What Is Congestive Heart Failure? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Heart failure is a condition in which the heart doesn’t pump blood as well as it should.

While the term “heart failure” (also known as congestive heart failure) may sound like the heart has stopped working, that isn’t actually the case. It still pumps, just inefficiently.

As a result, there’s a reduction in blood flow to the body and a backup (congestion) of fluid into the lungs, liver, abdomen, and lower extremities.

While there’s no cure for heart failure, medication and healthy lifestyle changes can help manage the condition and allow people to maintain a good quality of life.

During heart failure, the body tries to compensate for reduced blood flow in other ways, including:

• Enlarging the Heart Chamber This is the body’s attempt to get the heart to contract more strongly, in order to pump more blood. Initially, it may help the heart function more efficiently, but ultimately it causes the heart to not pump as effectively and causes fluid retention, leading to congestion in the lungs.
• Developing More Heart Muscle Mass The contracting cells in the heart get bigger, which initially lets the heart pump more strongly.
• Increasing Heart Rate This causes the heart to pump faster and increase its output.
• Increasing Fluid and Salt Retention and Tightening Some Blood Vessels This helps maintain the heart’s normal output.

These compensations may mask heart failure temporarily, but eventually heart failure gets worse, and people start to experience symptoms.

• F: Fatigue
• A: Activities limited
• C: Chest congestion
• E: Edema or ankle swelling
• S: Shortness of breath

• Coronary artery disease is the most common cause of heart failure. It causes narrowing of the arteries that supply blood to the heart muscle.
• A previous heart attack can leave scar tissue that interferes with the heart muscle’s ability to pump normally.
• High blood pressure (also called hypertension) makes your heart work harder than it should to circulate blood throughout the body.
• Abnormal heart valves as a result of disease or infections force your heart to work harder than it should to keep blood flowing. Over time, that extra work weakens the heart.
• Congenital heart disease or defects that you’re born with can cause healthy parts of your heart to work harder to pump blood. That extra strain can lead to heart failure.
• Heart muscle damage (such as cardiomyopathy), brought on by causes such as diseases, infections, alcohol abuse, and drug use, can lead to heart failure.
• Irregular heartbeats (called heart arrhythmias) may cause your heart to beat too fast, which can weaken the heart and prevent it from getting enough blood to the body.
• Chronic lung disease, such as chronic obstructive pulmonary disease (COPD) or emphysema, can cause heart failure.
• A blood clot in the lungs (called pulmonary embolism) may cause heart failure on the right side of the heart.
• Anemia and excessive blood loss can lead to heart failure.
• Diabetes complications can contribute to heart failure, because the condition tends to lead to hypertension and atherosclerosis, both of which have been linked to the disease.
• Obesity can cause a cardiomyopathy, which is a disease of the heart muscle. Being obese can also cause the heart to work much harder than it would in other people.
• Long-term use of certain drugs and supplements may worsen heart failure or interfere with heart failure medicines. Nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen (Advil or Motrin) and naproxen (Aleve), can elevate blood pressure and increase salt and fluid retention, putting you at risk of heart failure. Supplements like licorice and ginseng can raise your risk of high blood pressure and increase fluid retention, causing your heart to work harder.
• Alcohol abuse can cause cardiomyopathy, leading to a diseased heart muscle and a reduction in blood-pumping capacity.

Risk Factors for Heart Failure

• High blood pressure
• A past heart attack
• Diabetes
• Sleep apnea
• Congenital heart defects
• Valvular heart disease
• Viruses
• Alcohol use
• Tobacco use
• Obesity
• Irregular heartbeats

New Moms and Heart Failure Risk

The research supports the notion that at-risk women need closer observation during that time period.

The researchers also say that because many women are discharged from hospital care just a couple of days after giving birth and aren’t given a follow-up appointment until about six weeks later, the way doctors regard women who might be at risk of heart failure needs to change.

They call for comprehensive postpartum discharge health education, with emphasis on signs and symptoms to look for and when or where to seek immediate care.

If you’re experiencing any of the symptoms of congestive heart failure, speak to your healthcare provider.

Your doctor will take a full medical history and perform a physical examination. Using a stethoscope, a physician can listen for signs of congestion in your lungs and may also be able to pick up abnormalities in the sound of your heartbeat that can suggest heart failure.

Prognosis of Congestive Heart Failure

Your life expectancy after heart failure depends on the cause of your condition, as well as other factors, including age.

Heart failure is a chronic condition, and there is no cure. However, once you’ve been diagnosed, there are several things you can do to treat the condition and manage it so that it does not progress. Chief among them are lifestyle changes. That includes exercising and maintaining a heart-healthy diet that’s low in saturated fat, trans fats, and cholesterol.

Medication Options

• Angiotensin-converting enzyme (ACE) inhibitors to decrease blood pressure, helping blood flow through the body more easily and decreasing the workload of the heart. Also, ACE inhibitors can help limit bad changes to the heart in response to an injury (for example, after a heart attack).
• Angiotensin 2 receptor blockers have many of the same benefits as ACE inhibitors and are often prescribed as an alternative for patients who cannot tolerate ACE inhibitors.
• Beta-blockers work by slowing down the heart rate and decreasing the effects of adrenaline on the heart. This in turn lowers blood pressure, so that the heart has to do less work. These medications, similar to ACE inhibitors and angiotensin 2 receptor blockers, limit and may even reverse some of the damage to the heart caused by heart failure.
• Diuretics, often called water pills, rid the body of excess fluids and sodium through urination. This helps relieve the heart’s workload.
• Aldosterone antagonists are a type of diuretic that, unlike other diuretics, do not deplete potassium. They also have additional properties that can help a person with severe heart failure live longer.
• Digitalis can help the heart strengthen its contractions when its pumping function has been weakened. The drug can help reduce symptoms of heart failure.
• Positive inotropes are reserved for people with the most severe stage of heart failure and are generally used in the hospital. These are intravenous drugs that maintain blood pressure and improve heart function.
• Hydralazine and isosorbide dinitrate can help relax blood vessels and is typically used as a supplemental drug to treat heart failure, particularly if ACE inhibitors or beta-blockers aren’t working.
• Vericiguat is a newer once-a-day oral medication used to reduce the risk of death from heart failure.
• Sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors) are recommended as an additional therapy for people with heart failure and reduced ejection fraction, meaning the heart doesn't pump out enough blood with each heartbeat.

Surgery for Heart Failure

• Coronary bypass surgery treats blocked arteries by removing healthy arteries from other parts of the body and using them to reroute blood around clogged arteries. This improves blood flow to the heart. If severely blocked arteries are a contributing factor to your heart failure, your physician may suggest bypass surgery.
• Heart valve replacement modifies a faulty heart valve to eliminate backward blood flow. A surgeon will either repair the valve, if possible, or replace it with an artificial valve.
• Ventricular assist devices are mechanical pumps implanted in the abdomen or chest and attached to the weakened heart. The devices help pump blood from the lower heart chamber to the rest of your body.
• Implantable cardioverter-defibrillators are implanted beneath the skin in the chest with wires leading through the veins and into the heart. These devices monitor heart rhythm and will shock the heart back into normal rhythm if it develops a life-threatening arrhythmia. They can also act as pacemakers, speeding up the heart if it begins beating too slowly.
• Cardiac resynchronization therapy, also known as biventricular pacing, sends electrical pulses to the heart’s lower chambers to help them pump more efficiently.
• Heart transplant is an option in the most serious heart failure cases, when medication or surgery do not help. The procedure involves removing the damaged heart and replacing it with a healthy one from an organ donor.

Prevention of Congestive Heart Failure

The best way to prevent heart failure is to control your risk factors. The good news is that you can reduce or eliminate many of the risk factors that lead to heart disease, such as high blood pressure. Lifestyle changes and adhering to any medication your doctor prescribes can go a long way in preventing heart failure.

• Quitting smoking
• Eating a healthy diet
• Getting enough physical activity
• Maintaining a healthy weight
• Controlling high blood pressure and diabetes
• Reducing stress

• Rapid Weight Loss Severe heart failure can lead to a rapid loss of weight that can be life-threatening. Heart failure can cause blood to back up into the liver and intestines, causing these organs to swell. This swelling can lead to nausea and loss of appetite, and can prevent the body from absorbing nutrients from food.
• Impaired Kidney Function Congestive heart failure weakens the heart’s ability to pump blood, reducing blood flow to the kidneys. This can lead to kidney damage or kidney failure, if left untreated.
• Liver Damage Heart failure can cause fluid to build up in the liver, which can lead to scarring. This makes it more difficult for the liver to carry out its day-to-day functions.
• Arrhythmias Heart failure results in damaged heart muscles, which can lead to the development of an arrhythmia, or abnormal heart beat. Arrhythmias can include the heart beating too quickly, beating too slowly, or beating irregularly.
• Heart Valve Problems If the heart is enlarged due to heart failure, the valves of the heart, which ensure appropriate direction of blood flow through the organ, may not function properly.
• Angina and Heart Attack Heart disease is a major contributing factor in many heart failure cases, and people with congestive heart failure are at continued risk of angina and heart attack.

Edema and Heart Failure

Edema is swelling that is caused by excess fluid trapped in the body’s tissue.

The condition often occurs as the result of congestive heart failure. It can also be the result of medication, pregnancy, or another underlying condition, such as kidney disease or cirrhosis of the liver.

Signs that you have edema include:

• Swelling or puffiness of the tissue directly under the skin, especially in the legs or arms
• Arms or legs start to feel full or heavy
• Shiny or stretched skin
• Skin that retains pits, or dimples, after being pressed for several seconds
• Clothing or jewelry starts to feel tight and uncomfortable
• Skin near the swelling feels tight or warm
• It becomes more difficult to move the joints that are affected
• Increased abdominal size

Sleep Apnea and Heart Failure

People who have sleep apnea experience interruptions in breathing that can last 10 seconds or more and occur repeatedly throughout the night, as many as 30 times or more in the span of an hour.

This chronic disruption of the normal sleep cycle can leave individuals with the condition feeling exhausted and sleepy during the day, and it will put them at an increased risk of health problems associated with inadequate sleep, including irritability, problems with memory or concentration, anxiety, and depression.

Sleep apnea is commonly found in people with heart failure.

Our Favorite Organizations for Essential Congestive Heart Failure Information

American Heart Association

This is the leading heart disease organization in the United States. Their online resources on heart failure offer clear explanations of the condition for both patients and family members, as well as links to many other tools and resources. You can also get information through your local AHA office and learn about volunteer opportunities.

Heart Failure Society of America

The website for this society, which is made up of researchers, clinicians, and trainees, discusses new treatments and research results in their field. The site also provides valuable information for people living with a heart condition. You can learn facts about heart failure, as well as find out about apps and podcasts to help you better manage the condition.

CardioSmart

The American College of Cardiology’s website is full of resources for patient education and empowerment. Check out basics about heart conditions, drugs and treatments, and news and events. By creating a profile, you can sign up to receive personalized newsletters and discussion guides to bring with you to your next doctor appointment.

Our Favorite Apps and Gadgets

H20 Overload

This app can help you to keep track of your liquid intake to avoid excess fluid buildup, which can lead to complications. You can also track your weight, since sudden increases in weight can be due to water retention. Another great thing about this app is that it alerts you if your blood pressure or weight gets high enough that you should tell your doctor. It also allows you to send reports on your fluid intake and weight to your healthcare provider.

Heart Failure Health Storylines

This app, developed in partnership with the Heart Failure Society of America, is your one-stop shop for recording symptoms, vital signs, and medications to help you manage congestive heart failure. You can also track your information and keep a journal to maintain wellness and emotional health.

Our Favorite Online Support Groups

Together in HF

Sponsored by the American Association of Heart Failure Nurses, this online support community for anyone who has been affected by heart failure allows you to connect with others and to hear from real medical experts. There is also a resource section that has information on things like low-salt cookbooks and patient tips for getting through the holidays.

American Heart Association Support Network

This network has tracks for various heart conditions, where you can post questions, share your story, and learn more about your condition. Once you sign up to become a part of the community, you will receive personalized content based on your condition and concerns.

Our Favorite Website Offering Lifestyle Advice for People Living With Heart Failure

UCSF Health

The University of California San Francisco Medical Center has a page devoted to diet and congestive heart failure. You can learn more about how to reduce your salt intake, as well as get tips on eating out and preparing meals.

Additional reporting by Ashley Welch