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Heart Disease
  What Is Congestive Heart Failure?

By Stephanie Trelogan, MS

Reviewed by Andy Avins, MD

Congestive heart failure, or simply heart failure, is a condition that occurs when the heart is unable to pump enough blood to meet the needs of the body's tissues. It generally occurs as a result of other forms of heart disease.


Who Gets Congestive Heart Failure?

More than three million Americans have congestive heart failure.
Congestive heart failure is the most common reason for hospitalization among the elderly. More than three million Americans have congestive heart failure, and as the population ages the incidence of congestive heart failure is rising rapidly. A few general trends are:
  • Men are at higher risk than women (although the difference narrows with age).
  • People of African descent are at higher risk and are more likely to die from congestive heart failure than Caucasians.
  • A family history of early congestive heart failure caused by cardiomyopathies may predispose people to the disease.



How Does Congestive Heart Failure Occur?

Congestive heart failure can result from two problems:

  • When the heart fails to pump out all the blood that enters its chambers; or
  • When the heart's chambers are too stiff and cannot relax enough to fill with blood.

When failure occurs in the large chamber on the left side of the heart (the left ventricle), blood backs up into the lungs, causing the lung tissues to fill with fluid. This congestion results in shortness of breath and fatigue. When failure occurs in the large chamber on the right side of the heart (the right ventricle), blood backs up in other tissues. This causes swelling in areas such as the liver and the legs.

Unfortunately, people with heart failure tend to get gradually worse. Initially, the heart can compensate for weakness by beating faster and enlarging. Although this may offer a short-term fix, the damage it causes to the heart can be significant in the long term.

The good news is that doctors have recently made great strides in treating heart failure. Therefore, it is important to obtain medical care for this condition as early as possible. It is also important to see your doctor regularly in order to catch heart disease in its early stages when it may be easier to treat.



More on Screening for Heart Disease (Coming Soon)



What Causes Congestive Heart Failure?

Congestive heart failure usually occurs as a result of other heart diseases.
Heart failure is generally the result of other heart diseases. The major causes of congestive heart failure include:
  • Coronary artery disease (CAD). The most common cause of congestive heart failure is coronary artery disease (CAD), which is when the arteries that supply blood to the heart become clogged. CAD cuts off the heart's blood supply and damages the heart muscle. This damage can eventually result in congestive heart failure.
  • High blood pressure. Uncontrolled high blood pressure is a major cause of heart failure. In chronic high blood pressure, the heart muscle thickens in order to pump harder and overcome the increased resistance in the blood vessels. Over time, this thickening weakens the heart's ability to contract and relax, preventing it from filling properly with blood.
  • Diabetes. Many people with diabetes are also at risk for obesity, high blood pressure, and CAD — all of which contribute to congestive heart failure.



  • Valvular Heart Disease. When heart valves don't function properly, the heart muscle must work much harder to compensate for abnormal blood flow. Over time, this excessive workload causes the heart muscle to fail. Before antibiotics were available, most cases of valvular heart disease were caused by rheumatic fever. Now most valvular disease is congenital, which means that people are born with a physical defect.
  • Cardiomyopathies. Cardiomyopathy literally means disease of the heart muscle. There are several different types of cardiomyopathy, some if which are inherited while others are not. The progressive deterioration of the heart muscle that results from cardiomyopathy often leads to congestive heart failure.
  • Viral infections. Certain viral illnesses can cause an infection of the heart muscle known as acute myocarditis. Although this condition is rare, it produces temporary, but potentially life-threatening, heart failure. In some cases, it can even result in chronic congestive heart failure.



Signs and Symptoms

Many symptoms of heart failure result from the congestion that develops as fluid backs up into the lungs and leaks into the tissues. Other symptoms result from the body not getting enough oxygen. Since heart failure can progress rapidly, it is essential to consult a physician immediately if you experience any of the following symptoms:

Symptoms of left-side heart failure may include:

  • Fatigue and shortness of breath (but unlike the breathlessness of angina, which feels like a heavy weight pressing on the chest)
  • Difficulty breathing at night, sometimes causing awakening
  • Asthma-like wheezing or a dry hacking cough that worsens with lying down, but improves with sitting up or standing.
  • Unintended weight loss

Symptoms of right-side heart failure may include:

  • Fatigue
  • Accumulation of fluid: first in the feet, next in the ankles and legs, and finally in the abdomen
  • Enlargement of the liver
  • Weight gain (although muscle mass is lost and appetite may be depressed, weight gain often occurs because salt and water are retained)

If you experience the following symptoms, proceed immediately to the nearest emergency room:

  • A cough that produces a pinkish froth; wheezing and a sensation of bubbling in the lungs; or a feeling of drowning
  • Pale, clammy, or blue-tinged skin



In some cases, people with congestive heart failure can take drugs that reduce the symptoms of the disease. These drugs help the heart beat with more strength, keep the blood vessels open so blood can flow freely, and reduce the total volume of liquid in the blood so the heart doesn't have to work as hard. People with severe heart failure may need to be hospitalized or have a heart transplant. If the congestive heart failure is a result of CAD, doctors can treat the underlying CAD to prevent the heart failure from getting worse.




Coats, A. J. S. (1997) Syndrome of Chronic Heart Failure: Origin of Symptoms. In P. A. Poole-Wilson, et al. (Eds.), Heart Failure. (pp. 297–310). New York, NY: Churchill Livingstone, Inc.

Poole-Wilson, P. A. (1997) History, Definition, and Classification of Heart Failures. In P. A. Poole-Wilson, et al. (Eds.), Heart Failure. (pp. 269–278). New York, NY: Churchill Livingstone, Inc.

Vosberg, H.-P. & McKenna, W. J. (1997) Cardiomyopathies. In D. L. Rimoin, et al. (Eds.), Emery and Rimoin’s Principles and Practice of Medical Genetics, volume 1 (pp. 843–877). New York, NY: Churchill Livingstone, Inc.

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