Heart Failure

Heart failure (congestive heart failure) is a common, chronic (long-term) condition in which your heart can’t pump blood well enough to meet your body’s needs. Your heart is still working. But because it can’t handle the amount of blood it should, fluid builds up in other parts of your body. Most of the time, it collects in your lungs, legs and feet.

Think of it like a shipping department where the staff can’t keep up with all the packages moving on a conveyer belt. The packages start to back up instead of getting where they need to go, leading to issues.

Heart failure usually begins with the lower left heart chamber, called the left ventricle. This is the heart’s main pumping chamber. But heart failure also can affect the right side. The lower right heart chamber is called the right ventricle. Sometimes, heart failure affects both sides of the heart.

Types of congestive heart failure include:

• Acute heart failure: Heart failure develops suddenly or gets worse quickly.
• Left-sided heart failure: The left side of your heart can’t pump blood to your body as well as it should.
• Right-sided heart failure: The right side of your heart can’t pump blood to your lungs as well as it should. In time, your heart also will fail to get blood to the rest of your body.
• High-output heart failure: Your heart pumps more blood than usual but still can’t meet your body’s needs.

Symptoms of congestive heart failure

Symptoms and signs of heart failure can range from mild to severe. Sometimes, you may not have symptoms, or they may come and go. Heart failure usually gets worse over time. As it worsens, you may have more signs or symptoms — or different ones.

Heart failure symptoms include:

• Shortness of breath, which may wake you at night
• Chest pain
• Heart palpitations
• Fatigue when you’re active
• Swelling in your ankles, legs and belly
• Weight gain
• Needing to pee more often at night
• A dry, hacking cough
• A full (bloated) or hard stomach
• Loss of appetite or upset stomach (nausea)

Heart failure causes

Heart failure can develop when your heart becomes damaged, weak or stiff. Common causes include:

• Coronary artery disease: Reduced blood flow can damage or weaken your heart.
• High blood pressure: Pushing harder against high blood pressure can make your heart stiff and weak.
• Heart valve disease: A damaged valve can make your heart work harder to pump blood.
• Cardiomyopathy: Diseases of the heart muscle can make it harder for your heart to pump blood.
• Congenital heart disease: Heart issues present at birth can affect how well your heart pumps blood.
• Arrhythmias: Abnormal heart rhythms can sometimes weaken your heart.
• Myocarditis: Inflammation of the heart muscle can damage your heart and lead to heart failure.

Other conditions and factors can also cause heart failure, including certain infections, medications and long-term health conditions.

Heart failure risk factors

Some factors can increase your risk of developing heart failure, including:

• Diabetes
• COPD
• High cholesterol
• High blood pressure
• Kidney disease
• A BMI higher than 30
• Age over 65
• Tobacco or other substance use
• Lack of physical activity
• Eating foods high in salt and fat
• A biological family history of heart failure

You can’t change all of these risk factors, but healthy habits can help lower your risk of heart disease and heart failure.

Complications

Heart failure can affect more than your heart. When your heart can’t pump enough blood to meet your body’s needs, fluid can build up and your organs may not get enough blood. The complications you develop depend on how severe your heart failure is and what other health conditions you have.

Complications may affect:

• Your heart and blood vessels: Heart failure can lead to abnormal heart rhythms, heart valve problems, pulmonary hypertension, blood clots or cardiac arrest.
• Your lungs: Fluid can build up in your lungs and make it harder to breathe.
• Your kidneys and liver: Reduced blood flow can damage these organs over time.
• Your nutrition: Heart failure can affect your appetite and digestion, which may lead to malnutrition.

How doctors diagnose this condition

Your healthcare provider will perform a physical exam. They’ll look for signs of congestive heart failure and diseases that may have made your heart muscle weak or stiff. They’ll ask you about your symptoms, your medical history, other health conditions you have and any medicines you take.

Tests can help diagnose heart failure and determine its stage, cause and severity. For example, a blood test can measure B-type natriuretic peptide (BNP), a substance your heart makes when it’s working harder than usual. BNP levels that are higher than normal can be a sign of heart failure.

Tests may include:

• Blood tests
• Cardiac catheterization
• Chest X-ray
• Echocardiogram
• Heart MRI
• Cardiac CT
• Electrocardiogram (EKG/ECG)
• Stress test
• Genetic testing

What are the four stages of congestive heart failure?

There are four congestive heart failure stages (A, B, C and D). They range from being at risk for heart failure to having an advanced case.

• Stage A: You’re at high risk of developing heart failure because you have certain risk factors, but you don’t have symptoms or structural heart disease.
• Stage B (pre-heart failure): Your heart has structural changes or doesn’t work as well as it should, but you’ve never had symptoms of heart failure.
• Stage C: You have structural heart disease, and you currently have or previously had symptoms of heart failure.
• Stage D (advanced): You have advanced heart failure symptoms that interfere with daily life and may be difficult to manage with treatment.

What are the four classes of heart failure?

Healthcare providers may also use the New York Heart Association (NYHA) classification to describe how much your heart failure symptoms affect your daily activities. There are four classes:

• Class I: Physical activity doesn’t cause heart failure symptoms.
• Class II: Everyday physical activity may cause symptoms like shortness of breath or fatigue, but you’re comfortable at rest.
• Class III: Less-than-usual physical activity causes symptoms, but you’re comfortable at rest.
• Class IV: You have symptoms even at rest, and physical activity makes them worse.

How is it treated?

Treatment can alter the course of this disease. Heart failure can get worse over time, making it harder for your heart to pump enough blood to your organs. Treatment aims to slow this progression, manage your symptoms and help you feel your best.

Your treatment will depend on the type of heart failure you have and, in part, what caused it. Medications and changes to daily habits are part of every treatment plan for this condition. Your healthcare provider will talk with you about the best plan for your needs.

Changes to daily habits

These include:

• Regular physical activity
• Avoidance of tobacco and other addictive substances
• Limits on sodium (salt) in the foods you eat
• Limits on fluid intake

Medications

Heart failure medicines may include:

• ACE inhibitors
• ARBs
• Beta-blockers
• Diuretics
• Aldosterone antagonists
• SGLT2 inhibitors
• GLP-1 agonists
• Hydralazine/nitrate combination
• ARNIs
• Inotropic drugs

Procedures

Procedures may include:

• Biventricular pacemaker: This device helps the lower chambers of your heart pump together more effectively.
• Implantable cardiac defibrillator (ICD): An ICD detects and treats dangerous abnormal heart rhythms.
• Heart transplant: This surgery replaces a severely damaged heart with a healthy donor heart.
• Intra-aortic balloon pump (IABP): This device helps your heart pump more blood when it needs temporary support in the ICU.
• Ventricular assist devices (VADs): A VAD helps a weakened heart pump blood to the rest of your body while you’re in the ICU. You may also get a durable (long-term) left ventricular assist device (LVAD).
• Heart surgery to treat blocked arteries, valve disease or congenital problems: Surgery can correct heart problems that may cause or worsen heart failure.

Supportive care

If you have advanced heart failure, your care plan may also focus on relieving symptoms and improving your quality of life. Palliative care can help manage symptoms and provide emotional and practical support. You can receive it at any stage of a serious illness, not just at the end of life.

If your heart failure continues to get worse despite treatment, your healthcare provider may also talk with you and your family about your goals and wishes for future care.

When should I see my healthcare provider?

Let your provider know if you have new or worsening symptoms, like:

• Shortness of breath when you’re at rest
• Swelling in your legs or belly
• Sudden weight gain
• Constant tiredness

Call 911 (or your local emergency services number) or go to the emergency room if:

• You have new chest pain
• You have severe trouble breathing
• Your heart failure symptoms suddenly become much worse

These symptoms have several possible causes. So, you’ll need immediate medical care to find out what’s happening and get treatment.

What can I expect if I have this condition?

Your prognosis (outlook) will depend on your symptoms, your heart muscle function and how well your body responds to treatment.

Heart failure may limit your activities. But you can care for yourself by tracking and reporting new or worsening symptoms to your healthcare provider and going to regular follow-up visits.

Heart failure can get worse over time. So, it’s a good idea to share your wishes for medical care with your provider and family. You can complete advance directives, including a living will, to let everyone involved in your care know what you want. These documents detail the treatments you want or don’t want to prolong your life. If possible, prepare these directives while you’re well in case you aren’t able to make such decisions later.