Heart Failure

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What Is Heart Failure?

Heart failure is a chronic syndrome in which the heart cannot pump enough blood to meet the body’s needs or can do so only at abnormally high filling pressures. It may involve reduced contraction, impaired relaxation, or both, and can affect the left, right, or both sides of the heart.

Heart failure does not mean that the heart has stopped. Symptoms may remain stable with treatment or worsen suddenly during an acute decompensation that requires urgent care.

What Causes Heart Failure?

Common causes include coronary artery disease, previous heart attack, long-standing high blood pressure, heart-valve disease, cardiomyopathy, abnormal heart rhythms, congenital heart disease, and inflammation or toxins that damage heart muscle.

Diabetes, kidney disease, obesity, sleep apnea, thyroid disease, alcohol or stimulant misuse, certain cancer treatments, and genetic conditions can also contribute. Sometimes more than one cause is present.

Diagnosis

Diagnosis typically includes a medical history, examination, electrocardiogram, blood tests including natriuretic peptides, chest imaging, and echocardiography to evaluate heart structure and pumping function. Additional testing identifies the underlying cause and severity.

Treatment Options

Treatment may include diuretics for fluid retention and guideline-directed medicines that improve symptoms and reduce hospitalization or death. The exact combination depends on ejection fraction, blood pressure, kidney function, potassium levels, rhythm, and other conditions.

Cardiac rehabilitation, sodium and fluid guidance, treatment of contributing disease, implanted devices, valve procedures, revascularization, or advanced therapies such as ventricular assist devices and transplantation may be appropriate for selected patients.

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Living With Heart Failure

Daily self-monitoring can help identify worsening congestion early. Patients are often advised to track weight, swelling, breathlessness, blood pressure, and medication use and to follow an individualized action plan from their clinical team.

Regular physical activity within safe limits, vaccination, smoking cessation, and careful management of blood pressure, diabetes, kidney disease, and sleep apnea support long-term health. Nonsteroidal anti-inflammatory drugs and some other medicines can worsen fluid retention and should be reviewed with a clinician.

When to Seek Emergency Care

Seek emergency care for severe shortness of breath at rest, pink or frothy sputum, chest pain, fainting, blue or gray lips, new severe confusion, a very fast or irregular heartbeat with weakness, or rapid worsening accompanied by inability to lie flat.

Prognosis

Heart failure is usually a long-term condition, but symptoms and survival can improve substantially with modern therapy. Prognosis depends on the cause, heart function, kidney health, frailty, response to treatment, and frequency of hospitalizations.

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Risks

Risk factors include coronary artery disease, high blood pressure, diabetes, obesity, smoking, kidney disease, sleep apnea, heart-valve disease, abnormal rhythms, prior heart attack, cardiotoxic chemotherapy, heavy alcohol use, and a family history of cardiomyopathy. Complications include recurrent hospitalization, kidney or liver dysfunction, arrhythmias, blood clots, reduced mobility, and sudden cardiac death.

Symptoms

Symptoms include shortness of breath during activity or when lying flat, waking at night breathless, fatigue, reduced exercise tolerance, swelling of the feet, ankles, legs, or abdomen, rapid weight gain from fluid, persistent cough, palpitations, dizziness, loss of appetite, and difficulty concentrating. Right-sided failure may cause prominent abdominal swelling and neck-vein distention.

Diagnosis

Evaluation begins with symptom history, medication review, examination for congestion, electrocardiography, chest X-ray, and laboratory tests. Natriuretic peptide levels can support or argue against heart failure in the appropriate clinical setting, while kidney, liver, thyroid, blood count, iron, and electrolyte tests identify contributors and treatment constraints.

Echocardiography measures ejection fraction and assesses chamber size, valves, pressures, and wall motion. Coronary imaging, cardiac MRI, rhythm monitoring, stress testing, genetic assessment, or cardiac catheterization may be needed to identify the cause or plan advanced treatment.