Heart failure is most often a long-term (chronic) condition, but it may come on suddenly. It can be caused by many different heart problems.
The condition may affect only the right side or only the left side of the heart. More often, both sides of the heart are involved.
Heart failure is present when:
Your heart muscle cannot pump (eject) the blood out of the heart very well. This is called systolic heart failure.
Your heart muscle is stiff and does not fill up with blood easily. This is called diastolic heart failure.
As the heart's pumping becomes less effective, blood may back up in other areas of the body. Fluid may build up in the lungs, liver, gastrointestinal tract, and the arms and legs. This is called congestive heart failure.
The most common causes of heart failure are:
Coronary artery disease (CAD), a narrowing of the small blood vessels that supply blood and oxygen to the heart. This can weaken the heart muscle over time or suddenly.
High blood pressure that is not well controlled, leading to problems with stiffness, or eventually leading to muscle weakening.
Other heart problems that may cause heart failure are:
Congenital heart disease
Heart valves that are leaky or narrowed
Infection that weakens the heart muscle
Some types of abnormal heart rhythms (arrhythmias)
Other diseases that can cause or contribute to heart failure:
Too much iron in the body
Symptoms of heart failure often begin slowly. At first, they may only occur when you are very active. Over time, you may notice breathing problems and other symptoms even when you are resting. Symptoms may also appear suddenly after the heart is damaged from a heart attack or other problem.
Common symptoms are:
Fatigue, weakness, faintness
Loss of appetite
Need to urinate at night
Pulse that feels fast or irregular, or a sensation of feeling the heart beat (palpitations)
Shortness of breath when you are active or after you lie down
Swollen (enlarged) liver or abdomen
Swollen feet and ankles
Waking up from sleep after a couple of hours due to shortness of breath
Exams and Tests
Your health care provider will examine you for signs of heart failure:
Fast or difficult breathing
Leg swelling (edema)
Neck veins that stick out (are distended)
Sounds (crackles) from fluid buildup in your lungs, heard through a stethoscope
Swelling of the liver or abdomen
Uneven or fast heartbeat and abnormal heart sounds
An echocardiogram (echo) is most often the best first test for people when heart failure is being evaluated. Your provider will use it to guide your treatment.
Other imaging tests can look at how well your heart is able to pump blood, and how much the heart muscle is damaged.
Many blood tests may also be used to:
Help diagnose and monitor heart failure
Identify risks for various types of heart disease
Look for possible causes of heart failure, or problems that may make your heart failure worse
Monitor for side effects of medicines you may be taking
MONITORING AND SELF CARE
If you have heart failure, your provider will monitor you closely. You will have follow-up visits at least every 3 to 6 months, but sometimes much more often. You will also have tests to check your heart function.
Weight gain, especially over a day or two, can be a sign that your body is holding on to extra fluid and your heart failure is getting worse. Talk to your doctor about what you should do if your weight goes up or you develop more symptoms.
Limit how much salt you eat. Your doctor may also ask you to limit how much fluid you drink during the day.
Other important changes to make in your lifestyle:
Stay active. Walk or ride a stationary bicycle. Your provider can provide a safe and effective exercise plan for you. DO NOT exercise on days when your weight has gone up from fluid or you are not feeling well.
Get enough rest, including after exercise, eating, or other activities. This allows your heart to rest too.
MEDICINES, SURGERY, AND DEVICES
You will need to take medicines to treat your heart failure. Medicines treat the symptoms, prevent your heart failure from getting worse, and help you live longer. It is very important that you take your medicine as your health care team directed.
Help the heart muscle pump better
Keep your blood from clotting
Lower your cholesterol levels
Open up blood vessels or slow your heart rate so your heart does not have to work as hard
Reduce damage to the heart
Reduce the risk of abnormal heart rhythms
Rid your body of excess fluid and salt (sodium)
It is very important that you take your medicine as directed. DO NOT take any other drugs or herbs without first asking your provider about them. Drugs that may make your heart failure worse include:
At a certain point, the provider will decide whether it is best to keep treating heart failure aggressively. The person, along with his or her family and doctors, may want to discuss palliative or comfort care at this time.
Often, you can control heart failure by taking medicine, changing your lifestyle, and treating the condition that caused it.
Heart failure can suddenly get worse due to:
Ischemia (lack of blood flow to the heart muscle)
Eating high-salt foods
Infections or other illnesses
Not taking medicines correctly
New, abnormal heart rhythms
Most of the time, heart failure is a chronic illness that gets worse over time. Some people develop severe heart failure. Medicines, other treatments, and surgery no longer help at this stage.
People with heart failure may be at risk for dangerous heart rhythms. These people often receive an implanted defibrillator.
When to Contact a Medical Professional
Call your health care provider if you develop:
Increased cough or phlegm
Sudden weight gain or swelling
Other new or unexplained symptoms
Go to the emergency room or call the local emergency number (such as 911) if:
Goodlin SJ, Bonow RO. Care of patients with end-stage heart disease. In: Mann DL, Zipes DP, Libby P, et al, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 31.
Mann DL. Management of heart failure patients with reduced ejection fraction. In: Mann DL, Zipes DP, Libby P, et al, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 25.
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJV, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WHW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;128:e240-e327. PMID: 23741058 www.ncbi.nlm.nih.gov/pubmed/23741058.
Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.