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With heart failure, the heart pumps less than usual and blood flows more slowly into the body. As a result, the heart cannot provide enough oxygen and nutrients that the organism needs.
Symptoms of heart failure
The typical symptoms of heart failure are swollen limbs, breathlessness and exhaustion. They are usually less dramatic than those associated with a heart attack, but they also often threaten life. In economically advanced countries, up to one in five people develop heart failure at some point in their lives.
A modern threat?
The American evolutionary scientist Jared Diamond systematically compared traditional cultures in Papua, South Africa or the Amazon with today's industrial societies and found that in traditional cultures the main dangers are inefectious diseases, i.e. diseases that are caused by parasites (worms, mites, lice, fleas, etc .), Viruses, bacteria and fungi. However, the main causes of death in industrialized countries are non-infectious diseases such as heart disease or cancer.
The fact that people in industrialized countries suffer less from infectious diseases is primarily due to the successful vaccination programs, but also due to advanced public hygiene, effective sewage treatment plants and disease protection. Even in the 19th century, infectious diseases were a major cause of death in England and Germany. Hunters and gatherers as well as traditional small farmers, on the other hand, are as helpless as they are directly exposed to pathogens.
Hunters and collectors
In the case of heart diseases, on the other hand, the lifestyle is decisive: people in traditional cultures rarely suffer from being overweight, they hardly have too much body fat, they move to a great extent in everyday life, and they usually resort to a low-calorie and varied diet that intervenes includes a wide range of berries, fruits, roots and herbs.
A major risk for diabetes and heart diseases, namely the much too high intake of sugar in the industrialized countries, does not play a role for them, since they only consume sugar in the form of honey or fruits, which only represent a small part of their diet.
Diamond, however, admits one problem with such comparative studies: Contrary to the romantic ideas of “natural people”, life expectancy in traditional cultures is generally much lower than the average in the industrialized countries. This does not change the hotspots of the extremely old in the Caucasus or parts of China.
However, certain heart diseases particularly affect people over 65, i.e. at an age that is far above the average maximum age for traditionally living Papuans, Maori or Yanomami.
Conversely, some "indigenous people" suffer from heart disease to a large extent when they consume industrial food. The Pima Indians in the American Southwest suffer extremely from overweight, diabetes and heart failure. The reason is that for many centuries their organism had been preparing for a low-calorie, low-fat and virtually sugar-free diet: rabbits, lizards, cacti or roots.
The excess of fat and sugar substances in the American industrial food burden the organism in general - for the Pima, however, such a diet means a massive shortening of life.
A global question
Preventing heart failure diseases and deaths should be a global priority in health policy. In contrast to the increasing and huge number of people who live with heart failure and die from it, awareness of this problem is small - among the masses, politicians and even some health care professionals.
Although there is no general cure for heart failure, many cases can be avoided and most patients treated effectively to improve quality of life or, in the worst case, to survive.
Regular physical activity can reduce the symptoms. However, you should entrust yourself to a specialist who will work out an exercise program with you. Such programs are most successful for middle-aged people with chronic heart failure. People with heart failure at an advanced age, with comorbidities who have to take a lot of medication or suffer from depression need a much more complex management of their symptoms.
Heart failure requires lifelong care, which is why management is a multidisciplinary undertaking that involves both families and patients. Advice on lifestyle changes includes the following, among other things: Refraining from smoking, appropriate nutrition and nutrient intake, controlled use of alcohol depending on the cause of the condition.
Physical training also plays an important role in managing heart failure. Such exercises are only suitable for people with a stable clinical picture and in connection with drug treatment. The exercises should follow a formal program, for example thirty minutes of moderate activity 5 days a week with warm-up and relaxation exercises.
Types of heart failure
To understand what happens to heart failure, it helps to familiarize yourself with the anatomy of the heart and its work: it consists of two independent pumping systems, one on the right, one on the left.
The symptoms can traditionally be divided into “left and right side”, recognizable from the fact that the right and left side of the heart have different functions in the circulation of the blood.
Left-sided heart failure is the most common type. It is a condition that threatens life because the heart cannot pump enough blood into the body. The left side of the heart brings blood, rich in oxygen, from the lungs to the rest of the body. When the left side's ability is compromised, it can no longer pump enough oxygen-rich blood into the body, which is the cause of many organ failures.
Common causes of left heart failure include excessive alcohol consumption, heart attack, inflammation of the heart muscle, overactivity of the thyroid gland, and heart failure as a result of previous heart attacks.
A weakness on the right side of the heart usually follows a weakness on the left. However, it can also result from damage that follows a heart attack on the right side. If the left side fails, the fluid squeezes back into the lungs, damaging the right side of the heart. If it loses its ability to pump blood, the blood flows back into the veins, which often causes the body to swell, especially in the legs.
High blood pressure
Hypertension can increase the risk of heart failure for a long time. He is considered a creeping killer. Often, those affected have no symptoms.
If the heart has to apply higher pump frequencies, the muscles are chronically overworked. The heart enlarges, especially the left ventricle. Over time, the left wall of the heart becomes thicker to do its job. However, the thicker the muscle, the more oxygen it consumes, so the better the blood flow is. The heart is weakened by this permanent permanent load. The contractions pump less blood each time.
Atherosclerosis arises when plaques form in the arterial walls. This causes the veins to narrow and the blood to flow more poorly. Blood clots can even stop blood flow now. A weakness that already exists due to the narrow arteries can now lead to a heart attack or stroke.
Heart valve defect
Heart valve disorders arise when one or more of the valves is damaged. The heart has four of these valves that open and close with every heartbeat.
Birth defects, age-related changes, infections and other circumstances can impair the function of the heart valves. Intact heart valves ensure that the blood flows with sufficient force in the right way at the right time. In the case of heart valve diseases, however, these valves cannot open or close sufficiently, so that either blood flows back into the heart chambers or atria or insufficient blood can flow from the corresponding atrium into the chamber or from the corresponding chamber into the circulation.
Shortness of breath and irregular pulse
Symptoms of a heart valve defect include chest pain, irregular pulse, shortness of breath, and swelling. Shortness of breath takes your breath away. Too little oxygen gets into the body, which is why patients can do little. Choking feelings torment them and trigger fear.
Those affected gradually learn to avoid behavior. They reduce the stress in everyday life and hardly notice the symptoms. Working in front of the laptop also ensures that they do not notice the symptoms: breathing problems only become apparent when you exercise.
If the disease progresses, however, it becomes clear that the patient is experiencing difficulty in breathing when climbing stairs and walking, and breathing hurts them. If the heart valves are damaged, the heart can no longer pump enough blood and the blood builds up in the lungs (left heart) or veins (right heart). This triggers shortness of breath and shortness of breath.
This disease leads to heart failure because it damages the heart muscles. The muscle grows, becomes thicker, and in rare cases the muscle tissue is replaced by scar tissue.
The most common form of this disease is dilated (expanded) cardiomyopathy, which mainly affects middle-aged people. It affects the ventricles and takes its course when the heart muscles expand and become thinner. The cause is unknown, but since a third of the sufferers already have a family history of this disease, a genetic burden appears to play a role.
The hypertrophic cardiomyopathy on the other hand, it is presumably acquired and can affect people of all ages, both men and women. It is probably the result of excessive strain on the heart and therefore occurs particularly in people who do extreme competitive sports at a young age. This ensures that the cells of the heart muscle enlarge and the heart walls thicken.
It is very rare restrictive cardiomyopathy. With this disease, the heart sequences are normal, as is the thickness of the heart walls. The damage here is in the relaxation phases. The cause is an inefficient heart muscle that does not allow the ventricles to fill up with blood normally. This leads to a backflow, in which the blood flows back into the atria, as well as into the lungs and the body. In contrast to the first two forms, almost exclusively older people are affected.
Diseases of the lungs
The heart-lung system is inextricably linked, maintains the bloodstream and thus ensures that we can live. Damage to the lungs therefore affects the functioning of the heart.
A whole series of diseases of the lungs can cause heart failure because the air supply is cut off and too little oxygen gets into the heart. As a first symptom, this leads to shortness of breath and cough. However, breathing difficulties are not necessarily associated with diseases of the lungs: The spectrum of diseases that go hand in hand with breathing problems is so large because breathing stresses various organs: first of course the lungs, but also the heart, muscles and that Brain - even the bones are involved.
Breathlessness is usually a sign of a lack of oxygen or an excess of carbon dioxide. Both substances are balanced in a functioning organism. If this is disturbed, we notice it as a shortage of air. Diseases that cause these symptoms are: asthma, bronchitis, all forms of pneumonia, tuberculosis, lung and larynx cancer, heart attack, heart valve defects, myocardial inflammation, coronary heart disease and diseases of the pericardium.
Shortness of breath also arises from allergic shock, severe overweight, diabetes, iron deficiency, kidney failure and thyroid disorders. Psychologically related breathing difficulties occur with panic attacks, anxiety disorders and hyperventilation.
Heart failure can develop if the lungs can no longer function properly. Then those affected have too little oxygen in their bloodstream and the heart is no longer adequately supplied.
However, while diseases of the lungs can lead to cardiac insufficiency, symptoms such as shortness of breath and shortness of breath are similar in lung and heart diseases, making it difficult to diagnose what is the result and what is the cause.
Diseases of the thyroid and heart are closely linked. This is not surprising because the thyroid gland affects almost every cell in the body. An imbalance in the hormonal gland can lead to dramatic fluctuations in blood pressure, which can disrupt the heart's rhythm and overall cardiac functions. The heart muscle cannot work without the thyroid hormones, more precisely it cannot pump enough blood into the body.
A thyroid that works normally produces 80% thyroxine (T 4) and 20% triiodothyronine (T 3). It controls metabolism through the thyroid hormone, which it produces by extracting iodine from the blood and ingesting it into the hormones. These hormones are unique because they absorb and use iodine. That's why every other cell relies on the thyroid gland.
The thyroid hormones have a significant effect on long-term physiological processes such as physical development, body growth and metabolism, and a deficiency is not compatible with normal health.
Risk factors for heart failure
Some people are at greater risk of heart failure than others. While it is not possible to predict with certainty who will develop it at what time, there are some known risk factors. These include age, genetic disposition and overweight.
Age and gender
With age, the likelihood of heart disease increases in both sexes. About four in five people who die from coronary artery disease are 65 and older. It is therefore important to undergo regular cardiac examinations with increasing age, even if a person shows no symptoms.
Gender also plays a role. Heart disease has long been considered a male disease. This is not generally true because it also affects women. However, there is a tendency for heart disease to affect men earlier in life - but from the age of 65, the risk for women is just as great.
Ethnicity plays a role in heart diseases, but this is in a complex interplay with related factors, namely social, cultural and economic. This includes education, language difficulties, racism, different health systems, ideas of "traditional medicine". These interact with biological factors and social networks, for example risk factors such as smoking and alcohol. In general, however, there is no connection between the genetic makeup of human groups and heart failure.
Some risk factors are more common in some regions of the world than in others: South Asians, for example, show higher rates of diabetes but a lower level of stress than Central Europeans. East Asians often have high blood pressure, African Americans suffer from both hypertension and diabetes, and their risk of developing heart failure is 30% higher than that of “white” Americans.
Overall, South Asians, East Asians, and Africans have a lower risk of developing heart failure than Central Europeans. This is no coincidence, because the risk factors such as high-fat and high-calorie diets, a high level of stress, “flexible” working hours, combined with sedentary work and insufficient exercise, characterize (post) industrial societies.
Family history and genetics
The genetic requirements have an effect on heart diseases. This does not only show up with a heart attack, but already with high blood pressure or high cholesterol levels. Of course, risk factors such as smoking, obesity or excessive alcohol consumption increase this innate disposition, but heart failure affects sons and daughters, brothers and sisters when one smokes a chain and the other does not at all.
However, doctors have to distinguish very precisely between traditions passed on in the family and the basic biological equipment. A traditional lifestyle is often crucial. Because even if the genes can affect heart diseases, there is no specific gene that increases the risk alone - except for congenital defects in the heart valves, ventricles, arteries, blood circulation, etc.
Diabetes is characterized by a high level of blood sugar. The body usually breaks down glucose from food and brings it into the body's cells. The cells use a hormone called insulin to turn glucose into energy. People who have diabetes 1 of 2 are at higher risk of developing heart failure.
Insulin is made in the pancreas, behind the stomach. It also helps to save energy. Without the hormone, the body would not be able to function. Insulin enables the cells in the muscles, fat and liver to absorb glucose that is in the blood. This glucose can be turned into fat if necessary. Insulin is also necessary to break down fat and proteins.
Diabetics artificially inject insulin because they do not produce enough of it themselves. You will usually be given an injection. Over time, the blood sugar level that drives diabetes up can damage the blood vessels and nerves that control the heart. The longer someone has “diabetes”, the higher the risk of developing heart disease. In addition, diabetics are affected by heart problems earlier in their lives than non-sick people - the risk is twice as high.
Obesity is a known risk factor for heart failure. The rule applies: the higher the overweight and the fat, the higher the risk of developing heart disease. On the one hand, the reason for this is that being overweight brings with it other risk factors for heart diseases such as diabetes, high blood pressure and high cholesterol levels. Being overweight is also a danger.
Obesity means extra work for the heart
Extreme overweight means a permanent work overload for the heart. This in turn leads to a thickened and enlarged left side of the heart in the medium to long term. This in turn can lead to heart failure, an irregular pulse and even cardiac arrest and / or a heart attack.
Shortness of breath
Severe overweight can cause chronic shortness of breath, which then often accompanies developing heart failure: Shortness of breath is not a medical diagnosis at first, but a sensation. The body breathes more intensely because those affected do not get enough oxygen. Such shortness of breath differs from chronic shortness of breath in that those affected breathe deeply at first, only with increased breathing frequencies do the breaths become shallower - people breathe shorter because they breathe faster.
Inhalation transports the air to the lungs, where the oxygen gets into the blood and in the alveoli. The oxygenated blood pumps the heart into the circulation. The respiratory system, heart, vessels and blood work together.
Each of these “building blocks” is impaired if it receives too little oxygen. Receptors in the body detect the undersupply, notify the brain and this sends the information breathlessness and the order to increase the respiratory rate.
Obesity can also lead to an overproduction of the hormone leptin, which causes excessive internal inflammation like the dangerous arteriosclerosis of the heart. In addition, too much leptin prevents insulin metabolism. This can destroy heart cells. These are replaced by fat cells in obese people. As a consequence, this leads to fatal disturbances in the heart rhythm. The vernacular speaks correctly of "heart fat".
Another complication that arises from being overweight is breathing arrest while sleeping. Those affected snore heavily, but their breath kept coming back. Most of the time they wake up and take a breath, but the recurrent cessation of breath leads to a permanent undersupply of the body with oxygen and exposes the patient to an increased risk of developing heart failure.
Prevention: How to prevent heart failure
Heart failure cannot always be avoided, the causes are decisive. However, you can contain risk factors.
1.) Avoid negative stress, especially if you are constantly exposed to it. Those who learn to take breaks, take time to take a nap, sleep well at night, go on weekends and take a longer break instead of struggling to support a healthy heart in their work.
2.) Avoid excessive nicotine, alcohol and caffeine consumption.
3.) Even if you don't notice any symptoms. Go for a heart exam regularly, especially from the age of 50. (Somayeh Khaleseh Ranjbar; translated and supplemented by Dr. Utz Anhalt)
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dr. phil. Utz Anhalt, Barbara Schindewolf-Lensch
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ICD codes for this disease: I50ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.