Congestive Heart Failure

What is congestive heart failure?

Congestive heart failure, or heart failure, is a long-term condition in which your heart can’t pump blood well enough to meet your body’s needs. Your heart is still working. But because it can’t handle the amount of blood it should, blood builds up in other parts of your body. Most of the time, it collects in your lungs, legs and feet.

Think of it like a shipping department that can’t keep up with getting all the shipments where they need to go. The shipping department is always running behind and things pile up. When things pile up, they cause issues.

Types of congestive heart failure

Types of congestive heart failure include:

• Left-sided heart failure.
• Right-sided heart failure.
• High-output heart failure. This is a rare type of congestive heart failure.

How common is congestive heart failure?

More than 6 million people in the United States have congestive heart failure. It’s the leading cause of hospitalization in people older than 65.

What are the congestive heart failure symptoms?

Congestive heart failure symptoms include:

• Shortness of breath.
• Waking up short of breath at night.
• Chest pain.
• Heart palpitations.
• Fatigue when you’re active.
• Swelling in your ankles, legs and abdomen.
• Weight gain.
• Need to urinate while resting at night.
• A dry, hacking cough.
• A full (bloated) or hard stomach.
• Loss of appetite or upset stomach (nausea).

Sometimes, you may have mild symptoms of congestive heart failure or none at all. This doesn’t mean you don’t have heart failure anymore. Symptoms of heart failure can range from mild to severe and may come and go.

Unfortunately, congestive heart failure usually gets worse over time. As it worsens, you may have more or different signs or symptoms.

What causes congestive heart failure?

Causes of congestive heart failure include:

• Coronary artery disease and/or heart attack.
• Cardiomyopathy (genetic or viral).
• Heart issues present at birth (congenital heart disease).
• Diabetes.
• High blood pressure (hypertension).
• Arrhythmia.
• Kidney disease.
• A body mass index (BMI) higher than 30.
• Tobacco and recreational drug use.
• Alcohol use.
• Medications such as cancer drugs (chemotherapy).

Left-sided heart failure is the most common cause of right-sided heart failure. When your left ventricle isn’t working correctly, it allows blood to back up. At some point, this backup affects your right ventricle. Other causes include certain lung problems and issues in other organs.

What are the risk factors for congestive heart failure?

Risk factors for congestive heart failure include:

• Being older than 65.
• Using tobacco products, cocaine or alcohol.
• Having an inactive (sedentary) lifestyle.
• Eating foods that have a lot of salt and fat.
• Having high blood pressure.
• Having coronary artery disease.
• Having a heart attack.
• Having a family history of congestive heart failure.

What are the complications of congestive heart failure?

Some of the complications from congestive heart failure include:

• Irregular heartbeat.
• Sudden cardiac arrest.
• Heart valve problems.
• A collection of fluid in your lungs.
• Pulmonary hypertension.
• Kidney damage.
• Liver damage.
• Malnutrition.

How is congestive heart failure diagnosed?

Your healthcare provider will ask you about your symptoms and medical history. They may ask you about:

• Other health conditions you have.
• A family history of heart disease or sudden death.
• Your use of tobacco products.
• How much alcohol you drink.
• Any history of chemotherapy and/or radiation.
• The medications you take.

You’ll also have a physical exam. Your provider will look for signs of congestive heart failure and diseases that may have made your heart muscle weak or stiff.

What are the four stages of congestive heart failure?

Heart failure is a chronic condition that gets worse with time. There are four heart failure stages (Stages A, B, C and D). They range from having a high risk of developing heart failure to having advanced heart failure.

Stage A

Stage A (pre-heart failure) means you’re at a high risk of developing heart failure because you have a family history of congestive heart failure or you have one or more of these medical conditions:

• Hypertension.
• Diabetes.
• Coronary artery disease.
• Metabolic syndrome.
• History of alcohol use disorder.
• History of rheumatic fever.
• Family history of cardiomyopathy.
• History of taking drugs that can damage your heart muscle, such as some cancer drugs.

Stage B

Stage B (pre-heart failure) means your left ventricle isn’t working well and/or is structurally abnormal but you’ve never had symptoms of heart failure.

Stage C

People with Stage C heart failure have a congestive heart failure diagnosis and currently have or previously had signs and symptoms of the condition.

Stage D and reduced EF (ejection fraction)

People who have Stage D HFrEF (heart failure with reduced ejection fraction) have advanced symptoms that don’t get better with treatment. This is the final stage of heart failure.

What tests will be done to diagnose congestive heart failure?

Common tests to identify congestive heart failure, its stage and its cause include:

• Blood tests.
• Cardiac catheterization.
• Chest X-ray.
• Echocardiogram.
• Heart MRI (magnetic resonance imaging).
• Cardiac computed tomography (CT).
• Electrocardiogram (EKG or ECG).
• Multigated Acquisition Scan (MUGA scan).
• Stress test.
• Genetic testing.

How is congestive heart failure treated?

Your treatment will depend on the type of heart failure you have and, in part, what caused it. Medications and lifestyle changes are part of every heart failure treatment plan. Your healthcare provider will talk to you about the best treatment plan for you.

There’s no cure for heart failure. As congestive heart failure gets worse, your heart muscle pumps less blood to your organs, and you move toward the next stage of heart failure. Since you can’t move backward through the heart failure stages, the goal of treatment is to keep you from moving forward through the stages or to slow down the progression of your heart failure.

Stage A treatment

Treatment for people with Stage A heart failure includes:

• Regular exercise, such as walking every day.
• No tobacco products.
• Treatment for high blood pressure (medication, low-sodium diet, active lifestyle).
• Treatment for high cholesterol.
• No alcohol or recreational drugs.
• Angiotensin-converting enzyme inhibitor (ACE-I) or an angiotensin II receptor blocker (ARB) if you have coronary artery disease, diabetes, high blood pressure or other vascular or cardiac conditions.

Stage B treatment

Treatment for people with Stage B heart failure includes:

• Treatments for Stage A.
• Angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) if your EF is 40% or lower.
• Beta-blocker if you’ve had a heart attack and your EF is 40% or lower (if you aren’t already taking one).
• Aldosterone antagonist if you’ve had a heart attack or if you have an EF of 35% or less.
• Possible surgery or intervention as a treatment for coronary artery blockage, heart attack, valve disease (valve repair or replacement) or congenital heart disease.

Stage C treatment

Treatment for people with Stage C HFrEF includes:

• Treatments from Stages A and B.
• Beta-blocker.
• Aldosterone antagonist.
• Sodium-glucose transport 2 inhibitors (SGLT2i).
• Hydralazine/nitrate combination if other treatments don’t stop your symptoms and you’re African American.
• Medications that slow your heart rate if your heart rate is faster than 70 beats per minute and you still have symptoms.
• A diuretic (“water pill”) if symptoms continue.
• Restriction of sodium (salt) in your diet.
• Weight tracking every day. Tell your healthcare provider if you gain or lose more than 4 pounds.
• Possible fluid restriction.
• Possible cardiac resynchronization therapy (biventricular pacemaker).
• Possible implantable cardiac defibrillator (ICD) therapy.

If the treatment improves or stops your symptoms, you still need to continue treatment to slow the progression to Stage D.

Stage D treatment

Treatment for people who have Stage D heart failure includes treatments for Stages A, B and C. In addition, it includes evaluation for more advanced treatment options, including:

• Heart transplant.
• Ventricular assist devices.
• Heart surgery.
• Continuous infusion of inotropic drugs.
• Palliative or hospice care.

Stages C and D with preserved EF

Treatment for people with Stage C and Stage D heart failure and preserved EF (HFpEF) includes:

• Treatments for Stages A and B.
• Medications for the treatment of medical conditions that can cause heart failure or make it worse, such as atrial fibrillation, high blood pressure, diabetes, obesity, coronary artery disease, chronic lung disease, high cholesterol and kidney disease.
• Diuretic (“water pill”) to reduce or relieve symptoms.

It’s very important for you to manage your other health conditions, such as:

• Diabetes.
• Kidney disease.
• Anemia.
• High blood pressure.
• Thyroid disease.
• Asthma.
• Chronic lung disease.

Some conditions have signs and symptoms similar to congestive heart failure. If you have new or worsening nonurgent symptoms, tell your healthcare provider.

Complications/side effects of the treatment

Complications of congestive heart failure treatments may include:

• Hypotension.
• Kidney failure.
• Infections from frequent hospital visits that involve central IVs.

How can I lower my risk of congestive heart failure?

Although you can’t change some risk factors like age, family history or race, you can change your lifestyle to give yourself the best chance of preventing heart failure. Things you can do include:

• Staying at a weight that’s healthy for you.
• Eating foods that are good for your heart.
• Exercising regularly.
• Managing your stress.
• Stopping the use of tobacco products.
• Not drinking alcohol.
• Not using recreational drugs.
• Taking care of other medical conditions you have that can increase your risk.

What can I expect if I have congestive heart failure?

With the right care, congestive heart failure won’t stop you from doing the things you enjoy. Your prognosis, or outlook for the future, will depend on:

• How well your heart muscle is working.
• Your symptoms.
• How well you respond to your treatment plan.
• How well you follow your treatment plan.

One study says that people with congestive heart failure have a life span 10 years shorter than those who don’t have heart failure. Another study showed that the survival rates of people with chronic heart failure were:

• 80% to 90% for one year.
• 50% to 60% for year five.
• 30% for 10 years.

A different study found that people who had heart failure had expected life spans ranging from three to 20 years after their hospital stay, depending on various factors like age and assigned sex at birth. It’s important to look at your specific situation when considering your prognosis.

How long congestive heart failure lasts

Congestive heart failure is a chronic, or lifelong, condition. You’ll need to treat it for the rest of your life.

How do I take care of myself?

With the right care and treatment plan, many adults still enjoy life even though congestive heart failure limits their activities.

You can care for yourself by:

• Taking your medications.
• Being active.
• Following a low-sodium diet.
• Tracking and reporting new or worsening symptoms to your provider.
• Keeping regular follow-up appointments with your provider.

Congestive heart failure is a chronic, long-term illness that can get worse quickly, so it’s a good idea to let your provider and family know your preferences for medical care. You can complete an advance directive or living will to let everyone involved in your care know what you want. A living will details the treatments you want or don’t want to prolong your life. It’s a good idea to prepare a living will while you’re well in case you aren’t able to make these decisions at a later time.

What can’t I eat or drink with congestive heart failure?

People with congestive heart failure may need to limit how much salt and/or fluid they consume each day. Your provider can give you guidelines for this.

When should I see my healthcare provider?

It’s important to let your provider know if you have new symptoms or if your heart failure symptoms get worse. Contact them for new or worsening:

• Shortness of breath when you’re at rest.
• Swelling in your legs or belly.
• Sudden weight gain.
• Constant tiredness.

When should I go to the ER?

You need emergency treatment when your heart failure suddenly gets worse. Providers call this acute decompensated heart failure. They can give you medicine and oxygen to improve your condition.

What questions should I ask my doctor?

Questions to ask your healthcare provider include:

• Which stage of congestive heart failure do I have?
• What’s the best treatment for me at this stage?
• What kinds of exercise are safe for me to do?
• Is there a support group for people with congestive heart failure?

A note from Cleveland Clinic

If you have heart failure, you can take steps to improve your heart health. Take your medications, follow a low-sodium diet, stay active, take notice of sudden changes in your weight, keep your follow-up appointments and track your symptoms. If you have questions or concerns about your medications, lifestyle changes or any other part of your treatment plan, talk to your provider. They’re there to help you manage your heart failure.