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A weak heart cannot transport as much blood from the heart for circulation. The body and its organs are therefore supplied with less oxygen and energy. The results are general tiredness and weakness which can even intensify to feeling dazed and confused. A further effect of a reduction in the heart's pumping capacity is that blood collects in front of the ventricles. Blood rich in oxygen flows from the lung into the left ventricle. From there it is expelled into the body circulation. Blood collecting in front of the left ventricle causes a backlog in the lung. This leads to shortness of breath or breathlessness. At first breathlessness is only noticeable during physical exertion. When under physical strain the body needs more oxygen and the heart must beat faster. A weak heart is no longer able to achieve this increase in output. With progressive heart weakness breathlessness occurs even in a resting state. Medically, this is known as dyspnea. This breathlessness can progress so far that people affected in this way only get enough air by standing or sitting erect and supporting themselves with their arms. This state is given the medical term orthopnea. The backlog of blood in the lungs puts the fine blood vessels around the alveoli under great pressure. Blood serum seeps out of the fine capillaries into the alveoli. This can lead to the formation of a lung edema (fluid accumulation in the lungs)and lung function becomes limited. This increases breathlessness. The affected person is forced to cough-upbloody sputumand their breathing rattles.
Right-side heart failure
Blood with a low oxygen content flows from the body circulation into the right ventricle. The right heart chamber pumps this blood into the lungs so that it can be re-fortified with oxygen. If, in the case of right cardiac insufficiency (heart failure), there is backing up of blood into the right heart chamber, the systemic veins become engorged. This can impair all organs and all areas of the body. One consequence of this backing up is that, on the one hand, fluid from the blood can seep into the surrounding tissue, but, contrarily, because of the increased pressure, liquid from the tissue cannot be absorbed into the blood and the lymph ducts.
This can lead to a dilation of the veins of the neck or even to fluid accumulation between the lungs and the chest wall. This space is called the pleural cavity and the liquid congestion is known as pleural effusion. A pleural effusion, in connection with impaired breathing, often causes one-sided pains in the chest and breathlessness. Blue-coloured lips, known technically as lip cyanosis, are also characteristic.
Congestion in the abdominal cavity can cause enlargement of the liver (hepatomegaly) and perhaps the spleen (splenohepatomegaly). This in turn leads to functional restrictions of these organs. Often the bilious flow is hindered. The liver can be considerably enlarged. The affected person suffers from pains in the right upper abdomen and anything from a mild to a serious jaundice and cyanosis (reduced oxygen content in the blood). In severe cases there can also be a water build-up in the abdominal cavity. The stomach is then excessively bloated. The technical term for this is ascites.
The most common signs of right-sided heart failure, however, are water retention in the arms and legs. It is particularly prevalent in the legs. Ankle and lower leg edemas are regarded as diagnosis criteria for right-sided cardiac insufficiency (heart failure). In serious cases the edemas can spread up as far as the sacrum. This condition is called anasarca. The edemas can be equally pronounced on both sides.
NYHA stages
The different stages of heart failure are divided into four categories. They are known as the so-called NYHA stages (NYHA = New York Heart Association):
- Freedom from any complaints, normal physical exertion possible
- Discomfort resulting from heavy physical exertion
- Discomfort even from light physical exertion
- Discomfort in a resting state
