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Heart failure: symptoms & therapy

by Josephine Andrews
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In the case of cardiac insufficiency (cardiac insufficiency, cardiac insufficiency, myocardial insufficiency), the heart is no longer able to supply the body with sufficient blood and thus oxygen. The disease is one of the most common causes of death in Germany. Read everything you need to know about: What is heart failure? What causes can it have? What are the symptoms? How is heart failure diagnosed and treated?

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

I50

Heart failure: a brief overview

  • Causes: primarily narrowing of the coronary arteries ( coronary heart disease ), high blood pressure , heart muscle disease (cardiomyopathies), inflammation of the heart muscle (myocarditis), heart valve defects , cardiac arrhythmias , chronic lung diseases, heart valve defects, heart attack, liver cirrhosis , drug side effects, increased blood lipids, diabetes
  • Symptoms: depending on the stage, shortness of breath ( dyspnea ) during exertion or at rest, reduced performance, tiredness, pale or blue discoloration of the lips and nail beds, edema, especially in the ankles and lower legs, thickened vessels in the neck, rapid weight gain , urge to urinate at night, palpitations, cardiac arrhythmia, lower blood pressure
  • Diagnostics: physical Examination, blood pressure measurement, listening to the heart and lungs , taking blood to determine the biochemical heart failure markers BNP (brain natriuretic peptides), NT-proBNP, and MR-proANP (which are released via a stretch stimulus in the heart muscle), cardiac ultrasound, chest X -ray , ECG / long-term ECG , heart catheter
  • Treatment: Drugs to lower blood pressure (antihypertensives), flush it out (diuretics), slow the heart rate (eg beta-blockers), reduce the effects of certain hormones (aldosterone antagonists) and strengthen the heart (eg digitalis). Depending on the cause, surgery (e.g. heart valves , bypass , pacemaker ), sometimes heart transplantation

Heart failure: causes and risk factors

In the case of cardiac insufficiency (weak heart), the heart is no longer as efficient as a healthy heart. It can no longer supply the tissues of the body with sufficient blood (and therefore oxygen). This can be life-threatening. Heart failure can have a variety of causes:

The most common cause of heart failure is calcification of the coronary arteries ( coronary artery disease, CHD ). Due to the calcium plaque, the vessels that supply the heart muscle are narrowed and the blood can no longer flow through them properly. As a result, the heart muscle is undersupplied and is no longer as efficient.

The second main cause is high blood pressure (hypertension) . In the case of high blood pressure, the heart has to pump harder all the time, for example against constricted vessels in the bloodstream . Over time, the heart muscle thickens to hold more pressure (hypertrophy). In the long run, however, it cannot withstand this load – and the pumping capacity decreases.

Other causes of heart failure are cardiac arrhythmia and myocarditis . Defects in the heart septum and heart valve defects (congenital or acquired) can also lead to heart failure . The same applies to an accumulation of fluid in the pericardium (pericardial effusion or pericardial effusion , especially in pericarditis).

Heart failure can also be caused by heart muscle diseases (cardiomyopathies). These in turn can be caused, for example, by inflammation or excessive alcohol, drug or medication abuse. A special case is the so-called stress cardiomyopathy. After a severe traumatic event, life-threatening cardiac insufficiency suddenly occurs (usually in women after the menopause). In this disease, also known as tako-tsubo cardiomyopathy, the heart function usually returns to normal. So there is no permanent cardiac insufficiency. Life expectancy and quality of life are therefore not affected after surviving stress cardiomyopathy.

Metabolic diseases can also play a role in the development of heart failure. Examples are diabetes mellitus (diabetes) and disorders of the thyroid function (such as hyperthyroidism = overactive thyroid ).

Lung diseases such as pulmonary emphysema or COPD (chronic obstructive pulmonary disease) are other possible causes of heart failure. In particular, the rare right heart failure (functional weakness of the right half of the heart) can be based on a lung disease. Because in the diseased lungs, the vessels are usually also damaged. The blood can no longer flow properly through them (pulmonary hypertension). It builds up in the right heart and puts a strain on it.

In some people, heart failure develops as a result of anemia ( anemia ) or other organ diseases , such as the liver or kidneys. In rare cases, an AV fistula (AV shunt) leads to heart failure. This is an abnormal short circuit between an artery and a vein.

Sometimes medications also cause heart failure. This risk exists, for example, with certain medicines for cardiac arrhythmias, certain cancer medicines (antineoplastic medicines), appetite suppressants and migraine medicines (such as ergotamine). However, heart tumors or cancerous metastases can also trigger cardiac insufficiency.

Systolic and diastolic heart failure

Heart failure is generally composed of two parameters: systolic and diastolic heart failure.

The term systolic heart failure (also congestive heart failure) describes the reduced pumping ability of the heart: the pumping function and the ejection capacity of the left ventricle (ventricle) are reduced. As a result, the organs are no longer adequately supplied with blood. Also, the blood is backing up. This causes edema, for example in the arms and legs or in the lungs.

In addition to the systolic heart failure, there is usually also a diastolic heart failure. This means that the chambers of the heart are no longer sufficiently filled with blood. The left ventricle is usually pathologically altered, making it less flexible and no longer able to absorb enough blood. As a result, less blood is pumped into the systemic circulation. This leads to an insufficient supply of oxygen to the body. Diastolic heart failure occurs primarily in old age. Women are affected more often than men.

Heart failure: classification

Heart failure can be classified according to various criteria:

  • Depending on the area of ​​the heart affected, a distinction is made between left heart failure, right heart failure and global heart failure (both halves of the heart are affected).
  • Depending on the course of the disease, a distinction is made between acute heart failure and chronic heart failure.
  • A rough classification according to the state of the disease is that of compensated heart failure and congestive heart failure.
  • A more precise differentiation is offered by the NYHA classification of heart failure, a classification of the stages according to the severity of the symptoms, published by the New Y ork eart A ssociation .

The European Heart Society (ESC) also classifies heart failure according to the cardiac output . If the left heart continues to pump enough blood, doctors speak of a preserved ejection volume (ejection fraction = EF, normal value 60-70%). In contrast to this is the reduced sputum volume. This results in the following classification:

  • Heart failure with reduced left ventricular EF (HFrEF, EF<40%)
  • Heart failure with moderate EF (HFmrEF, EF = 40-49%)
  • Heart failure with preserved EF (HFpEF, EF is at least 50%)

In the case of right heart failure , the right atrium and the right ventricle of the heart muscle are particularly affected by the heart failure. The right side of the heart is the side to which deoxygenated blood from the body is first directed. From there it pumps the blood further into the lungs in order to “fill up” with new oxygen there. The enriched blood then flows into the left side of the heart and from there into the systemic circulation.

Increased pressure in the lungs due to illness leads to a backlog in the blood flow: The right ventricle then has to pump the blood into the lungs with more force. As a result, the heart is overloaded and damaged over time (pulmonary heart / cor pulmonale ). Excessive strain causes the muscle layer in the wall of the right ventricle to thicken.

If the right half of the heart can no longer generate the extra work, the blood accumulates in the supplying vessels ( veins ). The increased pressure in the veins causes water to collect (oedema) in the body, especially in the legs and abdomen.

Right heart failure usually develops as a result of chronic left heart failure.

In left heart failure , the pumping capacity of the left side of the heart is no longer sufficient. As a result, the blood backs up in the pulmonary vessels (congestion lungs). This is particularly dangerous as it can cause fluid to collect in the lungs (pulmonary oedema). Cough and shortness of breath are typical symptoms.

When global heart failure is present, the pumping capacity of both parts of the heart is reduced. So there are symptoms of right and left heart failure.

Acute heart failure and chronic heart failure

In the case of acute heart failure, the first symptoms appear very quickly, within a few hours to a few days. The causes are usually other diseases. Chronic heart failure develops slowly over the course of several months to years.

Compensated and decompensated heart failure

The terms compensated heart failure and congestive heart failure describe when symptoms occur. Compensated cardiac insufficiency usually only triggers symptoms under stress. At rest, on the other hand, the heart can still perform the required work, so that there are no symptoms.

In contrast, decompensated heart failure causes symptoms such as water retention (oedema) or shortness of breath (dyspnea) even at rest or under low stress.

Doctors use the terms primarily when cardiac insufficiency is already known. If the symptoms are under control (e.g. with the right medication), the heart failure is compensated. However, if this condition gets out of hand (e.g. due to acute illnesses or not taking pills), the heart failure is considered to be decompensated.

Heart failure: NYHA classification

The NYHA (New York Heart Association) has created a generally valid classification of heart failure according to the observable symptoms:

  • NYHA I: No physical symptoms at rest or during everyday exertion.
  • NYHA II: Slight limitations in physical endurance (e.g. 2 flights of stairs), but no symptoms at rest.
  • NYHA III: High limitations even with everyday physical exertion. Complaints such as exhaustion, cardiac arrhythmia, shortness of breath and “chest tightness” ( angina pectoris ) occur quickly, even with little exertion.
  • NYHA IV: Symptoms appear with any physical exertion and at rest. Those affected are usually immobile (bedridden) and dependent on permanent help in their daily life.

Heart failure: symptoms

Heart failure: symptoms of left ventricular failure

The left part of the heart is the part where blood is sent after it has been oxygenated in the lungs. If this half of the heart is no longer working properly, blood backs up in the lungs. This leads to coughing and shortness of breath (dyspnoea). In most cases, the shortness of breath initially only occurs during exercise (exercise dyspnea) and later also at rest (rest dyspnea). For many sufferers, it is particularly noticeable at night when lying down, since then the blood (and thus water) flows back more easily to the weak heart.

Heart failure symptoms with “cardiac asthma”

If the left heart failure progresses, fluid from the pulmonary capillaries overflows into the alveoli. In addition to shortness of breath, this also leads to an increased urge to cough. At the same time, the bronchi can spasm. This symptom complex is also called ” asthma cardiale ” (“heart-related asthma”).

If more liquid enters the lung tissue, a so-called pulmonary edema develops . Its hallmarks are severe shortness of breath and “bubbly” secondary breathing noises. The lack of oxygen causes the skin and mucous membranes to turn bluish ( cyanosis ). Some patients then cough up foamy, sometimes flesh-colored secretions. If fluid collects around the lungs in the pleural space, physicians speak of a pleural effusion . It is also one of the possible heart failure symptoms.

Due to the breathing problems, heart failure patients usually instinctively sit down with an upright and elevated upper body . This relieves the symptoms. In addition, the auxiliary respiratory muscles can be used more effectively in this position.

Heart failure: symptoms of right heart failure

The deoxygenated blood from the body flows into the right part of the heart. It is pumped from the right ventricle to the lungs, where it is oxygenated again. If the right side of the heart is affected by cardiac insufficiency, blood backs up in the veins of the body. In this case, typical heart failure symptoms are accumulation of water in the body ( oedema ). They usually show up first in the legs (leg edema) – especially on the ankles or on the back of the foot, then also on the shins. In bedridden patients, the edema usually develops first over the sacrum .

In the advanced stage of right heart failure, water also accumulates in the organs. Other typical cardiac insufficiency symptoms are impairments of organ functions. Congestion in the stomach (congestion gastritis) is expressed, for example, by loss of appetite and nausea, liver congestion by pain in the upper right abdomen. In addition, fluid can accumulate in the abdominal cavity ( ascites , ascites).

Water retention often causes rapid weight gain , often in excess of five pounds a week.

These swellings can dry out the skin because the pressure in the tissue becomes too great. Possible consequences are inflammation (eczema) , which can develop into open, poorly healing wounds  .

Global heart failure: symptoms

If both halves of the heart are affected by the organ weakness, this is referred to as global heart failure. The symptoms of both forms of the disease (right and left heart failure) then appear together.

Other heart failure symptoms

Heart failure causes fluid retention (edema) throughout the body. These are mainly released (mobilized) at night when the person concerned is lying down. The body wants to excrete the excess fluid that is released through the kidneys. As a result, those affected have to go to the toilet very often at night. This frequent urination at night is called nocturia.

Disturbed breathing occurs particularly in advanced stages of cardiac insufficiency . A common form is the so-called Cheyne-Stokes breathing. This can be recognized by the fact that the breathing depth and thus also the breathing noise periodically rise and fall. It occurs when the central nervous system is no longer properly supplied with blood due to advanced cardiac insufficiency.

Under stress, the heart beats very quickly ( palpitations = tachycardia). Cardiac arrhythmias can also occur, especially in the case of pronounced cardiac insufficiency. The arrhythmia can be life-threatening and must then be treated immediately.

Another classic sign of late-stage heart failure is low blood pressure .

General and very common heart failure symptoms are also reduced performance , tiredness and exhaustion .

Heart Failure: Investigations and Diagnosis

The heart failure diagnosis is based on the recording of the medical history (anamnesis) as well as on physical and instrumental examinations.

In the anamnesis interview, the doctor asks the patient, among other things, about their symptoms and whether there has already been a history of heart disease in the family (genetic predisposition).

There are various options for the physical examination , which vary in complexity and significance. The physical examination is also used to exclude other diseases that also cause heart failure symptoms such as shortness of breath and chest pain (differential diagnosis).

Heart ultrasound ( echocardiography )

Listening to the heart’s activity with a stethoscope provides the doctor with the first indications of a heart valve defect or heart muscle weakness. When listening to the lungs, a rattling noise is a sign of heart failure. It indicates water retention in the lungs. Rattling noises also occur, for example, with pneumonia. The doctor may also hear a third heart sound (this is otherwise only normal in children and adolescents).

In the case of edema in the legs, visible dents can be pressed into the skin. If the doctor measures the pulse, it may change its intensity with each beat ( pulsus alternans ). The examiner also recognizes protruding veins in the neck – a sign of a backlog of blood.

The function of the heart can be assessed with a heart ultrasound (echocardiography). The doctor can see whether there are defects in the valves, in the structure of the heart walls or in the interior of the heart. A thickened wall structure and the ejection capacity of the heart are also made visible in this way.

The blood flow that flows through the heart can be shown using color Doppler sonography . This is a special form of ultrasound examination. With an ultrasound device, the doctor can also see fluid accumulations in the abdomen (ascites) or chest (pleural effusions). At the same time, he checks the vena cava and organs for signs of congestion.

Cardiac arrhythmias are best detected with a long-term ECG . The person concerned gets a small portable device to take home with them. It is connected to electrodes placed over the patient ‘s chest by the doctor and continuously records the heart’s activity. A long-term ECG usually runs over 24 hours. The examination is painless and does not impair the patient.

With a heart catheter examination , the doctor can check whether narrowed coronary arteries are causing the heart failure. The examination usually takes place under local anesthesia. If constricted areas are discovered, they can be expanded immediately. Under certain circumstances, stents (vascular supports) are used to keep the coronary artery permanently open. Stress tests (e.g. on a bicycle ergometer) also help to assess the extent. In some cases, the heart is so weak that these tests are no longer possible.

Blood pressure is also measured if heart failure is suspected. The doctor also orders various urine and blood tests in the laboratory. Among other things, the urine status and a blood count are made. The electrolytes (above all sodium and potassium ) are also determined. Various organ parameters such as creatinine , fasting blood sugar, liver enzymes including coagulation values ​​and protein are also measuredBrain Natriuretic Peptide (BNP, also NT-proBNP). Heart failure leads to an increase in BNP levels, as it is released when the heart is overstretched and stressed. This value is closely related to the severity of heart failure (NYHA classification).

These examinations can also be used to identify disorders of the liver, kidneys or thyroid , for example . Elevated blood lipid levels and diabetes mellitus can also be diagnosed in this way.

In addition, chest x-rays and magnetic resonance imaging (MRI) can help diagnose heart failure.

Heart failure: treatment

Heart failure therapy consists of several components and depends primarily on the severity of the heart failure. Basically, in addition to drug therapy, personal lifestyle is also decisive. In severe cases, a pacemaker or a heart transplant may be necessary.

In general, heart failure is a progressive disease that often leads to death. The therapy guidelines of international specialist societies therefore recommend palliative care for all patients. On the one hand, this includes alleviating the symptoms (e.g. with medication or a surgical intervention). On the other hand, this also includes intensive communication between doctor and patient: Everything important about diagnosis, therapy, course and prognosis of the disease should be discussed together. You should also take care of powers of attorney and living wills. This makes it easier for the patient and their relatives to deal with the disease.

Heart failure: medication

With the drug heart failure therapy one wants to prevent complications of the disease and improve the quality of life of the patients. Depending on the cause of the heart failure, different medications are used. Some medications have been shown to improve the prognosis, while others primarily alleviate existing symptoms.

Drugs from the group of ACE inhibitors (first choice) and beta blockers are very often used in heart failure therapy. According to the latest studies, they have a life-prolonging effect. However, in order for these and other medications to work properly, they must be taken permanently and regularly as prescribed by the doctor.

Overall, various active ingredients are available for heart failure therapy. The most important include:

  • ACE inhibitors: They block a protein that is responsible for narrowing blood vessels in the body . As a result, the blood vessels remain permanently dilated and the blood pressure drops. This relieves the heart and the remodeling of the heart muscle as a result of the permanent overload is slowed down. The doctor usually prescribes ACE inhibitors first (NYHA I).
  • AT-1 antagonists (sartans): They block the action of a blood pressure-increasing hormone. However, they are only used if the patient cannot tolerate ACE inhibitors.
  • Beta blockers (beta receptor blockers):   They lower blood pressure and heart rate, prevent life-threatening cardiac arrhythmias and thus improve the prognosis of heart failure. They are usually used from NYHA stage II, but also earlier if, for example, a heart attack has occurred.
  • Mineralocorticoid receptor antagonists (MRA): These are additionally indicated in NYHA stages II-IV, especially when the heart no longer pumps sufficiently (EF<35%). They increase water excretion from the body, which ultimately relieves the heart. As an “antifibrotic therapy”, this treatment is intended to help reverse the harmful remodeling of the heart muscle.
  • Sacubitril/ Valsartan : This combination of active ingredients is only prescribed in certain cases of chronic heart failure. Sacubitril is a so-called neprilysin inhibitor and thus inhibits the breakdown of hormones in the body that dilate the blood vessels. Valsartan blocks the effects of the blood pressure-increasing hormone angiotensin.
  • Ivabradine: This drug lowers the heart rate. Doctors prescribe it if the heartbeat is too fast (>70/min) even under beta-blockers or if these are not tolerated.
  • Digitalis: Digitalis preparations improve the pumping power of the heart. It does not prolong life, but increases the quality of life and the resilience of those affected. Digitalis (digitoxin, digoxin ) is used for rate control in atrial fibrillation , a common cardiac arrhythmia.
  • Diuretics: Diuretics are diuretic drugs. They excrete stored fluid so that the heart and blood vessels are less stressed. They are therefore always used when the patient suffers from edema.
  • According to the new European guidelines for heart failure, standard therapy includes diuretics, ACE inhibitors and beta-blockers, and MRA in NYHA stages II-IV.

Any medication can also have side effects. A common side effect of ACE inhibitors, for example, is a dry cough. But this is mostly harmless. AT1 antagonists and diuretics can upset the blood salt balance, and beta-blockers can severely slow the heartbeat. If patients with heart failure experience side effects of medication, they should inform their doctor about it. He or she can adjust the dosage or possibly even prescribe a different preparation.

Hawthorn in heart failure

Herbal medicine recommends hawthorn preparations for heart failure. They are said to improve the power of contraction and the supply of oxygen to the heart muscle. They also counteract cardiac arrhythmia (antiarrhythmic effect). From a scientific point of view, no relevant and proven effectiveness of hawthorn in cardiac insufficiency could be proven. If patients still want to try such medicinal plant preparations, then in consultation with the doctor or pharmacist and in addition to conventional medical heart failure treatment.

Iron substitution as an infusion is indicated if the ferritin level is below 100 micrograms per liter or the transferrin saturation is below 20 percent. This measure can make breathing easier. Because iron is a basic building block of our oxygen transporters in the blood, the red blood cells (erythrocytes). Iron deficiency sooner or later leads to anemia, which promotes cardiac insufficiency.

Pacemaker against heart failure

In people with advanced heart failure, a so-called biventricular pacemaker (CRT = cardiac resynchronization therapy) can be combined with drug therapy. Both together can compensate for cardiac insufficiency. With CRT, pacemaker wires are inserted into the chambers of the heart so that they beat at the same rhythm again.

Patients who have survived cardiac arrest or are suffering from dangerous cardiac arrhythmias benefit from an implantable defibrillator (implantable cardioverter/defibrillator, ICD) . The device is used like a pacemaker. It delivers an electric shock when it detects a dangerous arrhythmia.

Sometimes doctors also use a combination device from both systems, the so-called CRT-ICD system (also CRT-D system).

surgical measures

If heart failure worsens despite ongoing therapy, it may be necessary to replace the old heart with a new one ( heart transplant ). Patients can receive a donor heart or an artificial heart. This can lead to various complications such as rejection reactions.

Narrowed coronary arteries (coronary heart disease, CHD) are among the most common causes of heart failure. The impaired blood flow can be improved surgically by widening the vessels as part of a heart catheter examination ( balloon dilatation , possibly with the installation of a stent = vascular support). You can also do a bypass .

If defective heart valves are the reason for the heart failure, an operation may also be necessary. Sometimes a “repair” ( reconstruction) of the heart valve is possible. In other cases, the defective heart valve is replaced (biological or mechanical valve prosthesis ).

Heart failure: What you can do yourself

If the doctor has diagnosed you with heart failure, you should definitely ensure a healthy lifestyle. This minimizes risk factors and improves the quality of life. You should therefore heed the following:

  1. Diet: Eat a diet with enough fruit and vegetables. If possible, avoid animal fats and eat low in salt. Salt ensures that water is retained in the body. The heart then has to work harder.
  2. Fluid Intake: Discuss the amount of fluid you should be hydrated with your doctor. In general, if you have heart failure, you should never drink three or more liters a day. In most cases, a liquid intake of about 1.5 liters per day is ideal.
  3. Exercise: An effective therapy for heart failure always includes exercise and moderate physical activity. In everyday life, for example, you can walk to work and take the stairs instead of the elevator. Walks, light strength and coordination exercises, swimming , cycling and walking are also recommended. You can also join a sports group for heart patients (rehab sports). Discuss with your doctor which physical activities and sports make sense in your case and to what extent you are allowed to train.
  4. Body weight: Being overweight has a very negative effect on heart failure. From a body mass index (BMI) over 40, the weight should definitely be reduced. Weight loss should be controlled and slow and always under the supervision of a doctor. Heart failure patients of normal weight should also check their weight regularly, preferably daily. A very rapid and large weight gain can be an indication of water retention in the body. Rule of thumb: If you gain more than three pounds in a night, more than five pounds in three nights, or more than five pounds in a week, you need to see a doctor.
  5. Alcohol: Minimize your alcohol consumption because alcohol can damage heart muscle cells. Women are advised not to consume more than 12 grams of pure alcohol (a standard drink) per day. Men should not consume more than 24 grams of pure alcohol (equivalent to two standard drinks) per day. Patients whose heart failure was caused by excessive alcohol consumption (alcoholic cardiomyopathy ) should avoid alcohol altogether.
  6. Smoking: It is best to give up smoking completely!
  7. Get vaccinated: Get vaccinated regularly every year for influenza and every six years for pneumococcus.
  8. Diary: Keep a diary of any symptoms you notice. So you can’t forget anything the next time you visit the doctor.

Sport in heart failure

Heart failure patients have long been advised to rest and avoid physical exertion. However, many scientific studies have found a positive effect of moderate endurance training in heart failure. Physical activity is not only safe, it is an important part of treatment.

Sport in heart failure improves the physical performance and quality of life of those affected. However, it is still unclear whether the activity also has an effect on the life expectancy of the patients.

Warning: If the patient has an acute medical condition such as acute coronary syndrome, shortness of breath at rest, water retention in the tissues or myocarditis within the previous two days, the patient should not do any sport.

Beginning of training in cardiac insufficiency

Before the patient can start training, the doctor carries out a spiroergometry . This allows him to determine the maximum performance of the patient. The patient then receives a tailor-made training plan.

Which sport for heart failure?

There is no universal training plan for people with heart failure. As with recreational sports, the variation of training is important to make progress. Sport in heart failure consists of three building blocks:

  • High-Intensity Interval Training (HIT): three times a week
  • moderate endurance training: three to five times a week
  • Strength endurance training: two to three times a week

High Intensity Interval Training (HIT)

HIT usually begins with an active “rest” phase. This means that the athlete moves at medium intensity, i.e. at 50 percent of his maximum performance. The duration is usually about three to five minutes. This is followed by the intensive training phase with a load of 60 to 100 percent of the maximum capacity. He does this for up to three minutes.

Note: The duration of the training phases in HIT must always be adapted to the individual health and fitness level of the person concerned.

With HIT, the rest phase and the intensive phase alternate and form a cycle. In a training session, several cycles follow one another. How many cycles form a unit is always adapted to the performance and the condition of the patient. The training lasts 15 to 30 minutes in total.

People with heart failure should do high-intensity interval training three times a week.

Moderate endurance training

With moderate endurance training, the training intensity remains the same over a longer period of time. In the beginning, the patient should train at 40 to 50 percent of their maximum capacity. If he sustains this intensity for 10 to 15 minutes, the intensity can be increased.

The person concerned follows the so-called ÖLI rule (= more often, longer, more intensively). This means that the training frequency is increased first, then the duration and finally the intensity.

So if the endurance training can be completed for 15 minutes, the training frequency is increased to three to five units per week. In the next step, the training units are extended: instead of 15 minutes, the patient then trains for 30 to 45 minutes. Finally, the intensity is increased: Instead of 40% of the maximum performance, it first goes to 50 percent, then to 70 percent and then up to 80 percent.

Suitable endurance training for people with heart failure is, for example:

  • (quick) walk
  • Walking/Nordic walking
  • Jog
  • step aerobics
  • Cycling or bicycle ergometer
  • Climbing stairs (e.g. on the stepper)
  • To swim
  • rowing

Three to five sessions of endurance training, each lasting 15 to 30 minutes, are recommended for people with heart failure.

strength endurance

Strength and resistance training is also important for people with heart failure. Because many of those affected show the so-called wasting syndrome in the advanced stage. This leads to a reduction in muscle mass and loss of strength.

Dynamic strength endurance training with little weight and many repetitions is recommended. In order to create a training plan, it makes sense to determine the so-called “one repetition maximum” (1-RM), i.e. the maximum weight for one repetition.

Ideally, the patient begins training at an intensity below 30 percent of 1RM for five to ten repetitions. Then slowly increase the workout to 30 to 50 percent of your 1RM for 15 to 25 reps.

Note: Correct breathing is particularly important in this training: Despite exertion, forced breathing should be avoided.

Patients with heart failure should do strength-endurance training two to three times a week.

Heart failure: disease course and prognosis

Heart failure is not curable. Only in a few cases can the symptoms be reduced to such an extent that a completely unimpaired life is possible. However, each patient can influence whether and how far the disease progresses. By changing their lifestyle and dealing with the disease consciously , those affected can do a lot to improve their prognosis.

In addition to the lifestyle, it is above all the adherence to the therapy (compliance) that patients have to consider. With therapy adherence or compliance, the doctor describes the extent to which patients adhere to the prescribed and discussed therapy. This includes, for example, taking the prescribed medication regularly, even if there are currently no symptoms at all. Complications and deterioration of the general condition can be prevented in advance.

Compliance also includes regular check-ups with the general practitioner. If blood values ​​(e.g. electrolytes, kidney values ) are outside the normal range, more frequent checks are necessary.

Also important in the case of cardiac insufficiency: If you suspect that your condition has deteriorated, consult a doctor immediately!

Heart failure: life expectancy

Statistically, half of all patients die within five years of being diagnosed with heart failure. However, life expectancy and the quality of life of patients have increased in recent years due to ever-improving medical care. Those affected now have a better prognosis and, despite the disease, still have a comparatively high life expectancy. In individual cases, this depends on the type (genesis) of the disease, the age of the person affected, possible concomitant diseases and personal lifestyle.

“Heart failure” is often given as the cause of death on death certificates. This refers to acute heart failure , which in many cases leads to death.

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