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

While the term heart failure, also known as congestive heart failure, may sound like your 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 your body and a backup (also called congestion) of fluid into your lungs, legs, and feet.

Signs and Symptoms of Congestive Heart Failure

With congestive heart failure, your body tries to compensate for reduced blood flow in other ways, including:

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

These compensations may mask heart failure for a time. But eventually the condition becomes worse, and you start to notice symptoms.

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

Congestive Heart Failure Causes and Risk Factors

• Coronary artery disease is the most common cause of heart failure. It causes narrowing of the arteries that supply blood to your heart muscle.
• A previous heart attack can leave scar tissue that interferes with your heart’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 of disease or infections force your heart to work harder than it should to keep blood flowing. Over time, that extra work weakens your 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 your heart and prevent it from pumping enough blood to your body.
• Chronic lung diseases, such as chronic obstructive pulmonary disease (COPD) or emphysema, can cause heart failure.
• A blood clot in your lungs (called a pulmonary embolism) may cause heart failure on the right side of your 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 these have been linked to the disease.
• Obesity can cause cardiomyopathy, which is a disease of the heart muscle. Obesity can also cause your heart to work much harder than it would in other people.
• Long-term use of certain medicines and supplements may worsen heart failure or interfere with heart failure medicines. Nonsteroidal anti-inflammatory drugs (NSAIDs) — including ibuprofen (Advil, Motrin) and naproxen (Aleve) — can elevate blood pressure and increase salt and fluid retention, putting you at risk of heart failure.
• 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 researchers also say that 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. So, the way doctors regard women who might be at risk of heart failure needs to change, the researchers say. 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.

How Is Congestive Heart Failure Diagnosed?

If you have any of the symptoms of congestive heart failure, be sure to talk with your healthcare provider.

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

Prognosis of Congestive Heart Failure

It’s possible to live a full, active life with heart failure, even though it’s a long-term condition. Your life expectancy with heart failure depends on many factors, including your:

• Age
• Gender
• Symptoms
• How well your heart muscle is working
• How well you follow and respond to your treatment plan

Treatment and Medication Options for Congestive Heart Failure

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

Medication Options

• Angiotensin-converting enzyme (ACE) inhibitors can lower blood pressure, helping blood flow through your body more easily and decreasing the workload of your heart. Also, ACE inhibitors can help limit bad changes to the heart in response to an injury (for example, after a heart attack).
• Angiotensin II receptor blockers (ARBs) have many of the same benefits as ACE inhibitors. They’re often prescribed as an alternative for people who can’t tolerate ACE inhibitors.
• Angiotensin–receptor neprilysin inhibitors (ARNIs) combine two blood pressure drugs, together called sacubitril-valsartan (Entresto), to treat heart failure. It has been found to be slightly more effective than using an ACE inhibitor or ARB alone.
• Beta-blockers work by slowing down your heart rate and decreasing the effects of adrenaline on your heart. This in turn lowers blood pressure, so that your 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 your heart caused by heart failure.
• Diuretics, often called water pills, rid your body of excess fluids and sodium through urination. This helps relieve your heart’s workload. Bumetanide nasal spray (Enbumyst) is a non-oral diuretic therapy that allows for more rapid absorption of the drug.

• Aldosterone antagonists are a type of diuretic that, unlike other diuretics, don’t deplete potassium. They also have additional properties that can help a person with severe heart failure live longer.
• Digitalis, also known as digoxin (Lanoxin), can help your 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 (BiDil) can help relax blood vessels. It’s typically used as a supplemental drug to treat heart failure, particularly if ACE inhibitors or beta-blockers aren’t working.
• Vericiguat (Verquvo) is a 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 your heart doesn’t pump out enough blood with each heartbeat.
• Finerenone (Kerendia) is a non-steroidal mineralocorticoid receptor antagonist (nsMRA) approved to treat heart failure with mildly reduced ejection fraction. Studies have shown lower rates of cardiovascular-related deaths and hospitalizations among people with heart failure taking this drug.

Surgery for Heart Failure

• Coronary bypass surgery treats blocked arteries by removing healthy arteries from other parts of your body and using them to reroute blood around clogged arteries. This improves blood flow to your heart. Your doctor may suggest bypass surgery if severely blocked arteries are a contributing factor to your heart failure.
• 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 your 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 your chest with wires leading through your veins and into your heart. These devices monitor your heartbeat and will shock your heart back into normal rhythm if it develops a life-threatening arrhythmia. They can also act as pacemakers, speeding up your heart if it begins beating too slowly.
• Cardiac resynchronization therapy, also known as biventricular pacing, sends electrical pulses to your heart’s lower chambers to help them pump more efficiently.
• A heart transplant is an option in the most serious heart failure cases, when medication or surgery doesn’t 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 get rid of many of the risk factors that lead to heart disease, such as high blood pressure. Making lifestyle changes and continuing to take any medication your doctor prescribes can go a long way toward preventing heart failure.

• Quit smoking if you light up.
• Eat a healthy diet.
• Get enough physical activity.
• Stay at a healthy weight.
• Take medications for all health conditions as directed.
• Reduce your stress.

Complications of Congestive Heart Failure

• Impaired Kidney Function Congestive heart failure weakens your heart’s ability to pump blood, reducing blood flow to the kidneys. This can lead to kidney damage or kidney failure if you don’t get treatment.
• Liver Damage Heart failure can cause fluid to build up in your liver, which can lead to scarring. This makes it harder for your 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 an irregular heartbeat. Arrhythmias can include the heart beating too quickly, beating too slowly, or not beating in a regular pattern.
• Heart Valve Problems If your heart is enlarged due to heart failure, the valves of your heart, which ensure that blood flows in the correct direction through the organ, may not work 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.
• 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 your liver and intestines, causing these organs to swell. This swelling can lead to nausea and loss of appetite, and it can prevent your body from absorbing nutrients from food.

Research and Statistics: How Many People Have Congestive Heart Failure?

Black and Hispanic Communities and Congestive Heart Failure

Conditions Related to Congestive Heart Failure

Edema and Heart Failure

Edema is swelling that is caused by excess fluid trapped in your body’s tissues.

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.

Edema symptoms include:

• Swelling or puffiness of the tissue directly under your skin, especially in your legs or arms
• Arms or legs start to feel full or heavy
• Shiny or stretched skin
• Skin 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 harder to move the joints that are affected
• Increased abdominal size

Sleep Apnea and Heart Failure

This ongoing disruption of the normal sleep cycle can leave you feeling exhausted and sleepy during the day. It also puts you at an increased risk of health problems linked 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, also known as congestive heart failure, is when your heart pumps inefficiently, leading to a reduction in blood flow to your body and a backup of fluid into your lungs, legs, and feet.
• Diagnosing heart failure may include a stress test, chest X-rays, blood work, and an echocardiogram.
• Heart failure cannot be cured, but it can be treated through various medications or surgery.