Classification of heart failure

If there is a disturbance in the filling of the heart chambers with blood, which can be the case, for example, after an inflammation of the pericardium (medical term: pericarditis), it is diastolic heart failure (cardiac insufficiency).If, on the other hand, the ejection of blood from a filled ventricle is caused by a contraction disorder of the heart, it is called systolic heart failure.

ComplaintsSymptoms

The main symptoms of heart failure are

Shortness of breath (medical: dyspnoea) and
Edema, i.e. the accumulation of fluid in the tissue

Symptoms of heart failure

Normally, symptoms of permanent and chronic heart failure develop gradually and insidiously during the course of the disease. In contrast, in acute heart failure, the symptoms begin suddenly and with high intensity. Depending on whether the left or right half of the heart, or even the entire heart is affected, the symptoms can also differ.

If our left half of the heart is affected by the disease, too little blood is pumped into the body’s circulation, so that organs are insufficiently supplied. The weakness of the heart also causes blood to back up into the pulmonary vessels. As a result, those affected are less able to perform and have less stamina.

Many patients complain of dizziness or “black-eyedness”. Nocturnal shortness of breath is also typical, which is particularly aggravated when lying down. This is often accompanied by a severe cough. In the case of a suddenly occurring left heart weakness, water can quickly build up in the lungs – the pulmonary edema. Severe shortness of breath and “bubbling” breath sounds are the consequence.

Edema as a symptom of heart failure

The edema, which is the second leading symptom of heart failure, is the result of a backlog of blood in the body’s circulatory system: the blood collects in the right heart, which is no longer working sufficiently, and whose ventricle and atrium dilate. The blood then backs up into the upstream, feeder, veins and organs. The increased pressure in the vessels of the venous system forces fluid out of the blood through the vessel walls into the tissue, comparable to a filter.

This results in swollen feet, for example. It should be noted that the exchange of substances between vessels and tissue is generally a natural process that represents a physiological balance, the driving force of which is solely the pressure in the vessels and the water-attracting proteins in the tissue (medically: colloid-osmotic pressure). However, the flow of fluid is not always directed from the vessels into the tissue; if the pressure in the vessels is low but the tissue pressure and the protein content in the vessels are high, the reverse phenomenon occurs: fluid is reabsorbed by the tissue into the vessels.

Therefore, in the arterial high-pressure system of the body, filtration with fluid escape predominates in healthy people, but it does not cause oedema, since it is returned to the body’s circulation by the venous system of the low pressure vessels. In the balance, 20 liters of the tissue fluid pressed out are directly recovered; the remaining two liters of the filtrate, a total of 22 liters on average, are returned to the venous system as lymphatic fluid via the so-called lactiferous duct of the lymphatic system (medically: thoracic duct). Only in the patient is this balance between fluid discharge and reabsorption (medically: between filtration and reabsorption) disturbed.

In heart failure, the pressure in the venous vessels is the cause of increased filtration. Damage to the liver – such as alcoholic cirrhosis of the liver, which is common in western latitudes – which also typically causes edema, has a different cause: the increased fluid outflow is caused by the reduced protein content of the blood (medically: colloid-osmotic pressure, see above). The accumulation of fluid, which appears as edema, especially in the dependent parts of the body, such as the feet, occurs in liver damage (cirrhosis of the liver) as well as in heart failure (cardiac insufficiency) when the capacity of the lymphatic system, which occurs almost everywhere in the body, is exceeded.

A further consequence of the increased pressure in the venous vessels caused by the pumping weakness of the right heart is the backlog of blood in the stomach, intestines and liver. This also explains why patients suffering from heart failure experience symptoms such as loss of appetite, constipation and a feeling of fullness, which do not primarily suggest a cardiac cause.A severe, congestive swelling of the liver (hepatomegaly) can cause pain under the right costal arch and is in this case called “cirrhosis cardiaque” (French). Frequent urination, especially at night, which is medically called “paroxysmal nocturia”, can often be the first indication of a weak heart pump.

The nocturnal urge to urinate can be explained by the increased reabsorption of fluid at night in a lying position, since less fluid is then pressed into the tissue (the pressure of gravity, which weighs on the vessels in a standing position, is eliminated). In addition to the heart, lungs, gastrointestinal tract and kidneys, the brain can also be affected by the excessive demands on the heart: In severe cases the lack of oxygen leads to symptoms such as , which can even lead to delirium. Typical for these so-called cerebral (lat. cerebrum = brain) symptoms is the breathing pattern known as Cheyne Stokes breathing, which is characterized by the constant change of increasing and decreasing depth of breath and breathing frequency.

Confusion
Hallucinations and
Disorientation