Congestive heart failure (CHF) is when the heart does not pump blood around the body efficiently. This can cause symptoms such as lung congestion and swelling due to fluid retention.

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

The body relies on the heart’s pumping action 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.

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 can lead to severe complications, such as heart attack and cardiac arrest.

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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Image credit: Wenzdai Figueroa

The possible symptoms of heart failure include:

Congestion in the lungs

Fluid builds up in the lungs and causes shortness of breath, even when a person is resting, 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 counteract the lower volume of blood 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 with a CHF diagnosis should monitor their symptoms carefully and report any sudden changes to their doctor immediately.

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.

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 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.

Risk factors for CHF include:

  • 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

Damage to the heart’s pumping action is not always reversible. Nevertheless, treatments can significantly improve a person’s quality of life by keeping heart failure under control and helping to relieve many of its symptoms. Treatment can also prevent CHF from progressing.

CHF treatments include medications and surgery.

Medications for heart failure

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 for heart failure

Not everyone with heart failure responds to drug treatments. In some cases, a doctor may recommend surgery to address the underlying cause and help manage symptoms. Surgical procedures include:

  • Coronary artery bypass graft: Doctors commonly recommend this procedure when coronary artery disease is the cause of CHF.
  • Percutaneous coronary intervention (PCI): This nonsurgical procedure involves placing a stent in the heart to open up the blood vessels.
  • Pacemaker: A surgeon places a small device called a pacemaker under the skin in the chest to help correct an irregular heartbeat.
  • Cardiac ablation: In cardiac ablation, a doctor inserts a catheter into the arteries or veins to help correct a heart rhythm problem.
  • 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 this for people waiting for a transplant.
  • Heart transplant: If no other treatments or surgeries help, a heart transplant is an option. Medical teams only consider a transplant for a person who is healthy beyond the problem affecting their heart.

A doctor, who may be a cardiologist, will recommend lifestyle modifications alongside medical treatment to address the underlying cause of a person’s heart failure. They include:

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

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: This shows whether the heart has become enlarged. It will also show whether there is fluid in the lungs.
  • An electrocardiogram records the electrical activity and rhythms of the heart and may also reveal damage from a heart attack.
  • An echocardiogram: This ultrasound scan shows the heart’s pumping action. 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 use an exercise machine, such as a treadmill, or take medication that stresses the heart.
  • A cardiac MRI or CT scan: This measures the ejection fraction and examines the heart’s arteries and valves. The results can help doctors determine whether the person has had a heart attack.
  • A PET scan: Doctors use this to 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.

CHF can be life threatening, but a person’s outlook 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

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% to 20% will live 1 year or longer after diagnosis.

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.

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.