Let's Talk About Congestive Heart Failure
When the heart weakens, it can trigger a serious domino effect in the body. We explore why it happens and what you can do.
If you’ve been given a heart failure diagnosis, you might be worried that your heart is in imminent danger of shutting down. Thankfully, the answer to that is usually no. While congestive heart failure is a complex type of heart disease that yes, usually worsens over time, there is much that can be done to slow its progression and make your heart healthier right now. Keep reading to learn how to improve your heart’s function—and even extend your life.
Our Pro Panel
We went to some of the nation’s top experts in heart failure to bring you the most up-to-date information possible.
Michael Goyfman M.D., MPH
Director of Clinical Cardiology
Long Island Jewish Forest Hills
David Friedman, M.D.
Director of Heart Failure Services
Northwell Health’s LIJ Valley Stream
Long Island, NY
Olujimi A. Ajijola, M.D., Ph.D.
Cardiologist and Assistant Professor of Medicine
David Geffen School of Medicine, UCLA
Not everyone realizes their heart is in trouble until they wind up in the emergency room. To avoid that scenario, never ignore shortness of breath, especially without exercise, or swelling in your arms or legs, which may be a sign that excess fluids are collecting inside your body. For any symptom that concerns you, don’t wait to see if gets better. Call your doctor today.
Your doctor will determine this during diagnosis. No matter what stage of your disease, keep in mind there are many treatment options available, including medications, implantable devices, and even heart transplantation.
Every heart failure patient is different, and so is the right treatment. Your best strategy is to get to know your disease, how it affects you, and how to monitor yourself. Then you and your doctor will come up with a plan that works for you.
Follow your treatment plan, manage any other underlying health conditions such as high blood pressure or diabetes, be as active as possible, and get enough sleep. If you smoke, quit. Most doctors also suggest people with heart failure should also avoid alcohol.
What Is Congestive Heart Failure, Anyway?
Just like you learned in biology class, your heart is a small—but powerful—pump that constantly circulates oxygen- and nutrient-rich blood to every nook and cranny of the body. Once the good stuff is delivered and the toxins are filtered out by the kidneys and liver, the heart brings the blood back around to receive a fresh load of oxygen, and the process begins again.
However, when something interferes with your heart’s ability to pump efficiently, it causes a systemwide slowdown. Blood and other fluids start to back up and collect in your veins and lungs—this is the congestive part—making it even harder for your heart to do its job. You may feel shortness of breath, or notice swelling in your legs or arms, when this starts to happen.
This type of heart failure affects 6.5 million Americans, according the Centers for Disease Control and Prevention (CDC). It’s a chronic and progressive condition, but there are plenty of treatment options that can ease symptoms and help your heart work with less strain. And while there’s no skirting around the seriousness of this condition, don't give up hope for a better tomorrow.
Life expectancy largely depends on the stage of the disease you're in, according to the Cleveland Clinic. There are four main stages—usually labeled as A, B, C, and D, with D being the most serious—so your job is to do everything in your power to help prevent progression. (This means following your treatment plan to a "T.") About half of all people diagnosed with heart failure will survive at least five years, while 10% go on to live another 10 years, according to a recent study published in the journal Circulation Research. We'll share all we know here to help give you as many tomorrows as possible.
How Is the Heart Supposed to Function?
Before we get into the details of congestive heart failure, let’s briefly review how your heart works:
The heart’s right atrium receives blood that has already passed through your body.
From there, it moves into the right ventricle, where it gets pumped over to the lungs to pick up more oxygen.
Then it returns to the left atrium and down into the left ventricle, to get pushed out to the body. This is why your left ventricle is the strongest chamber in the heart. It has the heaviest lift.
A series of valves between the heart’s chambers help ensure the blood keeps flowing in the right direction. And your heartbeat? That steady rhythm helps ensure each part of the heart does its job at precisely the right time.
What Happens When the Heart Doesn’t Pump Properly?
Your heart’s electrical system maintains that rhythm—but for many reasons your heart can lose its ability to contract or relax as well as it should. (We’ll get into the “whys” and “hows” in a few.) The result: Your body’s organ systems no longer get the blood, oxygen, and nutrients they need, so they in turn struggle to do their part. Your kidneys, for example, may become less able to filter fluid and waste. That leads to excess fluid retention in your blood, forcing your heart to work even harder. You may even start to notice swelling in your legs and feet, called edema. All that extra fluid has to go somewhere, and sometimes gravity wins.
More worrisome is when fluid accumulates in your lungs, too, causing a related condition called pulmonary edema. Obviously, if your lungs are filling with fluid, it’s more difficult for you to breathe, especially when you’re lying down. Why? Because in that position, the fluid can move to more parts of the lungs. When you sit up, it collects at the bottom, which can ease your breathing.
Heart failure usually starts in your left ventricle—remember, it’s your body’s main pumping chamber—but it can spread to the right side. That’s because as the left side becomes weaker, blood backs up inside your lungs, which puts extra pressure on your heart’s right side, which is supposed to be sending old blood over to get refreshed. Eventually, that side can become strained and start to fail, too. It’s the whole vicious circle thing.
Are There Different Types of Heart Failure?
The kind of heart failure you have is determined by what’s called ejection fraction (EF). This refers to the percentage of blood that gets pumped out of the heart with each beat. In a normal heart, the left ventricle pumps 55% to 60% of the blood that’s in it.
There are two general categories of heart failure:
Systolic heart failure is heart failure with reduced ejection fraction. (Doctors abbreviate it like this: HFrEF.) It occurs when the heart can’t contract as strongly as it needs to, so less blood gets pumped out with each beat. The result: a backup of blood and fluid inside the lungs. The EF in systolic heart failure is less than 40%.
Diastolic heart failure is heart failure with preserved ejection fraction (HFpEF). This means the heart can still pump normally, but it doesn’t have enough blood to actually send out. How does that happen? It occurs when the heart muscle has become stiff and can’t relax properly after it contracts. Normally, this relaxation period is when the heart fills with blood. But if it the muscle is stiff, an insufficient amount of blood flows in. The EF for diastolic heart failure is generally greater than 50%, but can sometimes be as low as 40%.
So, What Causes Congestive Heart Failure?
Sometimes the heart fails after years of struggling to function as it deals with other chronic conditions, like diabetes. Other times, people are born with structural issues, or develop electrical problems with their heart’s current. Let’s look at the many reasons that a heart can stop pumping efficiently:
When you have a heart attack, your heart’s supply of blood and oxygen gets reduced or cut off entirely. This can quickly cause permanent damage to your heart. The more severe the heart attack, the greater the harm. The damaged parts of your heart no longer work, and that can interfere with your heart’s ability to contract, so it no longer pumps enough blood to the rest of your body.
High Blood Pressure
Blood pressure (BP) is a measure of the force your heart exerts to move your blood through your body. Certain conditions, such as diabetes and coronary artery disease (CAD), can damage arteries and veins, making them less elastic and less able to keep blood moving, which raises BP levels. That's because your heart tries to make up the difference by pumping harder. That extra force can not only cause more damage to the vessels, it can harm the heart muscle itself, causing the tissue to grow larger and stiffen. Over time, such stiffness makes it impossible for your heart to relax fully after each beat—and that means too little blood flows into your left ventricle to be pumped out.
Infections of the heart—which are usually caused by viruses but sometimes by bacteria, too—trigger inflammation, called myocarditis, which can harm the heart’s ability to pump blood. Treating the infection often corrects the heart failure, though it may take months to return to normal.
Disorders of the Heart’s Valves
The valves in your heart help regulate how the blood moves between the chambers. Birth defects, infections, aging, or other conditions can cause one or more of your heart valves to malfunction, disrupting the normal flow. This make your heart work harder. The heavy workload enlarges the heart—remember, it’s a muscle, and it can grow just like your biceps and triceps after weightlifting. But in this case, that extra girth doesn’t make it stronger in the long run—it strains your heart and keeps it from functioning as it should.
Heart Muscle Damage
Called cardiomyopathy, damage to the heart muscle can also be caused by infections, as well by alcohol and drug abuse, including both legal and illegal drugs, such as chemotherapy medications and cocaine.
People with diabetes tend to develop high blood pressure and atherosclerosis—the buildup of plaque in blood vessels—both of which are risk factors for heart failure. In fact, heart failure is one of the most common complications of type 2 diabetes. This is especially true in younger adults with type 2 diabetes, whose risk of heart failure is as much as five times higher than normal.
Some abnormal heart rhythms, such as those that result from atrial fibrillation, can cause your heart to pump inefficiently, eventually leading to heart failure.
This sleep disorder repeatedly interrupts your breathing as you sleep, reducing the amount of oxygen to your blood and raising your blood pressure. Together, this can weaken your heart and put you at heightened risk for heart failure.
In as many as half of all cases of heart failure, doctors can’t determine a cause. They refer to this as idiopathic dilated cardiomyopathy. “Idiopathic” simply means “unknown.”
What Are the Symptoms of Congestive Heart Failure?
While heart failure has many notable symptoms, they may not always appear in its early stages. Why? Because your body attempts to compensate for your heart’s shortcomings— unfortunately making the problem worse. For example, your heart muscle will try to maintain its normal output of blood by growing larger and stronger. This works for a while, but it leads to increasing stiffness of the heart that is ultimately a progression of heart failure.
Eventually, significant symptoms will begin to develop. Still, different people experience heart failure differently. You could have severe heart failure with none of the following symptoms, or you could have less advanced disease and have many of the symptoms listed below. But, in general, for most people the worse their heart is functioning, the greater number of symptoms they experience, and the more pronounced those symptoms will feel.
Typical symptoms of heart failure include:
This starts to occur in the early stages. Your heart can’t provide your body with sufficient oxygen so physical exertion becomes more taxing. It also leaves you feeling fatigued and weak, especially your arms and legs. It’s also a vicious circle: The less you exercise, the less conditioned your heart becomes, and the more challenging it is to do regular activities.
Shortness of Breath
Struggling to catch your breath, officially called dyspnea, occurs from excess fluid building up in the lungs.
You may also experience persistent coughing or wheezing, too, along with breathing difficulties, and your cough may produce blood-tinged mucus.
Swelling in Your Extremities
As fluid builds up, it most commonly causes swelling in your legs, ankles, and feet, although swelling also may develop in your abdomen, liver, and lower back. You may notice that it’s more difficult to put your shoes on.
Sudden Weight Gain
This, too, is caused by fluid buildup. The more fluids you retain, the more weight you’ll gain. And such weight gain can be dramatic: We’re talking as much as five pounds in a single day. In fact, your doctor will likely ask you to weigh yourself once or twice each day, and if you gain more than two pounds in a single day, he or she may wish to adjust your medications.
When your heart weakens, it may try to continue pumping a normal amount of blood by beating faster.
Confusion, Difficulty Concentrating, and Impaired Thinking
Decreased blood flow to the brain can affect cognitive abilities.
How Do Doctors Diagnose Congestive Heart Failure?
When it comes to congestive heart failure, the earlier your diagnosis, the better. Catching this condition in its initial stages allows doctors to begin treating the disease—and hopefully slow its progression before your heart has suffered too much permanent damage.
So, when it comes to heart failure, what usually brings people to first see a doctor?
Shortness of breath
Swelling in the legs
Once there, your doctor will examine you. If you have congestive heart failure, generally your physician will find:
Low blood pressure (defined as lower than 90/60 mm Hg)
A weak pulse
The sounds of heart murmurs and fluid in the lungs (picked up by a stethoscope)
What Are the Diagnostic Tests for Congestive Heart Failure?
The goal of diagnostic testing is to inform your doctor what type of heart failure you have and determine its cause. Both will guide treatment decisions. Here are the range of tests used to diagnose this condition, which also help detect how far heart failure has progressed:
Your doctor will draw blood to test for the presence of natriuretic peptides, a hormone that is only found when heart failure is occurring.
This test reveals whether your heart is enlarged, and it also shows fluid buildup in the lungs.
This tests your heart’s electrical function. It can reveal abnormal heart rhythms as well as detect muscle damage to the heart.
Sound waves generate a picture of your heart, allowing your doctor to determine how well it’s pumping and whether its valves are opening and closing as they should. An ultrasound also measures ejection fraction, or EF, the percentage of blood that your heart pumps with each contraction.
What Is the Best Treatment for Congestive Heart Failure?
Any treatment plan for heart failure will include a multi-prong approach—and each part is equally important. Your plan may include:
Treating any underlying causes of your heart failure, such as an infection, or addressing other health conditions such as diabetes, arrhythmias, kidney disease, or sleep apnea
Adopting lifestyle changes to live your healthiest possible life going forward, even if you’ve been hard on your heart in the past
Taking targeted medications
Considering implantable devices or surgery, should your doctor deem either (or both) necessary
In most cases, heart failure is a disease that will likely worsen over time. We know how hard that is to read. But the good news is that there’s still plenty you and your doctor can do to curb your symptoms, boost your quality of life, and slow progression of the disease so that you can, yes, live longer—and feel better as you do it.
Which Lifestyle Changes Can Improve Congestive Heart Failure Symptoms?
You know the drill: Move your body more, eat and sleep well, tackle obesity, quit smoking. But we’re going to detail them here, anyway, because if you have congestive heart failure, doing all these things to the very best of your ability is just that important.
Physical activity, however much you are able to do, can lower your blood pressure levels and heart rate even as it improves your breathing. You may have some limitations depending on your current state of health, so speak with your doctor, who may recommend you enroll in cardiac rehabilitation to develop a custom exercise program for you.
Your goal? To get rid of all that dangerous fluid buildup. To do so, radically reduce your salt intake by eliminating processed foods loaded with sodium, like frozen dinners and packaged cold cuts. Then, make a point of cooking at home—using healthy oils like olive or canola—where you’re in full control of the salt shaker. The American Heart Association recommends you stack your daily plate with fruits, vegetables, whole grains, lean meat and fish, nuts and legumes, and low-fat dairy products. You might consider consulting a nutritionist, who can suggest a wide range of delicious and nutritious recipes to try. And don’t think of it as a diet—think of it as a new way of life, one that will help lower unhealthy high cholesterol levels, too.
Excess weight or obesity forces your already strained heart to work harder. We know—losing weight sometimes feels impossible, but your ticker is relying on you to try one more time. Digital apps, like Noom and Weight Watchers, can be powerful, interactive tools to help you on your weight loss journey. Remember, too many pounds is also often linked to hypertension and high cholesterol, too, both which further harm your heart.
Smoking raises your heart rate, which is the very last thing you need right now. It also constricts your blood vessels, forcing your heart to work even harder. If you’re still lighting up, do everything in your power to stub out that cigarette forever. Visit the American Heart Association to learn how to quit.
Quality zzz's—meaning seven or eight uninterrupted hours of sleep each night—are essential to better heart function, so make hitting the hay a top priority. If you’ve been diagnosed with sleep apnea, you need to protect your heart from this chronic condition’s negative effects. Talk to your doctor about using a continuous positive airway pressure (CPAP) machine, which helps keep your airways open all night long via a face mask or nose pillows.
What Are Common Congestive Heart Failure Medications?
Your doctor may prescribe any of the below drugs, based on your specific heart history:
Also known as water pills, these help rid your body of excess fluids, which eases the strain on your heart.
These drugs ease the heart’s workload by lowering blood pressure, preventing further weakening of the heart. According to a 2017 article published in Pharmacy and Therapeutics, this class of medications is considered the “mainstay” treatment to reduce mortality among people with heart failure.
These medications reduce your heart’s rate, which causes your heart’s need for oxygen to drop.
Angiotensin II Receptor Blockers
These drugs relax your arteries and veins, lowering blood pressure to make it easier for your heart to pump blood.
This medication strengthens your heart’s contractions so that it pumps more blood.
It’s important to note that with the exception of diuretics, these medications have been shown to work primarily for people with weaker hearts (reduced ejection fraction) rather than those whose heart muscles have stiffened (preserved ejection fraction). Treatment for this second group focuses instead on managing heart failure symptoms (like swelling), and addressing any underlying conditions such as high blood pressure, high cholesterol, and atrial fibrillation.
What Are the Devices and Surgical Interventions for Congestive Heart Failure?
For some people, medications and lifestyle changes are not enough to relive the symptoms of heart failure. If you are among them, you doctor may wish to discuss with you any of the following options:
This device detects any dangerous rhythm irregularities, and keeps your heart beating at a normal rhythm.
This device terminates dangerous (often fatal) rhythms by delivering an electric shock to the heart muscle, allowing the heart to return a normal rhythm.
Implanted Left Ventricular Assist Device
This device helps a severely weakened left ventricle pump blood. Often, it’s implanted while you wait for a heart transplant.
For people with severe heart failure, a transplant may be the only option. This is done during the most advanced stage of the disease, replacing your diseased heart with a healthy heart from a donor who has recently died.
What’s Life Like for People with Congestive Heart Failure?
In addition to making significant lifestyle changes, you’ll need to keep a close eye on your symptoms for any signs of disease progression. New or worsened symptoms may indicate a need for a different medication or alternative approaches to treatment. You’ll also want to weigh yourself each day to monitor fluid buildup. Remember: Sudden weight gain may signal an increase in fluid retention. Expect to see your doctor about every three months as long as you’re doing well.
It's equally important to care for your mental health. It’s common to feel depressed and anxious when you have heart failure. Such feelings may make you less likely to stick to your treatment plan, making your condition worse. If you’re feeling overwhelmed, anxious, or depressed, talk to your doctor about counseling and ask for a referral, ideally to a therapist who specializes in working with people who have heart disease. Another good idea? The American Heart Association offers a special interactive tool for heart failure (called HF Path) that shares resources and daily tips for a better quality of life.
- About Heart Failure (1): American Heart Association. (2017). “What is Heart Failure?” heart.org/en/health-topics/heart-failure/what-is-heart-failure
- About Heart Failure (2): Cleveland Clinic. (n.d.). “Heart Failure: Understanding Heart Failure.” my.clevelandclinic.org/health/diseases/17069-heart-failure-understanding-heart-failure
- About Heart Failure (3): Merck Manuals. (2020). “Heart Failure (HF).” merckmanuals.com/home/heart-and-blood-vessel-disorders/heart-failure/heart-failure-hf?query=Heart%20Failure%20%20(HF)
- About Heart Failure (4): National Heart, Lung, and Blood Institute. (n.d.). “Heart Failure.” nhlbi.nih.gov/health-topics/heart-failure
- Heart Failure Life Expectancy: Circulation Research. (2013.) “Epidemiology of Heart Failure.” ahajournals.org/doi/10.1161/circresaha.113.300268
- Heart Failure Causes: Mayo Clinic. (n.d.). “Heart Failure.” mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142
- Heart Failure Symptoms: University of California San Francisco. (n.d.). “Heart Failure Signs and Symptoms.” ucsfhealth.org/conditions/heart-failure/symptoms
- Heart Failure Diagnosis: Merck Manuals. (2020). “Heart Failure (HF).” merckmanuals.com/professional/cardiovascular-disorders/heart-failure/heart-failure-hf
- Heart Failure Treatment: Mann et al. (2015). “Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine.” elsevier.com/books/braunwalds-heart-disease-a-textbook-of-cardiovascular-medicine-single-volume/mann/978-1-4557-5134-1
- Heart Failure Medications: Pharmacy and Therapeutics. (2017.) “A Class Review of Pharmacotherapy.” ncbi.nlm.nih.gov/pmc/articles/PMC5481297/