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What Is Heart Failure?

Medically reviewed by Glenn Gandelman, M.D., M.P.H.
Updated on November 1, 2021

  • Heart failure is a serious — but manageable — chronic health condition.
  • The terms heart failure and congestive heart failure are often used interchangeably, but congestive heart failure is a specific type of heart failure.
  • If you have heart failure, there are treatments and lifestyle changes to improve your well-being.

A diagnosis of heart failure can be scary, especially if you do not know exactly what that means. When one thinks of an organ “failing,” it may bring to mind a body part that completely shuts down and ceases to function, but this is not the case.

Heart failure means the heart is not pumping blood efficiently and cannot keep up with the body’s needs. The heart is still beating, but for a variety of reasons, it is not currently working the way that it should.

Heart failure is a serious, chronic condition that affects more than 64 million people worldwide. Current data shows that 6.2 million adults in the United States have heart failure. The prevalence of heart failure has steadily increased over the past few decades and is highest in people over 60 years old.

Heart failure is a serious condition, but it can be managed with medical treatment and lifestyle changes.

Heart Failure Defined

Heart failure means the heart is pumping, but the amount of blood it can pump cannot meet the body’s needs. Heart failure does not mean that the heart has completely stopped functioning (cardiac arrest) or that it will stop at any moment.

Heart failure is also different from a heart attack, also called a myocardial infarction. A heart attack occurs when the blood flow through the coronary arteries that feed the heart muscle is cut off or severely reduced.

Causes of Heart Failure

Heart failure can be caused by any damage to the heart that makes it more difficult for the heart to pump blood. Many types of heart disease can cause heart failure, including high blood pressure, coronary artery disease, heart attack, heart valve disease, and irregular heartbeat (abnormal heart rhythm or arrhythmia).

When the heart experiences acute injury (like a heart attack) and long-term injury (like high blood pressure), the heart attempts to compensate by enlarging, increasing in muscle mass (hypertrophy), or pumping faster.

These physical changes in the heart muscle are called cardiac remodeling. Over time, these changes lead to heart dysfunction and chronic heart failure. The body also tries to compensate for reduced blood flow by narrowing blood vessels to increase blood pressure and restricting blood flow to certain organs.

Ultimately, these attempts to make up for poor heart function fail, the heart cannot pump enough blood, and symptoms of heart failure appear.

Other Risk Factors

Health concerns that increase the risk of heart disease also increase the risk of heart failure. These include obesity, high cholesterol, diabetes, kidney disease, and tobacco use. Congenital heart defects and thyroid disease can also contribute to heart failure.

Types of Heart Failure

There are different types of heart failure, categorized by how the heart is malfunctioning. The various types of heart failure can cause different symptoms and require different treatments.

Congestive Heart Failure

Congestive heart failure is often referred to simply as heart failure, but it is actually a specific type of heart failure. Congestive heart failure occurs when blood returning to the heart backs up in the veins because the heart is unable to pump properly. Congestive heart failure frequently causes swelling (edema) in the legs and ankles. Congestive heart failure can also cause pulmonary edema (excess fluid in the lungs). Weight gain with congestive heart failure can be a sign of fluid retention.

Left-Sided Heart Failure

The left ventricle of the heart is responsible for the bulk of the heart’s pumping function. Left-sided heart failure means the left ventricle is not able to adequately pump oxygen-rich blood from the lungs throughout the body. This can lead to excess fluid buildup in the lungs that causes shortness of breath. There are two types of left-sided heart failure: systolic heart failure and diastolic heart failure.

Systolic Heart Failure

This type of left-sided heart failure is also called heart failure with reduced ejection fraction. It occurs when the left ventricle becomes enlarged and weakened, making it more difficult for the heart to contract. Because it cannot contract properly, the left ventricle fails to pump, or eject, blood efficiently. Systolic heart failure reduces your ejection fraction, an important measure of how well the heart pumps blood.

Diastolic Heart Failure

Diastolic heart failure, which is also called heart failure with preserved ejection fraction, occurs when the left ventricle becomes thickened and stiff and cannot relax properly. This means that the left ventricle is not able to fill with blood as it should, making pumping less efficient.

Right-Sided Heart Failure

Right-sided heart failure affects the right ventricle and is often the result of left-sided heart failure. The right ventricle is responsible for pumping blood into the lungs to receive oxygen. Right-sided heart failure can lead to blood backing up into the veins, causing swelling in the legs and feet as well as the abdomen (ascites).

If You Are Diagnosed With Heart Failure

Heart failure is a chronic and often progressive condition that can have a tremendous impact on your quality of life. It can make you feel tired, weak, short of breath, and unable to do the things you enjoy, but there is hope.

Treatment and lifestyle changes can slow the progression of heart failure and reduce symptoms. In the early stages, treatment may even reverse some cases of heart failure.

Treatments for Heart Failure

The primary treatments for heart failure are medication, lifestyle changes, and, in severe cases, surgery — including a heart transplant. Heart failure may also require the implantation of a pacemaker or an implantable cardioverter defibrillator to control your heart rate and prevent life-threatening conditions, such as arrhythmia and cardiac arrest.

Your doctor may prescribe more than one medication and will likely counsel you on important lifestyle changes that can make a big difference in your prognosis. Medications for heart failure include beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, diuretics, digoxin, anti-arrhythmic drugs, and blood thinners.

Lifestyle Changes

No matter what treatment your doctor recommends, you can adopt healthy lifestyle habits to support your well-being. It may seem overwhelming at first, but even small steps can make a huge difference. Important lifestyle changes include eating a low-sodium diet, controlling your weight, exercising, and quitting smoking.

Seeking support from friends, family, and others living with heart failure can also help you stick to your lifestyle changes. Your teammates at MyHeartDiseaseTeam are always available to answer questions about their own experiences and offer support.

Exercise and Heart Failure

Until the late 1980s, doctors discouraged people with heart failure from exercising. Today, exercise is often an important part of a treatment plan for heart failure. Physical activity is known to have many benefits for your heart health and overall well-being, including increased energy, improved circulation, and greater muscle strength.

Heart failure can significantly limit your ability to safely perform physical activity, so it is important to start slow and watch for heart symptoms. What works for a family member or friend with heart failure may not be right for you.

Your doctor can help you determine which types of exercise are best for you based on the specifics of your condition and any other illnesses you may have. Always consult your doctor before trying a new workout.

Living With Heart Failure

You can live a full life with heart failure, and there are steps you can take every day to support your health and quality of life. Read more about what to expect when living with heart failure.

Ready to talk to your doctor about heart failure? Download these questions to ask your doctor and take them to your next appointment.

How do you manage your heart failure symptoms? Share in the comments below.

Updated on November 1, 2021
All updates must be accompanied by text or a picture.

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Glenn Gandelman, M.D., M.P.H. is assistant clinical professor of medicine at New York Medical College and in private practice specializing in cardiovascular disease in Greenwich, Connecticut. Review provided by VeriMed Healthcare Network. Learn more about him here
Kristopher Bunting, M.D. studied chemistry and life sciences at the U.S. Military Academy, West Point, and received his doctor of medicine degree from Tulane University. Learn more about him here

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