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Heart failure, sometimes known as congestive heart failure, occurs when your heart muscle doesn't pump blood as well as it should. Certain conditions, such as narrowed arteries or high blood pressure, gradually leave your heart too weak or stiff to fill and pump efficiently.
Heart failure often develops after other conditions have damaged or weakened your heart. However, the heart doesn't need to be weakened to cause heart failure. It also can occur if the heart becomes too stiff.
In heart failure, the main pumping chambers of your heart may become stiff and not fill properly between beats. In some cases of heart failure, your heart muscle may become damaged and weakened, and the ventricles stretch to the point that the heart can't pump blood efficiently throughout your body. Over time, the heart can no longer keep up with the normal demands placed on it to pump blood to the rest of your body.
Heart failure can involve the left side, right side or both sides of your heart. Generally, heart failure begins with the left side — your heart's main pumping chamber.
Not all conditions that lead to heart failure can be reversed, but treatments can improve the signs and symptoms of heart failure, and help you live longer. Lifestyle changes, such as exercising, reducing sodium in your diet, managing stress and losing weight, can improve your quality of life.
One way to prevent heart failure is to prevent and control conditions that cause heart failure, such as coronary artery disease, high blood pressure, diabetes or obesity.
Heart failure can be ongoing, or chronic, or your condition may start suddenly ― often called acute. Heart failure signs and symptoms can include:
- Shortness of breath when you exert yourself or when you lie down.
- Fatigue and weakness.
- Swelling in your legs, ankles and feet.
- Rapid or irregular heartbeat.
- Persistent cough or wheezing with white or pink blood-tinged phlegm.
- Increased need to urinate at night.
- Swelling of your abdomen.
- Rapid weight gain from fluid retention.
- Sudden, severe shortness of breath and coughing up pink, foamy mucus.
Causes and risk factors
A single risk factor may be enough to cause heart failure, but a combination of factors also increases your risk.
Risk factors include:
- High blood pressure — your heart works harder than it has to if your blood pressure is high.
- Coronary artery disease — narrowed arteries may limit your heart's supply of oxygen-rich blood, resulting in a weakened heart muscle.
- Heart attack — a heart attack is a form of coronary disease that occurs suddenly. Damage to your heart muscle from a heart attack may mean your heart can no longer pump as well as it should.
- Diabetes — having diabetes increases your risk of high blood pressure and coronary artery disease.
- Sleep apnea — the inability to breathe properly while you sleep at night results in low blood oxygen levels and increased risk of abnormal heart rhythms. Both problems can weaken the heart.
- Congenital heart defects — some people who develop heart failure were born with structural heart defects.
- Alcohol use — drinking too much alcohol can weaken heart muscle and lead to heart failure.
- Tobacco use — using tobacco can increase your risk of heart failure.
- Obesity — people who are obese have a higher risk of developing heart failure.
- Irregular heartbeats — these abnormal rhythms, especially if they are frequent and fast, can weaken the heart muscle and cause heart failure.
Heart failure is a chronic disease needing lifelong management. However, with treatment, signs and symptoms of heart failure can improve, and the heart sometimes becomes stronger. Treatment can help you live longer and have an improved quality of life.
Health care providers sometimes can correct heart failure by treating the underlying cause. For example, repairing a heart valve or controlling a fast heart rhythm may reverse heart failure. But for most people, heart failure treatment involves a balance of the right medications and in some cases use of devices that help the heart beat and contract properly.
- Coronary bypass surgery — if severely blocked arteries are contributing to your heart failure, your health care provider may recommend coronary artery bypass surgery. In this procedure, blood vessels from your leg, arm or chest bypass a blocked artery in your heart to allow blood to flow through your heart more freely.
- Heart valve repair or replacement — if a faulty heart valve causes your heart failure, your health care provider may recommend repairing or replacing the valve. The surgeon can modify the original valve to eliminate backward blood flow. Surgeons also can repair the valve by reconnecting valve leaflets or by removing excess valve tissue so that the leaflets can close tightly. Sometimes repairing the valve includes tightening or replacing the ring around the valve.
Valve replacement is performed when valve repair isn't possible. In valve replacement surgery, the damaged valve is replaced by an artificial valve.
Certain types of heart valve repair or replacement can now be performed without open-heart surgery, using minimally invasive surgery or cardiac catheterization techniques.
- Implantable cardioverter-defibrillators(ICDs) — an implantable cardioverter-defibrillator is a small device that is implanted under the skin in your chest with wires leading through your veins and into your heart.
The implantable cardioverter-defibrillator monitors the heart rhythm. If the heart starts beating at a dangerous rhythm, or if your heart stops, the implantable cardioverter-defibrillator tries to pace your heart or shock it back into normal rhythm. An implantable cardioverter-defibrillator also can function as a pacemaker and speed your heart up if it is going too slow.
- Cardiac resynchronization therapy (CRT), or biventricular pacing — a biventricular pacemaker sends timed electrical impulses to both of the heart's lower chambers so that they pump in a more efficient, coordinated manner.
Cardiovascular surgery is performed by Mayo Clinic Health System's world-class surgical team in Eau Claire, Wisconsin, or at Mayo Clinic in Rochester, Minnesota. Your local cardiology experts can manage your consultations and diagnostic tests, as well as preoperative and postoperative care. This approach ensures you receive the best heart care while minimizing travel and keeping you close to home and family. Mayo Clinic Health System is with you every step of the way, no matter the level of care needed in your health journey.