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Heart Failure

What is heart failure?

The heart is a muscle that pumps oxygen-rich blood to all parts of the body. When you have heart failure, the heart can’t pump as well as it should. Or the heart muscle can’t relax and fill the pumping chamber with blood. Blood and fluid may back up into the lungs. This causes congestive heart failure and pulmonary edema. Some parts of the body also don’t get enough oxygen-rich blood to work correctly. These problems lead to the symptoms of heart failure.

What causes heart failure?

Heart failure may result from:

  • Heart valve disease

  • High blood pressure

  • Active infections of the heart valves or heart muscle, such as endocarditis

  • A past heart attack

  • Coronary artery disease

  • Disease of the heart muscle (cardiomyopathy)

  • Heart disease or problems that are present at birth (congenital)

  • Heart rhythm problems (arrhythmias). These lead to fast heart rates that continue over time.

  • Long-term (chronic) lung disease and pulmonary embolism

  • Certain medicines. Or a reaction to certain medicines such as those used for chemotherapy.

  • Anemia and too much blood loss

  • Complications of diabetes

  • Obstructive sleep apnea

  • Alcohol and drug abuse

  • Certain viral infections

What are the symptoms of heart failure?

The most common symptoms of heart failure are:

  • Shortness of breath while resting, exercising, or lying flat

  • Weight gain from water retention

  • Visible swelling of the legs and ankles from fluid buildup. Sometimes the belly (abdomen) may swell.

  • Severe tiredness (fatigue) and weakness

  • Loss of appetite, nausea, and belly pain

  • Cough that doesn’t go away. It can cause blood-tinged or frothy sputum.

The severity of the condition and symptoms depends on how much of the heart's pumping ability has been affected. The first step in managing heart failure symptoms is knowing your baselines or what’s normal for you. How much do you weigh? Are you gaining weight but eating the same amount? How much can you do before you feel short of breath? Do your socks and shoes fit comfortably? Knowing what’s normal for you will help you see when symptoms are getting worse. Once you know your baselines, watch for changes daily.

The symptoms of heart failure may look like other health problems. Always see your healthcare provider for a diagnosis.

How is heart failure diagnosed?

Your healthcare provider will ask about your health history and do a physical exam. Other tests you may need are:

  • Chest X-ray. This test makes images of internal tissues, bones, and organs on film. This test shows the size and shape of your heart. Fluid in the lungs will also show up on X-ray.

  • Echocardiogram. This test is also called echo. It uses sound waves to assess the motion of the heart’s chambers and valves. The sound waves make an image on the screen as an ultrasound transducer is passed over the heart. This shows how well the heart pumps and relaxes. It also shows the thickness of the heart walls, and if the heart is enlarged. It is one of the most useful tests because it shows a great deal of information about the heart’s function and helps guide treatment decisions.

  • Electrocardiogram (ECG). This test records the electrical activity of the heart. It shows abnormal rhythms and can sometimes find heart muscle damage.

  • BNP testing. B-type natriuretic peptide (BNP) is a hormone released from the ventricles that occurs with heart failure. BNP levels are useful in the quick assessment of heart failure. In general, the higher the BNP levels, the worse the heart failure. BNP is measured from a blood sample.

  • Cardiac MRI. This test uses a magnetic field to generate images of the heart and its nearby structures without X-rays. It can assess how the heart muscle and valves are working.

How is heart failure treated? 

The cause of heart failure will guide the treatment plan. If heart failure is caused by a valve problem or coronary heart disease, then you may need procedures such as percutaneous coronary intervention or surgery. If heart failure is caused by a disease such as anemia or infection, then the healthcare provider will treat the underlying disease.

Some causes of heart failure are reversible or short-term, such as in an acute infection. For many causes of heart failure there is no cure. But many forms of treatment can help with symptoms. They are listed below.

Lifestyle changes

These healthy habits may help with heart failure:

  • Controlling blood pressure

  • Controlling blood sugar if you have diabetes

  • Quitting smoking

  • Losing weight, if needed

  • Exercising more

  • Limiting salt and fat in your diet

  • Not drinking alcohol or using illicit drugs

  • Getting enough rest

  • Other important lifestyle habits include getting vaccines such as for the flu and pneumococcal pneumonia.

If you have sleep problems, getting a sleep study get help find out what’s causing them. You may need to wear a C-PAP mask while you sleep. This will make sure you get enough oxygen. Too little oxygen can put stress on your heart.


Many types of medicines are available for heart failure. They include:

  • Angiotensin converting enzyme (ACE) inhibitors. These medicines lower the pressure inside the blood vessels and reduce the resistance against which the heart pumps. They also help remodel the heart, which can promote better pumping ability.

  • Angiotensin receptor blockers (ARB). Some people get a cough and need to stop taking ACE inhibitors. If that happens, an ARB may work for you. These help relax blood vessels and reduce stress on the heart

  • Angiotensin receptor-neprilysin inhibitors (ARNIs). This medicine combines an ARB and a neprilysin inhibitor which can help the heart as mentioned above as well as promote salt and water loss.

  • Sinus node I-f channel blocker. This medicine may be used to lower your heart rate, which puts less stress on your heart.

  • Diuretics. These reduce the amount of fluid in the body. They are among the most important medicines in helping control fluid buildup in the body.

  • Vasodilators such as hydralazine and nitroglycerin. These widen (dilate) the blood vessels and reduce workload on the heart.

  • Digitalis. This medicine helps the heart beat stronger and may help with controlling heart rate if there is an abnormal heart rhythm.

  • Antiarrhythmics. These help maintain normal heart rhythm in the presence of abnormal heart rhythm.

  • Beta-blockers. These reduce the heart’s tendency to beat faster. They can also promote better pumping over time.

  • Aldosterone blockers. This medicine blocks the effects of the hormone aldosterone, which causes sodium and water retention.

  • Statins or PCKS9 inhibitors. These medicines lower the amount of bad cholesterol in your blood. They are not used to treat heart failure. But you may take one if you have high cholesterol, or have had a past heart attack and are at risk for heart failure. People who have inherited forms of high cholesterol (familial hypercholesterolemia) may get help from a new class of medicines called PCKS9 inhibitors. These medicines lower cholesterol.

Heart procedures

These include opening blocked arteries in the heart. This brings back blood flow to the heart muscle. It helps the ventricles squeeze as they should. The procedure can be done in the cardiac catheterization lab. It uses balloons to push plaque and blood clots out of the artery. It also uses stents to keep the artery open. This can also be done by bypassing blockages during surgery (coronary artery bypass surgery).

Heart valve repair or replacement

In some cases medicines can’t help heart failure caused by heart valves that are narrowed (stenosed) or leak (regurgitant). The heart valve can be repaired or replaced. This can be done as an open-heart procedure. Or it can be done by going through a small tube (catheter) that is put into an artery or vein.


If your heart failure has also damaged your heart’s electrical wiring system, pacemakers can be implanted to restore normal heart rate and regularity. Cardiac resynchronizing pacemakers are used when one of the heart wires is damaged. This is often the wire located in the left ventricle. These pacemakers use implanted left and right sided wires to restore normal timing of the heart contraction in order to improve heart function.

ICD (implantable cardioverter defibrillator)

When heart muscle is damaged, dangerous heart circuits can form in the heart muscle. This leads to possibly fatal heart rhythms. An ICD is implanted in the body to sense and treat these cardiac arrest rhythms. It does this by overdrive pacing the heart rhythm. Or by delivering an energy shock to the heart.

VAD (ventricular assist devices)

These devices are surgically implanted in the chest. They connect to an outside motor which helps pump blood from the heart to the rest of the body. VADs can allow people with advanced heart failure to improve their overall symptoms and to walk more. This can be used as a long-term treatment. Or it can be used while someone waits for a donor heart for a transplant.

Heart transplant

In some cases, the diseased heart must be replaced with a healthy one from a donor.

Talk with your healthcare providers about the risks, benefits, and possible side effects of all treatments.

What are the possible complications of heart failure?

Complications of heart failure include:

  • Fluid buildup in the lungs (pulmonary edema)

  • Kidney and liver failure

  • Stroke

  • Abnormal heart rhythms

  • Death

Key points about heart failure

  • When you have heart failure, the heart can’t pump as well as it should.

  • Heart failure may result from health problems that affect the heart, such as high blood pressure, coronary artery disease, and heart attack.

  • Some common symptoms are shortness of breath, weight gain, and visible swelling of the legs and ankles.

  • A chest X-ray can help diagnose lung congestion.

  • Treatment varies based on the cause of heart failure. Most people are advised to make certain lifestyle changes and to take certain medicines, often for life. Procedures such as coronary intervention and surgery may be needed.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.

  • Before your visit, write down questions you want answered.

  • Bring someone with you to help you ask questions and remember what your provider tells you.

  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

  • Ask if your condition can be treated in other ways.

  • Know why a test or procedure is recommended and what the results could mean.

  • Know what to expect if you do not take the medicine or have the test or procedure.

  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.

  • Know how you can contact your provider if you have questions.

Online Medical Reviewer: Louise Cunningham, RN
Online Medical Reviewer: Mandy Synder, RN
Online Medical Reviewer: Steven Kang, MD
Date Last Reviewed: 4/1/2018
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