Heart failure

Cardiac Insufficiency

Cardiologie Luxemburg

Heart failure

Cardiac insufficiency

In principle, any heart disease can lead to heart failure (cardiac insufficiency). The most common cause, however, remains coronary artery disease. This is a circulatory disorder of the heart. Other common causes include heart muscle and valve disorders.


Overview of heart failure causes

  • Coronary artery disease (CAD)
  • Inflammation of the heart muscle
  • Heart valve defect
  • High blood pressure (arterial hypertension)
  • Cardiac muscle enlargement (dilated cardiomyopathy)
  • Inflammation of the heart muscle (myocarditis)
  • Arrhythmia
  • Dysfunction of the heart valves (heart valve diseases)
  • Accumulation of fluid between the heart and the sac surrounding the heart (pericardial effusion).
  • High blood pressure in the lung arteries (pulmonary hypertension)


Various options are available for ensuring the proper diagnosis of heart failure. The primary method is the physical examination.

The following diagnostic procedures are also available:

  • Blood test
  • ECG
  • (Chest) X-ray
  • Ultrasound examination (heart)

Laboratory analysis
To diagnose heart failure, the determination of the BNP value, i.e. the blood concentration of the “brain natriuretic peptide”, is particularly helpful. Depending on the severity of the cardiac insufficiency, moderately to greatly increased values can be noted, whereas with a normal, low BNP level (in an untreated patient), heart failure can be mostly be ruled out.

An ECG examination (tracing of the heart’s electrical activity) can help determine the cause of the heart failure – for example, a heart attack suffered in the past. The trace of the heart’s electrical activity can be used to determine cardiac arrhythmias, such as a pulse that is too slow or too fast, or intraventricular conduction disorders. An exercise ECG can often provide important additional information about how the heart is performing.

Echocardiography (cardiac ultrasound)
The ultrasound examination of the heart is the most important method for investigating heart failure. It allows quick and above all risk-free assessment of heart muscle function, the heart valves, and the pericardium. On the one hand, the suspected diagnosis of heart failure can be confirmed or excluded; on the other hand, significant causes can be determined.

X-ray examination
Using an X-ray of the chest, a image of the heart and lungs, among others, can be generated. If the heart failure has already progressed, an enlarged heart and an enlargement of the pulmonary veins (congestion) will be visible. However, the importance of X-ray examinations in diagnostics has decreased, since cardiac ultrasound provides more reliable results.

Cardiac catheterization
Discovering whether a circulatory disorder is causing heart failure requires coronary angiography, i.e. the contrast-agent-assisted imaging of the coronary arteries. As part of the cardiac catheterization, the cardiac cavities are also displayed with the assistance of a contrast agent. If the diagnosis is confirmed, appropriate treatment can then be given.


Patients affected by severe and acute heart failure (congestive heart failure) usually have to be treated in a hospital setting first.

In general, an attempt should first be made to determine the cause of heart failure and to eliminate it:

  • If coronary artery disease (CAD) is found, then balloon dilatation, stent implantation or bypass surgery can help
  • If increased blood pressure is found, then steps must be taken to lower it
  • If a significant heart valve defect is found, surgical valve replacement must be considered

Treatment with medications is usually needed regardless. The exact form of the drug therapy depends on the symptoms and the severity of the heart failure. The medication can alleviate the symptoms (symptomatic therapy) and/or increase the life expectancy of the patient (prognostic indication).

In addition, a healthy lifestyle is very important: If a person is overweight, weight reduction is necessary. The diet should be changed in consultation with the doctor, as well as the daily fluid intake. Of course, physical exercise is also very important. Alcohol consumption should be restricted and nicotine avoided completely.