Cardiac Failure Congestive

Congestive heart failure is a long-term condition where your heart can’t pump blood well enough to meet your body’s needs, causing blood and fluids to collect in your lungs and legs over time.

Table of contents

• What is congestive heart failure?
• Types of congestive heart failure
• How common is the condition?
• Symptoms
• Causes
• Risk factors
• Complications
• How is it diagnosed?
• Treatment and management
• Living with congestive heart failure

heart failure, CHF, cardiac failure, left-sided heart failure, right-sided heart failure

What is congestive heart failure?

Congestive heart failure is a 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 it can’t handle the amount of blood it should^[1]. Because of this, blood builds up in other parts of your body. Most of the time, it collects in your lungs, legs and feet^[1].

Think of it like a shipping department that can’t keep up with getting all the shipments where they need to go. The shipping department is always running behind and things pile up. When things pile up, they cause issues^[1].

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^[2]. Some heart conditions slowly leave the heart too weak or stiff to fill and pump blood properly^[2].

Types of congestive heart failure

Heart failure can affect one or both sides of your heart^[4]. The types include:

• Left-sided heart failure: Your heart can’t pump enough oxygen-rich blood out to your body. This happens when the left side of your heart becomes either too weak to pump enough blood or too thick or stiff to relax and fill with enough blood^[4]. Left-sided heart failure is more common than right-sided heart failure^[4].
• Right-sided heart failure: Your heart is too weak to pump enough blood to your lungs to get oxygen^[4]. Left-sided heart failure is the most common cause of right-sided heart failure. When your left ventricle (the main pumping chamber of your heart) isn’t working correctly, it allows blood to back up. At some point, this backup affects your right ventricle^[1].
• High-output heart failure: This is a rare type of congestive heart failure^[1].

How common is the condition?

More than 6 million people in the United States have congestive heart failure^[1]. With an estimated prevalence of 26 million people worldwide, congestive heart failure contributes to increased healthcare costs, reduces functional capacity, and significantly affects quality of life^[3].

Heart failure is the leading cause of hospitalization in people older than 65^[1]. In 2023, heart failure was mentioned on 452,573 death certificates and was responsible for 14.6% of all causes of death^[6].

Heart failure can happen at any age. It happens to both men and women, but men often develop it at a younger age than women^[4].

Symptoms

The symptoms of heart failure depend on which side of your heart is affected and how serious your condition has become. Most symptoms are caused by reduced blood flow to your organs and fluid buildup in your body^[4].

Fluid buildup happens because the flow of blood through your heart is too slow. As a result, blood backs up in the vessels that return the blood to your heart. Fluid may leak from the blood vessels and collect in the tissues of your body, causing swelling (edema) and other problems^[4].

Common symptoms of congestive heart failure include^[1][4]:

• Shortness of breath with activity or when lying down. This may be one of the first symptoms you notice^[4].
• Waking up short of breath at night
• Fatigue or weakness, even after rest
• Chest pain
• Heart palpitations (feeling your heart beating rapidly or irregularly)
• Swelling in your ankles, legs, feet and abdomen
• Weight gain from fluid buildup
• Need to urinate while resting at night
• A dry, hacking cough, particularly when lying down
• A full (bloated) or hard stomach
• Loss of appetite or upset stomach (nausea)
• Reduced ability to exercise
• Wheezing

Sometimes, you may have mild symptoms of congestive heart failure or none at all. This doesn’t mean you don’t have heart failure anymore. Symptoms of heart failure can range from mild to severe and may come and go^[1].

Unfortunately, congestive heart failure usually gets worse over time. As it worsens, you may have more or different signs or symptoms^[1].

Causes

Heart failure can start suddenly after a medical condition or injury damages your heart muscle. But in most cases, heart failure develops slowly from long-term medical conditions^[4].

Ischemic heart disease (conditions that reduce blood flow to the heart) is the leading cause of heart failure^[3]. The etiology of heart failure is variable and extensive^[3].

Conditions that can cause heart failure include^[1][4]:

• Coronary artery disease (narrowed arteries in the heart) and heart attack
• Cardiomyopathy (disease of the heart muscle, which can be genetic or viral)
• Congenital heart defects (heart issues present at birth)
• High blood pressure (hypertension)
• Arrhythmia (a problem with the rate or rhythm of your heartbeat)
• Heart valve diseases
• Diabetes
• Kidney disease
• Endocarditis (infection of the heart lining)
• A blood clot in your lung
• Certain severe lung diseases, such as COPD (chronic obstructive pulmonary disease)
• Obesity (a body mass index or BMI higher than 30)
• Tobacco and recreational drug use
• Alcohol use
• Medications such as cancer drugs (chemotherapy)

Risk factors

Your chance of developing heart failure increases if^[1][4]:

• You’re 65 years old or older. Aging can weaken and stiffen your heart muscle.
• Your family health history includes relatives who have or have had heart failure
• You have changes in your genes that affect your heart tissue
• You use tobacco products, cocaine or alcohol
• You have an inactive (sedentary) lifestyle
• You eat foods that have a lot of salt, fat, cholesterol and sodium
• You have high blood pressure
• You have coronary artery disease
• You’ve had a heart attack
• You have other medical conditions that can affect your heart, including any heart or blood vessel conditions, serious lung diseases, infections such as HIV or COVID-19, diabetes, sleep apnea, chronic kidney disease, anemia, thyroid disease, iron overload disease
• You’ve had cancer treatments that can harm your heart, such as radiation and chemotherapy
• You are African American. African Americans are more likely to develop heart failure and have more serious cases at younger ages than people of other races. Factors such as stigma, discrimination, income, education, and geographic region can also affect their risk of heart failure^[4].

Complications

Heart failure can be life-threatening. People with heart failure may have severe symptoms^[2]. Some of the complications from congestive heart failure include^[1]:

• Irregular heartbeat
• Sudden cardiac arrest
• Heart valve problems
• A collection of fluid in your lungs
• Pulmonary hypertension (high blood pressure in the blood vessels of the lungs)
• Kidney damage
• Liver damage
• Malnutrition

How is it diagnosed?

Your healthcare provider will ask you about your symptoms and medical history. They may ask you about other health conditions you have, a family history of heart disease or sudden death, and your use of tobacco products^[1].

Your healthcare provider will examine you and ask questions about your symptoms and medical history. They will check to see if you have risk factors for heart failure^[9]. Your care professional listens to your lungs and heart with a device called a stethoscope. A whooshing sound called a murmur may be heard when listening to your heart. Your care professional may look at the veins in your neck and check for swelling in your legs and belly^[9].

Tests that may be done to diagnose heart failure include^[9]:

• Blood tests: Blood tests can help diagnose diseases that can affect the heart. Blood tests also can look for a specific protein made by the heart and blood vessels. In heart failure, the level of this protein goes up.
• Chest X-ray: X-ray images can show the condition of the lungs and heart.
• Electrocardiogram (ECG or EKG): This quick and painless test records the electrical signals in the heart. It can show how fast or how slowly the heart is beating.
• Echocardiogram: Sound waves create images of the beating heart. This test shows the size and structure of the heart and heart valves and blood flow through the heart.
• Ejection fraction: Ejection fraction is a measurement of the percentage of blood leaving your heart each time it squeezes. This measurement is taken during an echocardiogram. The result helps classify heart failure and guides treatment^[9].
• Exercise tests or stress tests: These tests often involve walking on a treadmill or riding a stationary bike while the heart is monitored.

Treatment and management

For most people, heart failure is a long-term condition that can’t be cured. But treatment can help keep the symptoms under control, possibly for many years^[10].

Treatment usually involves healthy lifestyle changes, medications, devices implanted in your chest to control your heart rhythm, and surgery^[10]. In many cases, a combination of treatments will be required. Treatment will usually need to continue for the rest of your life^[10].

The general management of heart failure aims to relieve systemic and pulmonary congestion and stabilize hemodynamic status (blood flow), regardless of the cause. The treatment of heart failure requires a multifaceted approach involving patient education, optimal medication administration, and decreasing acute exacerbations^[3].

Medications

Most people with heart failure are treated with medication. Often you’ll need to take 2 or 3 different medicines^[10]. Some of the main medicines for heart failure include^[10]:

• ACE inhibitors (angiotensin-converting enzyme inhibitors): Work by relaxing and opening up your blood vessels, which makes it easier for your heart to pump blood around the body. Examples include ramipril, captopril, enalapril, lisinopril and perindopril.
• Angiotensin-2 receptor blockers (ARBs): Work in a similar way to ACE inhibitors by relaxing blood vessels and reducing blood pressure. Examples include candesartan, losartan, telmisartan and valsartan.
• Beta blockers: Work by slowing your heart down and protecting your heart from the effects of adrenaline and noradrenaline. The main ones used to treat heart failure include bisoprolol, carvedilol and nebivolol.
• Mineralocorticoid receptor antagonists (MRAs): Make you pass more urine, and help lower blood pressure and reduce fluid around the heart. The most widely used MRAs are spironolactone and eplerenone.
• Diuretics: Make you pass more urine and help relieve ankle swelling and breathlessness caused by heart failure. The most widely used for heart failure are furosemide (also called frusemide) and bumetanide.
• Ivabradine: A medicine that can help slow your heart down.
• Sacubitril valsartan: An angiotensin receptor-neprilysin inhibitor.
• SGLT2 inhibitors: A class of medications that help with heart failure.
• Digoxin: Used in some cases.

You may need to try a few different medicines before you find a combination that controls your symptoms but doesn’t cause unpleasant side effects^[10].

Devices and surgery

Some people with heart failure may need devices implanted in their chest to help control heart rhythm, or surgery such as heart transplant or devices to help the heart pump blood^[2].

Living with congestive heart failure

Living with congestive heart failure does not mean you have a poor quality of life. With a healthy diet, regular exercise, the right amount of sleep, and daily rest, you can enjoy and live your best life^[18].

Lifestyle modifications

It’s very important to take good care of yourself if you have heart failure^[17]. Managing symptoms with lifestyle modifications and keeping a daily healthy routine can help to prevent congestive heart failure from worsening^[7].

Important lifestyle changes include^[6][7][17]:

• Limit salt intake: Too much salt causes your body to retain fluid and increases blood pressure. A heart-healthy diet includes fruits, vegetables, whole grains and lean protein, with low levels of saturated fat, salt and sugar.
• Limit fluid intake: As recommended by your healthcare provider.
• Monitor your weight daily: Rapid weight gain can indicate fluid buildup, a sign of worsening heart failure. Contact your physician if you gain two or three pounds in one day.
• Exercise regularly: Keeping your body active is an essential part of good heart health. Light physical activity, including walking or swimming, strengthens your heart muscle. You should be offered an exercise-based cardiac rehabilitation programme.
• Get enough sleep: When you sleep, your heart does not work as hard to pump blood. Maintain a regular sleep routine and talk to your physician about any sleep-related breathing issues.
• Conserve your energy: Take frequent breaks to rest. Elevating your feet at rest time reduces the risk of swelling in your legs and feet.
• Stop smoking: If you smoke, stopping smoking can improve your overall health and reduce your risk of many other health problems.
• Limit alcohol consumption: You can usually continue to drink alcohol if you have heart failure, but it’s advisable not to exceed the recommended limits of more than 14 alcohol units a week^[17].

Medication management

Know the names and dosages of your medications. Keep a list and take your medication with you to the doctor or hospital. Take all medications as prescribed by your doctor. Do not stop taking them without consulting with your doctor first^[7].

Regular monitoring

Schedule regular checkups with your doctor to discuss symptoms, medication and overall quality of daily life. Checking in regularly can reduce the risk of serious complications such as heart attack, organ damage and sudden cardiac arrest^[18].

You’ll have regular contact with your GP or care team to monitor your condition at least every 6 months^[17]. These appointments may involve talking about your symptoms, a discussion about your medication, and tests to monitor your health. You may be asked to help monitor your condition between appointments, such as weighing yourself regularly^[17].

Getting vaccinated

Heart failure can put a significant strain on your body and mean you’re more vulnerable to infections. Everyone with heart failure should be offered the annual flu vaccine and the one-off pneumococcal vaccination^[17].