Heart failure

introduction

The Heart failure often too Heart failure called, is a common disease that is particularly elderly affects, but it can also occur in young people. Medically, the disease is also called Heart failure designated. Over time it comes to that Decrease in pumping capacity of the heart and ultimately to pump failure.

The heart failure can various causes have and in their Severity will vary. From a certain level onwards, patients often experience a high level of suffering, as their physical performance decreases sharply.

causes

The causes of heart failure are many. For example, the heart muscle can be damaged directly and lose its performance. This can be the case after a heart attack, coronary heart disease, or heart muscle inflammation.

In addition, the heart muscle is weakened if it always has to pump against too high a pressure, for example in the case of high blood pressure (arterial hypertension) or a narrowed aortic valve or pulmonary valve.
If the aortic valve is leaking, medical professionals also speak of aortic valve insufficiency in this context, part of the ejected blood volume flows back into the heart during the relaxation phase of the heart. This increases the volume and the chambers of the heart become excessively stretched. This condition can also lead to cardiac insufficiency in the long term.

If there is fluid in the pericardium (pericardial effusion), the heart is constricted and its function is restricted. This can also cause heart failure. In addition, it was found that people with sleep disorders are more likely to suffer from heart failure.

Read more on the topic: Symptoms of a heart attack

Symptoms

The Heart failure usually makes himself under first physical exertion noticeable. She expresses herself differently, depending on whether the right or left ventricle is primarily affected.

At a Left ventricle weakness, the so-called Left heart failure the patients suffer mainly from shortness of breath (Dyspnea / Difficulty breathing with heart failure) during physical exertion. In advanced stages of the disease, the shortness of breath can exist even under resting conditions, then one speaks of Resting dyspnea. The shortness of breath usually worsens when lying down, as more blood volume then flows back to the heart and higher pressure is placed on the chest. Those affected often sleep with their upper body elevated, for example by placing several pillows under their head and back.

Due to the inability of the heart to transport the entire volume of blood away quickly enough, it can go to the Fluid leaks into the lungs come. This is known as cardiac pulmonary edema. It's going through Shortness of breath, rattling noises noticeable when breathing and possibly frothy sputum when coughing. In left ventricular failure, this accumulates preferentially water in the lungs.

At a Degradation of the right ventricle, as Right heart failure called, water mainly collects in the legs. This Leg edema lead to one Feeling of heaviness and tension in the legs. They are swollen and often painful. The leg edema decreases when the patient is lying down, as the water can then flow more easily from the tissue back to the heart. This also explains why patients with heart failure often have to urinate at night.
Liquid collects often also in the free abdomen, one then speaks of Ascites. If it is severe, the belly is thick and very fluid-filled. In this case, when the abdominal wall bumps into it, a wave can be observed that is triggered by the sloshing liquid.

How do I recognize heart failure?

The Heart failure manifests itself through characteristic symptoms, such as Shortness of breath, decreased exercise capacity, Leg edema and frequent night urination (Nocturia).

As patients become more and more restricted by the disease, sooner or later they often see a doctor. Since the earlier it is discovered and treated, the better the prognosis for the disease Consulted a doctor become. A targeted examination can usually lead to a diagnosis very quickly and initiate the appropriate therapy.

diagnosis

The diagnosis of the Heart failure is provided by a doctor on the basis of various examinations. Already through Questioning the patient and description of the symptoms typical for the disease, the doctor can obtain clues for a cardiac event.

In the subsequent physical exam hints can also usually be found. Leg edema, jammed neck veins, ascites, too fast a pulse (Tachycardia) and an enlarged liver. When listening to the patient, rattling noises over the lungs caused by pulmonary edema and a third heart sound can be noticed.

The is particularly groundbreaking for diagnostics Ultrasound scan of the heart (Echocardiography). The doctor can visualize the heart and check its shape and functionality. Enlarged heart chambers, thickened heart muscle walls or dysfunctional heart valves would be seen on echocardiography.

Further investigative measures can also be taken to obtain additional information. One possibility is that Imaging by means of roentgen or MRI (read more on this topic at: MRI heart). Enlargement of the heart can be made visible and, for example, pulmonary congestion recognized. These procedures can also be insightful in finding out the possible cause of the heart failure.

Same goes for that Examination of the blood of the patient, in which, among other things, the sugar and kidney values ​​can be examined.

therapy

For the treatment of heart failure, it is important that risk factors that lead to the disease or that perpetuate it are eliminated or properly controlled.

This necessarily includes a modification of the lifestyle. Patients should normalize their weight, drink less than 2 liters a day to relieve the heart, consume little salt, and avoid alcohol and nicotine if possible.
Light physical endurance training is recommended in the early stages of the disease. In the late stages this would strain the sick heart too much and would no longer be of any benefit, so physical protection should be the focus there.

Since most patients do not only have heart failure, but also have other cardiovascular diseases, blood pressure should be well controlled.

Coronary artery disease as the cause of heart failure should be monitored regularly and, if necessary, intervened.
If there is an underlying heart valve disease, it should be treated surgically, depending on its severity.

Read more on this topic at: clinical aspects of the heart valves.

Other risk factors, such as increased blood sugar in the context of diabetes mellitus or increased cholesterol values, should also be well adjusted therapeutically.

In addition to these general measures, drug therapy is carried out. This depends largely on the stage of the disease. The stadiums are awarded according to the criteria of the New York Heart Association (NYHA). The four stages are treated with different amounts of drugs in ascending order (step therapy). Preparations used for this purpose are, for example, ACE inhibitors, AT1 antagonists, beta blockers, diuretics and aldosterone antagonists.

In very severe cases, in which drug therapy no longer helps, the implantation of a pacemaker may also be indicated. In these cases, a heart transplant should also be sought.

Read more on the topic: Therapy for cardiac insufficiency and cardiac pills

forecast

The Heart failure prognosis mainly depends on yours Severity. If the disease is recognized at an early stage and treated early and adequately, the patients can often lead a largely unrestricted life. In late stages the disease is often so advanced that even with drug therapy it is still possible strong restrictions the quality of life.

Life expectancy

The Life expectancy with a Heart failure can vary greatly from patient to patient differently be. It depends very much on the requirements that the patient brings with them. That are important Age and lifestyle of the patient, as well Severity of the disease and Comorbidities.

Patients who suffer from very advanced heart failure and who also have other cardiovascular diseases or other diseases die earlier than patients who have heart failure in the early stages without other diseases.
On average, half of the patients die within four years of being diagnosed, although the range is very large due to the different manifestations of the disease and concomitant diseases.

Consequences of a weak heart muscle

The Consequences of a weak heart muscle express themselves especially in the decreased resilience Of the patients. You suffer from Shortness of breath, can finally barely yet physical strain and accordingly hardly ever take part in activities. In addition, due to the restricted function of the heart, the other organs affected kidney failure can occur, for example.

In the worst case, a cardiogenic shock arise when the heart is acutely decompensated, i.e. acutely overloaded, and its functionality collapses. Cardiogenic shock manifests itself through one rapid pulse, low blood pressure, severe shortness of breath, Cold perspiration and Clouding of consciousness. This can lead to death under certain circumstances.

prophylaxis

The development of heart failure cannot always be avoided. Many factors play a role in the pathogenesis of the disease. Still, many help preventive measuresto keep the heart strong and healthy.

The Modification of lifestyle is therefore of central importance. Everyone should be physically active at least 3 times a week for 30 minutes each. These are suitable Endurance sports, such as jogging, swimming, cycling, or walking. The cardiovascular system is strengthened through endurance sport and is more resilient in the future.
Also one healthy and balanced diet plays a major role. Height Blood lipid levels are an important one Risk factor for cardiovascular diseases. The food should therefore be rich in fiber, rich in vitamins and rather low in fat. It is recommended that you eat five servings of fruits and vegetables a day.

By sufficient exercise and a healthy eating a lot can already be achieved and a large number of cardiovascular diseases can be avoided.

Sports

Sport works preventive in relation to cardiovascular diseases. Light endurance sports can significantly reduce the risk of heart failure.

If the heart muscle weakness is already present, sport should be in the Initial stages be practiced. It should light endurance sport be made that doesn't strain the heart too much. This can improve the heart's pumping function. competitive sport should not be exercised, because if the load is too heavy, the opposite effect is achieved.

In later stages of the disease becomes a exercise As a general rule not recommended. Since the patients in the later stages usually suffer from considerable shortness of breath, they are not able to exert themselves more physically anyway. Sports would only put too much strain on the heart and would not be able to meet the demands of the stressful situation. Therefore, from a certain degree of severity, physical rest up to bed rest is recommended.

Pregnancy with weak heart muscle

Pregnant womenthat under a Heart failure suffer a higher risk to their health and that of the child. However, heart failure is not per se a reason not to have a child. The pregnant woman should, however, note that she is regular both gynecological as well as cardiac monitoring leaves. In this way, you can react in good time in an emergency. During the examinations, the doctors closely monitor the development of the unborn child and observe whether it is really gaining in size and weight.

In addition, the medication often during pregnancy be adjusted. Many medications must not be taken during pregnancy. A woman who takes medication on a long-term basis and thinks she may be pregnant should therefore immediately have this checked by a doctor and her medication adjusted accordingly. Otherwise there is a risk that the child will suffer consequential damage.

Generally speaking, pregnant women with heart failure should avoid any More stress on your circulation avoid. Sport should only be practiced in consultation with a doctor, and meals should be taken in smaller portions throughout the day. The birth should take place in the hospital. In the case of severe heart defects, the pregnant woman is usually advised to have a caesarean section.