Introduction

Foto von Untersuchung eines Patienten mit Herzschwäche (PantherMedia / Alexander Raths) Heart failure is a condition caused by the heart being too weak to pump enough blood through the body. This can mean that organs, muscles and other tissue do not get enough oxygen. Heart failure is also sometimes referred to as congestive heart failure (CHF).

Heart failure can be acute, like after a heart attack, or it may develop over time, for example because of high blood pressure.

Less severe heart failure may go unnoticed, but if the heart is very weak it may also severely affect physical fitness. This can cause symptoms like fatigue, shortness of breath, chest pain or heart palpitations. Advanced heart failure makes even everyday activities more difficult. But most people have a milder form of the disease which can be managed quite well with suitable treatment.

Symptoms

The kind of heart failure someone has determines what type of symptoms they have. The three types of heart failure depend on what part of the heart is affected:

  • Left-sided heart failure: This is the most common form of heart failure. Blood accumulates in the pulmonary veins, which carry blood from the lung. This causes shortness of breath or coughing, especially during physical exercise.
  • Right-sided heart failure: Right-sided heart failure causes the blood to collect in the veins that carry blood from the organs and tissue back to the heart. The increased pressure inside the veins can push fluid out of the veins into surrounding tissue. This leads to fluid build-up in the legs, or less commonly in the genital area or abdomen.
  • Biventricular heart failure: In biventricular heart failure, both halves ("ventricles") of the heart are affected. This causes both shortness of breath and build-up of fluid.

Other symptoms of heart failure include:

  • Tiredness and exhaustion
  • Rapid or irregular heart beat
  • Sudden weight gain because of fluid build-up
  • Frequent need to urinate at night
  • Difficulty concentrating
  • Pale, cold hands and feet
  • Chest pain or tightness

Causes

Heart failure is usually caused by another disease that damages the heart muscle or the blood vessels. The heart muscles act as the "engine" of the heart: By contracting rhythmically, they pump oxygenated blood into the ventricles, and from there through the body’s circulatory system. But in case of heart failure this no longer works and not enough fresh blood reaches the rest of the body.

Heart failure is most often caused by coronary heart disease or a heart attack.

Coronary artery disease (CAD, also called coronary heart disease, or CHD) is caused by the narrowing of arteries that supply the heart with oxygen. This can prevent the heart from getting enough blood, resulting in heart failure. In a heart attack, one of the blood vessels is blocked so suddenly that no blood can get through to part of the heart and muscle tissue dies.

Constant high blood pressure can cause the blood vessels to lose their elasticity. That means that the heart is forced to work against this higher resistance all the time. Changes occur in the body to counteract this problem and make sure that all parts of the body are supplied with blood. This can include heart muscle growing larger and thicker, which increases the heart’s ability to pump blood at first. But over time the muscle hardens or the ventricles grow wider. This affects the heart’s ability to pump blood over the long term, leading to heart failure.

Heart failure can also be caused by conditions affecting the heart muscle, the heart valves or the heart sac (pericardium) including inflammation, congenital heart muscle abnormalities, heart valve defects and cardiac arrhythmias like atrial fibrillation. Alcohol abuse can also damage heart muscle.

 

Risk factors

The main risk factors for heart failure are:

  • Type 2 diabetes
  • Being severely overweight (adipositas)
  • Smoking
  • High blood pressure

Congenital predisposition for less common heart diseases, like some types of heart muscle disease, is also considered a risk factor for heart failure.

Prevalence

On average, 4 out of 100 people develop heart failure at some point. Most of them are over 65, and people over the age of 85 are most often affected. Later in life, women are affected more often than men.

Outlook

There are four stages of heart failure based on severity:

  1. Asymptomatic heart failure: There are no symptoms like fatigue or shortness of breath. Diagnostic tests can detect low heart performance.
  2. Mild heart failure: More strenuous physical exercise like climbing stairs or walking uphill causes symptoms like exhaustion or shortness of breath. But light physical exercise does not cause any symptoms.
  3. Moderately severe heart failure: Even everyday activities and light physical exercise like walking on a level surface can cause symptoms.
  4. Severe heart failure: Symptoms occur at rest or during even the slightest physical exercise. It is not possible to lie flat on your back. Some people with severe heart failure are bedridden.

Effects

 

Advanced heart failure can severely impair quality of life as normal activities become difficult or impossible.

Heart failure can cause arrhythmia. Increased pressure on the blood vessels and fluid build-up in the surrounding tissue can cause pneumonia and poor-healing ulcers on the lower legs.

Sudden fluid build-up in the lungs (pulmonary edema) can lead to choking fits with coughing and foamy sputum. Large amounts of fluid trapped between the ribs and the lungs can make it very difficult to breathe. Fluid may also accumulate in the belly or liver, causing bloating, loss of appetite, nausea and digestive problems.

When heart failure suddenly gets worse it can become life-threatening and hospital treatment may be necessary. A sudden turn for the worse is characterized by shortness of breath triggered even by light exercise or at rest, especially while lying down.

Diagnosis

If your doctor thinks you have heart failure, you will first need to describe your symptoms and medical history. This is followed by a physical examination and several different measurements:

  • The doctor will pat down your ankles and lower legs and tap on your chest and abdomen to detect any fluid build-up.
  • Listening to heart and lungs: Heart sounds, heart beat as well as heart murmurs or a rattling sound when breathing can hint at certain heart diseases.
  • Blood pressure reading.
  • Examination of the electrical activity of the heart using an ECG (electrocardiogram).
  • Ultrasound of the heart (echocardiography) to determine pumping capacity of the heart and check the function of the heart valves.

A blood sample is also taken for testing. These results can also help to determine possible causes of heart failure and rule out other diseases.

Treatment

Treatment of heart failure has four pillars:

  • Treating the underlying disease: Because heart failure is usually caused by another cardiovascular-related problem, treatment includes therapy for the underlying disease – CAD, heart arrhythmia or high blood pressure, for example.
  • General measures: General measures for everyday life aim to relieve the amount of stress put on the body’s cardiovascular system. They include: quitting smoking, drinking alcohol only in moderation, following a well-balanced diet, and, for people who are severely overweight, losing weight. People who have advanced heart failure often need to drink less fluids and watch their weight.
  • Medications: Medication to control the heartbeat, lower blood pressure, widen blood vessels, and dehydrate can take the strain from the heart.
  • Physical exercise: There are special heart exercise programs for people with heart failure that include individually adjusted training for stamina and muscles. These programs can improve physical performance and quality of life.

Research summaries

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