Health Topics
Congestive Heart Failure
What is Congestive Heart Failure?
Congestive heart failure (CHF) is a chronic progressive condition that develops when your heart doesn’t pump enough blood for your body’s needs.
Overview
More than 6 million adults in the United States are affected by congestive heart failure, a chronic condition that causes the muscle in the heart wall to slowly weaken, affecting its ability to pump blood.
To understand heart failure, it helps to know how the heart works. The right side of your heart gets oxygen-low blood from your body and pumps that blood into your lungs to pick up oxygen. The left side of your heart then pumps oxygen-rich blood to the rest of your body.
If you have congestive heart failure, your weakened heart muscle will not be able to pump enough blood out with each heartbeat.
The heart may enlarge to make room for extra blood—this is known as cardiomegaly. The heart will try to “make up” for the loss in capacity by beating faster and causing heart palpitations. Congestive heart failure doesn’t just impact the heart; it sets off a cascade of events affecting numerous organs and systems within the body.
Because the heart isn’t emptying the way it should, blood can “back up” into the pulmonary veins, forcing fluid from blood vessels to other tissues. Swelling (edema) can occur in the feet, legs, abdomen, and other body parts. Fluid can collect in the lungs, which can interfere with breathing and cause shortness of breath and respiratory distress. This is called pulmonary edema.
The body will begin to divert blood away from other vital organs and systems, including the kidneys, brain, and digestive system. As the digestive system receives less blood, it can cause problems with digestion and absorption of nutrients, leading to nausea, nutrient deficiencies, and weight gain. Inadequate blood flow to the kidneys can cause them to retain water and sodium, which can lead to kidney failure. Decreased blood flow to the brain causes fatigue, nausea, dizziness, and changes to brain structure that can lead to cognitive impairments and dementia.
Congestive heart failure is often chronic (long-lasting) and progressive, gradually worsening over time.
Types of congestive heart failure
There are three types of heart failure, named for where they occur in the heart.
- Left-sided heart failure: the left ventricle cannot effectively pump enough blood. The most common form of CHF.
- Right-sided heart failure: the right ventricle cannot effectively pump enough blood.
- Biventricular heart failure: a combination of left and right-sided heart failure.
Left-sided heart failure is the most common type of heart failure. When the left ventricle isn’t working properly, fluid can back up into the right ventricle.
How common is congestive heart failure?
It’s estimated that 6.5 million U.S. adults over the age of 20 have congestive heart failure. It directly accounts for 8.5% of all heart disease deaths in the United States.
Congestive Heart Failure Symptoms
Symptoms of heart failure can range from mild to severe and may come and go. Some patients may show no symptoms. The most common signs and symptoms of heart failure include:
- Increased heart rate
- Shortness of breath (also called dyspnea)
- Persistent coughing or wheezing
- Tiredness or fatigue
- Build-up of fluid (swelling or edema) in the feet, ankles, legs, fingers, or abdomen
- Lack of appetite, nausea, or a bloated or hard stomach
- Confusion, impaired thinking
- Unexplained weight changes; sudden weight gain or loss
CHF is progressive and typically worsens over time. Your signs and symptoms may change or worsen, as well.
Causes and Risk Factors
The most common cause of congestive heart failure is coronary artery disease. The heart muscle can also be damaged by certain infections, heavy alcohol or illegal drug use, some chemotherapy medications, genetics, and many other conditions.
Causes of CHF include:
- Coronary artery disease
- Heart attack
- High blood pressure
- Heart valve disease
- Myocarditis (inflammation of the heart muscle)
- Congenital heart defects
- Irregular heart rhythms (arrhythmias)
- Heart valve disease
- Severe anemia (low red blood cell count)
- Diabetes
- HIV infection
- Thyroid conditions
- Chronic kidney disease
- Obesity (BMI over 30)
- Sleep apnea
- Viral infections
- Some medications
Risk factors for heart failure include:
- Aging can weaken and stiffen your heart. Older adults (65 years or older) have a higher risk of heart failure and other health conditions that can cause heart failure.
- Family history of heart failure (genetics) can increase your risk of heart failure.
- Unhealthy lifestyle habits, such as unhealthy diet, smoking, durg or alcohol use, or a sedentary lifestyle.
- Existing conditions, diseases, and medications, such as heart, kidney, or lung diseases, high blood pressure, and diabetes, and infections, such as HIV or SARS-CoV-2. Cancer treatments and certain medications can also increase your CHF risk.
Genetics
Your family history can play a role in your likelihood of contracting congestive heart failure. Many of the causes of CHF can be passed down through genetics, such as coronary artery disease and diabetes. Several genes can increase your chance of getting heart disease and risk factors such as high blood pressure or high cholesterol.
What Are The Four Stages Of Congestive Heart Failure?
CHF is a chronic condition that worsens over time. CHF progresses through four heart failure stages known as Stages A, B, C, and D.
Stage A
The first stage of congestive heart failure, Stage A, means you have a high risk for developing congestive heart failure. You may be considered Stage A if you have one or more of these risk factors:
- Coronary artery disease
- Hypertension (high blood pressure)
- Diabetes
- Metabolic syndrome
- History of rheumatic fever
- History of alcohol use disorder
- Family history of cardiomyopathy
- History of taking drugs that can damage your heart muscle
Stage B
Pre-heart failure. In Stage B, your left ventricle is not working well or may have structural abnormalities. Symptoms of heart failure do not typically appear in Stage B, but you may have small limitations of physical activity.
Stage C
Stage C is known as symptomatic heart failure. Symptoms can range from mild to severe. In Stage C, you may experience a marked limitation of physical activity.
Stage D
If you have Stage D, or advanced heart failure, you have advanced symptoms that don’t get better with treatment. This is the final stage of heart failure.
Diagnosis
If you or a family member has signs of potential heart failure, its important to seek a diagnosis and begin testing for heart failure.
Your healthcare provider will ask you about your symptoms, medical history, and family history. They will also ask you about tobacco, alcohol, or drug use, and medications.
Testing for Congestive Heart Failure
Your healthcare provider will determine which tests and procedures should be performed to help determine if you have congestive heart failure. Some of the tests used to diagnose CHF include:
- Imaging tests can help reveal the structure and function of your heart’s chamber and ventricles.
- Electrocardiograms (EKG) can look at your heart’s electrical activity.
- Blood tests can examine how much oxygen and electrolytes are circulating in your blood.
- Exercise stress tests can measure how well your heart functions when you are active.
Treatment
Congestive heart failure is a chronic condition that needs to be monitored and treated for the rest of your life. Your treatment goal will be to slow the progression from one stage to the next.
Your heart failure treatment plan will depend on the type of heart failure you have, your stage of heart failure, and the causes of your condition. Your treatment plan is likely to include:
- Lifestyle changes such as managing your weight, eating a low-sodium diet, staying active, managing stress, and quitting smoking, alcohol use, and drug use.
- Medications for heart failure can help address symptoms or underlying causes of your condition and may slow its progression.
- Devices and surgical procedures such as implantable cardioverter defibrillators, angioplasty, coronary artery bypass surgery, or heart transplants may be needed to treat heart failure.
- Ongoing monitoring and care is required to manage this chronic and progressive condition.
Living With Congestive Heart Failure
Congestive heart failure is a chronic condition that does not go away. With the right care and treatment, many people with CHF can still enjoy their daily lives.
Follow your treatment plan, including the lifestyle changes recommended by your doctor. Eat a low-sodium, heart-healthy diet, be active, and take your medications. You will probably need to limit your salt and fluids—do this under the guidance of a healthcare provider. Monitor your condition, track and report new or worsening symptoms, and keep regular appointments with your healthcare provider.
Preventing Congestive Heart Failure
Can congestive heart failure be prevented?
Some of the risk factors for heart failure, such as age or genetic risk factors, can not be prevented. However, many of the lifestyle factors and underlying conditions that lead to heart failure can be addressed to reduce your risk of developing this chronic condition.
Preventative measures that may reduce the risk of heart failure include:
- Staying at a healthy weight.
- Eating a heart-healthy diet.
- Staying active and exercising regularly.
- Managing your stress.
- Stop or avoid the use of tobacco, alcohol, or recreational drugs.
- Getting treatment for existing medical conditions that may increase your risk.
FAQs
What is heart failure?
Heart failure, also known as congestive heart failure or CHF, is a chronic progressive condition that develops when your heart doesn’t pump enough blood for your body’s needs.
How common is heart failure?
It’s estimated that 6.5 million U.S. adults have congestive heart failure.
What causes heart failure?
The most common cause of congestive heart failure is coronary artery disease. It can be caused by infections, medications, and underlying conditions such as diabetes, high blood pressure, and heart attacks.
Can heart failure be cured?
Heart failure is a chronic and progressive condition. That means it is long-lasting and tends to worsen over time. There is no cure for heart failure, but treatment can slow or halt its progression.
What are the symptoms of heart failure?
Symptoms of heart failure can range from mild to severe, and can include fatigue, irregular heartbeat, shortness of breath, and swelling of the feet, legs, abdomen, or other body parts.
How is heart failure diagnosed?
Medical professionals will use diagnostic tests such as blood tests or imaging, as well as physical exams and medical history to diagnose heart failure.
When should I see a doctor about heart failure?
If you or a family member has signs of potential heart failure, it's important to seek a diagnosis and begin testing for heart failure.