Cardiac insufficiency – causes, complaints & therapy

Doctors define cardiac insufficiency as a disorder of the function of the heart in which the amount of blood pumped into the circulation is insufficient, resulting in poorer blood flow to the organs and tissues.

With a severe course of the disease, there is a risk of circulatory failure, which can lead to death. Depending on whether the symptoms occur suddenly or develop gradually over months or years, cardiac insufficiency is divided into acute heart failure or chronic heart failure.

In addition, it plays an important role whether the reduction in pumping power originates in the left ventricle (left heart failure), in the right ventricle (right heart failure) or in both ventricles (global heart failure).

Causes

Cardiac insufficiency can be triggered by a variety of pre-existing conditions that do not always originate in the heart itself. Heart failure diagnosed in childhood is often caused by a congenital heart defect such as a hole in the cardiac septum. With increasing age, the general risk of disease increases, whereby cardiac insufficiency is not an indispensable sign of aging.Common triggers include untreated high blood pressure, infection of the heart muscle by parasites, bacteria, fungi or viruses, a heart valve defect, cardiac arrhythmias in which the heart beats too fast (tachycardia) or too slowly (brachycardia), as well as deposits in the coronary arteries. This arteriosclerosis is favored by an unhealthy lifestyle with a high-fat diet, severe obesity, pronounced cigarette consumption and metabolic disorders such as diabetes mellitus.

Functional disorders of the thyroid gland, fever or anemia also put more strain on the heart and can lead to a mostly temporary heart failure. Lung diseases such as COPD, which destroy the lung tissue and thus reduce the number of blood vessels in the lungs, increase the pumping resistance of the heart, which can cause chronic heart failure. Pulmonary hypertension is also problematic, as it narrows or blocks the blood vessels in the lungs.

When to see a doctor?

Anyone who notices the typical symptoms of heart failure should consult a doctor. Classic warning signs include shortness of breath, fatigue and unusual water retention in the legs. If these symptoms occur, the suspicion of a serious illness is obvious. An appointment with the family doctor or cardiologist provides information about the cause and allows immediate treatment. If cardiac insufficiency is present, the doctor can also issue a medication passport – often a vital help in a medical emergency.

Patients with heart disease with a disease of the immune system or internal organs should talk to the responsible doctor in case of conspicuous symptoms. Early clarification can usually prevent serious complications. In the event of a heart attack or respiratory emergency, the emergency doctor must be alerted immediately. This must be accompanied by first aid measures. Regardless of the course, hospitalization is then required, during which the causes of the emergency are determined and, under certain circumstances, further treatment of cardiac insufficiency (e.g. dialysis or heart transplantation) is initiated.

Symptoms and course

Typical symptoms of heart failure:

• shortness of breath

• Cough

• Paleness

• Tachycardia

• Fatigue

The acute form of myocardial insufficiency is manifested by sudden shortness of breath, raging cough, tachycardia, as well as paleness and cold sweaty skin. The symptoms usually worsen within a short time and require immediate emergency medical care as there is a risk of death.

The first signs of the chronic form of myocardial insufficiency are a gradual decrease in performance combined with tiredness, rapid exhaustion and shortness of breath with little exertion. If the left ventricle is affected by the disease, the blood builds up back into the pulmonary vessels. The result is shortness of breath or, in the worst case, accumulation of fluid in the lungs. If the right ventricle is damaged in particular, the oxygen-poor blood cannot be pumped further into the lungs, causing the blood to back up in the veins. As a result, fluid accumulates in the legs, but also partly in the stomach or liver. This fluid retention often manifests itself in weight gain without the affected person changing their eating habits.

Diagnosis

If there is a suspicion of heart muscle weakness, the cardiologist first inquires in detail about the symptoms, possible previous illnesses and heart diseases in the family. In the subsequent physical examination, the heart and lungs are listened to, blood pressure measured and an electrocardiogram made, which, among other things, causes cardiac arrhythmiascan be diagnosed. With an echocardiogram, an ultrasound of the heart, the cardiologist checks the heart function and assesses possible pathological changes in the pericardium, heart muscle and heart valves. A heart catheter examination is suitable for making deposits in the coronary arteries visible. Patients suffering from cardiac insufficiency have elevated BNP levels in their blood, which can be detected by blood tests .

Complications

In the worst case, cardiac insufficiency can lead to the death of the person concerned. As a rule, there is no self-healing, so that treatment by a doctor must be carried out in any case. Those affected primarily suffer from permanent fatigue and also from exhaustion. It is not uncommon for this to lead to reduced resilience and loss of consciousness. Pain in the left breast is also not uncommon and can lead to fear of death or a panic attack. The quality of life of those affected is significantly restricted and reduced by the heart muscle weakness. Water retention can also occur in different regions of the body due to heart muscle weakness.

Furthermore, those affected suffer from severe breathing difficulties or pathological breathing noises due to the disease. If there is no treatment, the affected person usually dies from the heart muscle weakness. The treatment of this disease always depends on the cause. In many cases, surgical interventions are necessary, which are associated with a certain risk. Whether the course of the disease will be completely positive cannot be guaranteed in every case. The life expectancy of those affected may be reduced by the heart muscle weakness.

treatment and therapy

Treatment of myocardial insufficiency aims to treat the underlying disease and thereby relieve the heart. Many patients can be effectively helped by the administration of medication. ACE inhibitors are given to lower blood pressure because they limit the production of the body’s own protein angiotensin II.

A heart rate that is too fast is slowed down by beta-blockers by throttling the release of stress hormones. Edema can be successfully treated by dehydrating drugs (diuretics), as body water and salts can be excreted more easily.General measures can also contribute to improving well-being. In addition to weight reduction, possibly combined with a low-salt diet, not smoking and regulating the insulin balance and cholesterol level also have a positive effect.

If drug treatment is unsuccessful, surgery can help. Calcified coronary arteries that impair blood flow can be dilated with a balloon catheter and kept open permanently with the use of a stent.

If the myocardial insufficiency is accompanied by life-threatening cardiac arrhythmias, the insertion of a pacemaker can help. If the course of the myocardial insufficiency is severe, only a heart transplant remains after all treatment options have been exhausted. However, since there are only a few donor organs, the waiting lists are long and it can take several years before a donor heart becomes available.

Prevention

An effective measure to prevent cardiac insufficiency is to treat the underlying disease. Taking medications to lower blood pressure and cholesterol levels also significantly reduces the risk of coronary artery disease. Weight reduction, abstaining from alcohol and cigarettes, a balanced diet and plenty of exercise also promote heart health. In principle, heart diseases such as myocarditis must be completely cured, since prolonging the disease promotes heart muscle weakness.