In congestive heart failure, the heart does not pump blood around the body efficiently. This can cause symptoms such as lung congestion and swelling due to fluid retention. Treatment can help lower the risk of hospitalization and life threatening complications.

The body relies on the pumping action of the heart to deliver nutrient- and oxygen-rich blood to each of its cells. In congestive heart failure (CHF), the heart cannot pump blood effectively, and the cells do not receive adequate nourishment. As a result, the body cannot function properly.

There is usually no cure for CHF, but with the right treatment, people can often stay active and have a good quality of life.

According to the Centers for Disease Control and Prevention (CDC), over 6 million adults in the United States live with heart failure.

CHF can be systolic or diastolic, depending on whether it affects the heart’s ability to contract or relax. This article focuses mainly on systolic CHF and its causes, symptoms, types, and treatment.

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CHF results when damage to the heart means it no longer works as effectively as it should to pump blood around the body.

If the heart becomes weakened and cannot supply the cells with sufficient blood, it can lead to fatigue, breathlessness, and swelling due to fluid retention.

Everyday activities that used to be easy may become challenging.

Heart failure, heart attack, and cardiac arrest

In exploring the characteristics of heart failure, it can help to have a clear understanding of related issues, including:

  • Heart attack: This event involves damage to the heart muscle. It can result from the blockage of a coronary artery, which supplies blood to the heart. In this case, there is muscle damage because too little blood and oxygen are reaching it. The damage can also result from a supply and demand mismatch.
  • Systolic heart failure: This means that the heart muscle cannot pump blood around the body properly.
  • Cardiac arrest: This happens when the heart and blood circulation both stop, and the person has no pulse.

Stages of congestive heart failure

The stages of heart failure are:

  • Stage A: A person has not yet developed heart failure but has a higher risk due to one or more preexisting conditions, such as high blood pressure, coronary artery disease, or diabetes.
  • Stage B: A person has not developed heart failure or symptoms but has received a diagnosis of structural heart disease.
  • Stage C: A person has ongoing or past symptoms of heart failure and currently has structural heart disease that needs advanced treatment.
  • Stage D: A person has advanced heart failure that needs advanced treatment.

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Image credit: Wenzdai Figueroa

The following are possible symptoms of heart failure:

Congestion in the lungs: Fluid builds up in the lungs and causes shortness of breath, even when a person is resting, and particularly when they are lying down. It can also cause a dry, hacking cough.

Fluid retention: Less blood reaches the kidneys, which can result in water retention and can cause swelling of the ankles, legs, and abdomen. It can also cause weight gain.

Fatigue and dizziness: A reduction in the amount of blood reaching the brain and other organs can cause weakness, dizziness, and confusion.

Irregular and rapid heartbeats: The heart may pump more quickly to try to counteract the lower volume of blood that it pumps out with each contraction. It may also activate stress receptors in the body, increasing the release of stress hormones. Heart failure can increase the risk of arrhythmias that can cause these symptoms.

Many other conditions can cause similar symptoms, so it is important to see a doctor. People who have received a diagnosis of heart failure should monitor their symptoms carefully and report any sudden changes to their doctor immediately.

Damage that affects the heart’s pumping action is not always reversible. Nevertheless, treatments can significantly improve quality of life by keeping heart failure under control and helping to relieve many of the symptoms. Treatment can also prevent the progression of heart failure.

Doctors also focus on treating the cause of heart failure. This will reduce the burden on the heart. The doctor, who may be a cardiologist, will present the treatment options and make recommendations that suit each person’s circumstances.

Common treatments for heart failure include:

Medications

Many medications can treat the symptoms of CHF. They include:

Controlling blood pressure and cholesterol are also important considerations for treating heart failure, and a doctor may prescribe separate medications for this.

Surgery

Not everyone with heart failure responds to drug treatments. In some cases, a doctor may recommend surgery to address the underlying causes of heart failure and to help manage symptoms.

Coronary artery bypass graft: Doctors commonly recommend this procedure when coronary artery disease is the cause of CHF.

Percutaneous coronary intervention: Sometimes called PCI, this is a nonsurgical procedure to place a stent in the heart to open up the blood vessels.

Pacemaker: This is a small device that a surgeon places under the skin in the chest to help correct an irregular heartbeat.

Cardiac ablation: This procedure can help correct a heart rhythm problem. A doctor inserts a catheter into the arteries or veins.

Heart valve surgery: This procedure repairs a defective valve that makes the heart pump inefficiently.

Implantable left ventricular assist device: For people with advanced heart failure who have not responded to other treatments, this can help the heart pump blood. Doctors may recommend them for people who are waiting for a transplant.

Heart transplant: If no other treatments or surgeries help, a transplant is an option. Medical teams only consider a transplant for a person who is healthy beyond the problem affecting their heart.

Any condition that damages the heart muscle can cause systolic heart failure. These conditions include:

  • Coronary artery disease: The coronary arteries supply the heart muscle with blood. If these become blocked or narrowed, the flow of blood diminishes, and the heart does not receive the blood supply that it needs.
  • Heart attack: This involves damage to the heart muscle. It can result from a sudden blockage of the coronary arteries that causes scarring and reduces how effectively the heart can pump. The damage may also result from an increased demand for blood flow due to a fixed blockage.
  • Nonischemic cardiomyopathy: This disease involves weakness of the heart muscle caused by something other than a blockage in the coronary arteries. Possible causes include genetic conditions, drug side effects, and infections.
  • Conditions that overwork the heart: Examples include valve disease, high blood pressure, diabetes, kidney disease, sleep apnea, and heart irregularities present at birth.

There are several types of heart failure, and different ways to describe them. Heart failure may affect just one side of the heart — the oxygenated or deoxygenated side — or both sides.

Ways of categorizing types of heart failure include:

Systolic heart failure

Systolic dysfunction is the heart’s inability to pump efficiently after filling with blood. It often occurs if one or both sides of the heart become weak or enlarged. It is also known as right-sided heart failure.

Systolic heart failure symptoms include:

  • general weakness
  • cough
  • fatigue
  • swelling
  • bluish lips and fingers

Diastolic heart failure

Diastolic heart failure occurs when the heart muscle is stiffer than usual and does not relax normally but pumps normally. When the heart is stiff, it does not fill up with blood properly. Doctors refer to this as diastolic dysfunction.

When the heart does not fill up with blood as usual, it causes increased pressure inside the heart, which can lead to a backup of fluid into the lungs.

Diastolic heart failure symptoms include:

  • shortness of breath with physical activity
  • shortness of breath while lying down
  • swelling in the legs
  • fatigue

Doctors may call this heart failure with preserved or reduced ejection fraction.

If a doctor suspects heart failure, they will recommend further tests, which may include:

  • Blood and urine tests: The aim is to check the person’s blood count, as well as their liver, thyroid, and kidney function and any indications of “stretch” in the heart. The doctor may also want to check the blood for specific chemical markers of heart failure.
  • Chest X-ray: The aim is to show whether the heart has become enlarged. It will also show whether there is fluid in the lungs.
  • An electrocardiogram: The aim is to record the electrical activity and rhythms of the heart. It may also reveal any damage from a heart attack.
  • An echocardiogram: This is an ultrasound scan that shows the pumping action of the heart. Cardiologists measure the proportion of blood that leaves the left ventricle, the main pumping chamber, with each heartbeat. This measurement is known as the ejection fraction.

The doctor may also do additional tests, such as:

  • A stress test: This is to see how the heart responds to stress and determine whether there is a lack of oxygen due to blockages in the coronary arteries. A person may have to use an exercise machine, such as a treadmill, or take medication that stresses the heart.
  • A cardiac MRI or CT scan: The aim is to measure the ejection fraction and examine the heart’s arteries and valves. The results can help the doctor determine whether the person has had a heart attack.
  • A PET scan: A doctor can examine the heart muscle and look for signs of rare causes of heart problems, such as sarcoidosis.
  • An angiogram: An angiogram is an X-ray of the blood vessels around the heart. A doctor injects dye into the coronary arteries to help detect coronary artery disease or narrowed arteries, which can cause heart failure.

The following are risk factors for CHF:

  • diabetes
  • obesity
  • smoking
  • a high intake of alcohol
  • anemia
  • thyroid problems, including hyperthyroidism and hypothyroidism
  • lupus
  • myocarditis, which is inflammation of the heart muscle that usually occurs due to a virus and can lead to left-sided heart failure
  • heart arrhythmias, or irregularities — a fast heartbeat can weaken the heart, and a slow heartbeat can reduce blood flow, causing heart failure
  • atrial fibrillation, an irregular and often rapid heartbeat
  • hemochromatosis, a condition in which iron accumulates in the tissues
  • amyloidosis, in which deposits of proteins accumulate in one or more organ systems

Certain lifestyle changes can reduce the risk of heart failure or slow its progression. These include:

  • giving up smoking, if applicable
  • having a healthy diet that includes plenty of fruit, vegetables, quality fats, unrefined carbohydrates, and whole grains
  • exercising regularly
  • maintaining a moderate weight
  • not drinking more alcohol than experts recommend
  • getting enough quality sleep
  • reducing stress when possible because stress can strain the heart over time

In addition, people with heart failure should keep up to date with vaccinations, including the yearly flu shot.

CHF can be life threatening, but life expectancy will depend on the type of heart failure, the cause, the stage of the disease, and how effective treatment is.

When heart failure results from cardiomyopathy or coronary artery disease, a person typically has a less positive outlook than someone with heart failure in its earliest stage.

Complications can also affect a person’s life expectancy and quality of life. They include:

  • having another health condition, such as obesity or diabetes
  • a reduced ability to function in daily life
  • kidney and liver problems
  • complications relating to treatment, such as low blood pressure or kidney failure
  • mental health challenges due to chronic disease

Here are some questions people often ask about CHF.

What is the life expectancy of a person with CHF?

This will depend on the type of CHF, the severity of the condition, and individual factors, such as overall health and age. Overall, around half of people with a diagnosis of heart failure are likely to live another 5 years or longer. For those with advanced heart failure, 10–20% will live 1 year or longer after diagnosis.

Is congestive heart failure serious?

Doctors consider CHF a serious condition, and it can be life threatening. However, this will depend on the stage and other factors. With treatment, many people continue to function and enjoy a good quality of life.

What are the signs of congestive heart failure?

A person with CHF may have:

  • coughing and wheezing due to fluid in the lungs
  • shortness of breath
  • swelling in the abdomen and lower body because of fluid retention
  • fatigue
  • a diagnosis of a heart problem

CHF affects millions of people in the U.S. Doctors cannot always reverse the damage involved, but treatments can provide symptom relief and improve quality of life.

Anyone who experiences symptoms of heart failure should see a doctor for a diagnosis.

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