Congestive Heart Failure

A heart condition in which the heart muscle cannot pump enough blood that the body needs. Therefore, the heart does not work normally, not means it stops working. When the heart not working properly, the blood moves slower and heart pressure increases.

Roughly 7 million people experience this heart disease in the United States. One of the main reasons that people over 65 years old are hospitalized is heart failure.

Heart Failure Pathophysiology

A process that usually leads to heart failure is called pathophysiology. In case a person’s heart does not pump enough strongly, the body adapts and it can meet the body’s needs for blood. It occurs due to the heart’s chambers that hold more blood to pump through the body. This extra work usually provokes heart cells to die. As a result, the heart’s walls become weaker and the ability to pump blood decreases.

When an individual heart does not work properly, the body starts the release certain hormones that narrow the blood vessels and make the kidneys hold more water (fluid) and salt. An increased amount of salt and fluid increases blood pressure and provokes the heart to work harder. Usually, the extra fluid builds up in the feet, lungs, legs, ankles, arms, and other body parts. Healthcare professionals identify this health problem as congestive heart failure. Over time, the heart’s ability to pump enough blood decreases and heart failure occurs.

What is The Difference Between Heart Failure and Heart Attack?

A myocardial infarction (heart attack) occurs when a blood clot or plaque that builds up in the arteries blocks the blood flow to the heart. As a result, the heart does not get enough oxygen and starts to die. That’s why doctors consider heart attacks a medical emergency. In case you or someone around you experience a heart attack, immediate medical care is required to restore the blood flow.

Heart failure occurs when the heart muscle works hard for long periods and becomes damaged.


There are different health conditions that can provoke damage to the heart muscle. Examples include:

  • Coronary artery disease (CAD) – This is another heart condition that occurs when a build-up in the arteries decreases the blood flow to the heart.
  • Heart attack (myocardial infarction) – This condition happens when a blockage in an artery occurs suddenly.
  • Cardiomyopathy – The primary causes of this condition are alcohol, recreational drugs, genetic changes, and infections. They provoke heart damage and prevent the heart muscle from working properly.
  • Diseases that provoke heart overwork – These include congenital heart problems, hypertension (high blood pressure), heart valve disease, kidney disease, diabetes, thyroid disease, and others. All previous conditions provoke heart failure.


While some people do not experience any symptoms others may notice that they come and go or are constant. In addition, symptoms are different from mild to severe.

Early Heart Failure Symptoms

  • Tiredness
  • Shortness of breath
  • Cough
  • Wheezing
  • Swelling
  • Difficulty doing activities

However, other symptoms can also appear. For example:

  • Sudden urge to urinate, especially during nighttime
  • Loss of appetite
  • Nausea
  • Weakness
  • Dizziness
  • Confusion
  • Irregular or fast heartbeat
  • Sudden weight gain
  • Chest pain

In case you experience any of the previous symptoms, it is advised to visit a doctor.

What Are The Types of Heart Failure?

This heart disease can impact the left, right, or both sides of the heart. Therefore, experts classified this condition into three categories depending on how well the heart muscle pumps.

Left-sided Heart Failure

This heart failure type is considered the most common type. Normally, the left side of the heart (left ventricle) performs the most pumping. Therefore, in case the left ventricle cannot pump enough blood the extra blood goes to the pulmonary veins (blood vessels that carry blood away from lungs). In addition, physicians also divided left-sided heart failure into two categories depending on how the heart muscle is still pumping. For example:

  • Systolic heart failure – This type happens when the heart cannot pump blood out of the body. This condition is usually known as heart failure with decreased ejection fraction (EF).
  • Diastolic heart failure – Also known as heart failure with preserved EF. It occurs when the ventricles are too stiff, which leads to less blood flow to the heart.


Physicians usually perform a physical examination and ask you about symptoms and medical history. They can listen to your heart using a stethoscope to check for heart failure symptoms. Check below the most common questions that your doctor can ask:

  • Do you smoke or use any drugs?
  • Are you using any medications?
  • Do you drink alcohol and how much?
  • Have you any other heart conditions including CAD, diabetes, heart valve disease, or hypertension?

However, if doctors are not sure whether you have heart failure or not, they can order you to do some additional tests. For example:

  • Blood tests – Commonly, these tests help to check for kidney and thyroid gland function.
  • B-type natriuretic peptide (BNP) blood test – A test done to check the hormone that your heart releases (BNP).
  • Chest X-ray – Helps to determine the heart’s size and if there is a fluid buildup.
  • Echocardiogram – This is an ultrasound test that helps to check the movement, structure, and function of the heart.
  • EKG or ECG – This test is used to record the heart’s electrical impulses.
  • Cardiac catheterization – This test can show your doctor how well the heart works and sometimes the exact cause of heart failure.
  • Stress test – It verifies how the heart works during exercise.


Different treatment options are available for this heart disease. These include lifestyle changes, medicines, and others. In case the condition is getting worse despite medicines and lifestyle changes, you may need to visit a doctor specialized in heart failure treatment.

Physicians usually recommend the following lifestyle changes for people with early-stage heart failure. For example:

Check below some common medications prescribed by doctors in heart failure treatment:

  • Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (help to relax the blood vessels)
  • Beta-blockers (are used to slow the heart rate)
  • Angiotensin receptor-neprilysin inhibitors (improve blood flow)
  • Digoxin (strengthen heartbeat)
  • Diuretics and aldosterone antagonists (remove extra water from the body)
  • Potassium (helps to control the heart rhythm)
  • Hydralazine or isosorbide dinitrate (widens blood vessels)
  • Sodium-glucose cotransporter-2 inhibitors (decreases blood sugar and pressure)

Healthcare professionals can also recommend a cardiac rehabilitation program (it includes the possibility to exercise safely, smoking cessation, and diet changes). This program can also provide you with emotional support.

However, physicians may recommend other therapies if any of the medicines and lifestyle changes listed above do not work for you. Check some of them below:

  • Coronary bypass surgery (helps to restore blood flow caused by an artery blockage)
  • Heart valve repair or replacement
  • Implantable cardioverter defibrillator
  • Cardiac resynchronization therapy (also known as a biventricular pacemaker)
  • Ventricular assist device
  • A heart transplant (this procedure usually is required in severe heart failure cases).

Is It Possible to Reverse Heart Failure?

Yes, but not every time because it depends on the severity of the condition and other factors. Healthcare professionals consider that heart failure reversed if EF returns back to normal. In addition, some diseases can cause heart failure improvement for example infections (such as myocarditis) or cardiomyopathy provoked by stress. However, the more time you experience heart failure the more damage to the heart occurs and it becomes challenging to reverse it. In severe cases of heart failure, the only way to reverse it is a heart transplant.

What Are Heart Failure Stages?

This condition usually progresses or worsens over time and the American Heart Association and American College of Cardiology classified this heart disease into 4 stages depending on the condition’s severity. Therefore, physicians will prescribe treatment according to the stage you experience.

  • A – Do not have any symptoms but have conditions that can provoke heart failure including diabetes, blood vessel disease, or hypertension.
  • B – People still do not notice any symptoms but have heart structure problems and elevated pressure in the heart.
  • C – The heart failure symptoms appear.
  • D – Severe symptoms that interact with daily life or make you go to the hospital.

Furthermore, the New York Heart Association classified this condition in the way heart failure impacts daily life. For example:

  • 1 – This heart condition does not affect daily activities.
  • 2 – There are some interactions between activities and heart failure. They are caused by symptoms such as tiredness, shortness of breath, heart palpitations, chest pain, or others.
  • 3 – This heart disease limits the daily activities.
  • 4 – In such cases, heart failure symptoms occur even if a person rests.

Frequently Asked Questions

Is it possible to prevent heart failure?

There are some tips that can help to prevent this condition. For example:

  • Manage existing conditions that could provoke heart failure
  • Monitor the symptoms
  • Keep a fluid balance
  • Limit salt (sodium)
  • Follow the treatment exactly prescribed by the doctor
  • Have regular appointments with your doctor

Discuss with your doctor for more details.

What medicines should I avoid if was diagnosed with heart failure?

  • Pseudoephedrine
  • Antacids (such as sodium)
  • Nutritional supplements
  • Calcium channel blockers
  • Medicines used to control heart rhythm
  • Nonsteroidal anti-inflammatory drugs or NSAIDs (including Ibuprofen, Naproxen, and others)

What is the best diet for people with heart failure?

  • Consume lots of vegetables and fruits
  • Limit salt to less than 1.5g daily. Moreover, you should choose foods that are naturally low in salt (such as fish, chicken, fresh beans, peas, eggs, milk, plain rice, and others)
  • Season foods with spices, herbs, and citrus
  • High-fiber foods (including oatmeal, almonds, avocado, and others)
  • Reduce the amount of cholesterol, sugar, and Trans fats.

In case you have any additional questions, ask your healthcare professional.

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