Decompensated Heart Failure: Everything You Should Know

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Heart failure is a condition where your heart is unable to pump enough blood to meet all your body's needs. When heart failure becomes severe enough to cause symptoms requiring immediate medical treatment, it is called decompensated heart failure (DHF).

On the other hand, if you have heart failure but your heart is still functioning well enough that you don't have symptoms, you have compensated heart failure.

DHF can be acute (newly developed without a previous diagnosis) or the result of an exacerbation (period when symptoms become worse) of already present heart failure.

Common Causes of Decompensated Heart Failure - Illustration by Daniel Fishel

Verywell / Daniel Fishel


The main symptom of DHF is shortness of breath; a difficulty getting enough air that's often accompanied by a tightness in your chest when trying to take a deep breath.

While shortness of breath can also be caused by other conditions, such as lung problems, anemia, or even anxiety, if you have been diagnosed with heart failure, new or worsening shortness of breath often indicates the onset of DHF and should never be ignored.

Leg edema (swelling) and coughing at night are also very common symptoms of DHF.

Other symptoms that may occur with DHF include:

  • Orthopnea: Shortness of breath that occurs while lying down and is relieved when you sit upright
  • Paroxysmal nocturnal dyspnea: Severe shortness of breath that wakes you up from sleep

How DHF Occurs

The most common cause of DHF is not following your heart failure treatment plan. For example, eating a diet high in salt or taking medications improperly.

For new-onset heart failure, common causes include:

  • Acute coronary artery syndrome, especially heart attack
  • Acute or progressive heart valve disease
  • New-onset cardiomyopathy
  • Chronic hypertension
  • Cardiac infection
  • Cardiac inflammation
  • Pregnancy

For worsening of previously diagnosed heart failure, common causes include:

  • Excessive salt or water intake: Heart failure causes a backup of fluids in the body, so drinking too much water can make this problem worse. Consuming too much salt raises blood pressure, which can put stress on the heart.
  • Medications: These include NSAIDs (non-steroidal anti-inflammatory drugs), anesthesia, and medications for diabetes, arrhythmias (irregular heart rhythm), high blood pressure, and cancer.
  • Arrhythmias: This condition causes your heart to beat too fast, too slow, or irregularly. It will interfere with the heart’s ability to pump blood, increasing the risk of heart failure.
  • Fever and infections: Because inflammation is a major part of the body’s immune response, a viral or bacterial infection can put a strain on your heart. Endocarditis, myocarditis, and pericarditis are three types of heart inflammation that can cause heart failure.
  • Alcohol consumption: Some studies associate drinking moderate amounts of alcohol with a lower risk for heart disease, but there is not enough evidence to support this claim. What we do know is that if you are diagnosed with heart failure, consuming any amount of alcohol can be dangerous because it raises your blood pressure.
  • Pregnancy: In rare cases, pregnancy can cause peripartum cardiomyopathy, a type of heart failure that occurs in the third trimester.

New-Onset Heart Failure

In new-onset heart failure, patients will typically show no signs of heart failure beforehand. The condition is usually diagnosed during another health crisis, such as a heart attack, acute high blood pressure, or mitral valve prolapse, an improper closure of the valve between the heart's upper and lower left chambers.

Exacerbation of Chronic Heart Failure

With an exacerbation, symptoms may appear either suddenly or gradually in patients who have already been diagnosed with heart failure. Most cases of DHF are a result of exacerbations.


If heart failure is suspected after a physical exam, your healthcare provider will order tests to confirm the diagnosis.

Pulse Oximetry

Pulse oximetry measures the oxygen levels in your blood. Normal levels are between 90% and 100%. If you have heart failure levels below 90%, your organs and cells are not getting enough oxygen to function properly.

Lab Tests

Your doctor may order the following tests:

  • Natriuretic peptide (NP) tests: BNP (Brain natriuretic peptide) and NT (N-terminal)-proBNP are substances released into the blood when the lower chambers of the heart are under strain. Levels of NT-proBNP over 450 pg/mL for people under 50 and over 900 pg/mL for those over 50 may indicate heart failure.
  • Electrolyte panel: This measures how much sodium, chloride, and potassium are in your blood. An imbalance in these levels could be a sign of heart problems.
  • Renal function: Serum creatinine and blood urea nitrogen (BUN) levels show how well your kidneys are functioning.
  • ECG (electrocardiogram): An ECG evaluates the electrical signals in your heart. 


Your doctor may also order the following imaging tests:

  • Chest X-ray: This will determine if there is any fluid buildup around your heart and lungs.
  • Echocardiogram (echo): An echo cardiac ultrasound shows the size of your heart and how well your blood is being pumped through it.


The goal of any treatment plan for DHF is to stabilize the symptoms to prevent further damage to the heart and preserve kidney function.

The type of treatment you receive depends on whether your heart failure is acute or an exacerbation:

  • Chronic decompensated heart failure: Fluid retention in the body and lungs often appears with an exacerbation. These patients may be given diuretics (water pills) to reduce fluid buildup and vasodilators, medications that make your blood vessels wider, to lower blood pressure.
  • New-onset heart failure: Healthcare providers will determine the cause of your heart failure and treat it accordingly. It could be pulmonary edema (fluid in the lungs) or a heart attack. A sudden blockage of blood flow to the heart may require stenting or possibly bypass surgery.

Frequently Asked Questions

How long can someone live if they have decompensated heart failure?

The life expectancy of someone with decompensated heart failure depends on their age, sex, and any other chronic conditions they have. With aggressive treatment, people with DHF can often live many years of productive life.

What is the difference between compensated and decompensated heart failure?

In compensated heart failure, symptoms such as fatigue, shortness of breath, and edema are stable or absent. In decompensated heart failure, those symptoms are worse, to the point where medical attention is required.

Should you avoid taking beta blockers with decompensated heart failure?

While beta blockers have been a mainstay of therapy for many kinds of heart failure, they are not used during an episode of DHF. However, once a patient has been treated and stabilized, and shows no more signs of fluid retention, beta blockers are often recommended. Your healthcare provider will decide if beta blockers are right for you based on your health history.


Decompensated heart failure occurs when symptoms like shortness of breath severely interfere with your health and quality of life. It could be caused by certain medications, infections, and even pregnancy. DHF requires immediate medical treatment. If you have any symptoms, you should call your doctor or seek emergency medical help right away.

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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.