Heart failure

What is heart failure?

Heart failure is the inability of the heart to supply the body with sufficient amounts of blood and oxygen. This situation may arise when the heart muscle is too weak, or when the ventricles become stiff and can no longer fill properly between beats. In both cases, the heart's ability to pump blood around the body is reduced, resulting in reduced exercise capacity and reduced cognitive functioning.

Usually a chronic, progressive condition, heart failure can affect primarily the left or the right side of the heart, or it can affect both sides equally. This is why physicians refer to left-sided heart failure and right-sided heart failure. Heart failure is common. In fact, it is one of the most common causes of hospitalization in Germany. Treatment for heart failure constitutes one of the areas of specialization of the Brandenburg Heart Center, and its expertise makes it one of the leading centers in the Brandenburg region and beyond.

What are the main symptoms?

Heart failure is categorized according to the severity of symptoms, and is usually divided into four classes. While patients with class I heart failure are not affected by any symptoms, patients with class IV disease are usually affected by their symptoms even when at rest.

• Dyspnea (shortness of breath) is the main symptom of heart failure. Initially, patients only experience dyspnea during physical activity, such as e.g. when climbing stairs (exertional dyspnea).
• In left-sided heart failure, patients also typically experience: an increased breathing rate, a persistent cough and restlessness.
• Sometimes, patients may feel dizzy or faint.
• The following symptoms are indicative of right-sided heart failure: Edema affecting the legs and the feet, increased frequency of night-time urination and, sometimes, lack of appetite and a feeling of fullness.
• An irregular heartbeat (arrhythmia) is also a common symptom of heart failure.

What are possible causes?

Heart failure usually develops as a consequence of long-standing cardiovascular disease. Causes of heart failure include:

• Coronary heart disease and heart attack
• High blood pressure
• Cardiac arrhythmias
• Heart valve disease
• Disorders of the heart muscle (cardiomyopathies)
• Inflammation of the heart muscle
• Certain lung disorders (COPD, emphysema)
• Diabetes
• Certain medications (e.g. cancer medications)
• Tumors of the heart

Diagnosis of heart failure

Frequently, a physical examination is all that is needed to diagnose heart failure. Subsequent diagnostic steps may include: 

• Echocardiography to examine the structure and function of the heart
• X-ray examinations of the chest and lungs
• ECG or an ambulatory ECG (mobile heart monitor) to assess the electrical activity of the heart
• Blood tests, e.g. analysis of heart failure-specific markers (brain natriuretic peptide, BNP)
• Cardiac catheterization to help assess the coronary arteries for disturbances in normal blood flow
• Exercise challenge spirometry (measuring the amount of air that can be inhaled and exhaled following exertion) as an objective measure of exercise capacity and the impact that heart failure symptoms have on a person's ability to perform everyday tasks
• If appropriate, additional specialist technologies such as MRI or CT scans, myocardial biopsy and nuclear imaging

Treatment for heart failure

Considerable improvements in the treatment of heart failure over the past 20 years have led to a much improved outlook for patients with heart failure. The introduction of electrophysiology procedures has made a particular impact in this regard. At Brandenburg Heart Center, we specialize in this type of treatment, and our reputation and expertise have made us one of the foremost referral centers in the Brandenburg region and beyond.

Treatment for heart failure follows a stepped care model that includes a number of different treatment approaches. Particularly in patients with severe symptoms, treatment follows an interdisciplinary approach. Treatment strategies include the following:

• Measures aimed at modifying the patient's risk factors for heart failure and their lifestyle
• Modern drug treatment
• Electrophysiology - pacemaker systems including implantable defibrillators
• Specialized catheter-based procedures (e.g. catheter ablation)
• Surgical measures (e.g. ventricular assist devices)
• Follow-up treatment at our "Herzinsuffizienzambulanz" (Heart Failure Outpatient Clinic)

Measures aimed at modifying the patient's risk factors for heart failure and their lifestyle

Therapy is based on general lifestyle measures including: weight reduction (where applicable), dietary changes, salt restriction, fluid restriction, reduction of coronary risk factors (nicotine, cholesterol), regular moderate-intensity physical exercise.

Modern drug-based treatment for heart failure

Modern drug-based therapy for heart failure consists of various medications including diuretics, beta blockers, ACE inhibitors and angiotensin II receptor blockers (ARBs). Even cardiac arrhythmias, a common feature of heart failure, can be treated with medication.

Pacemaker systems including implantable defibrillators
In addition, pacemakers can be used to prevent arrhythmias in patients with heart failure. "Cardiac resynchronization therapy" represents a specialized form of pacemaker therapy. In some patients, the two main chambers of the heart (the ventricles) beat in an uncoordinated fashion. In these cases, a special type of pacemaker (biventricular pacemaker) is used to resynchronize the ventricles, thus making the heart more efficient.

Specialized catheter-based procedures
Specialized catheter-based procedures can be a useful tool in patients with heart failure. Arrhythmias that are particularly difficult to treat, for instance, can often be controlled using a procedure referred to as catheter ablation: using a special catheter - introduced via an artery in the groin - the physician can destroy (ablate) areas of the heart muscle responsible for producing abnormal electrical impulses. In many cases, this procedure manages to re-establish a normal heart rhythm. In some cases, a new minimally-invasive, catheter-based procedure can be used to repair defective heart valves that may be contributing to heart failure symptoms.

Surgical measures
Aside from heart valve surgery, the surgical measures available for patients with heart failure include the implantation of a device that helps to support the heart's function. This small pumping device is implanted into the chest, where it receives blood from one of the ventricles and pumps it into the aorta. While in severe cases of heart failure, these mechanical pumps can take over part of the heart's activity, a small number of patients may benefit from a heart transplant. The devices used at the Brandenburg Heart Center are left ventricular assist devices (LVADs), and patients who have had LVADs implanted receive regular long-term follow-up care through our "Herzinsuffizienzambulanz" (Heart Failure Outpatient Clinic).

Follow-up treatment at our "Herzinsuffizienzambulanz" (Heart Failure Outpatient Clinic)
Heart failure is usually a chronic condition. Patients with severe heart failure, who experience symptoms even while at rest (NYHA class ≥ III), can be treated at our Heart Failure Outpatient Clinic. The patient's treatment is coordinated by the Outpatient Department's cardiologist, in close cooperation with the patient's general practitioner. The Departments of Cardiology and Cardiac Surgery work closely together to find the best possible treatment strategy for each individual patient.

Where can I find out more about heart failure?

Information, research, care

Kompetenznetz Herzinsuffizienz (Competence Network Heart Failure):
www.knhi.de

Contact person for questions on heart failure

PD Dr. Christian Butter, Head of the Department of Cardiology
Tel. +49 3338-69-4610 

Sources

 Kardiologie compact, Mewis/Riessen/Spyridopoulos