Heart Failure: What It Is, What Causes It, Symptoms and Treatment

Heart failure means your heart can't pump enough oxygen-rich blood to meet your body's needs. It doesn't mean your heart has stopped or is about to. But without enough blood flow, organs may not work well, which can cause serious problems.

Right-sided and left-sided

Over time, left-sided failure can lead to right-sided failure.

Causes

Heart failure can start suddenly after an illness or injury damages the heart muscle, but it usually develops slowly from long-term conditions such as:

• arrhythmia — a problem with the heart's rate or rhythm
• cardiomyopathy
• congenital heart defects and other heart diseases present from birth
• coronary artery disease, heart attack and heart valve disease
• endocarditis
• high blood pressure
• a blood clot in the lung
• diabetes, obesity, and severe lung disease such as COPD (chronic obstructive pulmonary disease)

Who's at higher risk

It can happen at any age, in men and women — though men often develop it younger. Risk rises if you:

• are 65 or older — aging can weaken and stiffen the heart muscle
• have relatives with heart failure, or gene changes affecting heart tissue
• smoke, eat a lot of fat, cholesterol and salt, are inactive, have alcohol use disorder, or use illegal drugs
• have other conditions that affect the heart: heart or blood vessel disease (including high blood pressure), serious lung disease, infections such as HIV or COVID-19, obesity, diabetes, sleep apnea, chronic kidney disease, anemia, thyroid disease, iron overload disease, or heart-damaging cancer treatment such as radiation or chemotherapy
• are African American — more likely to develop heart failure, and more serious cases at younger ages. Stigma, discrimination, income, education and region can also affect risk.

Symptoms

Symptoms depend on which side is affected and how advanced it is. Most come from reduced blood flow and fluid buildup: blood moving too slowly through the heart backs up in the veins, and fluid leaks into the tissues, causing swelling (edema). Symptoms may be mild or absent at first and worsen over time:

• shortness of breath with activity such as climbing stairs — often one of the first signs
• fatigue or weakness, even after rest
• coughing
• swelling and weight gain from fluid in the ankles, lower legs or belly
• trouble sleeping lying flat
• nausea and loss of appetite
• swollen neck veins
• needing to urinate often

Complications

• breathing problems from fluid in and around the lungs — congestive heart failure
• kidney or liver damage, including cirrhosis
• malnutrition, when fluid makes eating uncomfortable or the stomach lacks blood flow to digest food
• other heart problems — irregular heartbeat and sudden cardiac arrest
• pulmonary hypertension

Diagnosis

Your provider will ask about your symptoms and family history, examine you, and likely run heart tests and blood tests, including a brain natriuretic peptide (BNP) test. You may be referred to a cardiologist.

Treatment

There's no cure, and heart failure usually worsens over time, so treatment is usually lifelong — but it can help you live longer with fewer symptoms. Most plans include:

• medicines
• less sodium and less fluid, to control fluid buildup
• quitting smoking, managing stress and staying as active as your provider advises
• treating conditions that make heart failure worse

Surgery may help if a heart defect or damage can be repaired, or if a weakening left side could benefit from a device: an implantable cardioverter defibrillator, a biventricular pacemaker (cardiac resynchronization therapy), or a mechanical heart pump — a ventricular assist device or a total artificial heart. A heart transplant may be recommended when heart failure is life-threatening and nothing else helps.

Watch your symptoms closely, since heart failure can worsen suddenly; a cardiac rehabilitation program can help you learn to manage it.

Prevention

You may prevent or delay heart failure by working with your provider to manage conditions that raise your risk, and by making healthy changes in eating, exercise and daily habits.

Sources

Based on "Heart Failure," MedlinePlus, U.S. National Library of Medicine, with a summary from the National Heart, Lung, and Blood Institute (NIH); a work of the United States government in the public domain.