diseases and amyloidosis or sarcoidosis or by a disease of the pericardium.

In isolated diastolic dysfunction, there is a disorder of isovolumic ventricular relaxation and decreased compliance of the left ventricle. The transmission of higher end-diastolic pressures into the pulmonary circulation can cause pulmonary congestion leading to dyspnea and eventually right heart failure.

diastolic-heart-failure-treatment

Diagnostics

Heart failure may be manifested by fatigue, exertional dyspnoea, paroxysmal nocturnal dyspnea, orthopnea, cervical venous stasis, rales, tachycardia, third or fourth heart sounds, hepatomegaly, and edema. Cardiomegaly and congestion of the pulmonary veins often occur in chest radiographs, but these findings are non-specific and can also occur in non-cardiac diseases. It is difficult to distinguish diastolic from systolic heart failure on the basis of physical examination alone.

Two-dimensional Doppler echocardiography is of great importance in the diagnosis of diastolic heart failure. This study not only provides important information about ventricular size, myocardium, heart valves, systolic function and pericardium, but also provides information on diastolic transmitral and pulmonary venous blood flow. In echocardiography, the peak velocity of blood flow through the mitral valve in the early diastolic filling phase corresponds to the e-wave. The atrial contraction corresponds to the A-wave. From these values, the I / O quotient is calculated. Usually E is greater than A, and the I / O ratio is about 1.5.

In early diastolic dysfunction, relaxation is disturbed and the I / O ratio drops to less than 1.0 with atrial contraction. As the disease progresses, left ventricular compliance decreases, increasing left atrial pressure and early left ventricular filling despite disturbed relaxation. This paradoxical normalization of the I / O quotient is called “pseudo-normalization”. In patients with severe diastolic dysfunction, the left ventricle is filled, especially in early diastole, resulting in an I / O ratio above 2.0. Although cardiac catheterization is preferred in the diagnosis of diastolic dysfunction. However, two-dimensional Doppler echocardiography has proven to be the best noninvasive method in everyday clinical practice. Rarely, radionuclide angiography is performed, especially in patients who find echocardiography technically difficult.

Treatment

Primary prevention of diastolic heart failure includes nicotine abstinence and the aggressive treatment of high blood pressure, hypercholesterolemia and coronary heart disease. Lifestyle changes such as weight loss, cessation of smoking, diet change, restriction of alcohol intake and physical activity serve to prevent diastolic and systolic heart failure. Diastolic dysfunction can remain asymptomatic for many years. Early diagnosis and treatment are important to prevent irreversible structural changes and systolic dysfunction. At first glance, it seems that the treatment of diastolic and systolic heart failure is not very different. However, the treatment of diastolic heart failure is limited due to the lack of large randomized controlled trials. In addition, optimal treatment for systolic heart failure may result in exacerbation of diastolic heart failure.

Improvement of the left ventricular function

For diastolic dysfunction, it is important to control the heart rate and prevent tachycardia to maximize the diastolic filling period. Beta-blockers are particularly useful for this purpose, but they do not directly affect myocardial relaxation. Beta blockers should be used in particular for the treatment of diastolic heart failure, if a high blood pressure, coronary heart disease or arrhythmia.

Optimization of hemodynamics

Hemodynamic optimization is achieved primarily by reducing cardiac preload and afterload. ACE inhibitors and angiotensin receptor blockers directly affect myocardial relaxation and compliance by inhibiting the formation of angiotensin II or blocking angiotensin II receptors, thus preventing interstitial collagen deposition and fibrosis. A Hemodynamic optimization also results in better filling of the left ventricle. and lowering blood pressure. In addition, there is an improvement in exercise capacity and quality of life.

Diuretics may provide optimal intravascular volume in diastolic dysfunction patients, minimize dyspnoea, and prevent acute heart failure. Although diuretics control blood pressure, lead to regression of left ventricular hypertrophy and reduce left ventricular stiffness, some patients with diastolic heart failure are sensitive to preload and develop hypotension or severe prerenal azotemia.

The hormone aldosterone promotes cardiac fibrosis. The aldosterone antagonist spironolactone (Aldactone® or generic) has been studied in a large clinical trial in patients with systolic heart failure. There has been a reduction in heart failure-associated mortality, but the specific effects of spironolactone on diastolic dysfunction are unclear.

Calcium antagonists directly improve diastolic function through myocardial relaxation and indirectly by lowering blood pressure and heart rate, reducing myocardial ischemia, and promoting regression of left ventricular hypertrophy. However, non-dihydropyridine-type calcium antagonists such as verapamil (Isoptin® or generics) and diltiazem (Dilzem® or generic) should not be used in patients with left ventricular dysfunction. Long-acting dihydropyridines such as amlodipine (Norvasc® or generic) should only be used to control heart rate and angina pectoris, If beta blockers are contraindicated or ineffective.

Vasodilators such as nitrates and hydralazine may be useful because of their anti-ischemic and preloading effects, especially if ACE inhibitors can not be used. However, vasodilators should be used with caution as a reduction in preload may reduce cardiac output.