An Overview: What Is Heart Failure?

Although heart failure sounds like the heart is no longer capable of working, it is actually a condition that means the heart is unable to pump well enough to fulfill the body's needs. This can occur if the heart cannot fill adequately with blood, or if it is not strong enough to pump blood correctly.

Read more about heart failure, its causes, symptoms, and treatment methods.

How the Heart Works

The heart is at the center of your circulatory system and is responsible for pumping blood throughout your body. The heart contains valves that are responsible for keeping blood flowing in the right direction.

With each contraction of the heart, blood travels through arteries, veins, and capillaries, carrying oxygen and nutrients to organs and tissues and carbon dioxide back to the lungs so that you can breathe it out. Arteries take newly oxygenated blood away from the heart, and veins bring blood back to the heart.

If the heart is weakened or damaged, the body’s organs will not receive enough blood to work properly.

What Is Heart Failure?

Heart failure does not mean that your heart has failed and stopped working. Instead, it means your heart does not have the ability to keep up with your body’s demands.

Heart failure occurs when the heart can’t pump enough blood to meet the body’s needs. This can occur if the heart is too weak to pump properly or can’t fill up with enough blood.

Onset of heart failure can happen suddenly or occur over time. Most heart failure is caused by another medical condition, such as high blood pressure, coronary heart disease, cardiomyopathy, or an irregular heartbeat.

Symptoms of Heart Failure

Symptoms of heart failure depend on the severity and type of heart failure. Depending on the side of the heart that is affected, symptoms will vary.

In milder cases, a person might not experience symptoms except when doing strenuous physical work. The most common and usually the first noticeable symptom is shortness of breath, especially during routine activities like walking up stairs.

As heart failure progresses and the heart becomes weaker, symptoms typically worsen.

Symptoms include, but are not limited to:

• Shortness of breath
• Loss of appetite
• Fatigue
• Coughing
• Wheezing
• Swelling of ankles, feet, legs, abdomen, and veins in the neck
• Weight gain
• Difficulty exercising
• Needing to pee often
• Inability to sleep lying flat
• Difficulty concentrating
• Bluish color of fingers and lips

Types of Heart Failure

There are three main types of heart failure: left ventricular, right ventricular, and biventricular, meaning both sides of the heart.

• Left heart failure is the most common type of heart failure. In left heart failure, the left ventricle of the heart no longer pumps enough blood to the body. Blood then builds up in the pulmonary veins that carry blood away from the lungs, causing shortness of breath, difficulty breathing, or coughing. Left heart failure is typically caused by coronary artery disease, a heart attack, or long-term high blood pressure.
• Right heart failure occurs when the right ventricle of the heart is too weak to pump enough blood to the lungs. Blood then builds up in the veins that carry blood from the organs back to the heart. This causes an increase in pressure in the veins, which can cause fluid to push into the surrounding tissue. When this occurs, swelling can develop in the legs, or less commonly in the genital region, organs, or belly. Right heart failure is sometimes caused by high blood pressure in the lungs or a pulmonary embolism. It can also occur when left heart failure becomes more advanced. The most common cause of right heart failure is left heart failure.
• Biventricular heart failure occurs when both sides of the heart are affected. This can cause a combination of symptoms that are associated with both left heart failure and right heart failure.

Diagnosis of Heart Failure

To diagnose heart failure, physicians take a complete medical history, conduct a physical exam, and may order a variety of tests, including blood work and imaging tests. People are usually referred to a cardiologist for management of heart failure.

During the appointment, they will listen to the heart and lungs with a stethoscope for signs of the heart not working properly or sounds of fluid buildup in the lungs. They will also measure heart rate, blood pressure, body weight, and look for swelling in the ankles, feet, legs, and veins in the neck.

Blood tests may be ordered to check certain levels in the blood, such as brain natriuretic peptide, which will rise during heart failure. Blood tests can also determine if other organs such as the kidneys and liver are affected.

A cardiologist may perform tests and scans to help diagnose heart failure, including:

• Echocardiogram: Determines the percent of blood that is pumped out of the heart with each heartbeat and evaluates the structure and function of the heart
• Electrocardiogram (EKG): Provides a tracing of the heart’s electrical activity
• Stress test: Measures how the heart responds to exercise or chemically induced stress in a controlled environment
• Cardiac catheterization: Shows the interior of the arteries in your heart to see if they are blocked and allows for measurement of right and left heart pressures
• Other imaging tests such as cardiac computed tomography (CT) scan, cardiac magnetic resonance imaging (MRI), or nuclear heart scan can be used to show how well the heart is working.

Treatment of Heart Failure

Through medical treatment, lifestyle modifications (such as exercise and diet changes), and certain surgical procedures, people can maintain a strong quality of life and possibly resolve their heart failure depending on the underlying cause.

Medications such as beta blockers, ACE inhibitors, SGLT2 inhibitors, and diuretics are the most commonly used medications to treat heart failure. These drugs stimulate the heart to pump more efficiently, preventing excess fluid from building up in the body.

In some cases, device implantation or surgical procedures may be necessary to treat heart failure. These can include:

• Valve replacement
• Pacemaker or defibrillator installation
• Left ventricular assist device (LVAD) implantation
• Coronary artery bypass surgery
• Angioplasty or stenting
  

If other treatment options fail, a heart transplant may be the only effective option. In a heart transplant, the patient's heart is surgically removed and replaced by a healthy heart from a donor. Heart transplants are complex procedures, and the recipient process can be long, but a patient's healthcare team will provide support throughout the process.

Risks of Heart Failure

The risk of developing heart failure increases over time or with certain conditions. Lifestyle factors that increase your risk of stroke and heart attack, such as smoking, eating foods high in fat and cholesterol, and inactivity, can also contribute to heart failure.

While the heart loses some of its blood pumping ability with age, the risk of heart failure increases with the added stress of certain health conditions that cause direct damage to the heart or make it work too hard. These include, but are not limited to:

• Coronary artery disease
• Past heart attack
• High blood pressure
• Abnormal heart valves
• Heart muscle disease or inflammation, such as dilated cardiomyopathy and myocarditis
• Heart defects present at birth
• Severe lung disease
• Diabetes
• Obesity
• Sleep apnea
• Severe anemia
• Hyperthyroidism
• Abnormal heart rhythm

How to Prevent Heart Failure

Treating any underlying conditions that lead to heart failure is critical. If you have any risk factors, it's important to talk to your physician and follow their recommended treatment plan. 

While some of the conditions that can lead to heart failure are present at birth or are not preventable, there is evidence that a healthy lifestyle can reduce heart failure.

Maintaining a healthy weight, exercising, limiting alcohol intake, eating a healthy diet, and not smoking have all been shown to reduce some of the major risk factors for heart failure, including coronary disease, diabetes, and hypertension.

A Word From Verywell

While a diagnosis of heart failure can be frightening, knowing that you have options to help manage the condition and any underlying conditions should help you gain a sense of control. Educating yourself and keeping an open line of communication with your physician can help you live well with heart failure.

Frequently Asked Questions

How common is heart failure?

About 6.2 million adults in the United States have heart failure.

What is the difference between congestive heart failure and heart failure?

Although these two terms are sometimes used interchangeably, congestive heart failure (CHF) refers to the stage in which the blood and fluid builds up in the body, causing swelling in the legs and ankles and, sometimes, fluid buildup in the lungs. CHF needs to be treated promptly.

What is the life expectancy of someone with heart failure?

Life expectancy with heart failure has improved due to advancements in treatment. However, life expectancy is still low. In one study, 46% to 50% of people survived at five years.