Heart Failure Therapy And Rehabilitation

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Heart Failure Therapy And Rehabilitation
Heart Failure Therapy And Rehabilitation

Video: Heart Failure Therapy And Rehabilitation

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Video: Cardiac Rehab Successful for Heart Failure 2023, January

Heart Failure: Therapy & Rehabilitation

Heart failure may or may not be curable, depending on the underlying causes. In sick people whose heart failure is caused by excessive alcohol consumption, heart function can return to normal if they completely refrain from alcohol. The successful treatment of an underlying disease can also have a positive effect on heart failure. Heart failure is a common reason for hospitalization. In many cases, subsequent rehabilitation is beneficial or even necessary.


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  • more on the subject
  • Advice, downloads & tools
  • Healthy lifestyle
  • Medical therapy
  • What can I do myself?
  • ">Pacemaker & Co.


  • Surgical interventions on the heart
  • Inpatient stay & rehabilitation
  • How are the costs going to be covered?


The earlier therapy is started, the more effectively the symptoms can be alleviated and the progression of the disease delayed. It includes treating the causes, living a healthy lifestyle, and medication. If none of these measures lead to a satisfactory result, implantable devices such as cardiac pacemakers to support the heart and, as a last but effective option, a heart replacement (artificial heart, heart transplant) are available for certain patients. Cardiac resynchronization therapy, which technically works like a pacemaker and re-synchronizes an asynchronously beating heart, can significantly improve the pumping function of the heart and the patient's performance.A built-in defibrillator can detect and interrupt life-threatening arrhythmias. If none of this works, there is also the option of installing a mechanical support system or a heart transplant.

The aim is to effectively remove the ground from the weak heart, e.g. through the following measures:

  • Conscientious control of high blood pressure,
  • Surgery or replacement of defective heart valves,
  • Bypass surgery to bypass narrowed coronary arteries.

Healthy lifestyle

Those affected can significantly alleviate the symptoms of heart failure through their own behavior.

  • Nutrition:Being overweight increases the risk of developing heart failure. However, if heart failure already exists, weight loss is associated with a poorer prognosis. Therefore, no weight reduction is recommended for heart failure patients with a body mass index (BMI) of up to 35. Only a few heart failure patients need to restrict their fluid intake. On the contrary: in the case of extreme heat and humidity, vomiting or diarrhea, an increase in fluid intake is advisable. Limiting the fluid intake to 1.5–2 liters per day can be considered in patients with severe heart failure to reduce symptoms and water retention. For more information, see Nutrition.
  • Move:Regular endurance training can significantly improve performance. We recommend physical activities in which a lot of movement is possible with relatively little physical effort, e.g. walking, hiking, Nordic walking or cycling. It is cheaper to exercise relaxed several times a week than to fully exhaust it once. The condition should be increased slowly. Before starting training, a cardiologist should use ergometry or spiroergometry to check the patient's physical capacity. Then you should clarify with your doctor which type of exercise is best. To avoid overloading, it can be advantageous tostart training in a heart center or rehabilitation clinic under the supervision of a sports therapist or doctor.
  • Avoidance of stress and overload: Anyone who has a physically demanding or very stressful job should consider the possibility of a career change.
  • Alcohol: Excessive alcohol consumption should be avoided. There is no objection to one standard alcoholic drink per day - except for patients in whom alcohol has led to heart failure (alcoholic cardiomyopathy). These patients should avoid alcohol altogether.
  • do not smoke.

Medical therapy

The goals of drug therapy are to alleviate symptoms, improve quality of life, reduce hospital stays and extend life. The following substance classes are mainly used:

ACE (angiotensin converting enzyme) inhibitors and angiotensin receptor blockers (sartans)

ACE inhibitors and sartans block the formation or effect of the hormone angiotensin II. So much of this hormone, naturally formed by the kidneys, is produced in heart failure that it has a damaging effect on the heart. This damaging effect is intercepted by blocking the formation or effect of angiotensin II using ACE inhibitors or sartans. In addition, the blood vessels relax and the heart has to pump against less resistance, which can contribute to a recovery of the pumping function.

Beta blockers

When the heart can no longer supply the body with blood and oxygen as well as it should, the body produces more stress hormones such as adrenaline and noradrenaline to keep the circulation going. For an already weak heart, this is harmful over a long period of time. Beta blockers protect the heart from this harmful effect by blocking the long-term effects of these stress hormones on the heart. This is shown by the fact that the heart beats slower and the blood pressure is slightly lower.

Mineralocorticoid receptor antagonists (MRA)

MRA block the effects of a hormone that is naturally made by the adrenal glands and that is made more in heart failure, which can make heart failure worse. They are usually given in addition to ACE inhibitors and beta blockers. MRA also affect the excretion of water and salt by the kidney. Therefore, they have a low dehydrating effect and potassium levels can rise during therapy.

Angiotensin receptor / neprilysin inhibitor (ARNI, sacubitril / valsartan)

Sacubitril / Valsartan is a combination of an angiotensin receptor blocker and a neprilysin inhibitor. This has two positive effects. One corresponds to the ACE inhibitor and angiotensin receptor blocker, the other intensifies the effect of cardiac hormones, which have numerous beneficial effects such as vasodilation and salt and water excretion. When sacubitril / valsartan is excreted, it is exchanged for the one existing ACE inhibitor or angiotensin receptor blocker.

Sinus Knot Inhibitor (Ivabradine)

Ivabradine works almost exclusively by inhibiting the sinus node, which is located in the right atrium of the heart and is the heart's "clock". Ivabradine thereby lowers the heart rate, which has advantages in heart failure. It is usually used in addition to ACE inhibitors, MRA and especially beta blockers.

Water tablets (diuretics)

Drainage medication promotes drainage by increasing the amount of urine excreted through the kidneys.

Digitalis preparations (cardiac glycosides)

Digitalis preparations are being used less and less because the benefits of their cardio-strengthening effect are controversial. They are sometimes used for atrial fibrillation when the heart rate is high, but this use is also becoming less common, since the benefit is questionable here too.

More medication

Occasionally other preparations are added, for example to control the heart rhythm, to lower blood pressure or to inhibit blood clotting ("blood thinners").

Note Treatment of heart failure usually requires multiple medications to be taken. Most of these preparations have specific target dosages with which the greatest benefit for the patient could be shown. Start with a low dose and slowly increase until the target doses are reached. That is why it sometimes takes weeks to months for those affected to notice a significant improvement. It may even be that the patients feel a slight deterioration at the beginning of the drug administration. This is why patience is particularly important at the beginning of heart failure therapy.

What can I do myself?

Regular medication and a healthy lifestyle are essential for successful treatment. It is very helpful to keep a patient diary. Body weight, blood pressure and heart rate (= pulse) are entered daily.

The doctor can use these records to optimize the therapy. If your body weight increases by more than two to three kilograms within one to two days and you also experience shortness of breath or swelling of your legs, you should contact your doctor immediately. By intensifying therapy at an early stage, it is possible in many cases to prevent hospitalization. Sometimes you can learn to react to such water accumulations yourself to a certain extent in an appropriate training course.

Pacemaker & Co

Some patients cannot be treated satisfactorily with medication and lifestyle improvements. If you have an abnormal heart rhythm or if the electrical impulses are not being passed through the heart properly, external support from the heart can be helpful. For this purpose, small devices can be implanted in the body that monitor the heart's function and, through the painless delivery of electrical signals, help the heart to beat regularly or to function better. In addition, many of these devices also offer the option of electronic transmission of clinical data directly to the doctor through a remote monitoring function. These data can be used to treat the disease and make it possible to identify any deterioration at an early stage.

The implants are usually inserted under the collarbone under local anesthesia as part of a 30-minute to around two-hour surgical procedure, so that they are not externally visible. Most devices are the size of a small pocket watch and have to be checked once a year on an outpatient basis, whereby the batteries usually last at least five years. Different types of devices are available, some of which are also used in combination:

  • Pacemaker: emits weak electrical impulses to the heart. This prevents the heart from beating too slowly.
  • Cardiac resynchronization therapy (CRT): Like a pacemaker, it delivers weak electrical impulses to the heart with the aim of resynchronizing a heart that is no longer beating synchronously. Indications of an asynchronously beating heart can be obtained from the EKG (wide chamber complexes). This device improves quality of life and performance, reduces hospital admissions for heart failure, and extends life.
  • Defibrillator (implantable cardioverter defibrillator, ICD): The main function of a " defibrillator " is to end life-threatening cardiac arrhythmias. Depending on the device type and setting, he can do this by means of light, rapidly successive current impulses or by delivering short electric shocks.

Note It is important that the patient informs every doctor and dentist that he / she is wearing an electrotherapy device. While most medical and dental procedures are unlikely to affect the operation of the appliance, some require certain precautionary measures to be taken to minimize interference.

The devices occasionally trigger an alarm in the security gate at the airport, although the function of the device is rarely disrupted. Therefore, the security staff should always be informed beforehand.

Surgical interventions on the heart

Sometimes it may be necessary to implant an artificial heart to support the heart's work. The last but effective option in the case of a far advanced disease is the possibility of a heart transplant for some sufferers.

Artificial hearts and other support systems

These are used to mechanically support the blood circulation or the work of the heart - either for an indefinite period or to bridge the waiting time before a heart transplant. Artificial hearts are also offered to patients for whom a heart transplant is no longer an option and who should be able to continue living as a result. These operations carried out under general anesthesia and the built-in mechanical support system itself can be associated with serious complications such as infections, blood clotting problems, etc. A distinction is made between different types of artificial hearts:

  • The left ventricular assist system (LVAD) is inserted into the left ventricle and pumps the blood from there into the main artery. This type of support is the most common type of artificial heart and replaces the function of the left heart.
  • The right ventricular assist system (RVAD) is implanted in the right ventricle, pumps the blood into the pulmonary artery and thus replaces the function of the left heart.
  • A VAD system for both heart chambers is called a BiVAD.
  • The total artificial heart (TAH) completely replaces the human heart. During the operation, the patient's heart is completely removed and replaced with a mechanical pump.

Heart transplant

The heart of an organ donor is implanted in a recipient. Transplants are associated with high risks and are only suitable for certain patients. After that, they have to take medication for life against unwanted reactions of the immune system (transplant rejection).

Inpatient stay & rehabilitation

Hospitalization may be necessary if:

  • acute heart failure or severe deterioration in health,
  • Shortness of breath already during rest phases,
  • new cardiac arrhythmias,
  • Problems with the pacemaker or defibrillator,
  • newly occurring diseases,
  • Accumulation of water in the body,
  • mental changes.

Hospitalization may also be required if medical devices (CRT, ICD) are installed.

Following acute treatment in the hospital, outpatient or inpatient rehabilitation in a corresponding rehabilitation center for four to six weeks can be useful. The offer includes medical training therapy to build up physical performance, risk factor management, comprehensive information about the disease, nutritional advice and various training courses on lifestyle modification.

How are the costs going to be covered?

The e-card is your personal key to the benefits of the statutory health insurance. All necessary and appropriate diagnostic and therapeutic measures are taken over by your responsible social insurance agency. A deductible or contribution to costs may apply for certain services. You can obtain detailed information from your social security agency. Further information can also be found at:

  • Right to treatment
  • Visit to the doctor: costs and deductibles
  • What does the hospital stay cost?
  • Prescription fee: This is how drug costs are covered
  • Medical aids & aids
  • Health Professions AZ
  • and via the online guide to reimbursement of social insurance costs.

In order to receive medical rehabilitation benefits, those affected must submit a rehabilitation application. If the social insurance agency approves the rehabilitation stay, a large part of the costs will be covered. For medical rehabilitation measures, an additional payment is provided by the insured, depending on the income.

For more information, see Rehabilitation.

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