Heart failure – the creeping danger

The heart failure is one of the most common illnesses in Germany. It is the most common reason for hospitalization among women and the fourth most common reason for hospitalization among men.

Heart failure is one of the most common illnesses in Germany. According to calculations by the Federal Statistical Office, it is the most common reason for hospitalization in women and the fourth most common reason for men. The term heart failure refers to a weakening of the heart as a result of a reduced pumping function. This is the case when the heart can no longer pump enough oxygen- and nutrient-rich blood into the body or cannot completely absorb the incoming used blood and pass it on to the pulmonary circulation. The result: The blood accumulates in the lungs and tissue.

“Heart failure usually occurs as a result of another Disease The causes are manifold,” says Dr. Reinhold Lunow, medical director of the practice clinic for preventive medicine near Cologne and Bonn, one of the leading check-up centers in Germany. The most common causes are untreated Hypertension or a circulatory disorder of the heart muscle (CHD: Coronary heart disease ). Likewise, a Heart attack, which disables more or less large areas of the heart muscle or is caused by a malfunction of the heart valves. If the opening of a valve is too narrow (stenosis), it allows too little blood to pass through; if it is too wide (valve insufficiency), blood flows back in the wrong direction. Cardiac arrhythmias can also permanently weaken the pumping capacity.

Find numerous Diseases can lead to heart failure

Other causes may include an inflamed heart muscle (myocarditis) or an enlarged heart muscle. In such a dilated cardiomyopathy, the left side of the heart (atrium and ventricle) is usually pathologically enlarged. This can be due to hereditary reasons or can be the result of external influences. The latter include viral infections, chronic excessive alcohol consumption, Diabetes mellitus, overactive thyroid (hyperthyroidism) or underactive thyroid (hypothyroidism) or rheumatological diseases.

But not the entire heart has to be weakened. A distinction is made between left heart failure, in which the pumping capacity of the left ventricle is reduced, so that the blood backs up into the lungs. The result is coughing and shortness of breath, and even pulmonary edema. The brain is supplied with less oxygen, which can lead to constant tiredness and lack of concentration or even dizziness, dizziness and clouding of consciousness.

In contrast, in right heart failure, blood backs up into the body's veins. The increased pressure in the veins leads to a build-up of water in the tissues, with edema, particularly in the lower parts of the body (legs) or in the free abdominal cavity (ascites). At night, there is an increased urge to urinate (nocturia), because blood flow to the kidneys increases when lying down and at the same time more fluid flows back from the tissues.

At the first signs of Doctor

Since the symptoms of heart failure are not always clear, many patients with risk factors go to the doctor too late. "Patients often do not experience any symptoms at all in the early stages of heart failure. Others blame their advancing age for symptoms such as rapid exhaustion or shortness of breath. The first symptoms of insidious heart failure are barely noticeable. This is why the disease is often neglected. When the diagnosis is made, it is often already in an advanced stage," reports Dr. Reinhold Lunow from his many years of experience.

Initially only in cases of particular physical exertion, such as Sports or when doing gardening, the main symptoms are shortness of breath, weakness and exhaustion. Depending on the severity, restlessness, a rapid pulse, palpitations, coughing during exertion and a strong need for fresh air are also present. At night, a Asthma cardiac with attacks of shortness of breath due to congestion in the pulmonary circulation.

First, the body develops a variety of compensatory processes to compensate for the reduced pumping capacity of the heart - this is known as compensated heart failure. Signs include a faster heartbeat, thickening of the heart muscle, constriction of the blood vessels or an increase in blood volume. If such mechanisms no longer help, decompensated heart failure occurs: pathological water retention (edema) and shortness of breath occur even at rest or with only slight exertion.

Modern examination methods for a fast and safe Diagnosis

Since heart failure is usually a gradual disease - apart from acute events such as heart attack or pulmonary embolism - it can be actively counteracted. The prerequisite is to identify personal risk factors and initiate appropriate countermeasures on this basis. However, only the doctor can ultimately determine whether a symptom is actually heart failure and how advanced it is.

"We therefore first take a medical history, followed by a thorough physical examination. For an accurate diagnosis, we also examine physical performance. Clinical signs such as congested neck veins, pulmonary congestion or edema are just as important as a heart examination using echocardiography," explains Dr. Lunow. With this so-called "cardiac echo", an ultrasound examination, the doctor can very quickly assess the size and performance of the heart and also identify causes of heart failure. Other important examination methods are the ECG (electrocardiogram) at rest and under stress. Dr. Lunow is also a big fan of so-called stress echocardiography. This is an ultrasound examination of the heart while the patient is exercising on a bicycle ergometer. "In this examination, we can use ultrasound to measure the function of the heart muscle during stress," emphasizes Dr. Lunow.

For several years now, a blood test, the so-called Pro-BNP A rapid test is available that can confirm or rule out a suspected diagnosis of heart failure within a few minutes. This is particularly important for patients who have shortness of breath, as this can also be caused by a lung disease. Pro-BNP also helps to assess the severity of heart failure as a cardiac marker.

"The treatment of heart failure always aims to eliminate the cause and relieve the heart of its workload," says Dr. Lunow. This can be achieved by reducing the amount of fluid circulating in the bloodstream, for example by limiting the amount of fluid you drink or by taking water-excreting medication (diuretics). The heart rate can be regulated using beta-blockers, which block stress hormones (noradrenaline, adrenaline) and thus reduce the pulse and blood pressure. The use of ACE inhibitors is also recommended: the blood vessels are less constricted, blood pressure drops, unfavorable remodeling processes in the heart muscle are reduced and less sodium and water is retained in the body. Determining the pro-BNP in the blood is also well suited to monitoring the progression and treatment of heart failure.

If there is a heart valve defect, surgical valve replacement should also be considered. If coronary heart disease is the cause of the heart failure, balloon dilatation, possibly with stent placement, or bypass surgery may be indicated.

Early ones prevention against heart failure

The sooner you undergo a check-up, the sooner simple measures will help. "The risk of heart failure can be reduced simply by making lifestyle changes," says Dr. Lunow. "For example, giving up nicotine, reducing your salt intake, losing weight, exercising more and eating less Stress have a positive effect on our heart. Therefore, you should get medical advice and examination early on."

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