Information about heart failure - Disclaimer

Information about heart failure - Disclaimer

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What is heart failure ?

Heart failure occurs when the heart is unable to pump sufficiently to maintain blood flow to meet the needs of the body.

Heart failure may cause edema; with left sided failure in the lung (pulmonary edema) and with right-sided failure edema mainly  in foot and ankle and in the abdomen (sacral edema).  A cardinal symptom of left sided failure is shortness of breath (dyspnoea) in the beginning with strenuous exercise; in severe cases even at rest. The shortness of breath may increase on lying flat (orthopnea), even sudden nighttime attacks of severe breathlessness (paroxsysmal nocturnal dispens). Pulmonary edema (fluid in the alveoli) may develop, suggested by rales or crackles, heard initially in the lung bases, or when severe, throughout the lung fields. Cardiac astma is indicated by coughing or wheezing.

The most severe kind of heart failure is the cardiogenic shock, symptoms rapid, weak, thready pulse, severe breathlessness, anxiety, restlessness, cool, clammy, and moteld skin.

Possible causes of heart failure
  1. Failure of heart muscle
    The most common cause of heart muscle disease is in western countries a disorder in blood perfusion of the heart (coronary heart disease) during or after a heart attack. Frequently a coronary heart disease is accompanied by high blood pressure. With about 20% of patients, high blood pressure (arterial hypertension) is the only cause of heart muscle failure. Even an inflammation of the heart muscle (myocarditis) results with about 60-70% of patients in an, at least temporary heart failure.

  2. Valvular heart disease
    Aortral or Mitral valve stenosis can result in a reduced ejection fraction of the heart. Even valves, which are not able to close completely can impact the blood ejection due to regurgitation.

  1. Irregular heartbeat
    Too slow heartbeat (bradycardia) reduces heart throughput. Event too fast heartbeat (tachycardia) can affect the filling of the heart compartments and thus reduce throughput.

Management of heart failure

Pharmacological management

Pharmacological management includes drugs with proven survival improvement and symptomatic medication improving live quality for the patient.

In the treatment of CHF, the following drugs have been shown to provide mortality benefit:

  • ACE inhibitor therapy is recommended for all patients with systolic heart failure, irrespective of symptomatic severity or blood pressure

  • Angiotensin II receptor antagonist therapy is an acceptable alternative if the patient is unable to tolerate ACE inhibitor therapy

  • β-blockers bisoprolol, carvedilol, nebivolol and metoprolol from NYHA II and 

  • Aldosterone receptor antagonists from NYHA-stadium II.

Symptom Management includes:

  • Diuretic therapy is indicated for relief of congestive symptoms.

  • Antiarrhythmic agents are used to suppress abnormal rhythms of the heart (cardiac arrhythmias)


Patients with NYHA class III or IV, left ventricular ejection fraction (LVEF) of 35% or less and a QRS interval of 120 ms or more may benefit from cardiac resynchronization therapy (CRT; pacing both the left and right ventricles), through implantation of a bi-ventricular pacemaker.

Patients exposing tachycardia may also benefit from an implantable cardioverter-defibrillator (ICD).

Another current treatment involves the use of left ventricular assist devices (LVADs). LVADs are battery-operated mechanical pump-type devices that are surgically implanted on the upper part of the abdomen. They take blood from the left ventricle and pump it through the aorta. LVADs are becoming more common and are often used by patients who have to wait for heart transplants.

The final option, if other measures have failed, is heart transplantation. This remains the recommended surgical treatment option. However, due to the limited number of hearts available for transplantation, an alternative heart support measure, the  cardiomyoplasty gets into focus.

Dynamic Cardiomyoplasty

Cardiomyoplasty is a surgical procedure in which healthy muscle from another part of the body is wrapped around the heart to provide support for the failing heart. Most often the latissimus dorsi muscle is used for this purpose. After an period of pre-stimulation (to improve perfusion), it is relocated from the back into the thorax and wrapped around the heart. A special pacemaker is implanted to make the skeletal muscle contract synchronously to the heart by applying a series of electrical pulses (burst).

Microstim MyoSen – An innovative muscle stimulator with integrated overstimulation protection function
MyoSen - Muscle Pacemaker (under development)

The MyoSen muscle stimulator is designed for the dynamic cardiomyoplasty, a surgical treatment for the chronic heart failure. It stimulates a muscle, which has been wrapped around the heart synchronously to the heartbeat.

The Microstim MyoSen muscle Stimulator includes a muscle protection function, which prevents muscle overuse and thus may preserve muscle structure and contractility.

The Microstim MyoSen muscle stimulator system is still under development. 

First clinical applications are due late 2015.