Decompensated heart failure (DHF) is heart failure that has worsened and needs immediate medical attention. It can develop in people with preexisting heart failure and those without signs of the condition.

The Centers for Disease Control and Prevention (CDC) estimate that there are 6.2 million adults with heart failure in the United States. The organization also states that heart failure was responsible for more than 370,000 deaths in the U.S. in 2018.

According to the American Heart Association (AHA), 1 in 5 people aged 40 years and older will develop heart failure at some point in life. It suggests that nearly 8 million individuals in the U.S. may have heart failure by 2030.

In this article, we examine decompensated heart failure in detail and discuss its symptoms, causes, and risk factors. We also look at how doctors diagnose and treat the condition.

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According to an older article from 2013, there are two types of decompensated heart failure:

Acute decompensated heart failure

Acute decompensated heart failure is the most common form of acute heart failure and occurs in people with no previous heart failure symptoms. A 2015 article states that this type of heart failure has a high mortality rate and requires frequent hospitalizations.

It can develop in those who have experienced a heart attack, hypertensive crisis, or mitral valve prolapse. A hypertensive crisis occurs when an individual’s blood pressure reaches an unusually high level. Mitral valve prolapse is a structural change in the heart’s mitral valve.

The 2013 article suggests that acute decompensated heart failure generally causes pulmonary congestion but does not usually affect blood volume.

Decompensated chronic heart failure

Decompensated chronic heart failure affects individuals who already have a diagnosis of heart failure.

Symptoms can occur gradually or suddenly, meaning people may need additional or immediate treatment.

Learn more about heart disease types, causes, and symptoms here.

One of the main symptoms of decompensated heart failure is dyspnea, the medical term for shortness of breath. Wheezing, edema, and coughing at night may also appear.

A 2017 review suggests that people with acute decompensated heart failure usually have congestion and fluid retention symptoms, such as:

  • weight gain
  • shortness of breath during exercise
  • orthopnea, which is shortness of breath while lying down that subsides in other positions
  • dependent edema, where fluid pools in the lower parts of the body

The review explains that acute heart failure can be life threatening and requires immediate treatment as it can lead to fluid overload.

According to the National Heart, Lung, and Blood Institute (NHLBI), heart failure can cause health problems such as:

Some conditions that may lead to heart failure include:

The following factors may worsen preexisting heart failure:

  • High water intake: Medical professionals may recommend limiting fluid intake if a person has heart failure. This helps avoid extra fluid ending up in the blood and making it difficult for the heart to pump.
  • Salt consumption: A 2020 article states that following a diet high in salt may raise blood pressure levels, putting more strain on the heart. The CDC suggest that lowering blood pressure can help reduce the chance of experiencing a heart attack or stroke.
  • Arrhythmia: An arrhythmia is an issue with the heartbeat where it is irregular, fast, or slow. Symptoms may include lightheadedness, sweating, or chest pain. The NHLBI states arrhythmias can be serious without treatment and may cause heart failure, stroke, or cardiac arrest.
  • Pregnancy: Peripartum cardiomyopathy is a rare form of heart failure that develops during the last few months of pregnancy. It can cause fatigue, low blood pressure, ankle swelling, or palpitations.

Some factors may increase a person’s risk of developing heart failure, such as:

  • age, as heart failure mainly occurs in older adults
  • sitting for long periods
  • having a family history of heart failure
  • having obesity, high blood pressure, or diabetes

A healthcare professional can use a pulse oximeter to measure blood oxygen levels. This test helps them check how well body organs receive blood from the heart. If oxygen saturations are below 85–94%, individuals may need oxygen supplementation.

Having a pulse oximeter may benefit those with any of the following conditions:

Learn more about 6 of the best pulse oximeters.

The following tests can also help determine if a person has heart failure:

  • Chest X-ray: A chest X-ray showing fluid in the lungs may be a sign of heart failure. It can also show if there is heart enlargement.
  • Electrocardiogram (ECG): This test measures the heart’s electrical activity and frequency of beats. The AHA points out that ECGs can indicate if someone has had a heart attack or is experiencing arrhythmias.
  • Echocardiogram: This ultrasound provides images of the heart’s size and allows doctors to see how well it is functioning in pumping blood.

Decompensated heart failure treatment helps stabilize symptoms and protect kidney function. Treatment will depend on the type of heart failure a person has.

Chronic decompensated heart failure

Doctors may prescribe diuretics to eliminate excess fluid buildup in people with chronic decompensated heart failure. Another common name for these drugs is water pills. They can also treat high blood pressure.

A person should inform a doctor of any other medications they are taking. Some medications, including thiazide diuretics or cyclosporine, can interact with heart medications such as digoxin (Lanoxin).

Vasodilators are another class of medications that people with chronic decompensated heart failure may take. The AHA explains that these widen the blood vessels and reduce blood pressure.

Acute heart failure

A 2022 article suggests that vasodilators can treat acute heart failure in individuals with pulmonary congestion.

Some people may have to undergo bypass surgery if there is a sudden blockage, as blood will be unable to flow to the heart.

During this procedure, surgeons typically use a blood vessel from the chest, leg, or arm to reroute the blood flow around the part of the artery causing a blockage.

Learn more about heart bypass surgery.

Heart failure during pregnancy

A 2016 article mentions diuretics as the first treatment the medical community recommends for people with heart failure during pregnancy.

Decompensated heart failure can occur in people with no previous heart failure diagnosis. It can also develop as a chronic condition, causing the worsening of symptoms in those who have had heart failure. The outlook for people with heart failure varies according to several factors.

A 2020 cohort study using data from hospitals across 44 countries suggests that 20% of people who received hospital treatment for acute heart failure died within 1 year.

According to the study’s authors, important predictors of 1-year mortality included old age, being on guideline-directed medical treatment at discharge, and the presence of other conditions such as anemia, chronic kidney disease, and valvular heart disease.

The authors also point out that acute heart failure has a particularly high mortality rate in people from low income regions with high income inequality.

For more science-backed information about cardiovascular health, visit our dedicated hub.

Compensated heart failure typically causes individuals to have stable symptoms, such as edema or shortness of breath. However, these symptoms are also sometimes absent in people with the condition.

In a person experiencing decompensated heart failure, symptoms worsen and require immediate care.

Decompensated heart failure can be acute or chronic and may cause shortness of breath, weight gain, or wheezing.

It may be more common if other health problems are present, such as valve disease, high blood pressure, or irregular heart rhythms.

Doctors can recommend the most suitable treatment option depending on the severity of a person’s heart failure.