Heart failure, myocardial insufficiency or cardiac insufficiency is a mostly irreversible heart disorder and disease. Above all, the circulatory system suffers from heart failure. As a result, there is no longer enough blood available for the organs. Shortness of breath, tiredness and general weakness, as well as water retention are typical signs of heart failure.
What is heart failure?
Every year around 295 out of 100,000 women and 380 out of 100,000 men in Germany develop cardiac insufficiency. 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.
Therefore, the amount of blood required by the organism for optimal blood circulation in the tissue cannot be guaranteed. A distinction is made between left heart and right heart failure, which have different symptoms that are typical of the disease. If both halves of the heart are affected, this is called global insufficiency.
According to Abbreviationfinder, the most common symptom of left heart failure is shortness of breath (dyspnea). In the early stages, it only occurs during physical exertion, but as the disease progresses it also occurs at rest. This shortness of breath can also intensify when lying down and lead to nocturnal attacks, which is popularly known as “cardiac asthma”. Another symptom of left heart failure is water retention in the lungs, which leads to gurgling noises when breathing.
With right heart failure, this water retention occurs in the abdomen (ascites) and the legs (leg edema). This water retention is partly excreted by the kidneys at night, so that frequent nighttime urination (nocturia) is another typical symptom, as is the patient ‘s weight gain caused by the water retention.
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. Left and right heart failure can be acute or chronic.
The list of causes for the occurrence of heart failure is quite extensive: Arteriosclerosis of the coronary arteries is the most common of all causes, followed by high blood pressure, myocardial disease, myocarditis, cardiac arrhythmias, heart valve abnormalities, pericardial effusion and the associated narrowing of the pericardial sac and metabolic diseases. Tachycardia and bradycardia (heart rate that is too fast or too slow) are often the cause of acute heart failure.
Symptoms, Ailments & Signs
The signs and symptoms of cardiac insufficiency depend on whether the form is acute or chronic. Possible symptoms of acute heart failure include coughing and severe shortness of breath, breath may sound rattling. Affected people also have an unusually fast heartbeat, and in individual cases cardiac arrhythmias also occur.
Outwardly, heart failure can be recognized by the pale skin and recurrent sweating. The symptoms usually appear suddenly and get worse within a short time. Acute heart failure is a medical emergency and must be treated immediately. Chronic cardiac insufficiency usually develops gradually.
The patient first notices a decrease in performance and feels exhausted and tired more quickly. Shortness of breath usually occurs even with light physical exertion. Another warning sign is edema. This fluid retention occurs primarily in the legs and increases in size as the disease progresses.
In the advanced stages of heart failure, the edema causes an increased need to urinate at night. Those affected also often gain weight without changing their eating habits. Chronic heart failure often develops over years and is ideally recognized and treated early on.
The course of heart failure is largely determined by its underlying cause and severity.
With almost all of the above-mentioned causes, a progressive deterioration must be expected. Drug therapy that becomes necessary can slow down this process, but not reverse it.
With a high degree of severity, the patient also suffers from a drastic impairment of the quality of life and reduced life expectancy, since the mortality rate (death rate) in heart failure is high.
In this context, sufficient medication to compensate for heart failure is a life-prolonging measure. The prognosis can continue to improve with a healthy lifestyle and regular medical check-ups.
Heart failure can cause serious complications, which in the worst case can result in the death of the person concerned. This applies primarily to untreated cardiac insufficiency. There is a risk 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 at risk of shock. As a result, blood pressure drops, posing a risk of failure of the circulatory system or vital organs. For example, congestive heart failure can 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 person’s heart may stop beating abruptly, which is not uncommon during a heart attack. Another dangerous complication of cardiac insufficiency is the formation of a blood clot (thrombosis). This in turn can lead to further life-threatening consequences such as a stroke or a pulmonary embolism.
In some cases, heart failure can have other effects, such as pulmonary edema or sleep apnea syndrome. Sleep apnea syndrome is understood to mean breathing pauses during sleep. These interruptions mostly appear at night and mean an additional strain on the cardiovascular system. Another conceivable risk factor in chronic heart failure is being underweight.
When should you go to the doctor?
If shortness of breath, hyperventilation and swelling are noticed again and again, heart failure may be the cause. A doctor should be consulted if symptoms do not go away on their own or other symptoms develop. If, for example, there is persistent inner restlessness, the family doctor must be informed. Water retention, abnormal breathing noises and loss of appetite are also clear warning signs. If the physical performance decreases rapidly, a doctor’s visit is recommended.
This is especially true when severe problems occur with everyday stress and simple activities such as climbing stairs can no longer be mastered. Medical advice must be sought at the latest when edema forms on the lower legs. If heart palpitations persist, a doctor must also be consulted immediately.
The same applies to stabbing pain in the heart area and persistent breathing difficulties when lying down. In addition to the family doctor, the cardiologist is the right contact person. If the symptoms are severe, the person concerned should immediately go to the nearest hospital or call an ambulance.
Treatment & Therapy
The first step in treating heart failure is to eliminate the underlying cause. This can be done medically or surgically. If, for example, there is a heart valve defect, then a surgical intervention is indicated to repair the defect. If the cause is elevated blood pressure, then antihypertensive drugs must be prescribed.
Patients with coronary heart disease are treated surgically (e.g. bypass surgery) and medicinally (nitrates, beta blockers, ACE blockers). Diuretics are prescribed for water retention, as are digitalis glycosides for atrial fibrillation and antiarrhythmics for cardiac arrhythmia.
Accompanying the therapy, moderate stress and physical exercise are required for most patients to strengthen the ailing heart muscle. In the case of severe heart failure, the last resort is a heart transplant.
Outlook & Forecast
The prognosis in the case of existing cardiac insufficiency is poor overall. Around half of all those affected die within five years of being diagnosed. 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 about 97 percent of cases, those affected also suffer from another disease.
Those affected by heart failure also have the opportunity to improve the prognosis. Adherence to therapy and willingness to change lifestyle are crucial here. In principle, the average survival time can be increased by avoiding risk factors despite cardiac insufficiency. Above all, this includes avoiding alcohol, tobacco and foods that are too greasy. Moderate exercise can also maintain heart health.
Adherence to therapy primarily relates to taking medication regularly and checking the heart regularly. Despite the possible absence of symptoms, drug therapy can contribute to a longer life. If the therapy is omitted, those affected risk a sudden worsening of the heart failure.
In addition, patients who experience the typical symptoms of cardiac insufficiency even when they are at rest have an annual survival rate of just 50 percent.
In the aftercare of heart failure, it is first important to take general measures to prevent further damage to the heart. Above all, lifestyle adjustments are of great importance 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 training program can be carried out, for example, as part of an outpatient heart sports group. Drug therapy is also a central part of the aftercare program. Here it is important to relieve the heart in its pumping activity.
By reducing the preload and afterload, the requirements of the circulatory system are adapted to the possibilities of the heart. Commonly used drugs are beta-blockers, which decrease the heart rate and oxygen consumption of the heart, and ACE inhibitors, which reduce circulatory afterload and limit fibrotic turnover of the heart muscle.
These prescription drugs must be prescribed by a doctor and the current dose must be checked regularly. In addition, a regular follow-up check with an accompanying re-evaluation of the disease must be carried out as part of the aftercare. Appropriate measures are echocardiography, electrocardiography, chest X-ray examination and laboratory control of cardiac insufficiency markers.
You can do that yourself
People with heart failure should continue to exercise, but pay more 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 included in the activities.
For example, the person affected can take regular breaks during a walk and sit down on a bench. It is also important that the person concerned does not put himself under time pressure in order to complete a certain activity in the shortest possible time. Shortness of breath can also occur when lying flat in bed.
The patient can improve breathing by elevating the head using an additional pillow or by adjusting the bed, if possible. Getting out of bed in the morning should be done slowly and calmly, as heart failure patients often experience dizziness. Standing up slowly, accompanied by light physical exercises, helps the patient to avoid feeling dizzy when standing up.
Another problem with heart failure is the occurrence of swelling. These can be improved by eating low-salt foods. In addition, those affected can develop depression due to the fact that they are restricted in their everyday lives. This should then be treated by a psychotherapist.