About heart failure - diagnosis and treatments

Prof. Dr. Thomas F. Lüscher: an interview with one of the top cardiologists in Switzerland about the leading causes of heart failure and how to prevent them.

Prof. Dr. Thomas F. Lüscher is an eminent cardiologist and one of the leading experts in Switzerland on heart diseases. In this interview, he shares his expert advice on the causes and treatment of heart failure.

Many heart diseases can eventually lead to chronic heart failure. Which symptoms hint at chronic heart failure?

The characteristic sign of chronic heart failure is being short of breath (dyspnea) while doing physical excercise.

With progressive heart failure, symptoms such as swollen legs and an inability to lie flat start to appear.

The latter is caused by water being present in the lungs. In this case, the heart failure has become highly advanced.

The characteristic sign of chronic heart failure is being short of breath (dyspnea) while doing physical excercise.

Prof. Lüscher

When is it advisable to consult a doctor?

First of all, it is important to understand why people suffer from heart failure. Most people who suffer from the disease are older than 65, but younger people can suffer from it too.

If dyspnea (being short of breath) occurs suddenly for the first time, a doctor should be consulted. Doctors can do different tests and examinations to assess the cardiac function.

A doctor will look closely at the systole (pump fucntion of the heart) but also the diastole of the heart (the filling phase during the cardiac cycle) using the cardiac ultrasound.

The level of BNP (brain natriurectic peptide) in the blood can also be tested. If it‘s within normal range, heart failure can nearly be ruled out. If BNP levels are high, heart failure is much more likely.

Patients who have had a heart attack should be tested on a regular basis, since heart attacks are one of the main causes of heart failure. Patients who suffer from heart muscle disease should also have ultrasound tests.

At your clinic DoubleCheck could a health check detect the warning signs of heart failure in patients?

The doctors at clinic DoubleCheck are able to take their time to make a careful and considered diagnosis.

With the tests and examinations, BNP and cardiac ultrasound that have been mentioned above, the heart function of people who get a health check at the clinic can be closely analysed.

What are the current treatment options for chronic heart failure?

Firstly, a patient should know exactly what they are suffering from. Then we advise patients accordingly, on limiting their daily salt intake and on exercising within their limits. 

It used to be thought that exercise was harmful to patients, but it‘s actually a crucial component of cardiac rehabilitation, in combination with other aspects.

The first step in therapy, however, is a prescription of drugs. Firstly, there are ACE-inhibitors, which inhibit the angiotensin-renin-aldosterone system in the body. These inhibitors can prolong life expectancy.

Then, there are beta blockers, which inhibit the sympatho-adrenal system, and improve your likelihood of surviving the illness.

If the pump function of the heart has been highly impaired, the aldosterone antagonists like spirinolactone can be prescribed. They act on the aldosterone system, a hormone responsible for blood pressure.These substances also contribute to a longer life for the patient.

If any of these are insufficient, the patient can be fitted with a bi-ventricular pace maker. This helps the heart to coordinate cardiac functions effectively.

As a last resort, a patient might be offered a heart transplant, though this is usually only for patients who are younger than 65 who already have heart failure at a very advanced stage.


What is the prognosis for heart failure? Is there any likelihood of a complete recovery?

The prognosis for heart failure is poor. Left untreated, 5-10% of patients with mild heart failure will die every year. Up to 20% of patients with advanced heart failure will die annually. 

Even with treatment, patients with heart failure may die from it, even though the various treatments available today may lower the rate significantly. The mortality rate for heart failure is similar to some malignant tumour diseases. 

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