• Congestive heart failure

    Heart failure is often the result of damage to the heart or a weakening from other health conditions. Heart failure simply means that the heart muscle cannot pump blood out well enough or effectively enough to meet the body’s need. Heart failure is also known as congestive heart failure because blood that cannot be pumped well backs up, and congests other areas of the body including the liver, lungs, legs and feet.

    Heart failure may start slowly (chronic heart failure) or happen more suddenly and have more severe symptoms (acute heart failure). Either type causes the main pumping chambers of the heart (ventricles) to become stiff and not fill properly between beats, or weaken and stretch to the point that the heart cannot pump with enough force to move blood out to the body well.

  • Causes

    Coronary artery disease (CAD)

    Coronary artery disease is the most common cause of heart failure. Over time, the arteries and veins that supply the heart with blood can become thickened and clogged with fatty deposits. This is called atherosclerosis. This slows the flow of blood to the heart and provides just enough blood to keep the muscle alive, but it won’t function as well as it should. If one of these fatty deposits breaks loose or ruptures completely, a clot can block the blood vessel and stop blood from reaching an area of the heart muscle. This results in a heart attack.

    High blood pressure

    High blood pressure (hypertension) forces the heart to work harder to move blood out to the body. Over time, this workload causes the heart muscle to thicken, become stiff, or be too weak to pump blood effectively.


    Damage to the heart muscle (cardiomyopathy) can come from many sources including alcohol and drug abuse, infection, and total-body disease like lupus or thyroid conditions.


    This infection around the heart can inflame the heart muscle itself. It’s usually caused by a virus, but can lead to left-sided heart failure.

    Birth defects

    Conditions like congenital heart disease and other conditions that influence the formation of the heart’s chambers, valves and other structures may cause the heart to pump ineffectively or wear out over time.

    There are a variety of other conditions that can influence the health of your heart and the development of congestive heart failure. Diabetes, emphysema, too much iron in the blood (hemochromatosis, inflammatory cells (sarcoidosis), and some medications including chemotherapy can also contribute to heart failure.

  • Symptoms

    Symptoms for both sudden (acute) heart failure and long term (chronic) heart failure are similar but sudden heart failure will often present with more severe symptoms and happen much more quickly.

    Long-term (chronic) heart failure symptoms

    • Shortness of breath when laying down or eating
    • Fatigue
    • Swelling in your legs, ankles and feet
    • Sudden weight gain
    • Lack of appetite
    • Difficulty concentrating
    • Irregular heartbeat

    Sudden (acute) heart failure

    Symptoms will include a rapid development of the above, plus:

    • Rapid, irregular heartbeat and palpitations
    • Coughing up pink foamy mucus
    • Chest pain
    • Sudden fluid buildup

    When to see your doctor

    If you think you are having a heart attack seek emergency care or call 911 immediately, and make sure to see your doctor as soon as possible for any other symptoms as soon as possible. 

  • Testing and diagnosis

    To diagnose CHF, your doctor will take a thorough history and do a physical assessment. He or she will listen to your lungs for sounds of fluid buildup and listen closely to your heart to identify an irregular rhythm. Your vital signs including your blood pressure will be checked and veins in your neck will be examined for signs of fluid backup in the body. Your doctor will also look at your feet and legs to check for swelling.

    Screening tests

    In addition, you can expect the following screening tests:

    • Chest X-ray
    • Blood work
    • Electrocardiogram (ECG)
    • Echocardiogram

    You may also require one or more of these:

    • Stress test
    • CT or MRI
    • Coronary catheterization (angiogram )

  • Treatment options

    For most people, a diagnosis of CHF is a life-long condition. Many cases can be treated well with medications and lifestyle changes and a few others may be reversed completely by treating an underlying physical cause like a faulty valve or irregular heartbeat. However, the majority of patients will not be able to reverse the condition completely.


    First line treatment for CHF will start with medications. Your doctor will prescribe medications to help the heart beat more effectively, blood pressure medications, drugs to control or slow some rhythms, and other medications designed to help reduce damage to the heart muscle and help it last as long as possible.


    If medication is not enough, you may need a surgical procedure to help your heart work as well as it can. These can include:

    • Coronary bypass surgery
    • Heart valve repair or valve replacement
    • Implantable defibrillators
    • Pacemaker placement
    • Heart pump assistance with an LVAD or ventricular assist device
    • Total heart transplant