Internal Medicine

Heart failure

definition

One speaks of one Heart failure (or heart failure in general), when the heart is no longer able to pump the necessary amount of blood through the circulation. This is mainly due to the fact that the two heart chambers no longer exert enough force to keep the circulatory function stable. Subsequently physical resilience is reduced, it comes to fatigue and Fainting. Today, heart failure is widespread and one of the most common causes of death in industrial nations. Depending on the stage and progress of the heart failure, life expectancy is between a few years and decades.

causes

As causes of heart failure are many factors known. These include various Heart diseasethat weaken the heart in the long run. By Cardiac arrhythmias the heart can no longer pump evenly and in a targeted manner. Either it hits too fast, too slowly, or generally uncoordinated. Such a condition burdens the heart as it has to do more work to transport the same amount of blood.
Other causes can be Valvular heart disease like closures or Bottlenecks be on the heart valves. Just like with leaky heart valves the heart has to do a lot more work.
Also a increased blood pressure in the body or in the pulmonary circulation puts a strain on the heart because it has to with every heartbeat fight against higher pressure. If the heart does not manage to pump all of the blood out of the chamber, more blood will enter the chamber during the filling phase and the heart also has to cope with a higher volume load.
It can also result in the so-called coronary artery disease (Constrictions or blockages in the coronary vessels) to a Undersupply of the heart muscles with blood and with it oxygen and other important nutrients come. This damages the muscle cells and can for example lead to a Heart attack to lead. The weakening of the heart muscles can also lead to heart failure.

diagnosis

Several examinations are required to make a diagnosis of heart failure. Initially, symptoms such as shortness of breath and reduced resilience lead to the suspicion of heart failure. With a heart ultrasound (Echocardiography) the performance of the heart can be measured in the tension and relaxation phase, the size of the different heart cavities and the thickness of the heart muscles can also be determined. All of this information can provide clues for heart failure. An X-ray examination can also show whether the heart is enlarged. In addition, a backlog of the blood in the pulmonary circulation or the veins (vessels that lead to the heart) can be detected.

Read more on the topic: Echocardiography, These tests are done when you have heart failure

Division into NYHA stages

Doctors divide heart failure into so-called NYHA stadiums a. (NYHA stands for New York Heart Association.) The division is made into four different NYHA classes and is based on the clinical symptoms. So after that at which load which complaints occur.

NYHA class I. is characterized by a normal exercise capacity out. In addition, there are no complaints at rest. The heart is able to easily transport the necessary amount of blood into the circulation. However, it is in NYHA Class I. apparent structural damage to the heart.
In NYHA class II also become a patient without discomfort at rest assigned. However, step with severe physical resilience complaints on. At rest and with little exertion, the cardiac output (i.e. the amount of blood that the body pumps into the circulation per minute) is sufficient; with greater exertion this is no longer the case.
In NYHA class III complaints occur too even with low loads on, the cardiac output is limited during exercise.
Patient in the NYHA class IV to have complaints even at rest and the heart can no longer pump enough blood into the circulatory system even without physical exertion.

Stages of heart failure

Heart failure is classified according to the American Heart Association (AHA) Stages A to D assigned. The disease is most advanced in stage D.

in the Stage A are still no structural heart changes recognizable. Also are with the patient no symptoms known of heart failure. However, lie various risk factors that promote the development of heart failure.
From Stage B are noticeable in the patient structural heart changes recognizable, suggesting heart failure. Also at this stage are still no symptoms of heart failure.
The Stage C Is characterized by current or previously known symptoms heart failure. There is also a structural heart disease in front.
in the Stage D is the structural heart disease already in one advanced Stage. Already severe symptoms occur at rest and complaints that the patient is despite drug therapy not resilient. To restore health, special medication or measures (artificial heart /Heart transplant) required.

Symptoms

Heart failure manifests itself with a variety of symptoms. First fall one decreased exercise capacity, as well as increased fatigue and a Feeling weak on. Shortness of breath, Dizziness and fainting spells can also speak for heart failure. All of these symptoms are special noticeable during or after physical exertion. The dizziness and fainting spells can also occur if you stand up too quickly.
Since the heart is increasingly too weak to pump the required amount of blood through the circulation, a certain amount of fluid often remains in the tissue. This is expressed in Water retention in the legs (also Edema called) or by Water in the abdomen (Ascites) out. These deposits can cause a sudden Weight gain over several kilograms Body weight or slowly become noticeable.
The blood also accumulates in the vessels that lead to the heart, i.e. back into the veins. In addition, a Congestion of blood in the liver, kidneys or stomach occur. Laying (especially at night), when the heart no longer has to pump so hard against gravity, it can increased need to urinate because only in this situation do the kidneys have sufficient blood supply to produce urine.

Cough as a symptom of heart failure

Heart failure can also manifest itself through coughing and shortness of breath.

During the development of heart failure, the blood not only backs up in the body's circulation. The same symptoms of congestion occur in the lungs. Accordingly, fluid collects in the area of the lungs. This can lead to coughing with sputum. If heart failure persists for a long time, the entire lung function can also be negatively affected. This leads to increased shortness of breath, in some cases the lungs are no longer able to bring enough oxygen into the blood, which leads to cyanosis (bluish discoloration of the skin and mucous membranes due to insufficient oxygen).

Read more on the topic: Difficulty breathing due to a weak heart , Why does a cough occur when the heart is weak?

Blood pressure in heart failure

Although heart failure may initially be triggered by high blood pressure, blood pressure values that are too low may become increasingly low as the disease progresses. As the disease progresses, the heart is less and less able to muster enough force to pump the blood into the circulation. When the ventricles become less powerful, the pressure cannot be exerted as much as with a healthy heart. This leads to low blood pressure values and promotes symptoms such as dizziness and fainting spells.

Read more on the subject at: Heart failure and high blood pressure

Symptoms in men with heart failure

Basically the symptoms in men and women do not differ much. Both sex groups suffer from decreased resilience, fatigue, weaknesses, dizziness and fainting, as well as water retention and blood backlog in the liver, stomach, kidneys and lungs. It is therefore not possible to precisely assign the complaints to the respective gender. However there is slight tendencies as to which symptoms appear earlier in men show and which occur more often in women. General men usually notice heart failure earlier as women, because the Symptoms often stronger to make noticable. Men also usually notice that Reduced exercise capacity and a reduction in general performance as the first symptom.

Symptoms in women with heart failure

Meanwhile with women they are Complaints related to the lungs are particularly pronounced. They therefore suffer particularly from shortness of breath and due to the deteriorated oxygen supply to the blood cyanosis. With the symptoms of heart failure are often too Fears and depressive moods connected. These are more common in women than in men.

therapy

In the case of heart failure, the cause should first be researched. Often there is a connection with high blood pressure, diseases of the coronary arteries or the heart muscles. Cardiac arrhythmias or diseases of the heart valves can also promote the development of heart failure. If one or more of these causes are detected, therapy for this causal disease is the first priority, as this also improves the performance of the heart. In addition, symptomatic treatment, i.e. therapy of the symptoms, should be sought.
If heart failure begins, the progression of the disease can be stopped by a special sports therapy training program. Weight loss, a low-salt diet and an increased Mediterranean diet have a positive effect on the disease. If symptoms such as water retention and blood congestion are already occurring, reducing fluid intake is recommended. Water tablets should also be prescribed by the family doctor or cardiologist. Regular monitoring of the electrolytes in the blood (especially sodium and potassium) is also important, as an imbalance can damage the heart and cause problems with the heart rhythm. In order to avoid unnecessary stress on the heart, beta blockers can also be prescribed.

Read more on the topic: Heart failure therapy

The medicinal product Korodin, which can be purchased herbal and without a prescription in pharmacies, is also used in the treatment of heart failure. For more detailed information, the editors recommend the following article: Korodin drops

Life expectancy with heart failure

Heart failure is basically a disease that in most cases cannot be cured. It therefore requires lifelong therapy with the aim of delaying the progression of the disease for as long as possible. Life expectancy is therefore strongly related to compliance (adherence to therapy). In addition, a change in lifestyle (change in diet, sports therapy, quitting smoking) has a positive effect on life expectancy. In general, the prognosis depends heavily on the stage of heart failure you are in. Detecting the disease as early as possible is therefore extremely important. In this way, risk factors can be eliminated at an early stage and the first steps against the progression of heart failure can be initiated. For this reason, it is quite possible to live with the disease for several decades with an early diagnosis.
This contrasts with the high mortality rate in the most advanced patients. Here, survival after 5 years is just 50%. That is about the same as many very malignant diseases.
Acute decompensated heart failure is a special case. In this case, the condition suddenly worsens dramatically due to an infection, very warm weather or overexertion. If this derailment can be contained and the worsening reversed through increased drug therapy and close monitoring, the prognosis does not deteriorate particularly. In cases where this is not possible, the heart failure may progress more quickly and thus a significantly shorter life expectancy.

More on this: Life expectancy with a heart failure