Updated March 12, 2022
If the heart is damaged, it loses the ability to pump blood efficiently. This causes the blood to back up into the heart, resulting in dilatation of the chambers and, eventually, congestion of the venous system, a condition called congestive heart failure. This is usually what is meant when someone uses the term “heart failure”, though it is a progressive condition that starts before symptoms appear. Once congestion occurs, medical intervention is required.
Risk Factors
The main risk factor for congestive heart failure is pre-existing heart disease, especially a prior heart attack. Those at most risk for heart disease and ensuing heart failure are older (>65 years of age), African-American (compared to Caucasian), overweight, and male.
Causes
| Condition | Mechanism |
| Hypertension | Can cause hypertrophy and damage to the heart muscle |
| Diabetes | Effect of metabolic dysfunction on the cardiovascular system |
| Coronary artery disease | Blockage damages the heart muscle (heart attack, ischemic heart disease, cardiomyopathy) |
| Cardiomyopathy | Heart muscle dysfunction |
| Arrythmias | Heart beat dysfunction |
| Heart valve disease | Ineffective pumping by the heart |
| COPD | Can be the origin of congestion and cause right-sided failure |
Mechanism of Congestive Heart Failure
Contraction of the heart is necessary for it to fulfill its function of pumping blood through the lungs and then ejecting it from the aorta out to the body. An inability to eject the blood out of the heart is called forward failure, systolic failure, or left-sided heart failure because the left side of the heart fails to contract properly during systole. This initial event results in kidney and liver problems as the circulation is compromised.
The blood remaining in the heart then backs up into the pulmonary vessels (in the lungs), leading to an accumulation of fluid in the lungs (pulmonary edema). As the congestion continues into the right side of the heart, it results in right-sided heart failure, also called backward failure. This is also often diastolic failure because the right-sided failure is caused by the left ventricle not relaxing properly.
Right-sided Failure vs. Left-sided Failure
Left-sided failure is most often caused by hypertension, ischemic heart disease (often caused by a myocardial infarction), mitral or aortic valve disease, and primary myocardial diseases.
Right-sided failure is most often a result of left-sided heart failure, though it can also occur as a result of cor pulmonale, which is most often caused by chronic obstructive pulmonary disease (COPD).
Symptoms
- Shortness of breath (called dyspnea)
- Heart palpitations (rapid, unsteady beat)
- Swelling in the extremeties (called edema)
- Persistent coughing or wheezing
- Tiredness or fatigue
- Lack of appetite or nausea
- Confusion or cognitive difficulty
Diagnosis
| Test | Looking for |
| Walking test | Distance and shortness of breath |
| Medical exam | Heart rhythm irregularities, fluid sounds in lungs, edema in the extremities |
| Blood test | Markers of damage to the organs, diabetes |
| Blood pressure | Hypertension |
| Chest X-ray | Enlarged heart, fluid in the lungs |
| Heart imaging (Doppler ultrasound/echo) | Problems with the functioning, movement,or size of the heart muscle |
| Stress test | Issues with heart and/or lungs during exertion |
| Ejection fraction (electrocardiogram, MUGA, CAT, catheterization, nuclear stress test) | How well the heart is pushing blood out |
| Electrocardiogram (e.g., Holter monitor) | Rhythm disturbances |
Compensated vs. Decompensated Heart Failure
Chronic heart failure can be compensated or decompensated.
Compensated heart failure occurs when the heart can maintain the needed output despite the dilatation, usually by increasing the number (heart beat) or strength (ventricular contraction) of its beats. This may occur even before symptoms arise.
Eventually the heart can no longer meet the demand, leading to decompensated heart failure ensues and resulting in death.
For an animation of heart failure, visit the American Heart Association.
Complications
Once heart failure develops, the condition remains, referred to as chronic heart failure. The continued strain on the heart as it moves from forward (left-sided) into backward (right-sided) failure can result in complications in other parts of the body.
| Complication | Treatment |
| Kidney disease | Dialysis |
| Liver fibrosis | Antifibrotics |
| Heart rhythm disturbances | Depends on the disturbance and symptoms |
| Heart valve dysfunction | Depends on which valve and symptoms, surgery |
Treatment
The damage done to the heart cannot be reversed. However, there are medications available to treat congestive heart failure and maintain the cardiac output. These drugs remove excess water and salt to limit the pressure in the compromised vascular system, strengthen the heart muscle, or affect the renin-angiotensin system.
- Beta-blockers
- Diuretics
- ACE inhibitors
- Digoxin/digitalis
- Valsartan and similar drugs
Other treatments involve dietary and lifestyle changes, such as exercise, low sodium diet (DASH diet), losing weight, stopping smoking, avoiding excessive alcohol intake, managing stress, and keeping other conditions (e.g., hypertension and diabetes) under control.
Prevention
| Manage your heart disease by seeing your doctor regularly and following your treatment plan |
| Eat healthy (e.g., low sodium, low cholesterol) |
| Exercise (daily activity) |
| Maintain a healthy weight |
| Avoid smoking and excessive alcohol consumption |
| Manage stress |
Disclaimer: This page is for informational and learning purposes only. It is not meant to diagnose or treat any medical condition and should not be used in place of speaking with a medical doctor or seeking treatment.
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