CHF; Congestive heart failure; Left-sided heart failure; Right-sided heart failure - cor pulmonale; Cardiomyopathy - heart failure; HF Heart failure is a condition in which the heart is no longer able to pump oxygen-rich blood to the rest of the body efficiently. This causes symptoms to occur throughout the body. The interior of the heart is composed
of valves, chambers, and associated vessels. The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away
from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide. The heart is a large muscular organ which constantly pushes oxygen-rich blood to the brain and extremities and transports oxygen-poor blood from the brain and extremities to the lungs to gain oxygen. Blood comes into the right atrium from the body, moves into the right ventricle and is pushed into the pulmonary arteries in
the lungs. After picking up oxygen, the blood travels back to the heart through the pulmonary veins into the left atrium, to the left ventricle and out to the body's tissues through the aorta. The abnormal buildup of fluid in the body is called edema. Edema is commonly seen in the feet and ankles, because of the effect of gravity, swelling is particularly noticeable in these locations. Common causes of edema are prolonged standing, prolonged sitting, pregnancy, being overweight, and increase in age. If you cough a lot, often feel weak, have lost your appetite, and need to urinate a lot at night, you might have symptoms of heart failure. Heart failure is a long-term condition that usually comes on slowly. However, it can develop suddenly,
for instance, after a heart attack. You have heart failure when your heart does not pump blood out of your heart very well, or when your heart muscles are stiff and do not easily fill up with blood. When you have heart failure, your heart cannot pump enough oxygen-rich blood to the rest of your body, especially when you exercise or move around a lot. As the heart loses the ability to pump blood, blood backs up in other parts of your body, including your lungs, liver, gastrointestinal tract, and
your arms and legs. The most common cause of heart failure is coronary artery disease, the narrowing of the blood vessels that supply blood and oxygen to your heart. So, how do you know if you have heart failure? Get to your doctor. You may have trouble breathing, an irregular heartbeat, swollen legs, neck veins that stick out, and sounds from fluid built up in your lungs. Your doctor will check for these and other signs of heart failure. A test called an echocardiogram is often the best test to
diagnose your heart failure. Your doctor can also use this test to find out why you have heart failure, and then monitor your condition going forward every three to six months. Your doctor will talk to you about knowing your body and symptoms that mean your heart failure is getting worse. You will need to learn to watch for changes in your heart rate, pulse, blood pressure, and weight. You will also need to limit salt in your diet, stop drinking alcohol, quit smoking if you need to, exercise,
lose weight if you need to, and get enough rest. Your doctor will probably ask you to take medicines to treat your heart failure. These medicines can treat your symptoms, prevent your heart failure from getting worse, and help you live longer. If you have heart failure, taking your medicines, changing your lifestyle, and treating the condition that caused heart failure can go a long way toward improving your health. But heart failure is a chronic, or long-term, illness, which means it may get
worse over time. Make sure you call your doctor if you start coughing more, have sudden weight gain or swelling, or feel week. Have someone take you to the emergency room right away if you have trouble with fainting, a fast and irregular heartbeat, or feel severe crushing chest pain. 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. Both sides of the heart also can be involved. Heart failure is present when:
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:
Other heart problems that may cause heart failure are:
Other diseases that can cause or contribute to heart failure:
SymptomsSymptoms 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:
Exams and TestsYour health care provider will examine you for signs of heart failure:
Many tests are used to diagnose and monitor heart failure. 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:
TreatmentMONITORING 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. Knowing your body and the symptoms that your heart failure is getting worse will help you stay healthier and out of the hospital. At home, watch for changes in your heart rate, pulse, blood pressure, and weight. 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 provider about what you should do if your weight goes up or you develop more symptoms. Limit how much salt you eat. Your provider may also ask you to limit how much fluid you drink during the day. Other important changes to make in your lifestyle:
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. These medicines:
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:
The following surgeries and devices may be recommended for some people with heart failure:
END-STAGE HEART FAILURE Severe heart failure occurs when treatments no longer work. Certain treatments may be used when a person is waiting for (or instead of) a heart transplant:
At a certain point, the provider will decide whether it is best to keep treating heart failure aggressively. The person, along with their family and doctors, may want to discuss palliative or comfort care at this time. Outlook (Prognosis)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:
Most of the time, heart failure is a chronic illness. Some people develop severe heart failure. At this stage, medicines, other treatments, and surgery no longer help the condition. People with heart failure may be at risk for dangerous heart rhythms. These people often receive an implanted defibrillator. When to Contact a Medical ProfessionalCall your provider if you develop:
Go to the emergency room or call the local emergency number (such as 911) if:
PreventionMost cases of heart failure can be prevented by living a healthy lifestyle and taking steps aimed at reducing your risk for heart disease. . ReferencesAllen LA, Stevenson LW. Management of patients with cardiovascular disease approaching end of life. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 31. Felker GM, Teerlink JR. Diagnosis and management of acute heart failure. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 24. Forman DE, Sanderson BK, Josephson RA, Raikhelkar J, Bittner V; American College of Cardiology's Prevention of Cardiovascular Disease Section. Heart failure as a newly approved diagnosis for cardiac rehabilitation: challenges and opportunities. J Am Coll Cardiol. 2015;65(24):2652-2659. PMID: 26088305 pubmed.ncbi.nlm.nih.gov/26088305/. Mann DL. Management of heart failure patients with reduced ejection fraction. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 25. Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136(6):e137-e161. PMID: 28455343 pubmed.ncbi.nlm.nih.gov/28455343/. Zile MR, Litwin SE. Heart failure with a preserved ejection fraction. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 26. Version InfoLast reviewed on: 7/30/2020 Reviewed by: Thomas S. Metkus, MD, Assistant Professor of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 09/28/2021. What happens when heart failure gets worse?Severe heart failure can result in blood and fluid pooling in the legs and abdomen. The body can usually accommodate large increases in volume, about five liters, but in severe heart failure, the extra fluid is enough to expand the extracellular compartments of the body.
Can congestive heart failure worsen suddenly?Heart failure can suddenly get worse due to: Ischemia (lack of blood flow to the heart muscle) Eating high-salt foods. Heart attack.
What are the final stages of congestive heart failure?Patients in the end stages of heart failure want to know what to expect. The symptoms of end-stage congestive heart failure include dyspnea, chronic cough or wheezing, edema, nausea or lack of appetite, a high heart rate, and confusion or impaired thinking.
Which are two signs of worsening heart failure?Signs of Worsening Heart Failure. Shortness of breath.. Feeling dizzy or lightheaded.. Weight gain of three or more pounds in one day.. Weight gain of five pounds in one week.. Unusual swelling in the legs, feet, hands, or abdomen.. A persistent cough or chest congestion (the cough may be dry or hacking). |