Congestive heart failure (cardiac insufficiency)

• Overview
• Causes and risk factors
• Disease progression
• Symptoms
• Diagnosis
• Treatment
• Prevention

Overview of heart failure

Congestive heart failure is a heart disease in which the ability of the heart to pump blood is severely compromised. As a result, the heart is no longer able to pump sufficient blood around the body, meaning the organs and tissues cannot get enough oxygen and nutrients.

Depending on whether the left or right ventricle is affected, the disease can be referred to specifically as left-sided heart failure or right-sided heart failure. In left-sided heart failure, the left ventricle is no longer able to pump blood sufficiently to maintain proper circulation. In right-sided heart failure, the right ventricle is too weak to pump enough blood to the lungs. If both ventricles are affected, it is known as biventricular heart failure.

Causes and risk factors

Heart failure can be triggered by a variety of heart diseases, meaning it has an extremely wide range of causes. However, it is often caused by chronic hypertension (high blood pressure) or coronary heart disease (CHD), i.e. a narrowing of the coronary arteries.

 Chronic hypertension

Uncontrolled high blood pressure is one of the main causes of heart failure. This is because elevated blood pressure over a longer period of time puts a strain on the heart and leads to a thickening and stiffening of the heart muscle as well as structural changes in the heart chambers. These changes can ultimately damage the heart’s ability to pump blood, increasing the risk of developing heart failure.

Coronary heart disease (CHD)

Coronary heart disease (CHD) is another common cause of heart failure. It is caused by narrowed or blocked coronary arteries, which reduce the blood supply to the heart muscle. This means the heart muscle tissue does not get enough oxygen, which can cause damage to the heart muscle over time. The damaged areas can lose the ability to pump normally, which can ultimately lead to heart failure. 

Other risk factors for heart failure

In addition to high blood pressure and coronary heart disease, there are a number of other heart conditions that can also contribute to the development of heart failure: 

Disease progression

A distinction can be drawn between chronic and acute heart failure. While the chronic form develops slowly over a longer period of time, acute heart failure has a sudden onset.

Chronic heart failure

In chronic heart failure, the insufficiency usually develops slowly over a longer period of time. The symptoms may initially be mild and become more severe over time. Heart failure can worsen without adequate treatment and lead to serious complications, including sudden onset pulmonary oedema, kidney failure, life-threatening cardiac arrhythmias and even sudden cardiac death.

Acute heart failure

In contrast to the chronic form, sudden-onset (acute) heart failure can lead to significant impairment of cardiac function within minutes or hours. This typically occurs when untreated chronic heart failure progresses unchecked or when, during a heart attack, part of the heart muscle is not sufficiently supplied with oxygen and is therefore no longer able to transport enough oxygen around the body. Acute heart failure is a medical emergency that requires immediate medical attention.

Symptoms

The symptoms of heart failure are varied and can often be exacerbated by the symptoms of the underlying cause. The possible signs of heart failure vary depending on which side of the ventricle is affected, as the left ventricle is mainly responsible for blood flow to the body, while the right ventricle is responsible for blood flow to the lungs. Biventricular heart failure occurs when both the left and right ventricles are affected, meaning the typical symptoms of both right- and left-sided heart failure can be present.

Symptoms of left-sided heart failure

• Dyspnoea (breathlessness) or shortness of breath, especially during physical exertion or when lying down
• Tiredness and feeling weak, even with little exertion
• Pulmonary oedema (fluid in the lungs)
• Coughing, especially at night or when lying down
• Cold hands and feet in the late stages

Symptoms of right-sided heart failure

• Swelling in the legs, especially in the ankles and lower legs
• Water retention in the abdomen (increased abdominal girth)
• Frequent urination at night (nocturia)
• Feeling of fullness and loss of appetite

Since not every person with heart failure exhibits all the symptoms and these are often difficult to pin down, you should consult a doctor if you experience shortness of breath, rapid-onset fatigue or water retention in order to obtain an early diagnosis and avoid or delay serious complications.

Diagnosis

The diagnosis of heart failure is typically made by a cardiology specialist and usually includes taking the patient’s medical history, a physical examination, laboratory tests and imaging techniques.

1. Medical history
The patient’s medical history is taken, where the doctor asks about symptoms, family history and any risk factors for heart failure such as high blood pressure or heart disease.

2. Physical examination
If heart failure is suspected, the patient will undergo a physical examination. This includes listening to the heart and lungs, measuring blood pressure and checking for oedema (swelling), particularly in the legs and abdomen.

3. Laboratory tests 
Common laboratory tests for suspected heart failure include blood tests and sometimes also urine tests. Both procedures can test for various substances that can indicate heart failure, monitor its progression and identify possible causes. 

4. Imaging techniques 
Imaging techniques and electrophysiological examinations are also essential components when it comes to diagnosing and monitoring heart failure. Echocardiography, which measures the pumping function of the heart, is particularly important. Other common diagnostic procedures for suspected heart failure include chest X-rays and electrocardiograms (ECGs).

Treatment 

Treatment of heart failure aims to alleviate the symptoms, slow down the progression of the disease and improve the patient’s quality of life. Various treatment approaches such as medication therapy, cardiac resynchronisation therapy, surgery and lifestyle changes can be used.

Prevention

Preventing heart failure focuses on reducing risk factors and promoting a healthy lifestyle:

• A healthy diet
• Regular physical exercise
• Weight management
• No smoking
• Moderate alcohol consumption
• Stress management
• Adequate sleep
• Careful use of medication
• Regular medical check-ups