Herzversagen

Heart failure means the heart does not pump or relax well enough to meet the body's needs without pressures rising inside it. It does not mean the heart has stopped. Fluid backs up into the lungs and legs, and effort becomes harder.

It is grouped by ejection fraction, the share of blood pushed out with each beat: reduced, mildly reduced or preserved. It is a long-term condition, but modern combinations of medicines and devices have markedly improved symptoms and outlook, and some hearts recover much of their function.

Symptome

• Breathlessness on exertion, and later at rest
• Needing extra pillows or waking breathless at night
• Swollen ankles, legs or abdomen
• Rapid weight gain over days from fluid
• Tiredness and reduced exercise capacity
• Persistent cough or wheeze
• Reduced appetite and nausea

Ursachen und Risikofaktoren

The commonest causes are coronary artery disease with previous heart attack and long-standing high blood pressure. Others include valve disease, cardiomyopathies (dilated, hypertrophic, and amyloid), myocarditis, persistent fast arrhythmias, alcohol, some cancer drugs, congenital defects and, for preserved ejection fraction, the combination of age, obesity, diabetes and hypertension that stiffens the heart.

Wie es diagnostiziert wird

• BNP or NT-proBNP blood test: A low value makes heart failure unlikely. A raised value prompts an echo.
• Echocardiography: Confirms the diagnosis, measures ejection fraction and looks at the valves.
• ECG: Shows rhythm, conduction delay and previous damage.
• Blood tests: Kidney function, electrolytes, iron studies, thyroid and blood count.
• Cardiac MRI: Clarifies the cause by showing scar, inflammation or infiltration.
• Coronary angiography: When blocked arteries may be responsible.

Behandlungsmöglichkeiten

• Four-pillar medication: For reduced ejection fraction: sacubitril-valsartan or an ACE inhibitor, a beta blocker, a mineralocorticoid antagonist and an SGLT2 inhibitor, started early and built up over weeks.
• Diuretics: Furosemide or similar tablets clear fluid and relieve breathlessness.
• Intravenous iron: Improves symptoms when iron deficiency is present.
• Cardiac resynchronisation and defibrillators: CRT improves pumping in people with a wide QRS on ECG. An ICD protects against dangerous rhythms.
• Treating the cause: Revascularisation, valve repair or replacement including catheter techniques, and ablation for arrhythmia.
• Advanced therapies: Left ventricular assist devices and transplantation for a small number of people with end-stage disease.
• Self-management: Daily weighing, modest salt intake, vaccination and cardiac rehabilitation.

Wenn es dringend ist

Seek emergency help locally for severe breathlessness at rest, pink frothy sputum, chest pain, fainting, or a fast irregular heartbeat with feeling unwell. A weight gain of about 2 kg in three days should prompt a same-week call to your heart failure team.

Reisen nach Türkiye zur Behandlung

Heart failure needs frequent dose adjustments and blood tests over months, so its routine care should be near home. A visit can provide a thorough work-up of the cause, a second opinion, or a planned procedure such as CRT or ICD implantation, valve intervention or bypass. Do not fly while breathless at rest or soon after a hospital admission. Transplantation in Türkiye is subject to national allocation rules and is not something a short trip can offer.

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