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heart failure

Synonyms in the broader sense

Medical: heart failure

Heart muscle weakness, pumping weakness of the heart, right heart failure, left heart failure

English:

definition

Cardiac insufficiency, also referred to as myocardial insufficiency, represents the inability of the heart to provide enough oxygen to the organs of the body.
Depending on the cause, the differences between systolic and diastolic cardiac insufficiency and cardiac insufficiency as well as some special forms (eg the "high output failure"), see section "Causes".
Anatomically, the inadequate performance of the entire heart ("global heart failure") can still be distinguished from the predominant reduction in the performance of one of the two ventricles ("right heart failure" and "left heart failure").

Frequency (epidemiology)

Occurrence of heart failure in the population. The proportion of sufferers (medically: prevalence ) is highest in the older population: in the age group of 66 to 75 years, an estimated 4-5% suffer from cardiac insufficiency / heart failure, while the proportion among 25-35 year olds is about 1 % is.
Overall, estimates suggest that about 1.2 million people in Germany are affected. Newly ill (medically: incidence ) mostly older people at a heart insufficiency / heart weakness, ie younger humans are affected less frequently. Due to the changing age structure of our society, the incidence of heart failure has dramatically increased over the last 20 years. Men are more than twice as likely as women.

The severity of heart failure / heart failure is divided into four stages, which are referred to as NYHA 1-4, according to the classification by the New York Heart Association (NYHA short).
This classification is based on the appearance of discomfort and the physical capacity of the patient:
For example, while physical performance is not (yet) limited in NYHA 1, and only changes under normal technical diagnostics can be observed in healthy individuals, NYHA 3 is severely impaired in physical performance in the absence of restlessness.
In NYHA 4 heart failure / heart failure, patients are bedridden and severely restricted during exercise and rest.
The NYHA 3 and 4 stages of cardiac insufficiency are a very serious disease, not just associated with a marked reduction in quality of life, but have a life expectancy comparable to that of cancer.

Figure heart: longitudinal section with opening of all four large cardiac cavities
  1. Right atrial -
    Atrium dextrum
  2. Right ventricle -
    Ventricle dexter
  3. Left atrium -
    Atrium sinistrum
  4. Left ventricle -
    Ventricle sinister
  5. Aortic arch - Arcus aortae
  6. Upper vena cava -
    Vena cava superior
  7. Lower vena cava -
    Vena cava inferior
  8. Strain of pulmonary arteries -
    Pulmonary trunk
  9. Left pulmonary veins -
    Vena pulmonary sinastrae
  10. Right pulmonary veins -
    Venae pulmonary dextrae
  11. Mitral Valve - Valva mitralis
  12. Tricuspid valve -
    Valva tricuspid
  13. Chamber septum -
    Septum interventriculare
  14. Aortic valve - Valva aortae
  15. Papillary Muscle -
    Muscular papillaris

Causes and origin

Cardiovascular System

The most common causes of heart failure / heart failure are:

  • increased blood pressure (arterial hyperia)
  • and atherosclerosis of the coronary arteries, known as coronary heart disease, or KHK for short.

However, there are also a variety of other reasons in question, which can go out primarily from the heart, as a previous, usually caused by viruses inflammation of the heart muscle (medical: myocarditis).

But completely different diseases can be the trigger:

  • Drugs or metabolic / toxins damage the heart when taking cytostatics (tumor medicines)
  • excessive alcohol or cocaine use
  • Diabetes mellitus (diabetes)
  • or renal failure (kidney failure)

lead to a summarized as "metabolic-toxic cardiomyopathy" disease (from Latin cardiomyopathy = suffering of the heart muscle).
In addition, tumors of the adrenal medulla (these are called pheochromocytoma) and an over- / or under-function of the thyroid gland can contribute to the development of cardiac insufficiency / cardiac insufficiency, "endocrine cardiomyopathy".
In the special form of heart failure / heart failure referred to as "high output failure", in contrast to the classical forms, there is not a reduction in cardiac output but an exaggerated oxygen requirement that is not covered by the heart can be.
This is the case, for example, with a strong anemia (anemia), in which there is insufficient blood for oxygen transport available and the heart tries to compensate for this by an increased pumping power. Another cause of "high output failure" is the hyperthyroidism, in which it comes through the increased metabolic performance to increased oxygen demand of the organs.

Classification of heart failure

If there is a disturbance in the filling of the heart chambers with blood, which may be the case, for example, after an inflammation of the pericardium (medical: pericarditis), it is a diastolic heart failure (heart failure).
If, on the other hand, the discharge of blood from a filled ventricle is caused by a contraction disorder of the heart, this is called systolic heart failure.

Complaints / symptoms

The main complaints in heart failure are:

  • Shortness of breath (medical: dyspnea) and
  • Edema, ie the accumulation of fluid in the tissue

Symptoms of heart failure

Normally, symptoms of permanent and chronic heart failure gradually develop gradually during the course of the disease.

In contrast, when acute cardiac insufficiency occurs, the symptoms are sudden and intense. Depending on whether the left or right half of the heart, or even the entire heart are affected, the symptoms may also differ.

If the left half of the heart is affected by the disease, too little blood is pumped into the systemic circulation, so that organs are inadequately supplied. Due to the weakness of the heart, there is sometimes a build-up of blood back into the pulmonary vessels. As a result, sufferers are less efficient and persistent. Many patients complain of dizziness or "black-eye-sight". Typical is also nocturnal air shortage, which worsens especially when lying down.

In addition, severe coughing often occurs. In case of sudden left-sided weakness of the heart, it can rapidly develop into pulmonary edema in the lungs. Violent breathlessness and "bubbling" breath sounds are the consequence.

  • Causes of water in the lungs
  • Why is there a cough in a heart failure?

In rare cases, only the right half of the heart is affected. Thus, the oxygen-depleted blood that flows from the periphery of our body back to the heart is not pumped effectively enough to the lungs. Due to the massive backwater accumulates blood especially in the jugular veins, which thus emerge clearly recognizable with the naked eye.
Depending on the severity and position, increased water retention ( edema ) in the ankle, lower leg, thigh or abdomen can be observed.

Water retention in the lungs ( pulmonary edema ) or in the abdomen (" ascites ", ascites ) can cause life-threatening conditions in the worst case. Ultimately, the body can even store so much water that sufferers in a short time, disproportionately gain weight. Since venous blood can back up into the liver or into the stomach, complaints such as a pressure-sensitive congestive liver are not uncommon. Patients often lose their appetite with advanced, right-sided heart failure.

Frequently, heart failure in the left half of the heart leads to an overall, so-called "global" heart failure. In addition to the symptoms described, patients suffer from frequent nocturnal water ( nocturia ), rapid heart rate or cold-sweaty skin.

For better comparability, physicians divide the severity of heart failure into the internationally valid "NYHA classification":

  • Stage I: normal exercise capacity without discomfort
  • Stage II: Discomfort only at heavier load
  • Stage III: complaints even under light load
  • Stage IV: complaints even at rest

Edema as a symptom of heart failure

The edema, the second key symptom of heart failure, is the consequence of a backflow of blood into the systemic circulation:
The blood collects in the insufficiently working right heart, whose chamber and forecourt expand (medically: dilate ).
Subsequently, the blood jams back into the upstream, supplying, veins and organs. Due to the increased pressure in the vessels of the venous system, blood is pressed out of the blood through the vessel walls, comparable to a filter, into the tissue. This manifests itself, for example, with swollen feet.

It should be noted that the mass transfer between vessels and tissue is generally a natural, a physiological balance representing process, the driving force of which alone are the pressure in the vessels and the water-attracting protein in the tissue (medical: colloid osmotic pressure ).
However, the fluid flow is not always directed from the vessels into the tissue; If the pressure in the vessels is low, but in return the tissue pressure and the protein content in the vessels are high, then the reverse phenomenon happens:
Fluid is taken up by the tissue back into the vessels (medical: reabsorbed). Therefore, in the arterial high-pressure system of the body in the healthy, filtration with leakage of liquid predominates, which, however, does not cause edema, since it is returned to the systemic circulation by the venous system having the vessels of the low-pressure.
In the balance, so 20 liters of the pressed-off tissue fluid directly recovered; the remaining two liters of the filtrate, measuring an average of 22 liters, return to the venous system via the so-called mammary duct of the lymphatic system (medical: thoracic duct) as a lymphatic / lymphatic fluid.
Only in the patient is this balance between fluid leakage and recovery (medically: between filtration and reabsorption) disturbed. In heart failure, the pressure in the venous vessels is the cause of the increased filtration. In an injury of the liver - as in Western latitudes often to be found example here the alcoholic liver cirrhosis - in which it also typically leads to edema, is another reason: The increased fluid outflow is due to the reduced protein content of the blood (medically: colloidosmotic Pressure, see above). The accumulation of fluid, especially in the dependent parts of the body, such as the feet, occurs both in damage to the liver (Lorber's cirrhosis) and in cardiac insufficiency (cardiac insufficiency), when the capacity (the so-called capacity) of the almost everywhere in the body occurs lymphatic system is exceeded.

Another consequence of the increased pressure in the venous vessels due to the pumping weakness of the right heart is the backflow of blood into the stomach, intestine and liver. This also explains why sufferers of heart failure, such as loss of appetite, constipation (constipation) and feeling of fullness occur, which do not primarily think of a caused by the heart (medical: cardiac) cause.
A strong, congestive swelling of the liver (hepatomegaly) can cause pain under the right costal arch and is referred to in this case as "cirrhosis cardiaque" (frz.).
Frequent, especially nocturnal urination, which is medically called "paroxysmal nocturia", can often be the first indication of a poor pumping of the heart.
The nocturnal urinary urgency can be explained by the reabsorption of fluid, which takes place at night in a recumbent position, as less fluid is pressed into the tissue (it eliminates the pressure of gravity, which rests on the vessels in a standing position).

In addition to the heart, lungs, gastrointestinal tract and kidneys, the brain can also be affected by the overstraining of the heart. In severe cases, the lack of oxygen leads to symptoms such as

  • confusion
  • Hallucinations and
  • disorientation

which can reach as far as Delir. Typical of these so-called cerebral (lat. Cerebrum = brain) symptoms is the respiratory pattern known as Cheyne Stokes respiration, for which the constant alternation of increasing and decreasing respiratory depth and respiratory rate is characteristic. You can also find more on this topic under: edema

Diagnosis of heart failure

The most important cornerstone is the detailed questioning of the patient ( anamnesis ). In particular, pre-existing conditions, such as heart attacks, the exact sequence of complaints or currently taken drugs are of great importance. For example, patients who are already taking dehydrating medications (" water tablets ") may still be free of pain at rest, even though the heart is already very weak.

Subsequently, the physical examination follows. In doing so, the doctor pays attention to possible heart sounds during auscultation (" eavesdropping "), water retention and congestion of the jugular veins.

Certain laboratory values, such as BNP or ANP, may be detected in your blood. For every diagnosis of cardiac insufficiency, an ECG and a cardiac ultrasound examination (echocardiography) are also included.

In this painless exam, physicians can use ultrasonic waves to evaluate their heart function three-dimensionally and in real time. For further clarification, an X-ray of the chest area ( thorax ) is also recommended. This allows one to assess the size of the heart, the potential accumulation of fluid in the lungs or the stasis of the vessels. For special questions, it is also possible to use tomography (MRI, CT), cardiac catheter examinations or biopsies.

ECG in case of heart failure

In heart failure diagnostics, the ECG plays an important role. The investigation can sometimes provide valuable clues to possible causes of the disease. These include:

  • Earlier heart attacks
  • Arrhythmia
  • Coronary heart disease (CHD)
  • Myokardititis

In the course of the heart failure, there is a gradual increase in size of the affected half of the heart, which can be seen as excessive stress on the ECG. On the basis of, for example, different types of postures, typical signs of enlargement of the heart (signs of hypertrophy) or disorders of arousal, physicians can draw conclusions about the following pathological phenomena:

  • Chronic right heart strain
  • Acute right-heart strain
  • Chronic left heart strain

In addition to the resting ECG, a stress ECG can provide insights into the condition of our heart.

Heart failure in old age

Heart failure is a typical old age condition. Estimates suggest that about 10% of 75-year-olds are affected by the disease.

But why is that? Many diseases of our cardiovascular system, in their course lead to heart failure. Thus, arterial hypertension, cardiac arrhythmia or coronary heart disease, especially in the last stages of life extremely common.

Often, older people do not initially attribute their symptoms directly to heart failure but to other illnesses. Only when, for example, increasing shortness of air and associated limitations in everyday life (eg climbing stairs ) seek victims in their old age the doctor.

In the therapy, the quality of life and well-being of the patient should be in the foreground! At the same time, other diseases must not be forgotten. For physicians, the treatment of heart failure in old age is therefore a special challenge.

Is the heart failure curable?

According to the latest research, heart failure is still not curable.

Intensive efforts can alleviate symptoms, slow the progression of the disease, and reduce the risk of serious complications. However, stopping or even reversing, unfortunately, the disease can not. Theoretically, a heart transplant can cure long-term sufferers. However, since there is extreme scarcity of donor organs, this treatment option is possible only in extreme cases. In sum, the prognoses of a terminal heart failure are comparable to a malignant cancer!

In view of the increasing aging of our society and the increasing number of people affected, the efforts of experts and researchers to find a cure for heart failure increase. Great hopes will be placed in the future, eg in the transplantation of renewable stem cells or the implantation of special pacemakers.

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