What Is a CHF Exacerbation and How Do I Manage It?

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Congestive heart failure (CHF) is a condition in which the heart is unable to meet the demands of the body. This is because the heart muscle has become less able to contract over time or has a mechanical problem that limits its ability to fill with blood. When that happens, organs in your body don’t get enough oxygen to function properly.

People with this condition can sometimes experience CHF exacerbations, which are characterized by worsening symptoms. Symptoms of CHF can include shortness of breath, coughing or wheezing, swollen ankles or legs, weight gain, fatigue, and heart palpitations. A CHF exacerbation can be triggered by many factors, such as high salt intake and lung infections.

People with CHF can successfully manage their condition with medications and lifestyle changes. In the United States, around six million people have CHF, and it is the leading cause of hospitalizations.

A man clutching his chest in pain

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Symptoms of CHF exacerbation can include one or more of the following:

  • Fatigue
  • Shortness of breath when performing activities, lying down, or sleeping
  • Cough
  • Feeling full after only eating a few bites of food
  • Weight gain
  • Bloating or swelling in the stomach


CHF exacerbations can be caused by lung infections, high sodium intake, certain medications, or not taking medications to control CHF:

  • Lung infections: Viral infections can cause complications such as pneumonia, an infection of the lungs that prevents enough oxygen from getting into the blood. This puts stress on your heart because it has to work harder to get blood into and out of your lungs.
  • High sodium intake: If you have CHF, your sodium intake should be no more than 1,500 mg per day. Too much sodium increases the fluid around your heart, forcing it to work harder, which increases your blood pressure. Following a diet that is low in sodium will help patients with CHF avoid exacerbations.
  • Medications: Medications that can cause CHF exacerbations include nonsteroidal anti-inflammatory drugs, beta blockers, and drugs used to treat arrhythmia (an irregular heartbeat). A change in medication or an increase in dosage can also cause an exacerbation.


A CHF exacerbation is diagnosed by a physical exam, imaging, and lab tests. Your doctor may order blood tests to check your electrolytes, renal function, and liver function. A chest X-ray may be taken if pneumonia is suspected. An echocardiogram will evaluate how much blood your heart is pumping throughout your body.

Treatment may involve being admitted to the hospital. Your healthcare provider will make this decision based on the following:

  • Difficulty breathing at rest or diagnosed pneumonia
  • Low cardiac output (the amount of blood that the heart pumps through the body each minute)
  • Abnormally low blood pressure, poor renal function, or confusion
  • Slow or rapid heart rate
  • Serious electrolyte imbalance


The main goal in treatment for CHF exacerbation is to reduce the fluid volume in the body. If recently prescribed beta-blockers or other medication changes caused your CHF exacerbation, you may be given diuretics, which are water pills that increase the amount of water and salt that leave your body through urination.

In the case of very low blood pressure or a serious cardiac event, beta-blockers may be discontinued temporarily.

Other possible treatment options include:

  • Ultrafiltration therapy: This process is similar to dialysis and manually removes fluid from the body. This is used if diuretics don’t remove enough fluid.
  • Vasodilators: These medications open your blood vessels so the blood can flow more freely. This can help resolve the symptoms of pulmonary edema and high blood pressure.
  • Inotropic drugs: Two commonly used inotropic drugs used to treat CHF exacerbation are dobutamine and milrinone. They help make your heartbeats stronger.

Even though beta-blockers can cause CHF exacerbation, your healthcare provider may resume beta-blocker therapy or add a low dose to your treatment plan if your fluid volume remains normal.

Once your fluid volume, blood pressure, and heart function are stable, your healthcare provider will discharge you. They may recommend changes to your diet or CHF therapy.


After you’ve been stabilized and set for discharge, your healthcare provider may prescribe new medications and recommend lifestyle changes to prevent exacerbations in the future.

The first follow-up will be by phone, where your healthcare provider will review the following:

  • Your knowledge of the signs of a CHF exacerbation
  • The medications you’re taking and if you have enough
  • Diet and regular exercise
  • Your next follow-up appointment

Frequently Asked Questions

What is CHF exacerbation?

CHF exacerbation occurs when there is an increase in or worsening of heart failure symptoms. Heart failure happens when your heart is unable to pump enough blood throughout your body.

What are common symptoms related to exacerbation of CHF?

Common symptoms of CHF exacerbation can include shortness of breath, persistent coughing, extreme fatigue, edema, and increased heart rate. If you have more than one of these symptoms, seek medical attention right away.

How do you manage chronic heart failure exacerbation?

There are a few different ways to limit CHF exacerbations. They include eating a low- or no-salt diet, maintaining normal blood pressure, staying active, and managing other chronic conditions such as diabetes or COPD (chronic obstructive pulmonary disease).

How do you  treat CHF exacerbation?

People who have CHF exacerbation are usually admitted to the hospital for treatment. Depending on medical history, treatment may include diuretics to treat edema, beta-blockers to slow down the heart rate, and ACE inhibitors to lower blood pressure. When discharged from the hospital, you may receive a new treatment plan to help prevent future exacerbations.

11 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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By Carisa Brewster
Carisa D. Brewster is a freelance journalist with over 20 years of experience writing for newspapers, magazines, and digital publications. She specializes in science and healthcare content.