Diagnosis of heart failure and blood pressure
A physical examination is performed at the beginning of the diagnosis. During this examination existing valve diseases (narrowing/stenosis or leaking valves/insufficiency) can be detected by heart murmurs. In addition, the lungs are listened to in order to rule out a possible fluid backflow into the lungs.
Basic diagnostics is echocardiography – an ultrasound of the heart. The movement of the heart walls and valves can be assessed. Existing wall movement disorders caused by a heart attack scar or calcified and thickened heart valves can be identified in this way.
In addition, the thickness of the heart muscle and the diameter of the heart chambers can be measured. This enables us to determine whether the right or left heart is more severely affected and whether it is an acute or chronic event. An additional Doppler examination can make the blood flow in the heart visible and reveal leaking valves or pendulum blood. In the further course of the procedure, an X-ray of the chest can be taken to show the extent of the disease. In order to exclude high blood pressure as the cause, a long-term blood pressure measurement over 24 hours will be necessary.
Associated symptoms
Due to an increasing heart failure, the blood arriving at the heart cannot be pumped completely further. Depending on which part of the heart is affected, it accumulates back into the circulation of the body or lungs. There, water escapes through the walls of the blood vessels into the tissue, and water accumulation develops in the legs (leg edema) or in the lungs (pulmonary edema).Those affected complain of heavy, thick legs, shortness of breath, coughing at night and reduced performance.
Congestion in the liver can lead to liver capsule expansion pain. In the stomach, congestion causes nausea and loss of appetite (congestive gastritis). A kidney dysfunction can also develop.
The symptoms increase as the disease progresses and under stress. In so-called right heart failure, the heart muscle of the right side of the heart is particularly weakened. It is difficult to pump blood from the right ventricle into the pulmonary circulation.
This leads to a backlog of blood in front of the heart into the body’s circulation. The blood is forced through the vessel walls into the surrounding tissue. Due to gravity, the fluid collects in the legs.
The circumference of the legs increases equally on both sides and gets worse in the course of the day. The legs feel heavy. The skin is soft and can be pressed in, leaving a dent which disappears only after some time.
The skin above the toes, on the other hand, is not swollen. Overnight, while lying down, the water spreads a little and some of it flows back into the blood. A typical symptom of this is that affected persons have to urinate more frequently at night.
Normally, the heart beats 60-80 times per minute at rest in adults. Tachycardia (tachycardia) is defined as a frequency of 100 beats per minute or more. In the context of a cardiac insufficiency, the heart can only pump a smaller amount of blood forward per beat.
The body’s circulation and all organs are less supplied with blood. In the early stages of heart failure, the body has various compensation mechanisms to maintain the cardiac output (amount of blood pumped by the heart per minute). By activating the sympathetic nervous system and releasing stress hormones (catecholamines) such as adrenaline and norepinephrine, the heart rate is increased.
This can improve the ejection performance of the heart for a short period of time. Tachycardia can become very unpleasant for those affected and trigger anxiety. For the already weakened heart, a permanent increase in heart rate is counterproductive, as it further fatigues and worsens the prognosis.
