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Heart failure - symptoms, causes, treatment, and prevention

Heart failure - symptoms, causes, treatment, and prevention



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Why does a heart suddenly stop beating?

Heart failure is a serious and feared complication in numerous heart diseases. Every year, over 100,000 people die from this complete loss of heart function in Germany alone, although improved early defibrillation as part of first aid measures could significantly reduce the death rate. And even in preventive care, the high number of cases of heart failure could be significantly reduced.

The heart: structure and function

The heart (Cor) is the motor of our body. As the center of the blood circulation, it is the most important organ for maintaining vital functions alongside the brain. Of course, the pumping ability of the heart muscle is essential, thanks to which the blood is conducted through the entire body through the vessels.

The various tasks of the cardiovascular system include:

Oxygen transport - The blood in the lungs is enriched with oxygen through regular breaths. Through the blood circulation, it then reaches all parts of the body and thus supplies organs and tissue structures with the necessary “fresh air”.

Nutrient transport - Nutrients that are digested in the gastrointestinal tract and metabolized are also largely transported through the blood. Vitamins and minerals, proteins and carbohydrates can quickly reach their place of use in the body thanks to the nutrient-conducting function.

Material removal - Many metabolic breakdown products are also removed from the body via the blood circulation. Urinary substances in the kidneys are filtered out of the blood and carbon dioxide, which is produced in the organs after the consumption of oxygen, is exhaled from the venous blood in the lungs

Immune defense - The cells in the blood also include white blood cells, the so-called leukocytes. These have a special role in immune function, since they either detect harmful foreign bodies such as infectious agents and pass on corresponding information to the immune system, or are even involved in the body's own defense because they produce specific antibodies against the intruders of the body.

Hormone transport - Hormones are an important component in the signal line for certain bodily functions. By distributing hormones through the bloodstream in the body, the heart therefore also has an internal “communication function” that controls hormone-based mechanisms.

Heat regulation - The heart is also involved in the development of body temperature. Because the blood circulation cools the body constantly and defuses local heat sources.

The pump function of the heart comes from regular muscle contractions of the heart muscle. The clock for this is the so-called Sinus node (Nodus sinutrialis). This is located in the right atrium and is controlled by the sympathetic and parasympathetic nervous systems. The impulses of the sinus node are over the Atrioventricular nodule (Nodus atrioventricularis, short: AV node), a muscular connecting piece between the left and right ventricle, passed on to the entire heart muscle.

The result is regular heart muscle contractions, which are perceived as heartbeats. This special control of the heart rhythm and radial pumping mechanism is also referred to in medicine as the conduction system

Definition of heart failure

Heart failure now describes the functional failure of this system consisting of excitation conduction and pump function. This condition, which can be triggered by various heart diseases, is always life-threatening. Doctors distinguish between two main forms of heart failure:

  1. acute heart failure - Heart failure occurs suddenly and without any warning
  2. chronic heart failure - Heart failure develops gradually and progresses together with an increasing deterioration in heart function

If the heart failure is treated in time, the heart function can be restored. However, it is often a matter of a few minutes that decide whether the conduction of the heart can be “brought back” or dry forever and thus result in cardiac death.

Causes of acute heart failure

Acute heart failure can have a variety of causes and is always a life-threatening situation. Often the symptoms are completely absent or only appear so shortly before the onset of unconsciousness that the person concerned and their surroundings are completely surprised by the event and accordingly overwhelmed by the situation are. For this reason, one speaks of sudden heart failure or sudden cardiac death if all help is unsuccessful.

Heart and vascular diseases as the main cause

The triggers are usually in one (undiscovered) Find disease of the heart. By far the most common is that patients have severe calcifications on their coronary arteries. The clinical picture is considered in medical circles Coronary heart disease known and often the result of a previous arteriosclerosis (hardening of the arteries), which is already very advanced. The calcification process is gradual and therefore often remains undetected until acute heart failure occurs. As a result, other heart and vascular diseases can also lead to acute heart failure. These include:

  • Irregular heartbeat
    e.g. Rapid heart rate, stumbling, ventricular or atrial fibrillation
  • Disruptions in the conduction or formation of arousal
    e.g. AV node blocking, AV node reentry tachycardia, carotid sinus syndrome, sick sinus syndrome, Wolff-Parkinson-White syndrome
  • congenital or acquired heart defects
    e.g. Aortic stenosis, Ebstein anomaly, heart valve defect or Marfan syndrome
  • other blood, heart and vascular diseases
    e.g. High blood pressure, diabetes mellitus, endocarditis or cardiomyopathies

If not treated, the diseases mentioned often go hand in hand with damage to the heart, which further increases the risk of acute heart failure. There are also a number of other influencing factors that promote such a scenario. For example, is the heart through a previous one Heart attack weakened, the patient must continue to be monitored in hospital for a while to ensure that the heart attack is not followed by another life-threatening heart failure.

Other causes of illness

Even after surviving Lung disease (e.g. pulmonary embolism or pneumonia) or infection the heart is generally bruised and more prone to malfunctions. Infections in particular are associated with an increased risk. Because if the pathogens are not completely combated, they can spread to the heart via the bloodstream and trigger severe inflammation with acute heart failure as a result. Likewise are complicated operations It is not uncommon for there to be a risk of heart failure.

Heart failure due to unhealthy lifestyle

The patient's individual lifestyle also plays an important role in the development of numerous cases of acute heart failure. From unhealthy eating habits that promote diseases such as obesity, arteriosclerosis or coronary heart disease through a diet that is too rich in fat or sugar, to the effects of stress to heart-weakening addictions, there are many scenarios that promote heart failure. Overall, the following aspects are relevant in everyday life:

  • unhealthy diet (especially too greasy food)
  • Overweight
  • Lack of exercise
  • Everyday stress
  • emotional distress
  • lack of sleep
  • Exorbitant consumption of intoxicants and luxury goods
  • Drug abuse or doping

Substance abuse is particularly tricky

With regard to substance abuse, it should be mentioned that substances that increase the heart rate are particularly dangerous. In addition to nicotine and alcohol, heart failure is a frequent, fatal side effect, especially with performance-enhancing drugs such as anabolic steroids and drugs like speed or crystal meth.

Furthermore, be warned of an increasingly fashionable and legally available drug called Spice (“Legal Highs”). Disguised as a supposed room freshener, there are innumerable herbal mixtures under this name in the range of tobacco and pipe dealers. The main ingredient is synthetically produced cannabinoids, which is already raising the alarm bells for many doctors because the effects of synthetic drugs are usually even more difficult to control than those of "natural" ones.

It is seldom possible to say exactly which herbs are also processed in the so-called New Psychoactive Substances (NpS). On the other hand, the health risks of consumption are well documented, because the legal highs can lead to serious poisoning. In addition to loss of consciousness and panic attacks, the threatening side effects also include rapid heartbeat and irregular heartbeat. Deaths from heart failure have not yet become public, but the risk of an overdose is very high.

Causes of chronic heart failure

Chronic heart failure also often has its causes in the previous illnesses and unhealthy everyday habits already described. The major difference here, however, is that the pumping power of the heart is not stopped abruptly, but gradually loses its function gradually over a course that sometimes lasts for years until it finally comes to a complete failure. In addition, some special health problems can also come into play in chronic heart failure. Which includes:

  • chronic lung disease (e.g. COPD or pulmonary fibrosis)
  • sleep disorders (e.g. due to sleep apnea syndrome)
  • hormonal disorders (e.g. hyperthyroidism)

Symptoms of heart failure

The harbingers of heart failure occur, at least in acute cases, relatively immediately before the heart fails. Fast action is therefore extremely important. Typical symptoms include breathing problems as well as pain and discomfort in the upper body. But supposed gastrointestinal complaints such as nausea or vomiting can also occur as a result of heart failure. Below is an overview of possible symptoms:

  • Difficulty breathing or shortness of breath up to respiratory arrest
  • oppressive feeling in the chest area
  • Chest pain
  • Chest, neck, or jaw pain
  • Radiation pain in the arms
  • dizziness
  • Nausea and vomiting
  • Upper abdominal pain (especially in female patients)
  • Facial pallor
  • dilated pupils
  • drying pulse
  • unconsciousness

Diagnosis

In the event of acute heart failure, an emergency doctor is always required. The fatal health complaint is usually determined on site by diagnosing a pump failure or complete cardiac arrest. If countermeasures are initiated in good time and the patient survives, further monitoring and a detailed examination in the hospital are common. For this purpose, imaging methods such as EKG, echocardiography, cardiac catheterization are used. It is also common to take blood samples for cardiac enzymes, blood electrolytes, blood coagulation values.

Warning: Acute heart failure is an absolute emergency

Acute heart failure is an absolute emergency and can lead to the patient's death within a very short time. The heart stops abruptly and stops pumping, so that the entire cycle fails. If the person concerned is not given adequate treatment immediately, he dies within a few minutes. And even with quick and appropriate treatment, the chances of surviving without consequential damage are not good, since the heart and body have usually already suffered considerable damage.

Therapy for acute heart failure

It is essential for patients with acute cardiac arrest to have one carried out permanently Cardiopulmonary resuscitation until the emergency doctor arrives. It ensures that the circulatory functions are maintained and thus greatly increases the patient's chances of survival. After the arrival of the medical staff, they take over the stabilization of the patient by means of defibrillation and, if necessary, measures for artificial ventilation and bring him to the nearest hospital as quickly as possible.

Therapy for chronic heart failure

Chronic heart failure is a slowly progressing process that later manifests itself in obvious symptoms. This fact alone makes it easier for medicine to apply adequate treatment strategies. Nevertheless, it must be mentioned that the heart failure associated with the chronic form can rarely be completely cured. But at least the symptoms that occur can be treated and the risk of heart failure mitigated.

Medical therapy

Drug therapy for chronic heart failure is based on several pillars that can be used individually or in combination. Relief of cardiac activity by lowering blood pressure and pulse and reducing the volume of fluid in the blood can be achieved in this regard, for example, by using antihypertensives and diuretics. To strengthen cardiac activity by stabilizing the heart rhythm and strengthening the heart muscle, additional drugs such as digitalis preparations or beta blockers are used.

Attention: It is a fallacy to believe that discontinuation of treatments such as antihypertensives after normalization of blood pressure can be carried out without further concerns. Blood pressure is normal because the medication works, not because it would have normalized itself. If you withdraw the corresponding active ingredients yourself, the blood pressure usually rises again. Therefore, it is important to adhere to the prescribed regimen in the treatment of heart failure and to go to the check-ups regularly.

Self-help measures for a healthy heart

Heart failure is a chronic disease that, although not cured, can still be treated well. It is also important that the patient develops an awareness of what is good for his heart and what is not. Heart-damaging everyday activities and lifestyle habits should therefore be stopped urgently. First of all, this means heart-healthy nutrition and stress-free everyday planning. Relaxation offers and healthy sleep hygiene are equally important.

Regular exercise and a renunciation of aggressive intoxicants and stimulants are essential if the heart weakness is to be alleviated. In addition, regular exercise helps to strengthen the heart muscle again, whereby appropriate sports offers are best discussed with the doctor or a professional trainer. Too much can favor failure rather than heart strengthening.

Prevention of heart failure through healthy eating

There is no specific heart failure diet, but there are a few easy-to-implement nutrition plan tips that can relieve or even strengthen the heart:

Low salt diet: Salt binds water in the body, which is why eating too much salt means that the heart has to do too much to pump the entire volume of fluid. But that doesn't mean that you generally have to do without salt - the amount makes the poison. The Sunday egg may still be salted sparingly, rather the hidden salts should be taken into account when eating, for example in sausages or ready meals.

Correct handling of edible fats: Saturated fatty acids, such as those found in sausages, red meat, fatty cheeses and whole milk products, have a negative impact on cholesterol levels and can therefore be heart-damaging in the long term. In contrast, unsaturated fats have a positive effect on the cholesterol level. Risk patients should look specifically for omega-3 fatty acids, because they are considered the healthiest fats and can even strengthen the heart. These fatty acids can be found, for example, in poultry, fish and cooking oils such as sunflower oil, safflower oil, olive oil, hemp oil or linseed oil. However, use the oils mentioned sparingly, because the right measure is also important here.

Adequate hydration: The volume of fluid in the body is an important quantity in patients with heart failure. Therefore, the doctor will make a recommendation on how much fluid the patient can consume throughout the day. It is important to drink enough, but still not to drink too much, so as not to put additional strain on the heart.

Heart-strengthening foods: There are some foods that are particularly beneficial to heart health. These include in particular dark berries such as blueberries, black currants or blackberries, which contain an abundance of anthocyanins. It is a plant-specific dye with an antioxidant effect, which cleans the blood vessels and protects them from arteriosclerotic deposits. Water-rich fruits and fruit types such as watermelons, tomatoes, cucumbers and salads are also very healthy for the heart and vessels. The high liquid content of these foods naturally dilutes the blood and can thus prevent high blood pressure and thus additional heart strain.

Medicinal herbs

Onions, garlic and ginger also have an antioxidant, blood-thinning and sometimes even lower cholesterol and blood sugar levels. Garlic and ginger as a medicinal plant component for the treatment of heart and vascular diseases originate from a centuries-old application philosophy of traditional Chinese medicine and are therefore well-tried for the prevention of heart failure.

In the treatment of heart failure patients, treatment with hawthorn preparations, such as hawthorn tea, has also become established as a supportive measure. The phytochemicals contained in the hawthorn cause an increased blood flow to the coronary arteries. As a result, the heart muscle is better supplied with blood and supplied with nutrients, which improves its effectiveness and performance.

Surgical treatment

If all of the above measures have been exhausted and no longer lead to the desired success, an operation is often unavoidable. There are various techniques that can be used depending on the cause and severity of the heart failure. This includes, for example, the implantation of a pacemaker or mini-defibrillator. If the latter were used more preventively, numerous deaths attributable to heart failure could be avoided, which is why patients with chronic heart failure in particular should think about the option of an implanted defibrillator at an early stage.

There is also the possibility of using a so-called artificial heart. However, the entire heart is not replaced, as the name may suggest. Rather, the damaged heart elements are replaced and replaced by artificial, supportive systems. However, a complete heart transplant is still possible. However, it should be noted that the waiting list for donor hearts is extremely long and a suitable donor cannot always be found.

Important: The treating doctors provide the indication for an operation. In doing so, they also carefully examine the surgical risk with the benefits of the procedure, because heart operations always carry a great risk. (ma)

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Barbara Schindewolf-Lensch, Barbara Schindewolf-Lensch

Swell:

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  • Merck & Co., Inc.,: Heart Failure (HR) (accessed: Jul 10, 2019), msdmanuals.com
  • Noble, Alan / Johnson, Robert / Thomas, Alan / u .: Understanding organ systems - cardiovascular system: integrative foundations and cases, Urban & Fischer Verlag / Elsevier GmbH, 2017
  • Herold, Gerd: Internal Medicine 2019, self-published, 2018
  • Steffel, Jan / Luescher, Thomas: Cardiovascular system, Springer, 2nd edition, 2014
  • Cleveland Clinic: Sudden Cardiac Death (accessed: July 10, 2019), my.clevelandclinic.org
  • Müller, Dirk / Agrawal, Rahul / Arntz, Hans-Richard: How Sudden Is Sudden Cardiac Death? Circulation, 2006, ahajournals.org
  • Katritsis, Demosthenes G. / Gersh, Bernard J. / Camm, A. John: A Clinical Perspective On Sudden Cardiac Death, Arrhythmia & Electrophysiology Review, Volume 5, Issue 3, 2016, aerjournal.com

ICD codes for this disease: I11, I50ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.


Video: Heart Failure Treatment (August 2022).