Heart failure is a condition in which the heart doesn’t pump 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.
Heart failure is a serious condition that is often the end stage or final outcome of many cardiovascular conditions, according to the American Heart Association (AHA). (1)
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.
Common Questions & Answers
Signs and Symptoms of Congestive Heart Failure
During heart failure, the body tries to compensate for reduced blood flow in other ways by:
- Enlarging the Heart Chamber By doing this, the heart muscle stretches in an attempt to contract more strongly in order to pump more blood. Initially, this may help the heart function more efficiently, but ultimately it causes the heart to function inefficiently and your body to retain fluid, leading congestion in the lungs.
- Developing More Muscle Mass This happens because the contracting cells of the heart get bigger, which initially lets the heart pump more strongly.
- Pumping Faster This is to increase your heart's output.
- Diverting Blood This means taking blood away from other tissues and organs such as the kidneys, the heart, and brain.
These compensations may mask heart failure temporarily, but eventually heart failure gets worse, and people start to experience symptoms.
The signs of heart failure can seem similar to those of normal aging and can be easy to ignore. This may explain why it takes some people years to realize that they have heart failure, notes the AHA. (2)
Causes and Risk Factors of Congestive Heart Failure
The following conditions can cause heart failure, yet many people aren't aware that they have them:
- Coronary artery disease is the most common cause of heart failure. Coronary artery disease 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 your body.
- Abnormal heart valves as a result from disease or infections force your heart to work harder to keep blood flowing as it should. Over time, this 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. This extra strain can lead to heart failure.
- Heart muscle damage (such as cardiomyopathy), brought on by causes such as diseases, infections, alcohol abuse, and drugs 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.
- Anemiaand 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 disease of the heart muscle. Being obese can also cause the heart to work much harder than it would for non-obese 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 a cardiomyopathy, leading to a diseased heart muscle and a reduction in blood-pumping capacity,according to the AHA. (4)
Risk Factors for Heart Failure
Having any of the following conditions can increase your risk for heart failure, per the Mayo Clinic: (5)
- High blood pressure
- Past heart attack
- Sleep apnea
- Congenital heart defects
- Valvular heart disease
- Alcohol use
- Tobacco use
- Irregular heartbeats
New Moms and Heart Failure Risk
A study published in January 2018 in the journal Circulation: Heart Failure found that women are most at risk for heart failure within the first six weeks after delivery, also known as the postpartum period. (6)
The research supports the notion that at-risk women need closer observation postpartum.
The researchers also say that because many women are discharged from hospital care just a couple of days after they give birth and aren’t given a follow-up 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 discharge health education, with emphasis on signs and symptoms to look for and when or where to seek immediate care.
How Is Congestive Heart Failure Diagnosed?
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.
After the physical exam, there are a number of tests that can help confirm a diagnosis of heart failure, including a stress test, chest X-rays, blood work, and an echocardiogram, according to the Mayo Clinic. (7)
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.
Still, the AHA reports that about one-half of people who develop heart failure die within five years of diagnosis. (8)
Treatment and Medication Options for Congestive Heart Failure
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. These include exercising and maintaining a heart-healthy diet that’s low in saturated fat, trans fats, and cholesterol.
You may also be prescribed drugs to decrease symptoms and improve heart function. These can include:
- Angiotensin-converting enzyme (ACE) inhibitors enlarge blood vessels and decrease blood pressure, helping blood flow through the body more easily and decreasing the workload of the heart.
- Angiotensin II 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 the heart rate down and decreasing the effects of adrenaline on the heart. This in turn lowers blood pressure so the heart has to do less work. These medications, similar to ACE inhibitors and angiotensin II 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.
- Digitalis can help the heart strengthen its contractions when its pumping function has been weakened. The drug can help reduce symptoms of heart failure.
- Inotropes are reserved for people with severe heart failure in the hospital. These are intravenous drugs that maintain blood pressure and improve heart function. (7,9)
Surgery for Heart Failure
If your doctor determines that your underlying causes of your heart failure can’t be treated with medication and lifestyle changes, surgery may be necessary. These procedures may include:
- 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 (VADs) are mechanical pumps implanted into the abdomen or chest and attached to the weakened heart. The devices help pump blood from the lower heart chambers to the rest of your body.
- Implantable cardioverter-defibrillators (ICDs) are implanted beneath the skin in the chest with wires leading through the veins and into the heart. These devices monitor heart rhythm and shocks the heart back into normal rhythm if it starts beating dangerously or stops beating. ICDs can also act as pacemakers, speeding up the heart if it begins beating too slowly.
- Cardiac resynchronization therapy (CRT), also known as biventricular pacing, sends electrical pulses to the heart’s lower chambers to help them pump more efficiently.
- Heart transplant is performed in the most serious of heart failure cases, when medication or surgery do no help. The procedure involves removing the damaged heart and replacing it with a healthy one from an organ donor. (7)
Prevention of Congestive Heart Failure
The best way to prevent heart failure is to control your risk factors. The good news is 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.
These lifestyle changes include: (5)
Complications of Congestive Heart Failure
Heart failure can lead to a number of complications that can influence the chance of survival, including:
- Rapid Weight Loss Severe heart failure can lead to an unintentional 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 on 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. (7,10)
Research and Statistics: How Many People Have Congestive Heart Failure
Black and Hispanic Communities and Congestive Heart Failure
Black Americans have a higher risk of congestive heart failure than white Americans, according to an article published in October 2018 in Cardiology. (13)
A 2020 study published in JAMA Cardiology found that non-Hispanic Black Americans ages 35 to 64 had a prevalence of heart failure almost 3 times that of their white counterparts. (14)
The Black community as a whole has a higher rate of heart disease, as well as a higher rate of many of the main risk factors for heart disease and heart failure, including high blood pressure, high cholesterol, diabetes, and obesity. While there is no one-size-fits all explanation for this increased risk, researchers believe a combination of socioeconomic factors, environment, education, stress levels, and culture are all at play, according to UT Southwestern Medical Center. (15)
Researchers suggest Hispanic Americans are at a greater risk of heart failure, as well. A study published in 2016 in the American Heart Association’s journal Circulation: Heart Failure found that about one-half of the middle-aged Hispanic adults studied had heart problems that could lead to heart failure. (16) However, fewer than 1 in 20 participants knew they had a health issue. The researchers found these individuals also had higher rates of obesity, high blood pressure, and diabetes.
Related Conditions of Congestive Heart Failure
Edema and Heart Failure
Edema is the 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, like 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
If you have any of these symptoms, make an appointment to see your doctor. Seek medical attention immediately if you experience these along with shortness of breath, difficulty breathing, and chest pain, says the Mayo Clinic. (17)
Sleep Apnea and Heart Failure
Sleep apnea is a common but potentially serious sleep disorder that affects an estimated 30 million people in the United States, according to an article published in August 2016 in the Journal of Sleep Medicine. (18)
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 will put them at increased risk for 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.
Heart failure can cause retention of sodium and water, and doctors suspect that the excess fluid may enter the lungs at night and lead to obstructive apnea. Heart failure also seems to be linked to problems with the respiratory control system, which may be a cause of central sleep apnea, notes the Mayo Clinic. (19)
Resources We Love
Our Favorite Organizations for Essential Congestive Heart Failure Information
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 find information on your local AHA office and learn about volunteer opportunities.
The website for this society, which is made up of researchers, clinicians, and trainees, discusses new treatments and research results in their field. It also has valuable information for people living with a heart condition in their patient section. You can learn facts about heart failure, and learn about apps and podcasts to help you better manage the condition.
The American College of Cardiology’s website is full of resources for patient education and empowerment. Check out basics on 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's appointment.
Our Favorite Apps and Gadgets
This tool from the American Heart Association can be used on a smartphone or desktop computer to track everything from daily exercise to medications. You can even set it up to remind you when it’s time for your daily doses. An accompanying app lets you electronically share vital medical information with your doctor.
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. The 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.
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
Sponsored by the American Association of Heart Failure Nurses, this online support community for any person 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 which has information on things like low-salt cookbooks and patient tips to get through the holidays.
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
The University of California San Francisco Medical Center has a page devoted to diet and congestive heart failure. There you can learn more about how to reduce your salt intake, with additional tips on eating out and preparing meals.
Additional reporting by Ashley Welch.
Editorial Sources and Fact-Checking
- Heart Failure. American Heart Association.
- What Is Heart Failure? American Heart Association. May 31, 2017.
- 5 Warning Signs of Early Heart Failure. Harvard Health. September 25, 2019.
- Causes of Heart Failure. American Heart Association. May 31, 2017.
- Heart Failure Symptoms and Causes. Mayo Clinic. May 29, 2020.
- Heart Failure in Pregnant Women. Circulation: Heart Failure. January 12, 2018.
- Heart Failure Diagnosis and Treatment. Mayo Clinic. May 29, 2020.
- Death in Heart Failure. Circulation: Heart Failure. May 28, 2008.
- Medications Used to Treat Heart Failure. American Heart Association. May, 31, 2017.
- Heart Failure: Complications. University Health Care System.
- Heart Failure. Centers for Disease Control and Prevention. September 8, 2020.
- Heart Failure Projected to Increase Dramatically, According to New Statistics. American Heart Association. January 25, 2017.
- One Size Does Not Fit All: The Role of Sex, Gender, Race and Ethnicity in Cardiovascular Medicine. Cardiology. October 19, 2018.
- Trends in the Prevalence of Self-Reported Heart Failure by Race/Ethnicity and Age From 2001 to 2016. JAMA Cardiology. September 2, 2020.
- Why do African Americans Face Higher Risk of Heart Disease? UT Southwestern Medical Center. August 17, 2015.
- Burden of Systolic and Diastolic Left Ventricular Dysfunction Among Hispanics in the United States. Circulation: Heart Failure. April 5, 2016.
- Edema Symptoms and Causes. Mayo Clinic. October 26, 2017.
- Health Care Savings: The Economic Value of Diagnostic and Therapeutic Care for Obstructive Sleep Apnea. Journal of Clinical Sleep Medicine. August 15, 2016.
- Sleep Apnea Symptoms and Causes. Mayo Clinic. July 28, 2020.