Heart failure — sometimes known as congestive heart failure — occurs when the heart muscle doesn't pump blood as well as it should. When this happens, blood often backs up and fluid can build up in the lungs, causing shortness of breath.
Certain heart conditions, such as narrowed arteries in the heart (coronary artery disease) or high blood pressure, gradually leave the heart too weak or stiff to fill and pump blood properly.
Proper treatment can improve the signs and symptoms of heart failure and may help some people live longer. Lifestyle changes — such as losing weight, exercising, reducing salt (sodium) in your diet and managing stress — can improve your quality of life. However, heart failure can be life-threatening. People with heart failure may have severe symptoms, and some may need a heart transplant or a ventricular assist device (VAD).
One way to prevent heart failure is to prevent and control conditions that can cause it, such as coronary artery disease, high blood pressure, diabetes and obesity.
Heart failure can be ongoing (chronic), or it may start suddenly (acute).
Heart failure signs and symptoms may include:
When to see a doctor
See your doctor if you think you might be experiencing signs or symptoms of heart failure. Call 911 or emergency medical help if you have any of the following:
Although these signs and symptoms may be due to heart failure, there are many other possible causes, including other life-threatening heart and lung conditions. Don't try to diagnose yourself.
Emergency room doctors will try to stabilize your condition and determine if your symptoms are due to heart failure or something else.
If you have a diagnosis of heart failure and if any of the symptoms suddenly become worse or you develop a new sign or symptom, it may mean that existing heart failure is getting worse or not responding to treatment. This may also be the case if you gain 5 pounds (2.3 kilograms) or more within a few days. Contact your doctor promptly.
Heart failure often develops after other conditions have damaged or weakened the heart. However, heart failure can also occur if the heart becomes too stiff.
In heart failure, the main pumping chambers of the heart (the ventricles) may become stiff and not fill properly between beats. In some people, the heart muscle may become damaged and weakened. The ventricles may stretch to the point that the heart can't pump enough blood through the body.
Over time, the heart can no longer keep up with the typical demands placed on it to pump blood to the rest of the body.
Your doctor can determine how well your heart is pumping by measuring how much blood is pumped out with each beat (ejection fraction). Ejection fraction is used to help classify heart failure and guide treatment. In a healthy heart, the ejection fraction is 50% or higher — meaning that more than half of the blood that fills the ventricle is pumped out with each beat.
But heart failure can occur even with a normal ejection fraction. This happens if the heart muscle becomes stiff from conditions such as high blood pressure.
Heart failure can involve the left side (left ventricle), right side (right ventricle) or both sides of your heart. Generally, heart failure begins with the left side, specifically the left ventricle — your heart's main pumping chamber.
|Type of heart failure||Description|
|Left-sided heart failure||Fluid may back up in the lungs, causing shortness of breath.|
|Right-sided heart failure||Fluid may back up into the abdomen, legs and feet, causing swelling.|
|Systolic heart failure (also called heart failure with reduced ejection fraction)||The left ventricle can't contract vigorously, indicating a pumping problem.|
|Heart failure with preserved ejection fraction||The left ventricle can't relax or fill fully, indicating a filling problem.|
Any of the following conditions can damage or weaken your heart and can cause heart failure. Some of these can be present without your knowing it:
Causes of sudden (acute) heart failure also include:
A single risk factor may be enough to cause heart failure, but a combination of factors also increases your risk.
Risk factors for heart failure include:
Complications of heart failure depend on the severity of heart disease, your overall health and other factors such as your age. Possible complications can include:
The key to preventing heart failure is to reduce your risk factors. You can control or eliminate many of the risk factors for heart disease by making healthy lifestyle changes and by taking the medications prescribed by your doctor.
Lifestyle changes you can make to help prevent heart failure include:
To diagnose heart failure, your doctor will take a careful medical history, review your symptoms and perform a physical examination. Your doctor will also check to see if you have risk factors for heart failure, such as high blood pressure, coronary artery disease or diabetes.
Your doctor can listen to your lungs for signs of fluid buildup (lung congestion) and your heart for whooshing sounds (murmurs) that may suggest heart failure. The doctor may examine the veins in your neck and check for fluid buildup in your abdomen and legs.
After the physical exam, your doctor may also order some of these tests:
Blood tests. Blood tests are done to look for signs of diseases that can affect the heart.
Chest X-ray. X-ray images can show the condition of the lungs and heart.
Electrocardiogram (ECG). This quick and painless test records the electrical signals in the heart. It can show the timing and length of the heartbeats.
Echocardiogram. Sound waves are used to produce images of the heart in motion. This test shows the size and structure of the heart and heart valves and blood flow through the heart. An echocardiogram can be used to measure ejection fraction, which shows how well the heart is pumping and helps classify heart failure and guides treatment.
Stress test. Stress tests measure the health of the heart during activity. You may be asked to walk on a treadmill while attached to an ECG machine, or you may receive an IV drug that stimulates the effect of exercise on the heart.
Sometimes a stress test is done while wearing a mask that measures how well the heart and lungs get oxygen and breathe out carbon dioxide.
Cardiac computerized tomography (CT) scan. In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of the heart and chest. Sometimes, contrast is given. Because the contrast agent could affect kidney function, talk to your doctor if you have kidney problems.
Magnetic resonance imaging (MRI). In a cardiac MRI, you lie on a table inside a long, tubelike machine. Radio waves create images of the heart.
A cardiac MRI may be done with a dye (contrast). It's important to tell your doctor about any problems with your kidneys before you receive a cardiac MRI or other MRI because contrast can cause a rare and serious complication in people who have kidney disease.
Coronary angiogram. In this test, a thin, flexible tube (catheter) is inserted into a blood vessel, usually in the groin, and guided to the heart arteries. A dye (contrast) is injected through the catheter to make the arteries show up more clearly on an X-ray, helping the doctor spot blockages.
Myocardial biopsy. In this test, a doctor inserts a small, flexible cord into a vein in the neck or groin, and removes very small pieces of the heart muscle for examination. This test may be done to diagnose certain types of heart muscle diseases that cause heart failure.
Results of tests to diagnose heart failure help doctors determine the cause of any signs and symptoms and decide on a treatment plan. To determine the best treatment for heart failure, doctors may classify heart failure using two systems:
New York Heart Association classification
This scale groups heart failure into four categories.
American College of Cardiology/American Heart Association classification
This stage-based classification system uses letters A to D and includes a category for people who are at risk of developing heart failure. Doctors use this classification system to identify risk factors and begin early, more aggressive treatment to help prevent or delay heart failure.
Your doctor often will use both classification systems together to help decide the most appropriate treatment options. Your doctor can help you interpret your score and plan your treatment based on your condition.
Heart failure is a chronic disease needing lifelong management. However, with treatment, signs and symptoms of heart failure can improve, and the heart sometimes becomes stronger.
Doctors sometimes can correct heart failure by treating the underlying cause. For example, repairing a heart valve or controlling a fast heart rhythm may reverse heart failure. But for most people, treatment of heart failure involves a balance of the right medications and, sometimes, use of devices that help the heart beat and contract properly.
Doctors usually treat heart failure with a combination of medications. Depending on your symptoms, you might take one or more medications, including:
Because diuretics make your body lose potassium and magnesium, your doctor may also prescribe supplements of these minerals. If you're taking a diuretic, your doctor will likely monitor levels of potassium and magnesium in your blood through regular blood tests.
Aldosterone antagonists. These drugs include spironolactone (Aldactone, Carospir) and eplerenone (Inspra). These are potassium-sparing diuretics that have additional properties that may help people with severe systolic heart failure live longer.
Unlike some other diuretics, spironolactone and eplerenone can raise the level of potassium in your blood to dangerous levels, so talk to your doctor if increased potassium is a concern, and learn if you need to modify your intake of food that's high in potassium.
Your doctor may need to adjust your doses frequently, especially when you've just started a new medication or when your condition is worsening.
You may be admitted to the hospital if you have a flare-up of heart failure symptoms. While in the hospital, you may receive additional medications to help your heart pump better and relieve your symptoms. You may also receive supplemental oxygen through a mask or small tubes placed in your nose. If you have severe heart failure, you may need to use supplemental oxygen for a long time.
Surgery or other procedures
Surgery or other procedures to implant cardiac devices may be recommended to treat the underlying problem that led to heart failure. Surgery or other procedures for heart failure may include:
Coronary bypass surgery. If severely blocked arteries are causing your heart failure, your doctor may recommend coronary artery bypass surgery. The procedure involves taking a healthy blood vessel from your leg, arm or chest and connecting it below and above the blocked arteries in your heart. The new pathway improves blood flow to your heart muscle.
Heart valve repair or replacement. If a faulty heart valve causes your heart failure, your doctor may recommend repairing or replacing the valve. Surgeons can repair the valve by reconnecting valve flaps or by removing excess valve tissue so that the leaflets can close tightly. Sometimes repairing the valve includes tightening or replacing the ring around the valve.
Heart valve repair or replacement may be done as open-heart surgery, a minimally invasive surgery or a heart procedure using flexible tubes called catheters (cardiac catheterization).
Implantable cardioverter-defibrillators (ICDs). An ICD is used to prevent complications of heart failure. It isn't a treatment for heart failure itself. An ICD is a device similar to a pacemaker. It's implanted under the skin in your chest with wires leading through your veins and into your heart.
The ICD monitors the heart rhythm. If the heart starts beating at a dangerous rhythm, or if your heart stops, the ICD tries to pace your heart or shock it back into normal rhythm. An ICD can also work as a pacemaker and speed your heart up if it is going too slow.
Cardiac resynchronization therapy (CRT). Also called biventricular pacing, CRT is a treatment for heart failure in people whose lower heart chambers (ventricles) aren't pumping in sync with each other. A device called a biventricular pacemaker sends electrical signals to the ventricles. The signals trigger your ventricles to contract in a more coordinated way, which improves the pumping of blood out of your heart. CRT may be used with an ICD.
Ventricular assist devices (VADs). A VAD — also known as a mechanical circulatory support device — is a device that helps pump blood from the lower chambers of your heart (ventricles) to the rest of your body. Although a VAD can be placed in one or both ventricles of your heart, it is most frequently implanted in the left ventricle.
Your doctor may recommend a VAD if you're waiting for a heart transplant. Sometimes, a VAD is used as a permanent treatment for people who have heart failure but who aren't good candidates for a heart transplant.
Heart transplant. Some people have such severe heart failure that surgery or medications don't help. These people may need to have their hearts replaced with a healthy donor heart.
A heart transplant isn't the right treatment for everyone. A team of doctors at a transplant center will evaluate you to determine whether the procedure may be safe and beneficial for you.
Palliative care and end-of-life care
Your doctor may recommend including palliative care in your treatment plan. Palliative care is specialized medical care that focuses on easing your symptoms and improving your quality of life. Anyone who has a serious or life-threatening illness can benefit from palliative care, either to treat symptoms of the disease, such as pain or shortness of breath, or to ease the side effects of treatment, such as fatigue or nausea.
It's possible that your heart failure may worsen to the point where medications are no longer working and a heart transplant or device isn't an option. If this occurs, you may need hospice care. Hospice care provides a special course of treatment to terminally ill people.
Hospice care allows family and friends — with the aid of nurses, social workers and trained volunteers — to care for and comfort a loved one at home or in hospice residences. Hospice care provides emotional, psychological, social and spiritual support for people who are ill and those closest to them.
Hospice care is available in your own home or in nursing homes and assisted living centers. For people who stay in a hospital, specialists in end-of-life care can provide comfort, compassionate care and dignity.
Although it can be difficult, discussing end-of-life issues with your family and medical team is important. Part of this discussion will likely involve advance care directives — a general term for oral and written instructions you give concerning your medical care should you become unable to speak for yourself.
If you have an ICD, one important consideration to discuss with your family and doctors is whether it should be turned off so that it can't deliver shocks to make your heart continue beating.
Lifestyle and home remedies
Making lifestyle changes can often help relieve signs and symptoms of heart failure and prevent the disease from worsening. These changes may be among the most important and beneficial you can make:
Coping and support
Proper heart failure treatment can sometimes improve symptoms and help you live longer. You and your doctor can work together to help make you most comfortable. Pay attention to your body and how you feel, and tell your doctor when you're feeling better or worse. This way, your doctor will know what treatment works best for you.
These steps may help you manage heart failure:
Managing heart failure requires an open communication between you and your doctor. Be honest about whether you're following recommendations concerning your diet, lifestyle and taking medications. Your doctor often can suggest strategies to help you get and stay on track.
Preparing for your appointment
If you think you may have heart failure or you are worried about your heart failure risk because of other underlying conditions, make an appointment with your family doctor. If heart failure is found early, your treatment may be easier and more effective.
Because appointments can be brief and there's often a lot to discuss, it's a good idea to be prepared for your appointment. Here's some information to help you get ready for your appointment and know what to expect from your doctor.
What you can do
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For heart failure, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
When did you first notice your symptoms?
Do your symptoms occur all the time, or do they come and go?
How severe are your symptoms?
What, if anything, seems to improve your symptoms?
Does anything make your symptoms worse?
What you can do in the meantime
It's never too early to make healthy lifestyle changes, such as quitting smoking, cutting down on salt and eating healthy foods. These changes can help prevent heart failure from starting or worsening.