Heart failure (cardiac insufficiency)Heart failure is associated with a pathologically reduced pumping capacity of the heart. Here you can find out more about the symptoms, causes and treatment of heart failure.
Heart failure, also commonly known as cardiac insufficiency or myocardial insufficiency, is a disease of the heart associated with abnormally reduced pumping capacity. The heart is too weak to pump a sufficient amount of blood through the body. More rarely, heart failure occurs even with normal or even increased pumping capacity – namely when the heart can only fill itself insufficiently with blood. In either case, weakness, fatigue and shortness of breath are the result. Heart failure often develops over a long period of time (chronic heart failure), but it can also occur 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.
A brief overview of heart performance
The heart with its pumping function is the engine for blood circulation. The incoming (used) blood from the veins reaches the right ventricle via the right atrium. From there, it continues to the lungs. In the lungs, the blood is enriched with fresh oxygen and returns to the heart, but this time to the left area of the heart. It flows into the left ventricle via the left atrium. Is pumped from there into the arteries. If the right ventricle is affected by heart failure, cardiologists refer to it as right heart failure, and if the left ventricle is affected, cardiologists refer to it as left heart failure. If both chambers of the heart are affected by the cardiac insufficiency, this is called global insufficiency. Depending on the type of heart failure, the symptoms vary.
Doctors divide the symptoms of heart failure into those of right-sided heart failure and those of left-sided heart failure.
Symptoms of left heart failure
In left-sided heart failure, the left heart is no longer able to pump enough blood into the body. The result is reduced exercise tolerance and physical weakness, and more rarely, low blood prere.
In addition, the blood backs up into the lungs. Sometimes the liquid components of the blood (mainly water) are forced out of the blood vessels into the lungs: Water accumulation in the lungs is the result, a pulmonary edema develops. Breathlessness and coughing develop as a result. As the disease progresses, the breathing difficulties increase to such an extent that the affected person can hardly breathe when lying down. This is why they typically sleep with their upper body elevated or completely seated. Usually, the higher the pillow at the top of the head, the more severe the left heart failure. In the event of prolonged and severe backflow of blood into the lungs, right heart failure may also develop and global insufficiency may result.
Symptoms of right heart failure
Right-sided heart failure can develop from left-sided heart failure, but can also occur without preceding left-sided 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 into the venous circulation. This increases the prere in the veins.
The following symptoms are typical of right-sided heart failure:
Heavy and swollen legs due to edema: When prere is strong and persistent, the liquid components of the blood are forced out of the blood vessels into the body ties: Water is deposited in the ties, edema develops. The water retention is concentrated in the lower legs, ankles and feet. The consequences include severe. Swollen legs. Typically, stockings or socks leave dents in the skin. As the disease progresses, blood may also rush to the neck veins. Back up into the veins at the base of the tongue. Thick vein strands are then visible at the neck and base of the tongue.
frequent urination at night: The stored water often leads to weight gain. Another typical symptom is nocturia (urination at night). Patients affected by right heart failure have to go to the toilet several times a night. This is due to the following reason: When the body is in an upright position, there is a large gradient between the legs and the heart, not so when sleeping in a horizontal position. The heart can therefore transport the stored water to the kidneys more easily when the patient is lying down. 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 facilitates their work and additionally improves the nocturnal excretory function.
Body water retention: In severe and persistent right heart failure, water is deposited not only in the legs and feet. The backlog of blood in front of the heart leads to a generally increased venous prere and to further water retention. If water accumulates in the abdominal cavity, physicians speak of ascites. Often the blood also backs up into the abdominal organs. This leads to an enlarged and painful liver (congested liver), and congested gastritis with loss of appetite and flatulence develops on the stomach. If water accumulates in the gap between the pleural membranes (i.e., between the lungs and the thoracic or thoracic cuff), the patient will have to go to the toilet several times a night. pleural effusion) develops in the abdominal cavity. This causes shortness of breath and coughing.
Symptoms of global insufficiency
If both parts of the heart are affected, physicians speak of global heart muscle weakness, global insufficiency. Global insufficiency combines symptoms of left and right heart failure.
Cardiac shock – most dangerous form of heart failure
The most dangerous form of heart failure is cardiac shock, medically referred to as cardiogenic shock. Patients with cardiogenic shock have severe shortness of breath and are cold and sweaty, their hands and feet are cool and their pulse is racing. In the worst case, clouding of consciousness. Doctors differentiate according to the course of the acute. Chronic heart muscle weakness. 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 according to its severity. Doctors distinguish between two classifications, the classification of the American Heart Association (AHA) and the classification of the New York Heart Association (NYHA). The NYHA classification is more common in Germany. According to NYHA, there are the following 4 stages of heart failure:
– Stage I: no complaints, normal physical exertion – Stage II: complaints during heavy physical exertion – Stage III: complaints even during light physical exertion – Stage IV: complaints during all physical activities and at rest.
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 cardiac insufficiency.
The following diseases can cause heart failure:
– narrowed coronary arteries (coronary heart disease, or CHD for short) , heart valve defects (for example mitral valve insufficiency), cardiac arrhythmias as well as heart inflammation and pericardial effusions (high blood prere) and increased blood volume in the body – hormonal disorders (z. B. thyroid overfunction) – metabolic diseases (e.g. B. Overweight or. obesity) – severe anemia or an increased need for blood in the presence of high fever .
The physician makes the diagnosis of heart failure on the basis of the symptoms and pre- and postoperative symptoms. Concomitant diseases. Laboratory tests, an ultrasound examination of the heart and a cardiac catheterization are usually performed to confirm the diagnosis. X-ray examinations and a magnetic resonance imaging (MRI) also help in making a diagnosis.
Drug therapy for heart failure is aimed at treating the underlying disease. In addition, heart-healthy or. Heart muscle-strengthening drugs are used. The following recommendations apply to the severity levels according to NYHA:
Currently (fall 2018), many patients are unsettled because the European Medicines Agency has withdrawn numerous drugs containing the active substance valsartan from the market. Caused by contamination with the potentially carcinogenic substance N-nitrosodimethylamine (NDMA). For further information, please refer to the section on hypertension under Treatment.
Nitro-based vasodilators (such as glycerol trinitrate, isosorbide mononitrate, isosorbide dinitrate or molsidomine) can improve blood and oxygen supply to the heart. They also relieve the pumping function of the heart. The active ingredient chlortalidone from the group of thiazide diuretics has a blood prere-lowering and dehydrating effect.
Surgery may be considered as a treatment for heart failure. This can be, for example, the implantation of a pacemaker or a defibrillator (cardiac shocker). In very severe cases, heart transplantation must be considered. However, the physician decides on the necessity of these therapeutic measures on an individual basis.
Treatment of incipient heart failure
For the treatment of an emerging or mild cardiac insufficiency, the physician will recommend a healthy lifestyle and physical exercise. Overweight people will be advised to lose weight. Smokers should quit the habit. Furthermore, alcohol consumption should be reduced to a minimum. In the Special Heart-Healthy Living you will find a variety of suggestions to keep your heart healthy or to support the treatment of heart failure in a sensible way.
Self-help against heart failure
You can improve symptoms of mild heart failure by adopting a healthy lifestyle with plenty of exercise. Regular physical activity has a heart-strengthening effect. However, before heart patients engage in sports activities, they should ask a doctor for advice. Special cardiac exercise groups (or coronary exercise groups) are particularly recommended. Your health insurance company will be happy to inform you about offers in your area.