Congestive Heart Failure: Symptoms, Causes, And More - Healthline

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Key takeaways

CHF is a chronic condition in which the heart doesn’t pump blood efficiently, leading to fluid buildup and symptoms like shortness of breath and swelling. Early diagnosis, lifestyle changes, and medical treatment can help manage the condition.

Symptoms of CHF can vary, with early stages showing fatigue and swelling, while later stages may include chest pain and rapid breathing, and prompt medical attention is crucial if severe symptoms arise.

CHF can result from conditions like high blood pressure and coronary artery disease, so preventive measures such as a balanced diet, exercise, and avoiding smoking are important for reducing the risk.

Congestive heart failure (CHF) is a chronic progressive condition that affects the pumping power of your heart muscle.

While often referred to simply as heart failure, CHF is a clinical diagnosis based on symptoms of shortness of breath, leg swelling, orthopnea, as well visible heart dysfunction on an echocardiogram.

Systolic CHF is when the heart muscle is weak, and the heart cannot pump blood, whereas diastolic CHF is when the heart cannot fill with blood. In both of these cases, it leads to fluid buildup.

You have four heart chambers. The upper half of your heart is made up of two atria, and the lower half of your heart is made up of two ventricles.

The ventricles pump blood to your body’s organs and tissues, and the atria receive blood from your body as it circulates back from the rest of your body.

Systolic CHF develops when your ventricles can’t pump enough blood volume to the body. Eventually, blood and other fluids can back up inside your:

lungs
abdomen
liver
lower body

CHF can be life threatening. If you suspect you or someone you know has CHF, seek immediate medical treatment.

What are the symptoms of congestive heart failure?

In the early stages of CHF, you most likely won’t notice any changes in your health. If your condition progresses, you’ll experience gradual changes in your body.

Symptoms you may notice first	Symptoms that indicate your condition has worsened	Symptoms that indicate a severe heart condition
fatigue	irregular heartbeat	chest pain that radiates through the upper body
swelling in your ankles, feet, and legs	a cough that develops from congested lungs	rapid breathing
weight gain	wheezing	skin that appears blue, which is due to lack of oxygen in your lungs
increased need to urinate, especially at night	shortness of breath, which may indicate pulmonary edema	fainting

Chest pain that radiates through the upper body can also be a sign of a heart attack. If you experience this or any other symptoms that may point to a severe heart condition, seek immediate medical attention.

Symptoms of heart failure in children and infants

It can be difficult to recognize heart failure in infants and young children. Symptoms may include:

poor feeding
excessive sweating
difficulty breathing

These symptoms can easily be misunderstood as colic or a respiratory infection. Poor growth and low blood pressure can also be signs of heart failure in children.

In some cases, you may be able to feel a resting baby’s rapid heart rate through their chest wall.

How is congestive heart failure treated?

You and your doctor may consider different treatments depending on your overall health and how far your condition has progressed.

Congestive heart failure drugs

There are several medications that can be used to treat CHF, including ACE inhibitors, beta-blockers, and more.

ACE inhibitors

Angiotensin-converting enzyme (ACE) inhibitors open up narrowed blood vessels to improve blood flow. Vasodilators are another option if you can’t tolerate ACE inhibitors.

You may be prescribed one of the following:

benazepril (Lotensin)
captopril (Capoten)
enalapril (Vasotec)
fosinopril (Monopril)
lisinopril (Zestril)
quinapril (Accupril).
ramipril (Altace)
moexipril (Univasc)
perindopril (Aceon)
trandolapril (Mavik)

On April 22, 2022, Pfizer issued a voluntary recall of 5 lots of the drug Accupril due to the presence of nitrosamine. Nitrosamine, a known carcinogen with the potential to cause cancer, was found to exist in the drug at levels greater than the Acceptable Daily Intake (ADI) as determined by the FDA. This recall is specific only to a handful of lot numbers and does not affect all Accupril tablets made by Pfizer. If you take Accupril tablets, talk with your pharmacist or doctor, and they will help you determine if your medication has been impacted by the recall.

ACE inhibitors shouldn’t be taken with the following medications without consulting a doctor because they may cause an adverse reaction:

Potassium-sparing diuretics and potassium supplements. These diuretics can cause potassium buildup in the blood, which may lead to abnormal heart rhythms. Examples include: riamterene (Dyrenium), eplerenone (Inspra), and spironolactone (Aldactone).
Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs such as ibuprofen, aspirin, and naproxen, can cause sodium and water retention. This may reduce the ACE inhibitor’s effect on your blood pressure.

This is an abbreviated list, so always speak with your doctor before taking any new medications.

Beta-blockers

Beta-blockers decrease the work the heart has to do and can reduce blood pressure and slow a rapid heart rhythm.

This may be achieved with:

atenolol (Tenormin)
bisoprolol (Zebeta)
carvedilol (Coreg)
esmolol (Brevibloc)
metoprolol (Lopressor)
nadolol (Corgard)
nebivolol (Bystolic)

Beta-blockers should be taken with caution with the following medications, as they may cause an adverse reaction:

Medications that slow the heart rate. These can increase cardiovascular effects, including slowed heart rate. Some examples include amiodarone (Nexterone), verapamil, diltiazem, and digoxin.
Albuterol (AccuNeb). The effects of albuterol on bronchodilation may be canceled out by beta-blockers.
Antipsychotics. Certain antipsychotics, such as thioridazine (Mellaril), may also cause low blood pressure in some people.
Fentora (Fentanyl). This may cause low blood pressure.
Clonidine (Catapres). Clonidine may increase risk of slow heart rate.

Some medications may not be listed here. You should always consult your doctor before taking any new medications.

Diuretics

Diuretics reduce your body’s fluid content. CHF can cause your body to retain more fluid than it should.

Your doctor may recommend:

Loop diuretics. These cause the kidneys to produce more urine. This helps remove excess fluid from your body. Examples include furosemide (Lasix), ethacrynic acid (Edecrin), and torsemide (Demadex).
Potassium-sparing diuretics. These help get rid of fluids and sodium while still retaining potassium. Examples include triamterene (Dyrenium), eplerenone (Inspra), and spironolactone (Aldactone).
Thiazide diuretics. These cause blood vessels to widen and help the body remove any extra fluid. Examples include metolazone (Zaroxolyn), indapamide (Lozol), and hydrochlorothiazide (Microzide).

Diuretics should be taken with caution with the following medications, as they may cause an adverse reaction:

ACE inhibitors. These can cause decreased blood pressure, including lisinopril (Zestril), benazepril (Lotensin), and captopril (Capoten).
Tricyclics. Also called tricyclic antidepressants (TCAs), they may cause lowered blood pressure. Examples include: amitriptyline and desipramine (Norpramin).
Anxiolytics. Anxiolytics are anti-anxiety drugs, which may lower blood pressure. Common anxiolytics include alprazolam (Xanax), chlordiazepoxide (Librium), and diazepam (Valium).
Hypnotics. Sedatives such as zolpidem (Ambien) and triazolam (Halcion) may cause low blood pressure.
Beta-blockers. Beta-blockers, such as metoprolol (Lopressor) and carvedilol (Coreg), may also cause low blood pressure.
Calcium channel blockers. CCBs can cause a drop in blood pressure. Examples include amlodipine (Norvasc) and diltiazem (Cardizem).
Nitrates. These drugs, such as nitroglycerin (Nitrostat) and isosorbide-dinitrate (Isordil), may lower blood pressure.
NSAIDs. These medications may cause toxicity of the kidneys.

This is an abbreviated list with only the most common drug interactions. You should always talk with your doctor before taking any new medications.

Surgeries and procedures

If medications aren’t effective on their own, more invasive procedures may be required.

Angioplasty, a procedure to open up blocked arteries, is one option.

Your cardiologist may also consider heart valve repair surgery to help your valves open and close properly.

Early signs of congestive heart failure

As mentioned, early signs of congestive heart failure may not be very noticeable. Here are some early warning signs to discuss with your healthcare professional:

excess fluid in body tissues like the ankles, feet, legs, or abdomen
coughing or wheezing
shortness of breath
weight gain that can’t be attributed to anything else
general fatigue
increased heart rate
lack of appetite or feeling nauseated
feeling confused or disoriented

Picture of swollen ankles due to CHF

When the heart can’t pump blood effectively, blood can get backed up in veins and tissues. Blood and other fluids can back up in certain areas and cause swelling (edema).

The ankles, feet, legs, and abdomen are common places that can swell.

Here is an example of edema:

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Congestive heart failure stages

Stage	Main symptoms	Outlook
Class 1	You don’t experience any symptoms during typical physical activity.	CHF at this stage can be managed through lifestyle changes, heart medications, and monitoring.
Class 2	You’re likely comfortable at rest, but normal physical activity may cause fatigue, palpitations, and shortness of breath.	CHF at this stage can be managed through lifestyle changes, heart medications, and careful monitoring.
Class 3	You’re likely comfortable at rest, but there’s a noticeable limitation of physical activity. Even mild exercise may cause fatigue, palpitations, or shortness of breath.	Treatment can be complicated. Talk with your doctor about what heart failure at this stage may mean for you.
Class 4	You’re likely unable to carry on any amount of physical activity without symptoms, which are present even at rest.	There’s no cure for CHF at this stage, but there are still quality of life and palliative care options. You’ll want to discuss the potential benefits and risks of each with your doctor.

What are the causes of CHF?

CHF may result from other health conditions that directly affect your cardiovascular system. This is why it’s important to get annual checkups to lower your risk for heart health problems, including:

high blood pressure (hypertension)
coronary artery disease
valve conditions

Hypertension

When your blood pressure is higher than normal, it may lead to CHF.

Hypertension has many different causes. Among them is the hardening of your arteries, which increases pressure in the arteries.

Coronary artery disease

Cholesterol and other types of fatty substances can block the coronary arteries, which are the small arteries that supply blood to the heart. This causes the arteries to become narrow.

Narrower coronary arteries restrict blood flow and can lead to damage to the heart muscle.

Valve conditions

Your heart valves regulate blood flow through your heart by opening and closing to let blood in and out of the chambers.

Valves that don’t open and close correctly may force your ventricles to work harder to pump blood. This can be a result of a heart infection or defect.

Other conditions

While heart-related diseases can lead to CHF, there are other seemingly unrelated conditions that may increase your risk, too.

These include:

diabetes
thyroid disease
obesity
certain chemotherapy drugs

Severe bacterial and viral infections, as well as allergic reactions, may also contribute to CHF.

What are the most common types of CHF?

Left-sided CHF is the most common type of CHF. It occurs when your left ventricle doesn’t properly pump blood out to your body.

As the condition progresses, fluid can build up in your lungs, which makes breathing difficult.

There are two kinds of left-sided heart failure:

Systolic heart failure occurs when the left ventricle fails to contract normally. This reduces the level of force available to push blood into circulation. Without this force, the heart can’t pump properly.
Diastolic failure, or diastolic dysfunction, happens when the muscle in the left ventricle becomes stiff. Because it can no longer relax, the heart can’t quite fill with blood between beats.

Right-sided CHF occurs when the right ventricle has difficulty pumping blood to your lungs. Blood backs up in your blood vessels, which causes fluid retention in your lower extremities, abdomen, and other vital organs.

It’s possible to have left-sided and right-sided CHF at the same time. Usually, the disease starts in the left side and then travels to the right when left untreated.

Can a person recover from congestive heart failure?

About 6.2 million U.S. adults had heart failure between 2013 and 2016.

A report from the American Heart Association estimates that about 50 percent of people diagnosed with CHF live past 5 years.

An older study showed results that some lower-risk patients who were diagnosed prior to the age of 50 had life spans of about 20 years after diagnosis.

Age at diagnosis, other conditions, and sex also contributed to variables in life expectancy, with some under 3 years after diagnosis.

The prognosis and life expectancy for congestive heart failure can vary based on many factors. Generally, early diagnosis and following a treatment plan can lead to better management and a longer life.

How is CHF diagnosed?

After reporting your symptoms to your doctor, they may refer you to a heart specialist or cardiologist.

The cardiologist will perform a physical exam, which will involve listening to your heart with a stethoscope to detect abnormal heart rhythms and heart murmurs.

To confirm an initial diagnosis, a cardiologist might order certain diagnostic tests to examine your heart’s valves, blood vessels, and chambers.

There are a variety of tests used to diagnose heart conditions. Because these tests measure different things, your doctor may recommend a few to get a full picture of your current condition.

Can a blood test detect congestive heart failure?

Blood tests can check for abnormal blood cells and infections. This includes testing for blood count, kidney function, and liver function. They can also check the level of BNP, a hormone that rises with heart failure.

Does a chest X-ray show congestive heart failure?

Chest X-rays can be used to assess heart size and fluid buildup in the lungs and blood vessels. This is usually one of the first tests your doctor will recommend.

Other tests

Your doctor may also use these tests to help with the diagnosis:

Electrocardiogram

An electrocardiogram (EKG or ECG) records your heart’s rhythm.

Abnormalities in your heart’s rhythm, such as a rapid heartbeat or irregular rhythm, could suggest that the walls of your heart’s chamber are thicker than normal.

Echocardiogram

An echocardiogram uses sound waves to record the heart’s structure and motion. The test can determine if you already have poor blood flow, muscle damage, or a heart muscle that doesn’t contract normally.

Stress test

Stress tests show any abnormalities in the blood flow to the heart muscle.

Making your heart work harder makes it easier for your doctor to diagnose problems.

Cardiac catheterization

Cardiac catheterization can show blockages of the coronary arteries. Your doctor will insert a small tube into your blood vessel and thread it from your upper thigh (groin area), arm, or wrist.

At the same time, the doctor can take blood samples, use X-rays to view your coronary arteries and check blood flow and pressure in your heart chambers.

MRI

An MRI takes pictures of your heart. With both still and moving pictures, this allows your doctor to see if there’s damage to your heart.

How to prevent congestive heart failure

Some factors are based on our genetics, but lifestyle can play a role as well.

There are several things you can do to lower your risk of heart failure or at least delay onset.

Avoid or quit smoking

If you do smoke and haven’t been able to quit, ask your doctor to recommend products and services that can help.

Secondhand smoke is also a health hazard. If you live with a smoker, ask them to smoke outdoors.

Maintain a well-balanced diet

A heart healthy diet is rich in vegetables, fruits, and whole grains. You also need protein in your diet.

Things to avoid include:

salt (sodium)
added sugars
solid fats
refined grains

Exercise

As little as 1 hour of moderate aerobic exercise per week can improve your heart health. Walking, bicycling, and swimming are good forms of exercise.

If you haven’t exercised in a while, start with just 15 minutes daily and work your way up.

If you feel unmotivated to work out alone, consider taking a class — it can even be online — or sign up for personal training at a local gym.

Watch your weight

Having obesity or overweight can be hard on your heart. Follow a healthy diet and exercise regularly.

If you aren’t at a healthy weight for your body, talk with a doctor about how to move forward. You can also consult a dietitian or nutritionist.

Other preventive steps

Drink alcohol only in moderation and stay away from illegal drugs. When taking prescription medications, follow instructions carefully and never increase your dose without a doctor’s supervision.

If you’re at high risk for heart failure or already have some heart damage, you can still follow these steps. Be sure to ask your doctor how much physical activity is safe and if you have any other restrictions.

If you’re on medication for high blood pressure, heart disease, or diabetes, take them exactly as directed. See your doctor regularly to monitor your condition and report any new symptoms right away.

CHF and genetics

Q:

Is congestive heart failure genetic? Can lifestyle changes help prevent it?

Anonymous patient

A:

Cardiomyopathy, or damage to the heart muscle, can be a cause of heart failure, and genetics could play a role in some types of cardiomyopathy. However, most cases of congestive heart failure (CHF) are not hereditary. Some risk factors for CHF, such as hypertension, diabetes, and coronary artery disease, can run in families. To reduce your risk of developing CHF, consider making lifestyle changes like eating a healthy diet and getting regular exercise.

Elaine K. Luo, MDAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Frequently asked questions

Can a CBC detect congestive heart failure?

While a complete blood count (CBC) test cannot point to CHF directly, certain markers tested can suggest a higher chance of heart disease. These markers may tell your doctor to send you for more specialized testing.

Can a heart recover from congestive heart failure?

CHF is typically a progressive illness. However, if it’s identified and treated early, it can potentially be reversed. Living a heart-healthy lifestyle and adhering to your medication schedule increases the chance of this.

How long does a person live with congestive heart failure?

On average, over 50% of individuals diagnosed with CHF live for at least 5 years, and approximately 35% survive for a decade after diagnosis.

Takeaway

When the heart cannot effectively circulate blood throughout the body, it can lead to CHF.

It can be improved with medication, surgery, or lifestyle changes. Your individual outlook depends on how advanced your CHF is and whether you have other health conditions to treat, like diabetes or high blood pressure.

The earlier your condition is diagnosed, the better your outlook. Talk with your doctor about the best treatment plan for you.

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How we reviewed this article:

SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

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Gustafsson F, et al. (2004). Effect of age on short and long-term mortality in patients admitted to hospital with congestive heart failure. DOI:https://doi.org/10.1016/j.ehj.2004.07.007
Heart failure. (2020).https://www.cdc.gov/heartdisease/heart_failure.htm
Heart failure in children and adolescents. (2017).http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/TheImpactofCongenitalHeartDefects/:%2520Heart-Failure-in-Children-and-Adolescents_UCM_311919_Article.jsp#.WEinbHeZNTY
Jones NR, et al. (2019). Survival of patients with chronic heart failure in the community: a systematic review and meta‐analysis.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6919428/
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Pfizer voluntary nationwide recall of lots of Accupril (quinapril HCI) due to n-nitroso-quinapril content. (2022). https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/pfizer-voluntary-nationwide-recall-lots-accuprilr-quinapril-hcl-due-n-nitroso-quinapril-content
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Medically reviewed by Uzochukwu Ibe, MD, MPH — Written by Brindles Lee Macon — Updated on February 2, 2024

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Key takeaways

What are the symptoms of congestive heart failure?

Symptoms of heart failure in children and infants

How is congestive heart failure treated?

Congestive heart failure drugs

ACE inhibitors

Beta-blockers

Diuretics

Surgeries and procedures

Early signs of congestive heart failure

Picture of swollen ankles due to CHF

Congestive heart failure stages

What are the causes of CHF?

Hypertension

Coronary artery disease

Valve conditions

Other conditions

What are the most common types of CHF?

Can a person recover from congestive heart failure?

How is CHF diagnosed?

Can a blood test detect congestive heart failure?

Does a chest X-ray show congestive heart failure?

Other tests

Electrocardiogram

Echocardiogram

Stress test

Cardiac catheterization

MRI

How to prevent congestive heart failure

Avoid or quit smoking

Maintain a well-balanced diet

Exercise

Watch your weight

Other preventive steps

CHF and genetics

Q:

A:

Frequently asked questions

Can a CBC detect congestive heart failure?

Can a heart recover from congestive heart failure?