Heart failure

In people with heart failure, the heart is no longer able to pump enough blood around their body. As a result, their organs, muscles, and other tissues no longer get enough oxygen and blood accumulates upstream of the heart. Heart failure is also referred to as cardiac insufficiency or congestive heart failure (CHF).

Heart failure can occur suddenly, for example, after a heart attack, or may develop over an extended period – for example, due to permanently elevated blood pressure.

Mild heart failure may go undetected or only cause mild symptoms. In advanced heart failure, physical endurance is significantly limited and even normal, everyday activities become difficult. Certain treatments can relieve the symptoms and increase life expectancy.

Heart failure can cause various symptoms. The most common symptoms are:

• shortness of breath and difficulty breathing
• tiredness and exhaustion
• a build-up of fluid in the feet, ankles or legs or – less commonly – in the genital area or abdomen (belly)
• weight gain due to fluid retention

Other symptoms are also possible. These include a rapid heartbeat, urinating often at night, difficulty concentrating and a dry cough. 

However, these symptoms may also have other causes – many people who have heart failure have other medical conditions too. As a result, it can sometimes be hard to recognize early signs of heart failure.

In most cases, heart failure is caused by another heart condition that has damaged the heart muscles or blood vessels. These are the most common causes: 

• coronary heart disease and heart attack
• high blood pressure
• heart valve defects
• cardiac arrhythmias 

In coronary heart disease (CHD), also called coronary artery disease (CAD), the arteries that supply the heart with oxygen-rich blood are too narrow. Heart failure can occur if there is an insufficient supply of blood to the heart. In a heart attack, one of these arteries is blocked so suddenly that no blood can get through to parts of the heart muscle and muscle tissue dies.

Constant high blood pressure puts pressure on the blood vessels and they become less elastic. This makes it harder for the heart to pump enough blood around the body. To ensure a continuing supply of blood, the heart muscle becomes enlarged and thicker, for example, which initially increases its pumping power.  Over time, however, the muscle stiffens or the lower heart chambers (ventricles) become extended, which negatively impacts the heart’s capacity for pumping and can ultimately lead to heart failure. 

Heart failure can also be caused by other heart conditions. These include inflammations, congenital heart muscle abnormalities, heart valve defects, and cardiac arrhythmias (irregular heartbeat), such as atrial fibrillation. Alcohol, illegal drugs, and certain types of medication can also damage the heart muscle. 

The most common risk factors include:

• Type 2 diabetes mellitus
• Smoking
• Alcohol consumption
• Obesity (severe overweight)
• Lack of exercise
• Certain drugs used to treat cancer

If several members of a person’s family already have rare heart conditions – such as genetic heart muscle diseases – the risk of that person developing heart failure is increased.

Heart failure mainly occurs in older people. It usually arises after the age of 65, The risk of developing heart failure increases with age. Over ten percent of people over 70 suffer from heart failure. Women and men are more or less equally affected.

If the heart suddenly stops pumping as effectively as before – for example, because a heart attack causes a larger area of the heart muscle to die – this is known as acute heart failure. This is considered an emergency. 

Chronic heart failure, on the other hand, develops over an extended period of time. It can initially go undetected. If the performance of the heart continues to decline, symptoms will appear sooner or later.

There are four stages of severity with heart failure:

Symptom-free (asymptomatic) heart failure

There are no symptoms, but certain tests can detect that the heart isn’t performing as well as it should.

Mild heart failure

More strenuous physical exercise like climbing stairs or walking uphill causes symptoms like exhaustion or breathing difficulty. But light physical exercise doesn’t cause any symptoms.

Moderate heart failure

Even everyday activities and light physical exercise, like walking on a level surface, can cause symptoms.

Severe heart failure

Symptoms occur at rest or during even the slightest physical exercise. Some people with heart failure become bedridden.

In addition to symptoms, doctors also consider how well the heart is filling with blood and how much blood it is pumping around the body with each heartbeat. 

The way in which heart failure continues to develop over time varies from person to person, depending on things like what is causing it and whether they have other medical conditions. In some people, the symptoms can be kept under control for many years. But for others the heart becomes weaker rather quickly. 

If another treatable condition – such as damaged heart valves or high blood pressure – causes heart failure, its progress can sometimes be halted or it may even disappear entirely once the cause has been treated. 

For most people, however, heart failure cannot be cured and the heart becomes increasingly weak over time. 

Possible signs of heart failure include difficulty breathing, exhaustion, and fluid retention. Abnormal heart sounds when listening to the heart or rattling breathing sounds provide further indications. To confirm the diagnosis, doctors normally carry out additional tests.

These include:

• an ECG (electrocardiogram) to measure the electrical activity of the heart and the heartbeat
• a blood test to measure various blood parameters
• an ultrasound scan of the heart (echocardiogram or “echo test”). This measures how effectively the heart is pumping blood and how well the heart valves are working.

It’s also important to find out what is causing the heart failure so that any underlying diseases can be treated where possible.

For more detailed information, for example about the different types of heart failure, visit gesundheitsinformation.de.

The treatment of heart failure is made up of several parts:

• Treating the underlying disease: If heart failure has developed because of another type of cardiovascular disease, such as high blood pressure, the patient receives targeted treatment for the underlying disease.
• Medication: This can reduce the strain on the heart and relieve symptoms. Drugs such as beta blockers, ACE inhibitors and diuretics are used for this purpose. The exact medication used will depend, for example, on the type of heart failure involved.
• Physical training: There are special heart exercise programs for people with heart failure, with a focus on individually adjusted training to build up their stamina and muscles. These programs can improve physical fitness and quality of life.

It is also beneficial to develop a medication plan together with a doctor to take account of potential interactions between various drugs. The plan should also list medications that are available without a prescription. Some of these, including painkillers such as diclofenac or ibuprofen, may not be suitable for people with heart failure.

For those with severe heart failure, implantable devices may be needed to prevent sudden cardiac death or to help the heart to pump.

There are also various things people can do to reduce the strain on their cardiovascular system. These include not smoking, drinking alcohol in moderation, and staying as physically active as possible.

With advanced heart failure, it is usually necessary to reduce daily liquid intake. This can prevent fluid retention and reduce exhaustion.