What Is Acute Heart Failure?

Your heart pumps oxygen- and nutrient-rich blood to different parts of your body. Your body depends on the heart's pumping ability to ensure cells are nourished so they can function normally.

When you have heart failure, your heart cannot efficiently fill with enough blood or pump blood to your cells. Due to the decreased flow of oxygen- and nutrient-rich blood, people with heart failure often experience fatigue, shortness of breath, and coughing. When someone with heart failure begins to have these symptoms, everyday activities such as walking, climbing stairs, or even getting groceries can be difficult.

woman with chest pain

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What Is Acute Heart Failure?

Acute heart failure can be a rapid change in the heart's ability to pump, or fill with, enough blood to nourish the body's cells. It is potentially life-threatening and often requires hospitalization for treatment. The goal of treatment is to reduce the stress on the failing heart, to allow it to function more efficiently while working to reverse the underlying cause of heart failure.

Acute vs. Chronic Heart Failure

In chronic heart failure, symptoms are kept at a manageable level, often for very long periods of time, with medical treatment and by the body's own compensatory mechanisms. These compensatory mechanisms may include:

  • Stretching or enlarging: When the heart stretches, it can fill with more blood, which the heart can then pump to meet the body's demands. Eventually, the heart struggles to maintain the larger size and its ability to pump blood declines.
  • Developing more muscle mass: Initially, this allows the heart to pump more blood. Over time, though, the heart cannot manage to sustain the increase in muscle mass and its ability to pump blood lessens.
  • Pumping faster: An increase in the heart rate allows the heart to pump more blood per minute.

Conditions that can cause chronic heart failure include:

  • Heart attack: A heart attack occurs when the blood supply to a portion of the heart muscle is interrupted, causing some of the cardiac tissue to die. Following a heart attack, the heart's muscles can be damaged due to a lack of blood flow and oxygen. To compensate for the damaged areas, the heart will attempt to stretch or enlarge and develop more muscle mass. Although these changes initially meet the body's demands, over time the heart cannot maintain these changes and the ability to meet the body's demands begins to fail.
  • Abnormalities within the heart: These can include congenital heart defects; valvular heart disease, when any valve of the heart is damaged or diseased; cardiomyopathy, which is heart muscle disease; myocarditis, inflammation of the heart muscle; and long-lasting rapid cardiac arrhythmias, or irregular heartbeats.

When chronic heart failure suddenly worsens or new symptoms of heart failure rapidly appear, it is called acute heart failure. Acute heart failure can also occur in a person who has never been previously diagnosed with heart failure.

Symptoms of Acute Heart Failure

If you have any of these symptoms, especially if they appear suddenly, you should have them evaluated by a healthcare professional as soon as possible—as they may indicate heart failure. These signs include:

  • Shortness of breath, or dyspnea: When blood cannot be effectively pumped to the body by the heart, the blood can back up into the pulmonary veins in the lungs. The backup of blood can leak out of the pulmonary veins into the surrounding lung tissue, which causes shortness of breath.
  • Persistent coughing or wheezing: The backup of blood leaking into the lung tissues creates a buildup of fluid in the lungs. This fluid buildup creates persistent coughing or wheezing.
  • Fluid buildup in body tissues, or edema: As the heart struggles to pump effectively, blood backs up into the veins. The blood leaks out of the veins into the surrounding tissues and causes swelling.
  • Fatigue: The heart's limited ability to pump enough blood often leads to poor exercise tolerance and becoming easily fatigued.
  • Lack of appetite and nausea: The digestive system is one of the less vital areas the body will divert blood from when the heart's compensatory mechanisms are unable to meet the overall demands of the body.

Diagnosis and Treatment of Acute Heart Failure

If any signs and symptoms of heart failure develop, especially if there has not been any previous diagnosis of heart failure, it is important to see a healthcare professional quickly. After performing a physical exam and obtaining information about current symptoms and your medical history, your doctor may order the following tests:

  • Blood tests: There are various blood tests that can indicate if the kidneys are not functioning properly and if there are signs of a hormone in the blood known as B-type natriuretic peptide (BNP). BNP is a hormone released from the lower chambers of the heart, which can help indicate whether you have heart failure.
  • Chest X-ray: A chest X-ray shows the size of the heart and any fluid buildup around the heart and lungs.
  • Electrocardiogram (ECG): An ECG is a picture of the heart's electrical activity. It can show if the heart has developed compensatory mechanisms for heart failure, such as adding more heart muscle. It can also show if there are abnormal heart rhythms, which can cause heart failure to develop.
  • Echocardiogram, or echo: An echocardiogram is an ultrasound of the heart that can show how effectively the heart can pump, measure the size of the heart, and show if there is any fluid buildup around the heart. The echocardiogram can indicate if the heart has developed compensatory mechanisms due to heart failure.
  • Ejection fraction (EF): The heart's pumping ability is measured by the ejection fraction. Using percentages, the ejection fraction is a measure of the amount of blood pumped out of the heart with each heartbeat. A normal ejection fraction is 50% to 70%. Heart failure can occur with a normal or reduced ejection fraction.

Heart Failure Doctor Discussion Guide

Doctor Discussion Guide Old Man


Heart failure occurs when your heart cannot efficiently pump blood to the rest of your body. Acute heart failure occurs suddenly, while chronic heart failure takes place over time. It typically requires medical help as soon as possible because it can be life-threatening if left untreated. Your doctor will help you identify the underlying cause of acute heart failure and start treatment.

A Word From Verywell

A diagnosis of heart failure can feel scary and overwhelming. Heart failure can be managed by collaborating with a healthcare professional on a plan of care that can allow life to be lived to its fullest. Adhering to your healthcare professional's guidance for chronic disease management and eliminating unhealthy personal habits can decrease the likelihood of developing acute heart failure.

Frequently Asked Questions

Are acute heart failure and acute decompensated heart failure the same thing?

The difference between acute heart failure and acute decompensated heart failure is subtle. Acute heart failure is the sudden development of signs and symptoms of heart failure, which need to be evaluated quickly to avoid serious complications, when there is no prior diagnosis of heart failure. Acute decompensated heart failure is the sudden development of worsening signs and symptoms of previously diagnosed heart failure.

How quickly does heart failure progress?

Acute heart failure symptoms develop quickly. Symptoms of acute heart failure from a heart attack can appear within minutes to hours, whereas symptoms from a virus or toxic incident can appear within hours to days.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. American Heart Association. What is heart failure?

  3. Heidenreich P, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failureJ Am Coll Cardiol.2022;79(17):e263–e421. doi:10.1016/j.jacc.2021.12.012

  4. American Heart Association. Ejection fraction heart failure measurement.

  5. Ural D, Cavusoglu Y, Eren M, et al. Diagnosis and management of acute heart failureAnatol J Cardiol. 2015;15(11):860-889. doi:10.5152/AnatolJCardiol.2015.6567

By Pamela Assid, DNP, RN
Pamela Assid, DNP, RN, is a board-certified nursing specialist with over 25 years of expertise in emergency, pediatric, and leadership roles.