Heart Failure (Cardiac Insufficiency): Symptoms, Complaints, Signs

The following symptoms and complaints may indicate heart failure (heart weakness):

Leading symptoms

  • Dyspnea* (shortness of breath or shortness of breath; at rest or on exertion).
  • Performance reduction / fatigue (fatigue) or fatigue.
  • Fluid retention (accumulation of fluid in the body).
    • Peripheral edema (water retention) in dependent parts of the body (ankles, lower legs, sacral in bedridden patients) – expressed as anasarca (accumulation of tissue fluid (edema) in the connective tissue of the subcutis with signs of dystrophy in the covering epidermal layers)
    • Pulmonary edema (water retention in the lungs), pleural effusion (accumulation of water between the pleura and the lung), ascites (abdominal fluid), weight gain

* Patients suffering from higher systolic heart failure struggle to breathe when bending forward, for example, when putting on socks or shoes. This form of dyspnea is called bendopnea (to bend, meaning to stoop). These patients are characterized by increased left atrial (“concerning the left atrium“) and pulmonary capillary (“belonging to the lungs”) pressures while sitting.Orthopnea, i.e., shortness of breath while lying down, is indicative of increased left ventricular filling pressure (correlated with increased (pulmonary capillary) wedge pressure (PCWP = Pulmonary Capillary Wedge Pressure). Other common symptoms of heart failure (cardiac insufficiency) may include:

  • Exertional dyspnea – shortness of breath on exertion, e.g., climbing stairs[usually not resting dyspnea, i.e., the patient is comfortable at rest but shortness of breath occurs with even mild exertion; comfortable at rest but breathless on slight exertion (CARBOSE)]
  • Intermittent, nocturnal dyspnea (shortness of breath).
  • Dry cough – esp. at night DD bronchial asthma, bronchitis or ACE inhibitor-induced cough.
  • Nocturia – nocturnal urination
  • Abdominal discomfort (abdominal pain), meteorism (flatulence), constipation (constipation).
  • Cachexia – severe form of emaciation.
  • Weakness in performance
  • Muscular atrophy (muscle atrophy)
  • Dizzy spells, palpitations (heart stumbles), and syncope – indicative of intermittent or permanent cardiac arrhythmias
  • Cerebral functional impairment – memory impairment; in elderly patients esp.confusional states.
  • Cyanosis (blue discoloration): usually begins with peripheral cyanosis (= blue discoloration of the acras/parts of the body furthest from the trunk: e.g., hands, fingers, feet, toes, nose) due to increased oxygen depletion of the blood in the capillary bed (due to. Forward failure of the heart with decreased cardiac output in the context of left heart failure); then later also central cyanosis (bluish discoloration of skin and central mucous membranes, e.g. tongue) [mixed central and peripheral cyanosis].

Tongue Diagnostics

  • Patients with heart failure have a more reddish tongue with pale yellow coating (Normal: Normal tongues are pale red with a bright white coating).Five bacterial genera distinguished heart failure patients from healthy individuals: Capnocytophaga, TM7 bacteria incertae sedis, Peptostreptococcus, Solobacterium, and Eubacterium. Furthermore, there was a decrease in the concentration of Eubacterium and Solobacterium with increasingly advanced heart failure.

Score for early diagnosis of heart failure (with non-acute dyspnea/breathlessness)

Parameter Score
Age > 75 3
BMI > 30 kg/m2 4
NT-proBNP > 125 pg/ml (14.75 pmol/l ) 9
Abnormal ECG 5
Lateral displacement of the cardiac apex 4
Systolic heart murmur 3
Heart rate above 90/min 1
Peripheral edema 4
Ischemic heart disease 2

Legend: ≥ 21 points = indication for echocardiography; negative predictive value of 87% and positive predictive value of 73%.

Left heart failure

Characteristic symptoms of left heart failure: in left-sided heart failure, the left ventricle is functioning inadequately (= inadequate cardiac output; “forward failure”, Engl.”forward failure”) and the blood backs up pulmonarily (= backpressure in the pulmonary circulation). Complaints due to insufficient cardiac output (HZV):

  • Tachycardia – heartbeat too fast: > 100 beats per minute.
  • Peripheral cyanosis (see above).
  • Restricted performance or drop in performance* .
  • Vertigo (dizziness)
  • Cerebral (“affecting the brain“) dysfunction.

Complaints due to congestion in the pulmonary circulation:

  • Severe dyspnea* (shortness of breath).
  • Pulmonary edema – accumulation of water in the lungs.
  • Pulmonary rales – rales of the lungs.
  • Foamy sputum (sputum)
  • So-called asthma cardiale
  • Congestive bronchitis (chronic bronchitis with constant cough).
  • Pleural pleural fluid – accumulation of fluid in the gap between the lungs and pleura.
  • Central cyanosis (see above).

* Dyspnea and performance insufficiency are cardinal symptoms of “heart failure with reduced ejection fraction” (HFREF). [echocardiographic left ventricular ejection fraction (ejection volume of the left ventricle): ≤ 40% (LVEF) = impaired left ventricular (LV) function].

Right ventricular failure

Characteristic symptoms of right heart failure: in right heart failure, the right ventricle is affected and there is also congestion of blood (= backward failure with congestion of blood in the venous system). However, unlike left heart failure, this does not occur pulmonarily (in the lungs) but in the following body organs (“congestion signs”):

  • Neck vein congestion
    • Sign of increased right ventricular filling pressure is jugular venous congestion (JVD) or increased jugular venous pressure (JVP).
    • Elevated JVD is commonly seen in patients with decompensated heart failure.
    • Hepatojugular reflux (HJR): reliably indicates increased pulmonary capillary wedge pressure (PCWP)Positive HJR: when the jugular vein remains congested (JVP 3 cm) for the entire time during a 10-second abdominal squeeze, and JVP abruptly decreases thereafter [Positive HJR is associated with a worse prognosis].
  • Stasis gastritis (gastritis).
  • Congestive liver or congestive cirrhosis (French. “Cirrhosis cardiaque”; irreversible damage to the liver, leading to a gradual connective tissue remodeling of the liver with restriction of liver function).
  • Congestive enteropathy (congestive diseases of the mucosa of the gastrointestinal tract) with malabsorption (disorder of food absorption).
  • Generalized water retention (anasarca).
  • Peripheral edema of the lower half of the body.
  • If necessary, stasis eczema and ulcers (ulcers) on the legs.
  • Weight gain

Furthermore, generalized peripheral cyanosis – blue discoloration of the lips and the acras (finger/toe extremities, nose, ears) – may occur due to the lack of oxygen.

Acute heart failure

Characteristic of acute heart failure are:

  • Symptoms of shock – pallor, cold sweat, hypotension (drop in blood pressure).
  • Tachycardia
  • Cool, moist limbs
  • Confusion
  • Oliguria – decreased urine output (max 500 ml/day).
  • Symptoms of congestion may be absent!

Symptoms and clinical signs of left-sided congestion (increase in blood volume due to decreased left-sided pumping ability) are typical:

  • Wet rales (wet RG; on auscultation (listening) to the lungs).
  • Dyspnea (shortness of breath), as well as.

Symptoms and clinical signs of right-sided congestion (increase in blood volume due to decreased right-sided pumping) are typical:

  • Edema (water retention)

Classification of patients in terms of their perfusion status (supply of blood to organs or parts of organs); differentiation into:

  • Well perfused [warm]
  • Poorly perfused [cold])
  • Congestion state (differentiation in:
    • Dammed [moist]
    • Not dammed [dry])

The acronym “CHAMP” aids in the rapid diagnosis of common causes of acute heart failure:

  • Acute coronary syndrome (AKS resp. ACS, acute coronary syndrome; spectrum of cardiovascular disease ranging from unstable angina (iAP; UA; “chest tightness”; sudden onset of pain in the heart region with inconstant symptoms) to the two main forms of myocardial infarction (heart attack), non-ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI)).
  • Hypertensive emergency,
  • Arrhythmia,
  • Acute mechanical cause (e.g., rupture of the LV free wall or ventricular septal defect in the setting of an acute coronary syndrome); and
  • Pulmonary embolism (” pulmonary embolism“).