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Overview

What Is Heart Failure?

Heart failure means the heart cannot pump or fill well enough to meet the body’s needs. As a result, the body may receive less blood and oxygen, while fluid can build up in the lungs, legs or other tissues. Heart failure does not mean that the heart has stopped. It can affect people of different ages and may develop because of several heart conditions, including coronary artery disease, high blood pressure or damaged heart muscle.

Symptoms

Heart Failure Symptoms

  • Breathlessness may occur during activity, when lying down or at rest as heart failure progresses.
  • Fatigue can result from reduced blood flow to the muscles and other tissues.
  • Reduced exercise tolerance may make usual activities, such as walking or climbing stairs, more difficult.
  • Swelling commonly affects the feet, ankles, legs or abdomen because of fluid buildup.
  • Rapid weight gain over a short period can signal increasing fluid retention.
  • A cough or wheezing, sometimes with frothy sputum, may occur when fluid collects in the lungs.
  • Palpitations may feel like pounding, fluttering or an irregular heartbeat.
  • Appetite changes, nausea or feeling full quickly may occur when fluid affects the digestive system.

WATCH FOR CHANGES

Symptoms that are getting worse

Track new or worsening breathlessness, swelling and rapid weight changes if your clinician recommends monitoring them. Follow your personal action plan for when to call the clinical team, adjust monitoring or seek urgent help.

Causes

Causes of Heart Failure

Heart failure can develop when the heart muscle is weakened, becomes stiff or has to work against unusually high pressure. Coronary artery disease and a previous heart attack can reduce or damage the heart’s blood supply. High blood pressure, valve disease, rhythm disorders, cardiomyopathy and congenital heart disease can also place extra strain on the heart. Other illnesses may contribute by affecting the heart muscle, circulation, kidneys or lungs.

Pumping and filling problems

  • Inflammation or infection of the heart muscle can weaken its ability to contract.
  • Toxins, including some recreational drugs and heavy alcohol use, can damage heart muscle.
  • Certain medicines or cancer treatments can affect heart muscle in some people.
  • Pregnancy-related heart disease can rarely weaken the heart during late pregnancy or after delivery.
  • Severe metabolic conditions, such as thyroid disorders, can alter heart rate or heart muscle function.
  • Serious lung disease can increase pressure in the blood vessels leading from the heart to the lungs.

Risk Factors

Risk Factors for Heart Failure

LESS CHANGEABLE

Risk can increase with older age, a family history of heart failure, inherited cardiomyopathy or previous heart damage, such as damage from a heart attack or congenital heart disease.

MODIFIABLE OR TREATABLE

High blood pressure, diabetes, smoking, obesity, excess alcohol, physical inactivity and uncontrolled cholesterol can increase risk but may be treated or improved with medical care and lifestyle changes.

Having a risk factor does not mean heart failure is inevitable. Controlling related heart problems, taking prescribed treatment and making sustainable health changes can reduce risk or delay progression.

Complications

Complications of Heart Failure

  • Reduced blood flow and congestion can impair kidney or liver function.
  • Pulmonary edema is a serious buildup of fluid in the lungs that can cause severe breathing difficulty.
  • Abnormal heart rhythms may worsen symptoms or increase the risk of other complications.
  • Blood clots can form in the heart or circulation and may travel to cause a stroke.
  • Pulmonary hypertension can develop when pressure rises in the blood vessels of the lungs.
  • Poor appetite, nausea and congestion can contribute to malnutrition or unintended weight loss.
  • Worsening symptoms may require hospitalization for monitoring and treatment.
  • Severe electrical or pumping problems can rarely lead to sudden cardiac arrest.

SAFETY NOTE

Worsening heart failure needs prompt attention

Sudden worsening can be serious, especially when breathing becomes difficult or swelling increases quickly. Your care plan should explain when to contact your clinical team and when to seek emergency help.

Diagnosis

How Heart Failure Is Diagnosed

Diagnosis begins with a clinical history and examination. A clinician may ask about breathlessness, fatigue, activity tolerance, chest symptoms and medical history, then check blood pressure, heart sounds, lung findings, swelling, weight and changes in the neck veins. These findings help identify heart failure and guide testing for its cause and type.

  • An echocardiogram uses ultrasound to assess heart structure, pumping strength, filling and valve function.
  • An electrocardiogram records the heart’s electrical activity and may show rhythm problems or previous heart damage.
  • A chest X-ray can show an enlarged heart or fluid congestion in the lungs and help assess other causes of breathlessness.
  • Blood tests, including natriuretic peptides, can support diagnosis and assess kidney function, blood counts and other contributors.
  • Stress testing evaluates how the heart responds to exercise or medication and may reveal reduced blood flow.
  • Cardiac MRI provides detailed images of the heart muscle, structure and areas of scarring or inflammation.
  • Coronary angiography or other catheterization testing may be used when clinicians need to assess blocked arteries or pressure inside the heart.

Treatment & Management

Heart Failure Treatment and Management

Heart failure treatment is individualized according to ejection fraction, symptoms, cause, kidney function, blood pressure, heart rhythm and overall health. The goals are to relieve symptoms, reduce fluid buildup, limit hospitalizations and protect heart function. A treatment plan may change as the condition or a person’s needs change.

DAILY MANAGEMENT

Follow sodium guidance, stay active as advised, monitor weight when instructed, keep vaccinations up to date, avoid tobacco and take medicines exactly as prescribed. Ask the care team how much fluid and activity are appropriate for you.

MEDICAL TREATMENT

Guideline-directed medicines may improve heart function and outcomes, while diuretics reduce excess fluid. Clinicians may also treat the underlying cause and control blood pressure or abnormal rhythms.

Prevention

Preventing Heart Failure

  • Control blood pressure, cholesterol and diabetes with regular care and prescribed treatment.
  • Avoid tobacco products and ask for support if stopping is difficult.
  • Limit alcohol according to medical advice, particularly if alcohol has affected the heart.
  • Maintain a healthy weight through realistic eating and activity goals.
  • Stay physically active at a level that is safe for your health.
  • Follow a heart-healthy eating pattern rich in vegetables, fruits, whole grains and suitable protein sources.
  • Manage known heart disease, valve problems and rhythm disorders with ongoing follow-up.

There is no universal routine screening test for heart failure in people who have no symptoms. Regular medical care can still identify and treat important risk factors, such as high blood pressure, diabetes and cholesterol problems, before they cause more heart damage.

Outlook and Prognosis

Outlook and Prognosis for Heart Failure

The outlook depends on the cause and type of heart failure, ejection fraction, symptoms, stage, other health conditions and response to treatment. Access to follow-up care, medication adherence and the ability to manage fluid and lifestyle needs also matter. Some people improve substantially with treatment, while others have a condition that gradually becomes more difficult to control.

Stages and symptom classes

When Should You See a Doctor

When Should You See a Doctor for Heart Failure?

  • Arrange a medical evaluation for persistent breathlessness, especially during activities that were previously easy.
  • Arrange an evaluation for new swelling in the feet, ankles, legs or abdomen.
  • Unexplained fatigue or a clear reduction in activity tolerance should be discussed with a clinician.
  • Arrange care for new or recurrent palpitations, particularly with dizziness or weakness.
  • If you have a history of heart disease and your symptoms are changing, contact your care team for advice.

CALL PROMPTLY

Symptoms that may signal worsening heart failure

Contact your clinician promptly for rapid weight gain, worsening swelling, increasing nighttime breathlessness, new dizziness or fainting, or symptoms that are not improving under your care plan.

GET EMERGENCY HELP

Severe or sudden symptoms

Seek emergency help for severe trouble breathing, chest pain or pressure, fainting, confusion, blue or gray lips, or sudden severe symptoms. Do not drive yourself if you may be seriously ill.

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