Heart Failure (Congestive Heart Failure)
Overview
What is heart failure?
Heart failure, or congestive heart failure, is a long-term condition that gets worse over time. Although the name sounds like your heart has stopped working, heart failure means your heart isn’t able to pump blood as well as it should. When your heart has less pumping power, that can damage your organs and fluid can collect in your lungs.
How common is heart failure?
Almost six million Americans have heart failure, and more than 870,000 people are diagnosed with heart failure each year. Heart failure (congestive heart failure) is the leading cause of hospitalization in people older than 65.
What are the types of heart failure?
There are many causes of heart failure, but the condition is generally broken down into these types:
Left-sided heart failure
Heart failure with reduced left ventricular function (HF-rEF)
The lower left chamber of your heart (left ventricle) gets bigger and cannot squeeze (contract) hard enough to pump the right amount of oxygen-rich blood to the rest of your body.
Heart failure with preserved left ventricular function (HF-pEF)
Your heart contracts and pumps normally, but the bottom chambers of your heart (ventricles) are thicker and stiffer than normal. Because of this, your ventricles can't relax properly and fill up all the way. Because there's less blood in your ventricles, your heart pumps out less blood to the rest of your body when it contracts.
Right-sided heart failure
Heart failure can also affect the right side of your heart. Left-sided heart failure is the most common cause of this. Other causes include certain lung problems and issues in other organs.
What is congestive heart failure?
This is a state in which your heart hasn’t been able to handle the blood volume. This causes an accumulation in other parts of your body, most commonly in your lungs and lower extremities (feet/legs).
What are the complications of heart failure?
Some of the complications from heart failure include:
- Irregular heartbeat.
- Sudden cardiac arrest.
- Heart valve problems.
- A collection of fluid in your lungs.
- Pulmonary hypertension.
- Kidney damage.
- Liver damage.
- Malnutrition
What are the heart failure stages?
Heart failure is a chronic condition that gets worse with time. There are four heart failure stages (Stage A, B, C and D). The stages range from "high risk of developing heart failure" to "advanced heart failure."
Stage A
Stage A is considered pre-heart failure. It means you’re at high risk of developing heart failure because you have a family history of heart failure or you have one or more of these medical conditions:
- Hypertension.
- Diabetes.
- Coronary artery disease.
- Metabolic syndrome.
- History of alcohol abuse.
- History of rheumatic fever.
- Family history of cardiomyopathy.
- History of taking drugs that can damage your heart muscle, such as some cancer drugs.
Stage B
Stage B is considered pre-heart failure. It means your healthcare provider has given you a diagnosis of systolic left ventricular dysfunction but you’ve never had symptoms of heart failure. Most people with Stage B heart failure have an echocardiogram (echo) that shows an ejection fraction (EF) of 40% or less. (See "Diagnosis" section for more about ejection fraction.) This category includes people who have heart failure and reduced EF (HF-rEF) due to any cause.
Stage C
People with Stage C heart failure have a heart failure diagnosis and currently have or previously had signs and symptoms of the condition.
There are many possible symptoms of heart failure. The most common are:
- Shortness of breath.
- Feeling tired (fatigue).
- Less able to exercise.
- Weak legs.
- Waking up to urinate.
- Swollen feet, ankles, lower legs and abdomen (edema).
Stage D and reduced EF
People who have Stage D HF-rEF have advanced symptoms that don’t get better with treatment. This is the final stage of heart failure.
Symptoms and Causes
What are the symptoms of heart failure?
Symptoms of heart failure include:
- Shortness of breath.
- Feeling tired (fatigue) and having leg weakness when you’re active.
- Swelling in your ankles, legs and abdomen.
- Weight gain.
- Need to urinate while resting at night.
- Rapid or irregular heartbeats (palpitations).
- A dry, hacking cough.
- A full (bloated) or hard stomach, loss of appetite or upset stomach (nausea).
There may be times that your symptoms are mild or you may not have any symptoms at all. This doesn't mean you no longer have heart failure. Symptoms of heart failure can range from mild to severe and may come and go.
Unfortunately, heart failure usually gets worse over time. As it worsens, you may have more or different signs or symptoms. It’s important to let your doctor know if you have new symptoms or if your symptoms get worse.
What causes heart failure (congestive heart failure)?
Although the risk of heart failure doesn’t change as you get older, you’re more likely to have heart failure when you’re older.
Many medical conditions that damage the heart muscle can cause heart failure. Common conditions include:
- Coronary artery disease.
- Heart attack.
- Cardiomyopathy.
- Heart issues present at birth (congenital heart disease).
- Diabetes.
- High blood pressure (hypertension). This is a common cause in people assigned female at birth.
- Arrhythmia (abnormal heart rhythms, including atrial fibrillation).
- Kidney disease.
- Having obesity.
- Tobacco and recreational drug use.
- Medications. Some drugs used to fight cancer (chemotherapy) can lead to heart failure.
Diagnosis and Tests
Heart Failure Diagnosis
In order to determine if you have heart failure, your healthcare provider needs to know about your symptoms and medical history. They will ask you about things such as:
- Other health conditions you have, such as diabetes, kidney disease, chest pain (angina), high blood pressure, high cholesterol, coronary artery disease, or other heart problems.
- If you have a family history of heart disease or sudden death.
- If you smoke or use tobacco.
- How much alcohol you drink.
- If you’ve had chemotherapy and/or radiation.
- The medications you take.
You’ll also have a physical exam. Your provider will look for signs of congestive heart failure and diseases that may have caused your heart muscle to become weak or stiff.
What is the importance of ejection fraction?
Your ejection fraction (EF) is one way to measure the severity of your condition. If it’s below normal, it can mean that you have heart failure. Your ejection fraction tells your healthcare provider how good of a job your left or right ventricle is doing at pumping blood. Usually, your EF number is talking about how much blood your left ventricle is pumping out because it’s your heart's main pumping chamber.
Several non-invasive tests can measure your EF. With this information, your healthcare provider can decide how to treat you or find out if a treatment is working as it should.
A normal left ventricular ejection fraction (LVEF) is 53% to 70%. An LVEF of 65%, for example, means that 65% of the total amount of blood in your left ventricle is pumped out with each heartbeat. Your EF can go up and down, based on your heart condition and how well your treatment works.
What types of tests are used to diagnose heart failure?
You’ll have tests to see how bad your heart failure is and what caused it. Common tests include:
Management and Treatment
How is heart failure treated?
Your treatment will depend on the type of heart failure you have and, in part, what caused it. Medications and lifestyle behaviors are part of every treatment plan. Your healthcare provider will talk to you about the best treatment plan for you. Treatment is the same, regardless of gender.
As heart failure gets worse, your heart muscle pumps less blood to your organs, and you move toward the next stage of heart failure. Since you can’t move backward through the heart failure stages, the goal of treatment is to keep you from moving forward through the stages or to slow down the progression of your heart failure.
Stage A treatment
The usual treatment plan for people with Stage A heart failure includes:
- Regular exercise, being active, walking every day.
- Stopping the use of tobacco products.
- Treatment for high blood pressure (medication, low-sodium diet, active lifestyle).
- Treatment for high cholesterol.
- Not drinking alcohol or using recreational drugs.
- Angiotensin-converting enzyme inhibitor (ACE-I) or an angiotensin II receptor blocker (ARB) if you have coronary artery disease, diabetes, high blood pressure, or other vascular or cardiac conditions.
- Beta-blocker if you have high blood pressure.
Stage B treatment
The usual treatment plan for people with Stage B heart failure includes:
- Treatments listed in Stage A.
- Angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) (if you aren't already taking one).
- Beta-blocker if you’ve had a heart attack and your EF is 40% or lower (if you aren't already taking one).
- Aldosterone antagonist if you’ve had a heart attack or if you have diabetes and an EF of 35% or less.
- Possible surgery or intervention as a treatment for coronary artery blockage, heart attack, valve disease (valve repair or replacement) or congenital heart disease.
Stage C treatment
The usual treatment plan for people with Stage C HF-rEF includes:
- Treatments listed in Stages A and B.
- Beta-blocker.
- Aldosterone antagonist if a vasodilator medicine (ACE-I, ARB or angiotensin receptor/neprilysin inhibitor combination) and beta-blocker don't relieve your symptoms.
- Hydralazine/nitrate combination if other treatments don't stop your symptoms. Patients who are Black should take this medication (even if they’re taking other vasodilator medications) if they have moderate to severe symptoms.
- Medications that slow your heart rate if your heart rate is faster than 70 beats per minute and you still have symptoms.
- A diuretic ("water pill") may be prescribed if symptoms continue.
- Restriction of sodium (salt) in your diet.
- Tracking your weight every day. Tell your healthcare provider if you gain or lose more than four pounds.
- Possible fluid restriction.
- Possible cardiac resynchronization therapy (biventricular pacemaker).
- Possible implantable cardiac defibrillator (lCD) therapy.
If the treatment causes your symptoms to get better or stop, you still need to continue treatment to slow the progression to Stage D.
Stage D treatment
The usual treatment plan for people who have Stage D heart failure includes treatments listed in Stages A, B and C. In addition, it includes evaluation for more advanced treatment options, including:
- Heart transplant.
- Ventricular assist devices.
- Heart surgery.
- Continuous infusion of intravenous inotropic drugs.
- Palliative or hospice care.
- Research therapies.
Stages C and D with preserved EF
Treatment for people with Stage C and Stage D heart failure and preserved EF (HF-pEF) includes:
- Treatments listed in Stages A and B, although some may not be appropriate.
- Medications for the treatment of medical conditions that can cause heart failure or make the condition worse, such as atrial fibrillation, high blood pressure, diabetes, obesity, coronary artery disease, chronic lung disease, high cholesterol and kidney disease.
- Diuretic ("water pill") to reduce or relieve symptoms.
It’s very important for you to manage your other health conditions, such as:
- Diabetes.
- Kidney disease.
- Anemia.
- High blood pressure.
- Thyroid disease.
- Asthma.
- Chronic lung disease.
Some conditions have signs and symptoms similar to heart failure. If you have new or worsening non-urgent symptoms, tell your healthcare provider.
Prevention
How can I prevent heart failure?
Although you can’t control some risk factors like age, family history or race, you can change your lifestyle to give yourself the best chance of preventing heart failure. Things you can do include:
- Staying at a healthy weight.
- Eating foods that are good for your heart.
- Exercising regularly.
- Managing your stress.
- Stopping the use of tobacco products.
- Not drinking alcohol.
- Not using recreational drugs.
- Taking care of other medical conditions you have that can increase your risk.
Outlook / Prognosis
What is the outlook with heart failure?
With the right care, congestive heart failure won’t stop you from doing the things you enjoy. Your prognosis, or outlook for the future, will depend on:
- How well your heart muscle is working.
- Your symptoms.
- How well you respond to your treatment plan.
- How well you follow your treatment plan.
One study says that people with heart failure have a life span 10 years shorter than those who don’t have heart failure. Another study showed that the survival rates of people with chronic heart failure were 80% to 90% for one year, but that dropped to 50% to 60% for year five and down to 30% for 10 years.
A different study found that people who had heart failure and were discharged from the hospital had expected life spans ranging from three to 20 years, depending on various factors like age and gender. It’s important to look at your specific situation when considering your prognosis.
Living With
How does heart failure affect the quality of life and lifestyle?
With the right care and treatment plan, many adults still enjoy life even though heart failure limits their activities. How well you feel depends on:
- How well your heart muscle is working.
- Your symptoms.
- How well you respond to your treatment plan.
- How well you follow your treatment plan.
This includes caring for yourself by:
- Taking your medications.
- Being active.
- Following a low-sodium diet.
- Tracking and reporting new or worsening symptoms to your provider.
- Keeping regular follow-up appointments with your healthcare provider.
Because heart failure is a chronic, long-term illness, talk to your doctor and your family about your preferences for medical care. You can complete an advance directive or living will to let everyone involved in your care know what you want. A living will details the treatments you do or don’t want to prolong your life. It’s a good idea to prepare a living will while you are well in case you aren’t able to make these decisions at a later time.
A note from Cleveland Clinic
If you have heart failure, you can take steps to improve your heart health. Take your medications as instructed, follow a low-sodium diet, stay active or become physically active, take notice of sudden changes in your weight, live a healthy lifestyle, keep your follow-up appointments and track your symptoms. Talk to your healthcare provider about questions or concerns you have about your medications, lifestyle changes or any other part of your treatment plan.
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