Heart failure

Heart failure, is a serious condition in which the heart is no longer able to pump enough blood around the body. This can lead to a range of symptoms, including fatigue, shortness of breath and fluid retention in different parts of the body.

Frequency and cause

Cardiac arrhythmias, where the heart beats irregularly, are a common side effect of heart failure and can further aggravate the situation. But heart rhythm disorders, such as atrial fibrillation, can also trigger heart failure.  

Heart failure is widespread, affecting about 1-2% of the adult population in developed countries. The incidence increases with age - in people over 70 it is about 10%. There are many causes of heart failure. They include coronary heart disease and heart attacks, high blood pressure, diabetes, obesity, smoking and alcohol abuse. In addition, there are numerous genetic causes for developing heart failure. Cardiac arrhythmias can also contribute to heart failure as they force the heart to work harder to supply blood to the body. 

Symptoms and workup

The symptoms of heart failure can vary depending on the severity of the disease. Common symptoms include shortness of breath, fatigue, swollen legs and feet, fast or irregular heartbeat and reduced physical performance.

The diagnosis of heart failure is based on a combination of symptoms, physical examination and special tests, including blood tests, ECG (electrocardiogram), echocardiography (ultrasound of the heart) and sometimes a cardiac catheterisation. 

Heart failure is a medical diagnosis made by a physician. In the meantime, however, everyday technical devices - such as an Apple Watch - can provide the such as an Apple Watch - can provide initial indications of a cardiac arrhythmia. 

Do you have a finding and would like a second opinion or are you not sure whether you have heart failure? One of our specialists will be happy to take the time for a consultation. 

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Therapy und prevention

The treatment of heart failure aims to:

  • improve symptom relief
  • better cardiac function
  • prevent progression
  • decrease mortality

This can be achieved through a combination of medications, lifestyle changes and, in appropriate patients, interventional procedures.

Medical management

The exact choice of medication depends on the type and severity of heart failure.

Commonly used medications are:

  • ACE inhibitors and angiotensin receptor blockers (ARBs): These medicines help to lower blood pressure and reduce the strain on the heart
  • Beta-blockers: These slow down the heartbeat and reduce blood pressure, which relieves the strain on the heart.
  • Diuretics (water tablets): They help remove excess fluid from the body, which can relieve symptoms such as swelling and shortness of breath.
  • Aldosterone antagonists: These medicines can help lower blood pressure and reduce the strain on the heart.
  • Sacubitril/valsartan (Entresto): A newer drug that has been shown to reduce the risk of hospitalisation and death in certain patients with heart failure.
  • So-called SGLT inhibitors: Originally a class of substances used in diabetes, these have been enjoying a real triumph in cardiology for some years now and are a major reason for the rapid decline in mortality in heart failure.

Device- and interventional treatments

In addition to medication and lifestyle changes, there are also a number of device-based and interventional treatments that can be used for heart failure and cardiac arrhythmias such as atrial fibrillation.

One of these treatments is Cardiac Resynchronisation Therapy (CRT). This therapy uses a special pacemaker to help the two chambers of the heart beat in sync again - with the aim of relieving the symptoms of heart failure, slowing down the progression of the condition and improving quality of life. For atrial fibrillation, a type of heart rhythm disorder that often occurs in people with heart failure, interventional treatment such as catheter ablation can be helpful. This procedure involves inserting a thin tube (catheter) into the heart and then using it to obliterate small areas of the heart that are causing the irregular heartbeats. This can control atrial fibrillation and reduce the risk of complications such as stroke and heart failure.

Similar to preventing atrial fibrillation, preventing heart failure involves controlling risk factors such as high blood pressure and diabetes, eating a healthy diet, exercising regularly, avoiding smoking and excessive alcohol consumption, and seeing a doctor regularly.

Mortality in combination with other conditions

Heart failure is a serious condition that can significantly shorten life expectancy. Without treatment, its course is as deadly as that of the most aggressive cancers. It is a major cause of hospitalisation and death in the elderly. In addition, heart failure can increase the risk of other conditions, including kidney failure, liver problems and respiratory disease. 

Modern treatment is now able to enable many affected patients to lead active and fulfilling lives despite the severity of heart failure. Early diagnosis and good medical care can help control symptoms and improve quality of life.