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.
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:
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:
Your health care provider will examine you for signs of heart failure:
Many tests are used to diagnose and monitor heart failure.
After an electrocardiogram (ECG), 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:
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.
Knowing your body and the symptoms that mean 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.
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.
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.
Contact your provider if you develop:
Go to the emergency room or call the local emergency number (such as 911) if:
Most cases of heart failure can be prevented by living a healthy lifestyle and taking steps aimed at reducing your risk for heart disease..
Felker GM, Teerlink JR. Diagnosis and management of acute heart failure. In: Libby P, Bonow RO, Mann DL, Tomaselli, GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 49.
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/.
Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e895-e1032. PMID: 35363499 pubmed.ncbi.nlm.nih.gov/35363499/.
Lam CSP, Shah SJ, Solomon SD. Heart failure with preserved and mildly reduced ejection fraction. In: Libby P, Bonow RO, Mann DL, Tomaselli, GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 51.
Mann DL. Management of heart failure patients with reduced ejection fraction. In: Libby P, Bonow RO, Mann DL, Tomaselli, GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 50.BACK TO TOP
Review Date: 10/5/2022
Reviewed By: Thomas S. Metkus, MD, Assistant Professor of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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