Heart failure: what is it?

Doctors speak of heart failures when the heart is no longer able to pump enough blood into the bloodstream. They also call the disease myocardial insufficiency or, more simply, cardiac insufficiency or cardiac insufficiency.

The consequence of heart failure is that organs, muscles and tissues are no longer adequately supplied with blood - and thus oxygen and nutrients. Those affected often complain of pain and shortness of breath . Heart failure occurs especially in old age. Mostly she meets people over 65 years of age. Experts assume that one in ten people in their 70s suffers from heart failure.

Heart failure: forms and types

Doctors differentiate between different types of heart failure:

• Acute heart failure : This is when the heart failure occurs only briefly - for example as a result of a heart attack.
• Chronic heart failure : Doctors refer to cardiac muscle weakness as chronic if it persists - for example due to high blood pressure or damaged blood vessels.
• Left heart failure : This variant is the most common type of heart failure. It affects people whose left ventricle does not carry enough blood through the body. Left heart failure usually results from coronary artery disease (CHD) or untreated high blood pressure.
• Right heart failure : Here the right ventricle is too weak to carry enough blood. Right heart failure usually develops when there is left heart failure.
• Global heart failure : In this form of heart failure, both heart chambers are affected.
• Systolic heart failure : Doctors use systole to describe the phase in which the heart contracts. In patients with systolic heart failure, the organ cannot pump enough blood to the body when it contracts. Doctors also speak of heart failure with reduced ejection capacity.

 

Systolic and  diastolic  heart failure affect the left half of the heart , which is supposed to supply the body with oxygen-rich blood. The pumping power is no longer sufficient, blood backs up. Fluid may build up in the lungs. 

Normal condition : A healthy heart transports more than half of the blood from the chambers into the circulation.

Systolic malfunction : the heart does not contract enough and pumps too little blood into the body

• Diastolic heart failure : Doctors understand diastole to be the phase in which the heart relaxes and expands. In those affected, the organ can no longer expand completely and fill with blood. Experts also call this form heart failure with preserved ejection performance.

 

Normal condition : A healthy heart transports more than half of the blood from the chambers into the circulation.

Diastolic malfunction : the left ventricle is stiffened. It can no longer stretch sufficiently and fill with blood.

• Compensated heart failure : Here the body can still compensate for the heart's reduced pumping capacity. For example, it releases more adrenaline and noradrenaline. These stress hormones make the heart beat faster. In this way the organ transports more blood. Often the muscle fibers of the heart also thicken in order to cope better with the load. However, by the body taking these first aid measures, the disease can progress unnoticed. People with compensated heart failure often only notice symptoms when they are doing a lot of physical exertion.
• Decompensated heart failure : the body can only compensate for the weak heart function for a short time. If he can no longer do it, doctors speak of a decompensated heart failure. Symptoms appear at the latest in this form. For example, the patient is easily breathless when walking uphill.

Heart Failure: NYHA Stages

Doctors divide heart failure - depending on its severity - into so-called NYHA stages. The name comes from the specialist society "New York Heart Association", abbreviated NYHA.

• NYHA stage 1: At this initial stage , the patient does not yet feel any symptoms. Even when he exerts himself physically and climbs stairs to about the fifth floor , he does not notice any changes. At this stage, however, the doctor can already see that the heart's performance is reduced.
• NYHA stage 2: Here doctors speak of mild heart failure. At this stage, the patient will notice the first symptoms when he is doing physical exertion. For example, he is exhausted faster than usual when climbing stairs.
• NYHA stage 3: Doctors also refer to this stage as moderate heart failure. Patients experience discomfort even with light physical exertion, such as when going for a walk. Affected people find it difficult to breathe when climbing stairs.
• NYHA stage 4: In this form of severe heart failure , the symptoms appear at rest, for example while sitting. During this stage, many patients become bedridden. They usually have to raise the headboard to get better air.

It should be noted that this classification is based on the patient's complaints. And these can be highly subjective. The NYHA stages cannot therefore say precisely how much the heart's pumping capacity is actually restricted.

 Heart Failure: Symptoms of a Weak Heart

People with heart failure can have different symptoms. On the following signs doctors detect the disease in most cases:

• shortness of breath
• Shortness of breath
• Decreased resilience, rapid exhaustion
• Tiredness, difficulty concentrating
• Retention of fluid in the legs (edema)
• Rapid weight gain due to water retention
• Rattling noises in the lungs
• Loss of appetite
• Dry cough

Depending on which form of heart failure the patient suffers, different symptoms are in the foreground. People with left heart failure mainly complain of shortness of breath. They often have to breathe faster and cough or rattle. People with right heart failure, on the other hand, often notice that their feet and lower legs swell and that edema develops.

Heart failure is usually not curable. However, with a health lifestyle and the right therapy, you can alleviate your symptoms and prevent the disease from getting worse.

Heart failure drugs

Doctors usually treat heart failure with medication to relieve the heart and reduce symptoms. For example, they use the following medicines:

• Beta blockers
• ACE inhibitors
• Sartans
• Mineralocorticoid receptor antagonists
• Diuretics - dehydrating drugs for edema
• Digitalis / cardiac glycosides
• Ivabradine
• Sacubitril / valsartan

To avoid complications, you should strictly adhere to the drug intake schedule. It often makes sense to work with your doctor to develop a medication plan. This will usually make it easier for you to think about all of the tablets every day. It is also important that you see your doctor regularly for check- ups.

Heart failure - further therapies

There are also other treatments for severe heart failure. These include, for example:

• Implantation of a defibrillator / cardio converter
• Cardiac resynchronization therapy, or CRT for short - a biventricular (affecting both heart chambers) pacemaker, often combined with medication
• Vascular dilatation using balloon dilatation or bypass, if the coronary arteries are narrowed, sometimes implantation of a stent to keep the vessel open
• Reconstruction or replacement of damaged heart valves
• Heart transplant

Heart failure: The causes are often other diseases

In most case, heart failure is caused by an existing underlying disease of the heart. These include coronary artery disease (CHD), high blood pressure or a heart attack . These clinical pictures can damage the heart muscle or the coronary arteries and thus trigger heart failure. Doctors therefore cite the same points as risk factors for heart failure as for general heart diseases:

• Overweight and obesity ( obesity )
• smoking
• Alcohol consumption
• Type 2 diabetes

Hereditary heart diseases such as a heart valve defect or congenital cardiac arrhythmias are another, albeit less common, cause . Also, inflammation of the heart and certain medications can cause heart failure.

Heart failure: life expectancy depends on the severity

How a heart failure develops and what life expectancy patients can expect varies greatly from person to person . The prognosis depends, among other things, on

• how much the heart's pumping capacity is already restricted.
• whether concomitant diseases such as high blood pressure or diabetes mellitus are present.
• whether you lead a healthy lifestyle.

Those who take medication regularly, eat healthily and are physically active (exercise, sport) can achieve a relatively good quality of life.

However, this does not apply to all people with heart failure: on average, every second patient dies within five years of being diagnosed. If the doctor only recognizes the disease at an advanced stage (NYHA 3), life expectancy is even lower: around one in four people affected dies within a year of being diagnosed. The prognosis for patients with diastolic heart failure is similar to that of systolic heart failure. However, no medication can help here. This can reduce life expectancy.

Heart failure: diagnostics and examinations

In the case of heart failure, the body compensates for the heart's lack of pumping capacity for a while. Those affected therefore often only have symptoms when the disease has progressed - and therefore do not consult a doctor until late. So that doctors can make the diagnosis in good time and start therapy early, you should make a doctor's appointment promptly if you have mild symptoms.

The doctor will usually first ask you about your symptoms and then examine you physically. For example, it measures the pulse and blood pressure . With electrocardiography (EKG) , doctors can also make the heart currents and the heart rhythm visible. An ultrasound examinations of the heart (echocardiography) can measure the pumping capacity and check whether the heart valves are functioning normally.