Congestive Heart Failure Symptoms, Causes & Treatment Options

This article will review the symptoms, causes, diagnosis, and treatment of the chronic condition congestive heart failure. Symptoms include shortness of breath, a persistent cough, swollen legs, tiredness, and confusion.

What Is Congestive Heart Failure?

Heart failure is a condition in which the heart is no longer able to effectively pump blood to the rest of the body. Heart failure can affect the right side, left side, or both sides of the heart. It can be subcategorized as “heart failure with preserved ejection fraction (HFpEF)” or “heart failure with reduced ejection fraction (HFrEF).” The ejection fraction is the portion of blood in the heart that gets ejected through the blood vessels to the rest of the body with each pump. HFpEF is a condition in which the fraction of blood in the heart that is pumped with each beat is normal but the ventricle, one of the chambers of the heart, has been stiffened so does not fill with blood as effectively. HFrEF is a condition in which the fraction of blood ejected from the heart with each beat is reduced.

You should schedule an appointment with your physician as soon as possible.

Symptoss of Congestive Heart Failure

Main symptoms

The following symptoms are associated with heart failure:

  • Shortness of breath: Also called dyspnea, this symptom is often seen in people with heart failure. The blood in the heart that is not being effectively pumped out backs up into the blood vessels of the lungs. This increased fluid in the lungs leads to leakage. This leakage leads to feelings of shortness of breath. This symptom can be particularly pronounced if you are lying flat.
  • Persistent cough: As fluid backs up from the heart to the lungs, it can leak into lung tissue and cause irritation, thus producing a cough.
  • Swelling of the legs: As fluid backs up from the heart to the rest of the body, it starts to pool in a gravity-dependent way and can cause swelling of the legs. In addition to excess fluid backing up from the heart, the kidneys are also not as effective in heart failure. As a result, the body cannot dispose of fluids as effectively.
  • Tiredness: Many people with heart failure report that they have decreased exercise tolerance and have to stop to catch their breath after walking very short distances. Since the heart is not pumping blood to the rest of the body as effectively in heart failure, muscles tire out more easily without the necessary nutrients they normally receive from fresh blood from the heart.
  • Confusion: People may experience changes in mental status when they have heart failure. The kidney is one of the regulatory mechanisms for electrolytes in our bodies. Since the kidney is not receiving as much blood as it should, it senses low blood volumes or dehydration and takes up more salt to try and correct this. These high salt levels can produce changes in mental status.


This section will provide an overview of the diagnostic process of heart failure. If you are experiencing the symptoms listed above, your provider may have you undergo further testing for heart failure. This diagnostic process always begins with a history and physical exam. While a number of blood tests are performed depending on your clinical presentation and past medical history, notable blood tests include a B-type natriuretic peptide and a basic metabolic panel to determine levels of electrolytes in the body. B-type natriuretic peptide is released into the bloodstream when the chambers of the heart are stretched to a greater degree than normal. Someone with heart failure will have excess stretching of the heart chambers as they are not effectively pumping the blood outwards.

In addition to blood tests, imaging tests are also performed for the diagnosis of heart failure. If you are suspected to have heart failure, you will likely receive a chest X-ray to determine if there is fluid present in your lungs. You will also likely receive an echocardiogram, which helps determine if the ejection fraction is reduced.

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Congestive Heart Failure Causes

There are a number of causes of heart failure. The most common causes of the condition are coronary artery disease (plaque buildup along the inside of the arteries of the heart) which can reduce the blood supply to the cardiac tissue and lead to damage over time. High blood pressure is another major cause of heart failure. The heart is responsible for pumping blood into the blood vessels for the rest of the body. If the pressure in the blood vessels of the rest of the body is too high, it can lead to enlargement of the heart, which ultimately results in less effective pumping. Other causes of heart failure include the following:

  • Previous heart attack
  • Heart valve disease caused by past rheumatic fever
  • Other infections of the heart valve (endocarditis)
  • Congenital heart defects
  • COPD
  • Pulmonary embolism (blood clot in the blood vessels of the lung)
  • Certain medications
  • Anemia
  • Thyroid disease

Treatment Options and Prevention


People with heart failure are treated for their condition for symptomatic relief as well as to reduce the strain on their hearts. It will be important to receive an echocardiogram to determine if you have heart failure with preserved or reduced ejection fraction as the treatment for each of these is different. People with preserved ejection fraction should receive medications to control their hypertension, if present, and should also receive diuretics to relieve the symptoms associated with excessive fluid.

People with reduced ejection fraction should also receive diuretics and medications to control hypertension. In addition, you should also receive a number of other pharmacologic therapies including:

  • Angiotensin-converting enzyme inhibitor (ACE inhibitor): Controls blood pressure
  • Angiotensin-receptor blocker (ARB): Controls blood pressure
  • Beta blockers: Reduce strain on the heart

People with advanced heart failure may have to undergo even more serious interventions. Such interventions include ventricular assist devices, cardiac pacemakers, or heart transplant.

When to Seek Further Consultation

If you begin experiencing any of the symptoms described above, you should undergo further consultation with your healthcare provider. A number of conditions can cause shortness of breath, fatigue, cough, and confusion, so other diagnoses may be considered as well. While heart failure does not present an immediate threat to life, you can receive significant relief of symptoms from therapy and will need treatment for your condition over time.

Questions Your Doctor May Ask to Diagnose

  • Any fever today or during the last week?
  • Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
  • Have you lost your appetite recently?
  • Is your fatigue getting any better or worse?
  • Is your fatigue constant or come-and-go?

Self-diagnose with our free  if you answer yes on any of these questions.

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  2. Warning Signs of Heart Failure. American Heart Association. American Heart Association
  3. Heart Failure. Johns Hopkins Medicine. Johns Hopkins Link
  4. Yancy et. al. 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on 5. Practice Guidelines. 2013;62(16):e147-e239. Science Direct Link
  5. Heart Failure-Medicines. U.S. National Library of Medicine: MedlinePlus. Updated Jan. 7, 2019. MedlinePlus Link