Heart failure, heart muscle weakness or cardiac insufficiency is a mostly irreversible disorder and disease of the heart. Most notably, the circulatory system suffers from heart failure. As a result, insufficient blood can be provided to the organs. Shortness of breath, fatigue and general weakness, as well as water retention are typical signs of heart failure.
What is heart failure?
Each year, about 295 out of 100,000 women and 380 out of 100,000 men develop heart failure in Germany. The average age at onset of the disease is between 70 and 80 years for both sexes. However, certain forms of heart failure can also occur at an earlier age. In this disease, there is usually a weakening of the heart muscle, which impairs the heart’s pumping function. As a result, the amount of blood required by the organism for optimal perfusion of the tissues cannot be guaranteed. A distinction is made between left heart failure and right heart failure, which have different symptoms typical of the disease. If both halves of the heart are affected, the condition is referred to as global insufficiency. The most common symptom of left heart failure is dyspnea. In the early stages, it occurs only during physical exertion, but as the disease progresses, it also occurs at rest. This shortness of breath can intensify when the patient lies down and lead to attacks at night, which is commonly referred to as “cardiac asthma“. Another symptom of left heart failure is water retention in the lungs, which leads to gurgling sounds when breathing. In right heart failure, these water retention symptoms occur in the abdomen (ascites) and legs (leg edema). Some of these water deposits are excreted by the kidneys at night, so that frequent urination at night (nocturia) is another typical symptom, as is the patient’s weight gain caused by the water deposits. A basic distinction is made between a chronic and an acute form of heart failure. The acute form occurs within a few hours or days. The chronic form, on the other hand, takes months or years to develop. Left and right heart failure can be acute or chronic.
Causes
The list of causes of heart failure is quite extensive: atherosclerosis of the coronary arteries is the most common of all causes, followed by hypertension, myocardial disease, myocarditis, arrhythmias, valvular abnormalities, pericardial effusion and associated constriction of the pericardium, and metabolic disease. Tachycardias and bradycardias (heart rates that are too fast or too slow) are often the cause of acute heart failure.
Symptoms, complaints, and signs
The signs and symptoms of heart failure depend on whether it is the acute or chronic form. Possible symptoms of acute heart failure include coughing and severe shortness of breath; breath may sound raspy. Affected individuals also have an abnormally fast heartbeat, and in isolated cases, cardiac arrhythmias occur. Externally, heart failure can be recognized by pale skin and recurrent sweating. The symptoms usually occur quite suddenly and worsen within a short time. Acute heart failure is a medical emergency and must be treated immediately. Chronic heart failure usually develops gradually. The patient first notices a decrease in performance and feels exhausted and tired more quickly. In most cases, shortness of breath occurs even with slight physical exertion. Another warning sign is edema. These fluid deposits occur primarily in the legs and increase in size as the disease progresses. In the advanced stages of heart failure, the edema causes an increased urge to urinate at night. Affected individuals also often gain weight without dietary changes. Chronic heart failure often develops over years and, in the best cases, is detected and treated early.
Course
The course of heart failure is critically determined by its underlying cause and severity. In almost all of the causes mentioned above, progressive deterioration must be expected.If drug therapy becomes necessary, this process can be slowed down but not reversed. In cases of high severity, the patient also suffers from a drastic impairment of quality of life and reduced life expectancy, since the mortality rate (death rate) in heart failure is high. In this context, adequate medication to compensate for heart failure is a life-prolonging measure. The prognosis may be further favored with a healthy lifestyle and regular medical checkups.
Complications
Heart failure can cause severe complications that, in the worst cases, result in the death of the affected person. This is primarily true in the case of untreated heart failure. This poses a threat of severe cardiac arrhythmias, which in the further course trigger sudden cardiac death. The countermeasures are no longer sufficient to compensate for the reduced cardiac output. If acute decompensated heart failure occurs, the patient is threatened with shock. As a result, blood pressure drops and there is a risk of failure of the circulatory system or vital organs. For example, it is possible for decompensated heart failure to cause sudden heart failure. In addition to the cardiac arrhythmias already described, inflammation of the heart muscle (myocarditis) or a heart attack are possible triggers. In the case of advanced heart failure, the heart of the affected person may abruptly stop beating, which not infrequently happens in the case of a heart attack. Another threatening complication of heart failure is the development of a blood clot (thrombosis). This in turn threatens further life-threatening sequelae such as a stroke or pulmonary embolism. In some cases, heart failure can have other effects, such as pulmonary edema or sleep apnea syndrome. Sleep apnea syndrome refers to breathing pauses during sleep. These interruptions usually occur during the night and place an additional burden on the cardiovascular system. Another conceivable risk factor in chronic heart failure is the presence of underweight.
When should you see a doctor?
If shortness of breath, hyperventilation, and swelling are noticed repeatedly, heart failure may be underlying. A physician should be consulted if the symptoms do not resolve on their own or if additional symptoms occur. For example, if there is persistent inner restlessness, the family doctor must be informed. Water retention, abnormal breathing sounds and loss of appetite are also clear warning signs. If physical performance declines rapidly, a visit to the doctor is recommended. This is especially true if severe problems occur during everyday exertion and simple activities such as climbing stairs can no longer be performed. Medical advice must be sought at the latest when edema forms on the lower legs. If there is persistent heart palpitations, a doctor must also be consulted immediately. The same applies to stabbing pains in the area of the heart and persistent breathing difficulties when lying down. In addition to the family doctor, the cardiologist is the right person to contact. If the symptoms are severe, the affected person should immediately go to the nearest hospital or call the emergency doctor.
Treatment and therapy
The first step in the therapy of heart failure is to eliminate its underlying cause. This can be done with medication or surgery. For example, if a heart valve defect is present, then surgery to repair the defect is indicated. If the underlying cause is elevated blood pressure, then the prescription of antihypertensives is necessary. Patients with coronary artery disease are treated surgically (e.g., bypass surgery) and with medications (nitrates, beta blockers, ACE blockers). Diuretics are prescribed for water retention, as are digitalis glycosides for atrial fibrillation and antiarrhythmics for cardiac arrhythmias. Accompanying therapy, most patients require moderate exercise and physical activity to strengthen the ailing heart muscle. In the most severe heart failure, the only last resort is heart transplantation.
Outlook and prognosis
The prognosis for presenting heart failure is poor overall. For example, approximately half of all those affected die within five years of diagnosis.Acute heart failure usually occurs as a result of cardiac insufficiency. Men are slightly more susceptible to possible death from heart failure than women. In approximately 97 percent of cases, those affected also suffer from another disease. Those affected by heart failure also have the opportunity to improve their prognosis. The decisive factors here are adherence to therapy and a willingness to make lifestyle changes. Basically, the average survival time despite heart failure can be increased by avoiding risk factors. This includes, in particular, avoiding alcohol, tobacco and excessively fatty foods. Moderate exercise can also maintain heart health. Adherence to treatment refers primarily to taking medications regularly and having the heart checked regularly. Despite possible lack of symptoms, drug therapy can contribute to a longer life. If therapy is foregone, sufferers risk a sudden worsening of heart failure. Patients who experience the typical symptoms of heart failure even at rest also have an annual survival rate of only 50 percent.
Follow-up
In the aftercare of heart failure, it is first important to take general measures to prevent further damage to the heart. Above all, lifestyle adjustment is of great importance here for a good long-term prognosis. First and foremost, alcohol and nicotine should be avoided. In addition, weight reduction should be aimed for in overweight patients. Light physical activity improves endurance, quality of life and resilience in heart failure. An optimal exercise program can take place, for example, in an outpatient cardiac sports group. Furthermore, drug therapy is a central component of the aftercare program. Here it is important to relieve the heart in its pumping activity. By lowering the preload and afterload, the demands of the circulatory system are readjusted to the heart’s capabilities. Medications often used are beta-blockers, which reduce heart rate and oxygen consumption by the heart, and ACE inhibitors, which reduce afterload in the circulation and limit fibrotic remodeling of the heart muscle. These prescription medications must be prescribed by a physician and the current dose must be reviewed regularly. In addition, regular follow-up with concomitant reevaluation of the disease must be performed as part of follow-up care. Appropriate measures include echocardiography, electrocardiography, Röngten chest examination, and laboratory monitoring of heart failure markers.
Here’s what you can do yourself
People with heart failure should continue to exercise, but should pay closer attention to the body’s signs, such as the onset of shortness of breath. This symptom often occurs in heart failure. Therefore, regular recovery periods should be scheduled during activities. For example, during a walk, the affected person can take regular breaks and sit down on a bench. It is also important that the affected person does not put time pressure on himself to complete a certain activity in the shortest possible time. Shortness of breath may also occur while lying flat in bed. The patient can improve breathing by elevating the head using an additional pillow or by moving the bed, if possible. Getting out of bed in the morning should be done slowly and with rest, as patients with heart failure often suffer from dizziness. Getting up slowly accompanied by light physical exercises helps the patient avoid the dizziness when getting up. Another problem with heart failure is the appearance of swelling. These can be improved by eating a low-salt diet. In addition, sufferers can develop depression due to the fact that they are restricted in their daily lives. This should then be treated by a psychotherapist.
