Decline in performance and exhaustion: when I also assess the heart

If stairs, sport or a long working day feel noticeably harder than they did a few months ago, you should have the heart assessed for a decline in performance. I am a specialist in internal medicine and cardiology. When exercise capacity is declining, I examine the heart and circulation and at the same time look at the energy production of the cells (mitochondria), the nutrient supply and the function of the small vessels. The cause often lies in a combination of several of these levels.

These symptoms fit a cardiac decline in performance

• Shortness of breath on exertion (exertional dyspnoea), already when climbing stairs or at an easy pace
• Chest tightness, pressure or burning behind the breastbone on exertion (angina pectoris)
• Skipped heartbeats, a racing heart or an irregular pulse
• Dizziness and a sudden drop in performance during sport, the pulse rises too quickly or is too slow overall
• Recovery after exertion takes distinctly longer than it used to
• Fluid retention at the ankles and lower legs (oedema)
• passing urine at night (nocturia), lying flat causes shortness of breath
• cold hands and feet, calf pain when walking
• persistent exhaustion after infections, including after COVID-19
• fluctuating or raised blood pressure

You will find more on individual symptoms in the articles Heart failure, Checking skipped heartbeats and Checking high blood pressure.

When other causes are more in the foreground

If sleep disturbance, problems with concentration, loss of drive and exhaustion even at rest are in the foreground, I place the symptoms in a separate diagnostic work-up. This includes neurotransmitter and stress-hormone status and a standardised questionnaire. More on the burnout check at the practice. I describe the basics of the condition in the article Burnout syndrome.

The cardiological basis

At the beginning come the consultation and the physical examination, a resting ECG, heart ultrasound (echocardiography), an exercise ECG or stress echocardiography and, when there are rhythm symptoms, a long-term ECG. In the basic laboratory I determine the blood count, iron and ferritin, the thyroid values TSH, fT3 and fT4, blood glucose and HbA1c, kidney values and NT-proBNP as a marker of cardiac weakness. With this I identify heart failure, coronary heart disease (CHD), heart rhythm disorders, anaemia and hypothyroidism. How the exercise assessment is carried out you can read under More on the exercise and fitness check at the practice, the overall cardiological check under Heart check.

My focus: assessing a decline in performance as a whole

Many of my patients have unremarkable standard findings and are nevertheless distinctly less able to exercise. I then look further at the level of the cell.

Specialist laboratory for nutrient supply

In the specialist laboratory I determine minerals, trace elements and vitamins in whole blood, including magnesium, zinc, selenium, the B vitamins and vitamin D. In addition I determine coenzyme Q10, the omega-3 index, the aminogram and homocysteine. The heart muscle needs magnesium for every contraction and coenzyme Q10 for energy production in the mitochondria. A deficiency often does not show in the serum, but it does in whole blood. Iron deficiency without anaemia, recognisable by a low ferritin, reduces the oxygen supply of the muscles and thus physical performance. Which further values the practice determines you will find under More on laboratory diagnostics at the practice.

Mitochondria and redox status

The mitochondria are the power stations of the cell and form ATP, the "battery" of the cells. The heart muscle has the highest density of mitochondria in the body. When the mitochondria work less well (mitochondrial dysfunction), the heart responds early with a decline in performance. Typical signs are muscle weakness, rapid exhaustion even after slight exertion, a worsening on the day after the exertion (post-exertional malaise), muscle cramps, sensitivity to cold and difficulties with concentration. I measure mitochondrial performance, oxidative and nitrosative stress and the redox status, that is the balance between oxidative burden and antioxidant protection. This includes glutathione status. Glutathione is the most important endogenous antioxidant of the cell.

Functional circulation diagnostics

With pulse-wave analysis I measure the stiffness of the arteries. Heart-rate variability (HRV) shows how well the autonomic nervous system regulates the heart and circulation. I often find a low HRV in chronic overload, lack of sleep and after infections. Cardisiography supplements the ECG with an analysis of heart function, and the measurement of body composition shows the proportions of muscle, fat and water.

Extended investigation of causes

When the findings do not yet explain the decline in performance, I look for further burdens:

• Post-COVID: A COVID-19 infection causes a microcirculation disorder in the capillaries and mitochondrial dysfunction, which lower exercise capacity over months.
• Post-Vac: A spike burden after vaccination causes vascular inflammation, microthrombi in the capillaries and inflammation of the heart muscle.
• Heavy metals: A heavy-metal burden blocks enzymes of the mitochondria and causes vascular calcification and hypertension.
• Silent inflammation: Silent inflammation causes oxidative stress, damages the endothelium and restricts the energy production of the cells.

For Post-COVID and Post-Vac I offer a dedicated consultation: More on the Long COVID and Post-Vac consultation at the practice.

What can follow from the findings

From the results I work out together with you what is sensible. I replenish demonstrated deficits in a targeted way. Where there are signs of a mitochondrial burden, I offer interval hypoxia-hyperoxia therapy, high-dose magnesium therapy and the glutathione push in the practice. Which treatment comes into question for you, we discuss on the basis of your findings.

• More on IHHT at the practice
• More on magnesium-oxygen therapy at the practice
• More on the glutathione push and orthomolecular therapy at the practice

Heart check, burnout check or Premium Check-up

If the exercise capacity of the heart is in the foreground, the heart check with an exercise assessment fits. For exhaustion with sleep and concentration problems, the burnout check fits. The Premium Check-up combines the heart diagnostics with the detailed specialist laboratory, hormone status and ultrasound of further organs. We set the scope in the preliminary consultation.

Arrange an appointment

Bring previous findings, your medication plan and, if available, readings from your heart-rate watch or your blood-pressure log. You arrange an appointment via Doctolib or via Contact. Further specialist articles can be found under Expert tips.

The information on this page does not replace individual medical advice, examination or treatment. Whether any measures are appropriate is decided in a personal consultation. Courses differ from person to person.