Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentCoping
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Coping
Congestive heart failure (CHF)is the term used to describe what happens when the heart is unable to pump enough blood to meet the body’s needs. (It should not be confused withcardiac arrestin which the heart stops beating entirely.)CHFis simply the inadequate functioning of the heart muscle. The condition can either be acute (it occurs rapidly), or chronic (it occurs over the long term).
Severe cases may require an implantable cardiac device to improve the strength or rhythm of the heart. In the worst-case scenario, aheart transplantmay be required.
Low output heart failureoccurs in people withheart failurewho have little or no lung congestion. In these situations, the main problem tends to be that the heart muscle has become so extremely weak that the heart is no longer able to pump enough blood to the body’s organs.
People whose heart failure is primarily low output heart failure are more likely to have low blood pressure, lightheadedness, and syncope (fainting). Low output heart failure is usually a sign of veryadvanced heart failureand is associated with a very poor prognosis.
Verywell / Emily Roberts
Congestive Heart Failure Symptoms
Left-Sided Failure
The left side of the heart is responsible for receiving oxygen-enriched blood from the lungs and pumping it to the rest of the body.
If the heart is failing on the left side (referred to as left ventricular heart failure), it will back up into the lungs, depriving the rest of the body of the oxygen it needs.
Left-Sided Systolic Heart Failure
Characteristic symptoms of left-sided heart failure include:
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Right-Sided Failure
The right side of the heart is responsible for receiving oxygen-poor blood from the body and pumping it to the lungs to be oxygenated.
If the right side of the heart is failing (known as right ventricular heart failure), the heart cannot fill with enough blood, causing the blood to back up into the veins.
Characteristic symptoms ofright-sided heart failureinclude:
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Biventricular Failure
Biventricular heart failure involves the failure of both the left and right ventricles of the heart. It is the type most commonly seen in clinical practice and will manifest with symptoms characteristic of both left and right heart failure.
One of the common features of biventricular heart failure ispleural effusion, the collection of fluid between the lung and chest wall.
While pleural effusion can occur with right-sided heart failure and to a lesser extent with left-sided heart failure, it is far more characteristic when both sides are involved. Symptoms of pleural effusion include:
Complications
CHF is a potential complication of many different diseases and disorders. However, the development of CHF can spur further complications, increasing the risk of illness, incapacitation, and death. Characteristic complications of CHF include:
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Causesof CHF include coronary artery disease, high blood pressure, heart valve disease, infection, excessive alcohol use, or a previous heart attack.
Congestive heart failure (often referred to simply as heart failure) affects around 6 million Americans and is the leading cause of hospitalization in people over 65 years old. Over 650,000 new cases are diagnosed each year.
The word “congestive” refers to the build-up of fluid in the veins and tissues of the lungs and other parts of the body. It is this congestion which triggers many of the characteristic symptoms of CHF.
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Acute Decompensated Heart Failure
Chronic heart failure is the stage in which the heart condition is stable. Chronic heart failure can sometimes progress to acute decompensated heart failure (ADHF) in which the symptoms worsen and increase the risk of respiratory failure.
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Physical Examination
After a review of your symptoms and medical history, your healthcare provider will perform a physical exam to identify the symptoms indicative of CHF.This will include, among other things, a review of your:
Laboratory Tests
There are a number of blood tests used to diagnose CHF, some of which can identify the underlying cause of the dysfunction. These may include acomplete blood count(to check for anemia), a C-reactive protein (to detect signs of infection), and liver function, kidney function, or thyroid function tests (to establish whether other organ systems are involved and why).
The BNP test is one of the cornerstone diagnostics of heart failure. However, increases in BNP values do not necessarily correspond to the severity of the condition.
In most labs, a BNP of less than 100 picograms per milliliter (pg/mL) can definitively rule out CHF in 98% of cases.
High BNP levels are far less conclusive, although levels above 900 pg/mL in adults over 50 years old can accurately diagnose CHF in around 90% of cases.
Imaging Tests
The primary imaging tool for diagnosing CHF is anechocardiogram. An echocardiogram is a form of ultrasound that uses reflected sound waves to create real-time images of the beating heart. The echocardiogram is used to determine two diagnostic values:
The comparison of the SV to the EDV can then be used to calculate the ejection fraction (EF), the value of which describes the pumping efficiency of the heart.
Normally, the ejection fraction should be between 55% and 70%. Heart failure can typically be diagnosed when the EF drops below 40%.
Another form of imaging, known as angiography, is used to evaluate the vascular structure of the heart. If coronary artery disease is suspected, a narrow catheter would be inserted into a coronary artery to inject contrast dyes for visualization on an X-ray. Angiography is extremely useful in pinpointing blockages that may be damaging the heart muscle.
A chest X-ray on its own can help identifycardiomegaly(enlargement of the heart) and evidence of vascular enlargement in the heart. A chest X-ray and ultrasound can also be used to help diagnose pleural effusion.
Other Tests
In addition to the BNP and echocardiogram, other tests can be used to either support the diagnosis or characterize the cause of the dysfunction. These include:
CHF Classification
If congestive heart disease is definitively diagnosed, your cardiologist would classify the failure based on a review of your physical exam, lab findings, and imaging test. The aim of the classification is to direct the appropriate course treatment.
The NYHA functional classification is broken down into four classes based on both your physical capacity for activity and the appearance of symptoms.
The ACC/AHA staging system provides greater insight as to what medical interventions should be implemented at whichstages.
The ACC/AHA system is especially useful—each stage corresponds to specific medical recommendations and interventions.
The treatment of congestive heart failure is focused on reducing symptoms and preventing the progression of the disease. It also requires treatment for the underlying cause of the failure, whether it be an infection, a heart disorder, or a chronic inflammatory disease.
Lifestyle Changes
One of the first steps in managing CHF is making changes in your life to improve your diet and physical fitness and to correct the bad habits that contribute to your illness. Depending on the stage of the CHF, the interventions may be relatively easy to implement or may require a serious adjustment of your lifestyle.
Reduce Sodium Intake:This not only includes the salt you add to food, but also the types of food that are high in sodium. The less salt in your diet, the less fluid retention there will be. Most healthcare providers recommend no more than 2,000 milligrams per day from all sources.
Limit Fluid Intake:This can vary depending on the severity of your condition, but generally speaking, you would limit your fluids to no more than 2 liters (8.5 cups) per day.
Achieve and Maintain a Healthy Weight:If you are overweight, you may need to work with a nutritionist to first determine your ideal weight and daily calorie intake, and then to design a safe and sustainable low-sodium diet.
Stop Smoking:There is no safe amount of smoking. Smoking contributes to the development ofatherosclerosis(hardening of the arteries), making your heart work much harder than it normally would have to.
Exercise Regularly:You need to find an exercise plan you can sustain and build upon to get stronger. Try starting with no less than 30 minutes of exercise three times per week, incorporating cardio and strength training. Working with a personal trainer can help ensure the appropriate workout routine, which is one that neither overtaxes you nor leaves you unchallenged.
Reduce Alcohol Intake:While an occasional drink may not do you any harm, moderate alcohol intake can sometimes complicate left-sided heart failure, particularly in people with alcohol-induced cardiomyopathy.Speak to your healthcare provider about the appropriate limits based on the nature and severity of your CHF.
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Medications
There are a number of medications commonly prescribed to improve the function of your heart. These include:
Drugs to Avoid:There a number of drugs that you may need to avoid if you have heart failure, which may either undermine therapy or contribute to cardiac congestion. These drugs include:
Since other drugs (including ketamine, salbutamol, tamsulosin, and thiazolidinediones) can affect heart function, it is important to advise your practitioner about any drugs you are taking, including supplements and herbal remedies.
Implantable Devices
Heart failure is described when the EF is 40% or less. This means that 40% or less of the blood in your left ventricle leaves the heart with each heartbeat.
If your EF falls below 35% or you experience severe arrhythmia as a result of CHF, your healthcare provider may recommend an implantable device to reduce the risk of illness or death. Different approaches are used for different conditions.
The implants are typically inserted beneath the skin of the upper left chest. Before the surgery, medication will be given to make you sleepy and comfortable.
The implantation of a device does not requireopen-heart surgery, and most people can go home within 24 hours.
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Surgery
If a heart attack has occurred, surgery is often needed to repair the bulging and thinning of the left ventricular, known as a ventricular aneurysm.
Some surgeries are minimally invasive—accessing the heart through a blood vessel or through the chest without opening the ribcage—while others are open-heart.
Aheart transplantis typically indicated with the EF has dropped below 20% and/or the risk of death within one year is high. Around 3,500 heart transplants are performed around the world each year, more than half of which are performed in the United States.
People who successfully undergo heart transplant surgery can expect to live an additional 15 years on average.
Being diagnosed with congestive heart failure doesn’t mean that you’re going to die or that your heart will suddenly stop. It simply means that your heart is failing to work as well as it is supposed to.
While there is no cure for CHF, there are steps you can take to maintain or improve your heart function.
Take Your Medications Daily:You need to maintain a steady concentration of medications in your bloodstream to sustain the desired effect. Some drugs used to treat CHF have a short drug half-life (including Entresto with a half-life of 10 hours) and must be taken as prescribed without missing any doses. To avoid missed doses, try programming alarm reminders on your cell phone.
Keep Your Healthcare Provider Appointments:People who remain under consistent medical care invariably do better than those who don’t. Making and keeping your appointments allows your practitioner to intervene before a medical problem become serious or irreversible.
Check Food Labels:Sodium is hidden in many foods that we eat. Learn how to read product labels and to choose foods low in salt, including lean meats, poultry, fish, fruit, vegetables, eggs, low-fat dairy, rice, pasta, and dry or fresh beans. Avoid canned or packaged foods, and be aware that “reduced-sodium” products may still contain more than you need.
Find Alternative Seasonings:Instead of salt or sodium-rich condiments, season your food with fresh herbs, dried spices, lemon juice, or flavored vinegar.
Plan Ahead When Eating Out:Check the menu online in advance of your reservation, and call ahead to discuss your dietary requirements so that you make the right choices.
Try to Relax:Don’t treat your stress with alcohol or sleeping pills. Instead, explore methods of stress relief, including exercise, yoga, or meditation. If you are unable to cope, ask your practitioner for a referral to a therapist who can either help you one-on-one or enlist you in group therapy. Heart failure has also been linked to depression, so addressing your feelings with a mental health professional can be helpful.
A Word From Verywell
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23 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Heart Association.Heart failure signs and symptoms.American Heart Association.Types of heart failure.Inamdar AA, Inamdar AC.Heart failure: diagnosis, management and utilization.J Clin Med. 2016;5(7). doi:10.3390/jcm5070062Yunina D, Sharma D, Fazio R, Amin H, Tsirlin Y, Shetty V.Advanced biventricular heart failure due to left ventricular noncompaction cardiomyopathy leading to the formation of a fastric bezoar: the implications of heart failure on the gastrointestinal tract.Case Rep Cardiol. 2018;2018:4386025. doi:10.1155/2018/4386025Dean SM, Abraham W.Venous thromboembolic disease in congestive heart failure: venous thromboembolic disease in congestive heart failure.Congestive Heart Failure. 2010;16(4):164-169. doi:10.1111/j.1751-7133.2010.00148.xGiallourakis CC.Liver complications in patients with congestive heart failure.Gastroenterol Hepatol (N Y). 2013;9(4):244–246.Centers for Disease Control and Prevention.Heart failure.Joseph SM, Cedars AM, Ewald GA, Geltman EM, Mann DL.Acute decompensated heart failure: contemporary medical management [published correction appears in Tex Heart Inst J. 2010;37(1):135. Dosage error in article text].Tex Heart Inst J. 36(6):510–520.Teerlink JR, Alburikan K, Metra M, Rodgers JE.Acute decompensated heart failure update.Curr Cardiol Rev. 2015;11(1):53–62. doi:10.2174/1573403x09666131117174414American Heart Association.Common tests for heart failure.MedlinePlus.Natriuretic peptide tests (BNP, NT-proBNP).Gaggin HK, Januzzi JL.Cardiac biomarkers and heart failure. American College of Cardiology.Heidenreich P, Bozkurt B, Aguilar D, et al.2022 AHA/ACC/HFSA guideline for the management of heart failure.J Am Coll Cardiol. 2022;79(17):e263–e421. doi:10.1016/j.jacc.2021.12.012Brakohiapa EKK, Botwe BO, Sarkodie BD, Ofori EK, Coleman J.Radiographic determination of cardiomegaly using cardiothoracic ratio and transverse cardiac diameter: can one size fit all? Part one.Pan Afr Med J. 2017;27:201. doi:10.11604/pamj.2017.27.201.12017American Heart Association.Classes and stages of heart failure.American Heart Association.Lifestyle changes for heart failure.Maisch B.Alcoholic cardiomyopathy: the result of dosage and individual predisposition.Herz. 2016;41(6):484–493. doi:10.1007/s00059-016-4469-6Page RL, O’bryant CL, Cheng D, et al.Drugs that may cause or exacerbate heart failure: a scientific statement from the American Heart Association.Circulation. 2016;134(6):e32-69. doi:10.1161/CIR.0000000000000426American Heart Association.Devices and surgical procedures to treat heart failure.Cook JA, Shah KB, Quader MA, et al.The total artificial heart.J Thorac Dis. 2015;7(12):2172-80. doi:10.3978/j.issn.2072-1439.2015.10.70Centers for Disease Control and Prevention.Smoking cessation—the role of healthcare professionals and health systems.National Institute on Alcohol Abuse and Alcoholism.Treatment for alcohol problems: finding and getting help.National Heart, Lung, and Blood Institute.Heart disease and depression: a two-way relationship.
23 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Heart Association.Heart failure signs and symptoms.American Heart Association.Types of heart failure.Inamdar AA, Inamdar AC.Heart failure: diagnosis, management and utilization.J Clin Med. 2016;5(7). doi:10.3390/jcm5070062Yunina D, Sharma D, Fazio R, Amin H, Tsirlin Y, Shetty V.Advanced biventricular heart failure due to left ventricular noncompaction cardiomyopathy leading to the formation of a fastric bezoar: the implications of heart failure on the gastrointestinal tract.Case Rep Cardiol. 2018;2018:4386025. doi:10.1155/2018/4386025Dean SM, Abraham W.Venous thromboembolic disease in congestive heart failure: venous thromboembolic disease in congestive heart failure.Congestive Heart Failure. 2010;16(4):164-169. doi:10.1111/j.1751-7133.2010.00148.xGiallourakis CC.Liver complications in patients with congestive heart failure.Gastroenterol Hepatol (N Y). 2013;9(4):244–246.Centers for Disease Control and Prevention.Heart failure.Joseph SM, Cedars AM, Ewald GA, Geltman EM, Mann DL.Acute decompensated heart failure: contemporary medical management [published correction appears in Tex Heart Inst J. 2010;37(1):135. Dosage error in article text].Tex Heart Inst J. 36(6):510–520.Teerlink JR, Alburikan K, Metra M, Rodgers JE.Acute decompensated heart failure update.Curr Cardiol Rev. 2015;11(1):53–62. doi:10.2174/1573403x09666131117174414American Heart Association.Common tests for heart failure.MedlinePlus.Natriuretic peptide tests (BNP, NT-proBNP).Gaggin HK, Januzzi JL.Cardiac biomarkers and heart failure. American College of Cardiology.Heidenreich P, Bozkurt B, Aguilar D, et al.2022 AHA/ACC/HFSA guideline for the management of heart failure.J Am Coll Cardiol. 2022;79(17):e263–e421. doi:10.1016/j.jacc.2021.12.012Brakohiapa EKK, Botwe BO, Sarkodie BD, Ofori EK, Coleman J.Radiographic determination of cardiomegaly using cardiothoracic ratio and transverse cardiac diameter: can one size fit all? Part one.Pan Afr Med J. 2017;27:201. doi:10.11604/pamj.2017.27.201.12017American Heart Association.Classes and stages of heart failure.American Heart Association.Lifestyle changes for heart failure.Maisch B.Alcoholic cardiomyopathy: the result of dosage and individual predisposition.Herz. 2016;41(6):484–493. doi:10.1007/s00059-016-4469-6Page RL, O’bryant CL, Cheng D, et al.Drugs that may cause or exacerbate heart failure: a scientific statement from the American Heart Association.Circulation. 2016;134(6):e32-69. doi:10.1161/CIR.0000000000000426American Heart Association.Devices and surgical procedures to treat heart failure.Cook JA, Shah KB, Quader MA, et al.The total artificial heart.J Thorac Dis. 2015;7(12):2172-80. doi:10.3978/j.issn.2072-1439.2015.10.70Centers for Disease Control and Prevention.Smoking cessation—the role of healthcare professionals and health systems.National Institute on Alcohol Abuse and Alcoholism.Treatment for alcohol problems: finding and getting help.National Heart, Lung, and Blood Institute.Heart disease and depression: a two-way relationship.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Heart Association.Heart failure signs and symptoms.American Heart Association.Types of heart failure.Inamdar AA, Inamdar AC.Heart failure: diagnosis, management and utilization.J Clin Med. 2016;5(7). doi:10.3390/jcm5070062Yunina D, Sharma D, Fazio R, Amin H, Tsirlin Y, Shetty V.Advanced biventricular heart failure due to left ventricular noncompaction cardiomyopathy leading to the formation of a fastric bezoar: the implications of heart failure on the gastrointestinal tract.Case Rep Cardiol. 2018;2018:4386025. doi:10.1155/2018/4386025Dean SM, Abraham W.Venous thromboembolic disease in congestive heart failure: venous thromboembolic disease in congestive heart failure.Congestive Heart Failure. 2010;16(4):164-169. doi:10.1111/j.1751-7133.2010.00148.xGiallourakis CC.Liver complications in patients with congestive heart failure.Gastroenterol Hepatol (N Y). 2013;9(4):244–246.Centers for Disease Control and Prevention.Heart failure.Joseph SM, Cedars AM, Ewald GA, Geltman EM, Mann DL.Acute decompensated heart failure: contemporary medical management [published correction appears in Tex Heart Inst J. 2010;37(1):135. Dosage error in article text].Tex Heart Inst J. 36(6):510–520.Teerlink JR, Alburikan K, Metra M, Rodgers JE.Acute decompensated heart failure update.Curr Cardiol Rev. 2015;11(1):53–62. doi:10.2174/1573403x09666131117174414American Heart Association.Common tests for heart failure.MedlinePlus.Natriuretic peptide tests (BNP, NT-proBNP).Gaggin HK, Januzzi JL.Cardiac biomarkers and heart failure. American College of Cardiology.Heidenreich P, Bozkurt B, Aguilar D, et al.2022 AHA/ACC/HFSA guideline for the management of heart failure.J Am Coll Cardiol. 2022;79(17):e263–e421. doi:10.1016/j.jacc.2021.12.012Brakohiapa EKK, Botwe BO, Sarkodie BD, Ofori EK, Coleman J.Radiographic determination of cardiomegaly using cardiothoracic ratio and transverse cardiac diameter: can one size fit all? Part one.Pan Afr Med J. 2017;27:201. doi:10.11604/pamj.2017.27.201.12017American Heart Association.Classes and stages of heart failure.American Heart Association.Lifestyle changes for heart failure.Maisch B.Alcoholic cardiomyopathy: the result of dosage and individual predisposition.Herz. 2016;41(6):484–493. doi:10.1007/s00059-016-4469-6Page RL, O’bryant CL, Cheng D, et al.Drugs that may cause or exacerbate heart failure: a scientific statement from the American Heart Association.Circulation. 2016;134(6):e32-69. doi:10.1161/CIR.0000000000000426American Heart Association.Devices and surgical procedures to treat heart failure.Cook JA, Shah KB, Quader MA, et al.The total artificial heart.J Thorac Dis. 2015;7(12):2172-80. doi:10.3978/j.issn.2072-1439.2015.10.70Centers for Disease Control and Prevention.Smoking cessation—the role of healthcare professionals and health systems.National Institute on Alcohol Abuse and Alcoholism.Treatment for alcohol problems: finding and getting help.National Heart, Lung, and Blood Institute.Heart disease and depression: a two-way relationship.
American Heart Association.Heart failure signs and symptoms.
American Heart Association.Types of heart failure.
Inamdar AA, Inamdar AC.Heart failure: diagnosis, management and utilization.J Clin Med. 2016;5(7). doi:10.3390/jcm5070062
Yunina D, Sharma D, Fazio R, Amin H, Tsirlin Y, Shetty V.Advanced biventricular heart failure due to left ventricular noncompaction cardiomyopathy leading to the formation of a fastric bezoar: the implications of heart failure on the gastrointestinal tract.Case Rep Cardiol. 2018;2018:4386025. doi:10.1155/2018/4386025
Dean SM, Abraham W.Venous thromboembolic disease in congestive heart failure: venous thromboembolic disease in congestive heart failure.Congestive Heart Failure. 2010;16(4):164-169. doi:10.1111/j.1751-7133.2010.00148.x
Giallourakis CC.Liver complications in patients with congestive heart failure.Gastroenterol Hepatol (N Y). 2013;9(4):244–246.
Centers for Disease Control and Prevention.Heart failure.
Joseph SM, Cedars AM, Ewald GA, Geltman EM, Mann DL.Acute decompensated heart failure: contemporary medical management [published correction appears in Tex Heart Inst J. 2010;37(1):135. Dosage error in article text].Tex Heart Inst J. 36(6):510–520.
Teerlink JR, Alburikan K, Metra M, Rodgers JE.Acute decompensated heart failure update.Curr Cardiol Rev. 2015;11(1):53–62. doi:10.2174/1573403x09666131117174414
American Heart Association.Common tests for heart failure.
MedlinePlus.Natriuretic peptide tests (BNP, NT-proBNP).
Gaggin HK, Januzzi JL.Cardiac biomarkers and heart failure. American College of Cardiology.
Heidenreich P, Bozkurt B, Aguilar D, et al.2022 AHA/ACC/HFSA guideline for the management of heart failure.J Am Coll Cardiol. 2022;79(17):e263–e421. doi:10.1016/j.jacc.2021.12.012
Brakohiapa EKK, Botwe BO, Sarkodie BD, Ofori EK, Coleman J.Radiographic determination of cardiomegaly using cardiothoracic ratio and transverse cardiac diameter: can one size fit all? Part one.Pan Afr Med J. 2017;27:201. doi:10.11604/pamj.2017.27.201.12017
American Heart Association.Classes and stages of heart failure.
American Heart Association.Lifestyle changes for heart failure.
Maisch B.Alcoholic cardiomyopathy: the result of dosage and individual predisposition.Herz. 2016;41(6):484–493. doi:10.1007/s00059-016-4469-6
Page RL, O’bryant CL, Cheng D, et al.Drugs that may cause or exacerbate heart failure: a scientific statement from the American Heart Association.Circulation. 2016;134(6):e32-69. doi:10.1161/CIR.0000000000000426
American Heart Association.Devices and surgical procedures to treat heart failure.
Cook JA, Shah KB, Quader MA, et al.The total artificial heart.J Thorac Dis. 2015;7(12):2172-80. doi:10.3978/j.issn.2072-1439.2015.10.70
Centers for Disease Control and Prevention.Smoking cessation—the role of healthcare professionals and health systems.
National Institute on Alcohol Abuse and Alcoholism.Treatment for alcohol problems: finding and getting help.
National Heart, Lung, and Blood Institute.Heart disease and depression: a two-way relationship.
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