Causes and treatment of cardiac insufficiency

In heart failure, the heart is no longer able to pump enough blood through the body. As a result, the brain, muscles and organs are no longer supplied with sufficient oxygen. The earlier heart failure is detected, the more favorable the course. What are the symptoms of cardiac insufficiency and how can it be treated?

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Quick Reference: Heart Failure

What is heart failure? In the case of cardiac insufficiency (weak heart), the heart muscle can no longer muster the pumping capacity necessary for the body.

What are the symptoms of heart failure? Heart failure can cause mild or severe symptoms. Possible signs are, for example, shortness of breath, water retention, tachycardia, dizziness and nocturnal coughing. Especially at the beginning, an asymptomatic course, i.e. without any symptoms at all, is possible. As a result, cardiac insufficiency is often recognized late.

Can heart failure be cured? Only rarely does the heart regain full functionality. As a rule, the disease continues to progress. Appropriate treatment can delay this.

How is heart failure treated? Drug treatment plays an important role. In addition, surgical procedures are also used. A healthy lifestyle, such as avoiding nicotine and alcohol, supports the therapy.

Article content at a glance:

Heart muscle inflammation: These symptoms can be warning signs

Heart muscle inflammation: These symptoms can be warning signs

Definition: What is heart failure?

The heart has the important task of pumping blood through the large blood vessels into the body. This contains oxygen and nutrients that are needed by the cells of the tissues and organs.

In the case of cardiac insufficiency (also cardiac insufficiency or myocardial insufficiency), the pumping capacity of the heart has decreased and the organism can no longer be supplied with sufficient oxygen. Heart failure is not an independent disease, but usually the result of another heart disease such as a heart attack.

Heart failure: frequency

In Germany, almost four million people suffer from cardiac insufficiency – about one in 20 people. The risk of heart failure increases with age in particular: more than 10 percent of those over 60 are affected. Therefore, the old age heart is often mentioned. Heart failure is one of the most common causes of death.

Symptoms of heart failure are often non-specific

Chronic heart failure develops very gradually. The first signs are, for example, that performance is declining. Especially when exercising, those affected may notice that they are exhausted more quickly and need more breaks. If the heart failure progresses, everyday movements become increasingly difficult. Affected people are often out of breath after just a short walk or a few steps.

Symptoms of heart failure can vary and vary in severity depending on the severity. The following signs are possible, among others:

In addition, cardiac insufficiency can have further consequences and be accompanied by comorbidities. Those affected, especially those who are bedridden, have an increased risk of thrombosis, for example. Some sufferers also develop chronic obstructive pulmonary disease (COPD). In this disease, the lungs are damaged and airways are narrowed.

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Heart failure: forms and degrees of severity

Heart failure can be diagnosed in different types and degrees of severity:

Right and left heart failure

Depending on which chamber of the heart is mainly affected, experts distinguish:

  • Right heart failure: The muscle strength of the right ventricle is reduced. Those affected suffer more from water retention because the heart cannot pump away the blood sufficiently and a backwater occurs.

  • Left ventricular failure: The left ventricle, which normally pumps oxygen-rich blood into the circulatory system, is weakened. Symptoms such as shortness of breath are in the foreground.

  • global heart failure: Both chambers of the heart are diseased and cannot transport enough blood. This is the case for most sufferers.

Acute and chronic heart failure

Depending on the course over time, acute or chronic heart failure is defined:

  • acute heart failure: Heart failure occurs after an acute event, such as a heart attack.

  • chronic heart failure: The performance of the heart deteriorates over several months or years. The symptoms develop insidiously and are often misjudged by sufferers.

Compensated and decompensated heart failure

Another classification distinguishes between the compensated and decompensated form:

  • compensated heart failure: The body tries to balance out (compensate for) the weak cardiac output by, for example, increasing blood pressure through the release of hormones. As a result, the heart changes over time: muscle fibers thicken and/or the ventricles widen.

  • congestive heart failure: In this case, the body is unable to compensate for the weakened cardiac output.

NYHA stages of heart failure

According to the New York Heart Association (NYHA) classification, heart failure is divided into different stages:

  • NYHA I: Those affected do not notice any symptoms.

  • NYHA II: In the second stage, there may be mild limitations in vigorous physical activity such as walking uphill.

  • NYHA III: Symptoms such as tachycardia or shortness of breath occur even with slight exertion (e.g. walking).

  • NYHA IV: In end-stage heart failure, symptoms are also present at rest and worsen with exercise.

Heart failure: causes and risk factors

Heart failure occurs due to damage to the heart muscle or when the heart is overworked by disease or other factors.

Possible causes of heart failure are:

  • coronary artery disease (CHD): The most common cause of heart failure is a narrowing or blockage of the blood vessels that carry oxygen to the heart.

  • heart muscle inflammation: Inflammation of the heart muscle (myocarditis) can also lead to heart failure.

  • heart valve disease: Narrowing or leaking of the heart valves impairs heart function.

  • cardiac arrhythmia: Irregular heartbeats can weaken the heart.

  • chronic high blood pressure: Untreated high blood pressure overloads the heart over time.

In addition, congenital heart defects or other diseases such as diabetes mellitus or an overactive thyroid gland are also possible. Factors such as excessive alcohol consumption, smoking and obesity can increase the risk of heart failure.

This is how heart failure is diagnosed

The diagnosis of heart failure is made from a combination of different tests and laboratory values:

  • Anamnese: A detailed discussion about complaints and previous illnesses of those affected takes place. Typical signs are, for example, shortness of breath, nocturnal breathing difficulties and swelling of the ankles.

  • Laboratory values: As a biomarker for a weakened heart serves the N-terminal Pro-B-type natriuretic peptide (NT-Pro-BNP value). It is a hormone that is made in the heart and released when the pressure in the heart increases. An elevated value is a possible indication of heart failure.

  • Echocardiography (ultrasound of the heart): This allows the doctor to measure the percentage of blood in a heart chamber that is ejected per beat (ejection fraction, EF). When the EF decreases, the contraction of the heart muscle is weaker.

  • Electrocardiogram (ECG): The functioning of the heart is recorded in the form of curves.

  • Cardiac catheterization: A thin plastic tube (cardiac catheter) is advanced through a blood vessel to the heart during an X-ray check. In this way, heart valves and coronary arteries can be visualized.

Sometimes additional examinations such as computed tomography (CT), X-rays or a blood count are also necessary.

Therapy: How is heart failure treated?

The aim of the treatment is to slow down the progression of the heart failure and to relieve the symptoms. Therefore, it is first important to identify and treat the underlying underlying disease of the heart failure. In many cases, quality of life and expectations can be improved by appropriate drug therapy and sufficient exercise.

Medicines for heart failure

Medication is an important part of treating heart failure. These can be divided into four groups of active ingredients:

  • SGLT-2 Inhibitors: These drugs improve heart and muscle metabolism and can reduce the symptoms of heart failure.

  • Beta blockers: They lower the heart rate, which means that the heart muscle needs less oxygen and is relieved.

  • ACE Inhibitors/Sartans/Angiotensin Receptor Neprilysin Inhibitors (ARNI): They inhibit the endocrine system, which affects the kidneys and blood vessels, thereby improving heart activity.

  • Aldosterone antagonists: She ensure that more water is excreted in the urine together with salts. This reduces the blood volume and the heart is relieved.

Other drugs, such as diuretics, may also be prescribed. The dehydrating drugs promote the excretion of urine, which makes it easier to flush out water retention in the body.

In addition to drug therapy, heart failure can also be treated with surgical procedures. For example, a special cardiac pacemaker or an implantable defibrillator can be used. If the heart failure progresses dangerously despite therapy, a heart transplant may make sense. In addition, heart support systems (also known as artificial heart pumps or artificial hearts) can relieve the heart.


General measures such as not smoking, low alcohol consumption or avoiding being overweight support the therapy.

Course and life expectancy in heart failure

In most cases, heart failure cannot be cured. Only in exceptional cases, such as viral myocardial inflammation, can the heart regain its functionality. Otherwise, the heart failure will continue to progress. However, therapy can slow this process down.

The course of heart failure depends crucially on its cause and its severity. The average life expectancy for those affected is often shorter than for many types of cancer: the five-year survival rate for chronic heart failure is only 50 percent.

However, annual deaths from heart failure have declined in recent years due to medical advances. In addition, mortality (mortality) is highly dependent on age and the start of treatment. If therapy is started early, the life expectancy of patients can increase by up to ten years on average.

22 tips for a healthy heart

22 tips for a healthy heart

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