Heart Failure (Cardiac Insufficiency): Complications

The following are the major diseases or complications that may be contributed to by heart failure (heart failure):

Respiratory system (J00-J99)

Blood, blood-forming organs – immune system (D50-D90).

Endocrine, nutritional, and metabolic diseases (E00-E99).

  • Underweight – in patients with chronic heart failure, the relatively common chronic weight loss has been known since Hippocrates as the syndrome of cardiac cachexia; weight loss in chronic heart failure is considered an isolated independent risk parameter

Cardiovascular (I00-I99).

  • Acute cardiac decompensation with sudden cardiac death.
  • Acute right heart failure (RHV) secondary to left heart failure.
  • Apoplexy (stroke)
  • Cardiac arrhythmias, v.a. extrasystoles (heartbeats that occur outside the normal heart rhythm), ventricular (coming from the ventricle) tachycardia (accelerated pulse to over 100 beats per minute), atrial fibrillation (VHF; risk increase: women: 350%; men: 490%).
  • Cardiorenal syndrome (KRS) – simultaneous appearance of heart and kidney failure, in which acute or chronic functional impairment of one organ leads to functional impairment of the other organ
    • Up to 50% of all patients with heart failure have concomitant chronic kidney disease (CKD) (glomerular filtration rate (GFR) persistently <60 ml/min/1.73m2)
    • Patients with moderately impaired renal function (> CKD stage 3 or a GFR < 60 ml/min/1.73m2) have a 3-fold higher risk of heart failure than patients with normal renal function (GFR > 90 ml/min/1.73m2)
  • Pulmonary embolism – occlusion of a pulmonary vessel by a blood clot.
  • Sudden cardiac death (PHT)
    • Systolic heart failure: at approximately 40%, PHT is the leading cause of death.
    • Diastolic heart failure (heart failure with preserved ejection fraction; HFpEF: Heart Failure with preserved Ejection Fraction): about 20% PHT.
  • Thrombosis – blood clot formation in blood vessels.

Liver, gallbladder and bile ducts – Pancreas (pancreas) (K70-K77; K80-K87).

  • Hypoxic hepatitis in acute heart failure or cardiogenic shock (shock induced by heart failure).
  • Liver congestion in chronic heart failure → increase in cholestasis parameters (cholestasis parameters: AP (alkaline phosphatase), GGT (γ-GT, gamma-GT; gamma-glutamyl transferase), bilirubin) [see also under Laboratory Diagnostics].

Musculoskeletal system and connective tissue (M00-M99).

  • Osteoporosis (bone loss)
  • Sarcopenia (muscle weakness or muscle wasting).

Psyche – nervous system (F00-F99; G00-G99)

  • Insomnia (sleep disturbance; light sleep phase occupies more than half of total sleep).
  • Psychosis
  • Sleep apnea approximately 50% of all patients with acute heart failure have central sleep apnea (ZSA).Conclusion:All patients with an ejection fraction (ejection fraction) of less than 40% should be screened for sleep apnea. Therapy: Adaptive Servo Ventilation (ASV) is used for treatment. Inhalation and exhalation pressure are determined for each breath. When breathing is stable, the device provides only minimal pressure support. This produces better results than CPAP (“continuous positive airway pressure“): the number of breathing stops decreases more significantly and heart function improves more. Notice: In one study, heart patients with and without this respiratory aid were examined. It certainly found that mortality (death rate) actually increased in heart failure patients when they were ventilated by ASV (34.8% versus 29.3%; HR 1.28; P = 0.01 and 29.9% versus 24.0%; HR 1.34; P = 0.006, respectively).
  • Decreased brain performance

Symptoms and abnormal clinical and laboratory parameters not elsewhere classified (R00-R99).

  • Cachexia (cardiac cachexia; emaciation, severe emaciation).
  • Cardiogenic shock (form of shock caused by weakened pumping action of the heart).

Genitourinary system (kidneys, urinary tract – reproductive organs) (N00-N99).

  • Acute renal failure (ANV)

Further

  • Lungs:
    • Restrictive lung function (vital capacity and total lung capacity ↓) and/or obstructive lung function (airway resistance ↑).
    • Hyperventilation (excessively rapid and deep breathing) with hypocapnia (decreased partial pressure of carbon dioxide in arterial blood), at rest and with exertion (common)

Prognostic factors

  • Anemia (anemia) – Iron deficiency anemia (anemia due to iron deficiency) (10-33%); even functional iron deficiency without anemia (ferritin 100-300 ng/ml and transferrin saturation <20% ) worsens the symptomatology in heart failure patients and thus their prognosis.Two groups should be distinguished in patients with iron deficiency:

    in a prospective observational study, only barely filled iron stores were associated with increased mortality (death rate) and more frequent hospitalization for heart failure.

  • Anorexia (loss of appetite)-three independent predictors of appetite in heart failure: Activation of inflammatory hormones, loop diuretic use, and cachexia.
  • Smoking
  • Angina pectoris (AP; “chest tightness”; sudden onset of pain in the heart area).
  • Congenital or acquired heart defects
  • Respiratory diseases
  • Exertional dyspnea/CARBOSE (comfortable at rest but breathless on slight exertion; patients who feel comfortable at rest but have shortness of breath on even mild exertion when admitted to the hospital have the worse prognosis than those admitted with resting dyspnea (probably, exertional dyspnea is a reflection of severe dysfunction of the right heart)
  • High resting heart rate in HFrEF (“heart failure with reduced ejection fraction”; heart failure with reduced ejection fraction/ejection fraction (= systolic heart failure).
  • Decrease in ejection fraction
  • Low ejection fraction (ejection fraction).
  • Low systolic pressure: Patients with left heart failure with preserved systolic pump function (HFpEF) live longer and better if their systolic pressure is not too low (< 120 mmHg).
  • Depression – fivefold increased risk of mortality (death) from any cause within 1 year (HR 5.2; 95% CI 2.4-10.9; p <0.001); the degree of depression correlated with mortality (death rate) within the 1-year observation period as follows:
    • With moderate to severe depression, one in two died
    • With mild depression died just over one in five (22.2%)
    • Without depression died only 8.7%
  • Endocrinological and metabolic diseases – e.g., diabetes mellitus (insulin resistance): diabetes mellitus type-2: 3-fold higher mortality compared with patients without heart failure.
  • Inflammatory heart disease – myocarditis (inflammation of the heart muscle), endocarditis (inflammation of the inner lining of the heart), pericarditis (inflammation of the pericardium).
  • Heart valve disease
  • Cardiac arrhythmias
  • Hypertension (high blood pressure)
  • Cardiac cachexia (heart-related emaciation).
  • Cardiomyopathy (heart muscle disease).
  • Coronary artery disease (CAD; coronary artery disease).
  • Myocardial infarction (heart attack)
  • Neoplasms – malignant (malignant) diseases.
  • Renal insufficiency (kidney weakness)
  • Sleep apnea (see above “Psyche – Nervous System (F00-F99; G00-G99)/Sleep apnea”).
  • Subclinical hypothyroidism ( “mild” hypothyroidism, which is usually manifested only by a change in the thyroid parameter TSH) – TSH values of ≥ 7 mlU/L are associated with a significantly worse prognosis; as is the low T3 syndrome (triiodothyronine (T3) too low and TSH and FT4 values in the normal range).
  • Syncope (brief loss of consciousness).
  • Vasculitides (inflammatory rheumatic diseases characterized by a tendency to inflammation of the (mostly) arterial blood vessels) and other autoimmune diseases
  • Vitamin D deficiency (plasma 25-hydroxyvitamin D levels in the range < 75 nmol/l) (vitamin D supplementation has no effect on mortality)
  • Medications: poor response to diuretics is associated with low blood pressure, renal dysfunction, low urinary output, and increased risk of mortality or hospital readmission shortly after discharge in patients with acute heart failure (AHI).