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Congestive Heart Failure

What is Heart Failure?


The heart is unable to pump the right amount of blood through the body. This causes blood to back up in the veins. It can lead to a buildup of excess fluid in places like the lungs and feet.

Heart failure can get worse with time. Vital organs can be damaged from low blood flow.

Blood Flow through the Heart
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The leading causes of heart failure are:

Other common causes include:

Other less common causes include:

Risk Factors

Heart failure is more common in older adults. Other things that raise the risk of heart failure include:


Heart failure can cause:

  • Shortness of breath—at first it only happens with activity, then it progresses to having shortness of breath at rest
  • Unexplained weight gain
  • Swelling of feet, ankles, or legs
  • Needing to sleep propped up
  • Fatigue, weakness
  • Wheezing
  • Cough—may be dry and hacking or wet sounding, may have a pink, frothy sputum
  • Frequent urination, especially at night
  • Belly pain


The doctor will ask about symptoms and past health. A physical exam will be done. The doctor may note changes caused by heart failure such as fluid build up in legs. They may also hear abnormal sounds when they listen to the heart. Blood tests may be done to look for certain markers of change in the heart.

Tests can help show what parts of the heart are affected. They can also show changes in blood flow. This can be done with:

Doctors will use the test results to determine level of heart failure. This will help guide the treatment plan.


The goal of treatment is to keep the symptoms from getting worse. Treatment can ease symptoms and improve quality of life. Some may also have some improvement in heart strength. Heart failure will need lifelong care.

Treatment will vary by person and over time. Tracking weight and symptoms every day will help catch changes early. Treating these changes fast may help keep heart failure from getting worse.

Heart failure may be caused by another health issue. Treating this issue may improve heart failure or prevent it from getting worse. For any form of heart failure, treatment may include:


Medicine may be given to ease the heart's workload by:

  • Widening blood vessels
  • Helping the heart pump
  • Slowing the heart rate and lowering blood pressure
  • Removing excess fluid
  • Reducing cholesterol levels

Lifestyle Changes

Daily habits can affect heart health. Changes that may help ease stress on the heart include:

  • Quitting smoking
  • Eating a heart healthy diet that is low in fat, high in fiber, and has lots vegetables and fruits
  • Reducing salt intake
  • Working out regularly
  • Keeping a healthy weight
  • Avoiding alcohol or recreational drugs that may stress the heart
  • Managing and reducing stress

Heart Support and Surgery

Heart failure may cause or be worsened by heart rhythm problems. A defibrillator or pacemaker may be implanted. They give electrical shocks if the heart starts dangerous rhythms.

Other devices can help support the heart. They may be needed for a short time to help recover from an injury or illness. They may also support the heart in the last stages of heart failure until a transplant can be done. These devices increase the amount of blood pumped to the body without making the heart work harder. Examples include:

  • Intra-aortic balloon pump (IABP)
  • Ventricular assist device

A heart transplant may be needed for severe heart failure if other treatments have not helped.


The best way to prevent heart failure is to reduce the risk of heart disease, high blood pressure, and diabetes. General steps include:

  • Aiming to be active 150 minutes each week
  • Quitting smoking
  • Limiting alcohol
  • Maintaining a healthy weight
  • Eating a healthy diet


  • Congestive heart failure and congenital defects. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/TheImpactofCongenitalHeartDefects/Congestive-Heart-Failure%5FUCM%5F307111%5FArticle.jsp#.Wbk5j7KGNQJ.
  • Explore heart failure. National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health/health-topics/topics/hf.
  • Heart failure with reduced ejection fraction (HFrEF). EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/heart-failure-with-reduced-ejection-fraction-hfref.
  • Lifestyle changes for heart failure. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HeartFailure/PreventionTreatmentofHeartFailure/Lifestyle-Changes-for-Heart-Failure%5FUCM%5F306341%5FArticle.jsp#.Wbk6sbKGNQJ.
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  • Yancy, C.W., Jessup, M., et al. 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. Journal of the American College of Cardiology, 2013; 62 (16): e147-e239.
  • 4/2/2014 DynaMed Systematic Literature Surveillance https://www.dynamed.com/quality-improvement/choosing-wisely: Updated July 23, 2015.
  • 1/18/2017 DynaMed Systematic Literature Surveillance https://www.dynamed.com/condition/coronary-artery-disease-cad: Emdin, C.A., Odutayo, A., et al. Meta-analysis of anxiety as a risk factor for cardiovascular disease. American Journal of Cardiology, 2016; 118 (4): 511-519.