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Congestive Heart Failure

Managing and treating this chronic heart disease.
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Last updated January 14, 2021

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What is congestive heart failure?

Congestive heart failure (CHF) is when your heart muscle does not pump enough blood for your body to function normally. The heart might have become stiff and can’t relax enough to fill with blood, or it has been weakened and can’t pump enough blood out. Either way, breathing becomes very hard. CHF can also cause your kidneys to retain fluid instead of flushing it out. That fluid can build up in the legs, abdomen, or lungs.

CHF is a serious condition, and it can be fatal. But many people with CHF can lead active lives if they are getting medical treatment and following a heart-healthy lifestyle.

Most common symptoms

Pro Tip

Congestive heart failure patients are often most stable when they take all medications as prescribed without any missed doses, limit salt and fluid intake, engage in safe levels of aerobic exercise, and proactively reach out to their medical team if they notice weight gain or more subtle symptoms of fluid retention. —Dr. Anubodh Varshney

The most common symptoms of congestive heart failure are:

  • Trouble breathing when you:
    • Exercise or move around
    • Lie down flat (orthopnea)
    • Bend over (bendopnea)
  • Swelling in the ankles, feet, and/or legs
  • Dry cough
  • Extreme fatigue
  • Abdominal bloating or swelling
  • Feeling full after eating small amounts of food (early satiety)
  • No appetite
  • Nausea
  • Poor concentration

Depending on the specific cause of CHF, additional symptoms may include:

  • Chest discomfort when you move a lot, if CHF is due to coronary artery disease.
  • Feeling lightheaded when you move a lot, if CHF is due to certain kinds of heart valve disease.
  • Fast or irregular heartbeat, if CHF is due to abnormal heart rhythms (arrhythmias).

What causes congestive heart failure?

Pro Tip

In patients with known congestive heart failure, there are typically specific instances of dietary indiscretion, such as eating a salty meal at a restaurant, family gathering, or sporting event, that occurred prior to the development of symptoms. —Dr. Varshney

CHF is related to health issues a person already has, which are called existing or underlying medical conditions. You’re more likely to have CHF if you have coronary artery disease (blockages in the arteries that carry blood to your heart) or if you have had a heart attack. A heart attack starves the heart of oxygen, and that makes it less able to pump blood properly.

You’re also more likely to have CHF if you have high blood pressure, which makes the heart work harder and become harder and stiffer. That makes the heart less able to properly relax and can tire out the muscle over time.

Risk factors

Underlying conditions linked with getting diagnosed with CHF include:

  • Coronary artery disease
  • A previous heart attack
  • Uncontrolled high blood pressure
  • Diabetes
  • Abnormal heart valves
  • Severe lung disease
  • Obesity
  • Sleep apnea
  • Heavy alcohol or drug use

Other, much more rare risk factors include:

  • Genetic abnormalities that can cause inherited forms of CHF
  • Thyroid disease
  • Exposure to certain chemotherapy drugs or a history of radiation to the chest to treat cancer
  • Certain types of long standing abnormal heart rhythms (arrhythmias)

How to treat heart failure

Dr. Rx

One type of new device helps the right and left sides of the heart pump in a synchronized fashion. It has improved outcomes for certain heart failure patients. Another is the newest left ventricular assist device for patients with advanced heart failure. —Dr. Varshney

CHF is a serious heart condition. If you feel the symptoms of CHF such as trouble breathing while lying down or bending over, extreme tiredness, or bloating in your legs or abdomen, go to the emergency room.

If you have been diagnosed with CHF, you will need to be followed by a cardiologist (heart specialist). The first step is for your doctor to figure out the cause of your CHF and treat that.

Your cardiologist may send you to a CHF specialist—a cardiologist who only treats CHF—if you may need a left ventricular assist device (an implant that helps the heart to pump) or a heart transplant.

Medication

Medications can help CHF patients feel better and live longer. Possibilities include:

  • Diuretics (e.g., furosemide or torsemide) help get rid of fluid build-up by causing you to pee more often.
  • Beta blockers (e.g., metoprolol, carvedilol) help make it easier for the heart to pump,  suppress abnormal heart rhythms, and lower the effects of the hormone adrenaline on the heart.
  • ACE inhibitors (e.g., lisinopril, enalapril), angiotensin receptor blockers (e.g., valsartan, losartan), and mineralocorticoid receptor antagonists (spironolactone) help the heart pump more efficiently over time.
  • Sacubitril/valsartan (Entresto) is a relatively new medication, and has been shown to be better than ACE inhibitors for people with CHF. It also helps the heart pump more efficiently over time.

In addition to taking medication, it’s important to commit to a heart-healthy lifestyle:

  • If you smoke, quit.
  • If you’re overweight, try to lose weight and maintain a healthy weight.
  • If you drink alcohol, stop completely. Alcohol is toxic to the heart.
  • Limit your salt intake.

Procedures

Sometimes, specific cardiac procedures or surgeries may be recommended. These include:

  • Coronary artery bypass grafting surgery: This open-heart surgery uses other blood vessels to bypass (go around) blockages in your coronary arteries.
  • Cardiac resynchronization therapy: Inserting a special type of pacemaker helps the left and right sides of the heart pump in sync.

What are the 4 stages of congestive heart failure?

Heart failure gets worse over time if it isn’t treated. CHF has four stages:

Stage A is pre-heart failure. This is when your risk of developing heart failure is high because of family history or medical conditions you have, like high blood pressure, diabetes, coronary artery disease, or a history of alcohol abuse. In this stage, if you make major lifestyle changes, you might be able to avoid developing CHF altogether.

Stage B is still pre-heart failure. That means you have some type of heart disease (e.g., coronary artery disease, heart valve disease, etc.), but have not developed symptoms of HF. Lifestyle changes can help but likely won’t be enough. Your doctor will probably start you on medication, like beta blockers and/or ACE inhibitors

Stage C means you've been diagnosed with heart failure. You have symptoms like shortness of breath, fatigue, weak legs, or swollen feet or ankles. Stage C treatment—in addition to the treatments for Stages A and B—likely calls for more medication, including pills to remove fluid by making you urinate more.

Stage D means advanced congestive heart failure. The symptoms are serious and don't get better with treatment. Your doctor will talk with you about the need for additional drugs and possibly surgeries or procedures.

How long can you live with congestive heart failure?

That depends on how much the disease has progressed, how old you are when you’re diagnosed, and how well you stick to your treatment plan. If your CHF is caught early and treated immediately, you could have close to a normal lifespan. But often CHF is not caught early, so about 50% of people with CHF live five years past diagnosis, and about 10% to 25% of people survive 10 years or more.

Preventative tips

Heart failure can be prevented by:

  • Staying active. Get moderate aerobic exercise at least 150 minutes per week (usually 30 minutes a day, five days a week). If possible, also do two sessions of resistance training (using weights, resistance bands, or your own body weight) each week.
  • Doing a cardiac rehabilitation program, if you’re eligible for it.
  • Keeping your weight in a healthy range.
  • Not smoking or quitting smoking. Also stay away from secondhand smoke and, if you can, air pollution.
  • Treating any health issues that can become underlying conditions, including high blood pressure, high cholesterol, or diabetes.
  • Eat mostly vegetables, fruit, fish, and lean meats. Avoid sweets, red meat, and unhealthy fats (trans and saturated fats).
  • Avoid heavy alcohol or drug use.
  • Taking preventative medications (such as aspirin or statins) if your doctor advises.
Share your story

Dr. Varshney is a board-certified Internist and current Cardiovascular Medicine Fellow at Brigham and Women's Hospital / Harvard Medical School. He earned his undergraduate degree in Biomedical Engineering from Washington University in St. Louis (2010) and graduated first in his class from the University of Texas Southwestern Medical School (2014). He then completed an internal medicine residency at Brigham and Women's Hospital / Harvard Medical School. Following this, he worked as a hospitalist at Brigham and Women's Hospital for 1 year while completing multiple projects spanning translational, clinical, and implementation research. He then began Cardiovascular Medicine Fellowship at Brigham and Women's Hospital in 2018.

Dr. Varshney is interested in the evidence-based design, development, evaluation, and implementation of technologies to improve outcomes for patients with cardiovascular disease. He has a particular interest in remote monitoring and mechanical circulatory support devices and is pursuing multiple academic endeavors in these areas. He plans to complete additional clinical training in the care of patients with advanced heart failure, cardiac transplantation, or need for mechanical circulatory support after completing Cardiovascular Medicine Fellowship. He has published multiple articles in the peer-reviewed medical literature and has written for other outlets including U.S. News & World Report and Doximity.

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