What Is Congestive Heart Failure?

Congestive heart failure is a condition that occurs when your heart isn’t able to pump enough blood supply to your body. Many different conditions can cause congestive heart failure to occur, including coronary artery disease and heart attack.

An estimated 6.2 million people in the U.S. have congestive heart failure. That’s why knowing the symptoms, understanding when to reach out to your healthcare provider, and learning your treatment options are so important. 

Types 

Healthcare providers usually divide heart failure into different categories, based on a person’s estimated ejection fraction—which is a measurement that refers to the percentage of blood the heart pumps out every time it contracts. 

There are three primary levels of congestive heart failure, which include:

• Heart failure with preserved ejection fraction (HFpEF): A person with HFpEF has a normal ejection fraction, meaning their heart is pumping normally. However, their heart is not relaxing as well as it used to. Someone with this condition usually has an ejection fraction of 50% or higher. Keep in mind: an ejection fraction of 50% to 70% is considered normal.
• Heart failure with mid-range ejection fraction (HFmrEF): A person with HFmrEF has an ejection fraction of between 40% and 50%. Symptoms can vary between not noticing significant problems, having a hard time with physical strenuous activity, or more severe symptoms.
• Heart failure with reduced ejection fraction (HFrEF): A person with HFrEF generally has an ejection fraction of less than 40%.

Symptoms

Your symptoms will depend on what level of heart failure you are in and the severity of your condition. Common symptoms of heart failure include:

• Rapid heart rate 
• Fatigue
• Frequent coughing 
• Nausea 
• Poor appetite 
• Trouble thinking clearly 
• Shortness of breath 
• Swelling in the feet and ankles 
• Wheezing 

If you have a milder form of heart failure, it’s likely that you will only experience symptoms with a strenuous physical activity level. However, with severe congestive heart failure, you may experience symptoms while resting.

Causes

Congestive heart failure typically happens due to an underlying condition that affects your heart’s ability to pump properly. This can force your heart to work harder with the increased demand for blood and oxygen. As a result, your heart’s walls can become thicker, causing your arteries (blood vessels) to become narrow—which affects your heart’s ability to properly pump blood.

Risk Factors 

You may be at a higher risk of congestive heart failure if you live with other underlying conditions that place extra demands on your heart. These conditions include:

• Coronary artery disease
• Diabetes
• High blood pressure 
• Obesity
• Valvular heart diseases, such as aortic stenosis or mitral regurgitation 

Rare, but possible, medical conditions that can also lead to heart failure include Chagas disease, rheumatic heart disease, and amyloidosis.

Certain lifestyle factors can also increase your risk for congestive heart failure, including: 

• Drinking excessive amounts of alcohol 
• Eating a high-fat, high-cholesterol, or high-sodium diet
• Living a sedentary lifestyle 
• Smoking cigarettes or using tobacco  

Diagnosis

Healthcare providers haven’t established one definitive test or criteria to diagnose heart failure. There are many different criteria, including the Framingham, Gothenburg, and Boston criteria—which can help providers make an accurate diagnosis for heart failure. 

To make a diagnosis of heart failure, your provider will learn about your symptoms and medical history and get started on testing measures. They may use one or more of the following tests:

• Chest X-ray: This imaging technique can show if your heart is enlarged, which can happen with heart failure. 
• Basic natriuretic peptides (BNP): This blood test measures BNP, a hormone your body commonly makes when your heart is failing or starting to fail. 
• Echocardiogram: An echocardiogram helps your provider estimate your heart’s ejection fraction. 
• Electrocardiogram (ECG/EKG): An electrocardiogram can help your healthcare provider determine if you are having abnormal heart rhythms, which may occur due to heart failure. 

Treatment

Treatment for heart failure focus on slowing down the progression of heart failure and reducing your symptoms. Heart failure treatments will depend on your symptoms and underlying causes. Your provider may recommend one or more of the following treatment options:

• Medications: Healthcare providers may prescribe medications from categories such as ACE inhibitors, angiotensin receptor-neprilysin inhibitors (ARNi), angiotensin-receptor blockers (ARBs), sodium-glucose cotransporter-2 inhibitors (SGLT2i), beta-blockers, and mineralocorticoid receptor antagonists (MRA). 
• Dietary changes: Reducing sodium and cholesterol intake may help improve symptoms. 
• Treating underlying conditions: Managing conditions that are known to worsen heart failure may help you live better. These conditions include high blood pressure, type 2 diabetes, coronary artery disease, and sleep disorders. 

According to the guidelines from the American Heart Association, American College of Cardiology, and Heart Failure Society of America, your survival and quality of life have a greater chance of improving when a provider who specializes in heart failure (e.g., a heart failure specialist or cardiologist) helps you manage your condition. 

How to Prevent Congestive Heart Failure 

Reducing your risk factors for congestive heart failure can help you prevent heart failure or slow down your condition from progressing. These steps include: M

• Refraining from smoking 
• Maintaining a weight that is right for you
• Engaging in regular exercise, such as 30 minutes of moderate-intensity exercise most days of the week 
• Limiting your alcohol intake (no more than one drink per day for women and two drinks per day for men) 
• Eating a low-sodium, low-cholesterol diet 
• Taking your medication(s) on time and as prescribed 

Comorbid Conditions 

A number of comorbid conditions can occur with heart failure (or, conditions that happen at the same time as heart failure). Specifically, 76% of people with heart failure also experience high blood pressure and 40% of people with heart failure receive a diagnosis of type 2 diabetes.

Living With Congestive Heart Failure 

The prognosis (or, how a condition progresses over time) for congestive heart failure usually depends on the severity of your symptoms. The 1-year survival rates for people who require a hospital stay for heart failure are usually lower than those who have a milder heart failure condition. Generally, 55% to 65% of people with end-stage heart failure live after one year, while 80% to 90% of people with mild heart failure live after one year.

The good news is that new treatments and medical advancements have helped people with heart failure live longer. If you have heart failure or may be at risk for the condition, keeping in contact with your provider can help you improve symptoms, prolong your life, and manage your health.