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Heart failure - overview

Alternative Names:

CHF; Congestive heart failure; Left-sided heart failure; Right-sided heart failure - Cor pulmonale; Cardiomyopathy - heart failure


Symptoms of heart failure often begin slowly. At first, they may only occur when you are very active. Over time, you may notice breathing problems and other symptoms even when you are resting. Symptoms may also appear suddenly after the heart is damaged from a heart attack or other problem.

Common symptoms are:

  • Cough
  • Fatigue, weakness, faintness
  • Loss of appetite
  • Need to urinate at night
  • Pulse that feels fast or irregular, or a sensation of feeling the heart beat (palpitations)
  • Shortness of breath when you are active or after you lie down
  • Swollen (enlarged) liver or abdomen
  • Swollen feet and ankles
  • Waking up from sleep after a couple of hours due to shortness of breath
  • Weight gain


If you have heart failure, your doctor will monitor you closely. You will have follow-up visits at least every 3 to 6 months, but sometimes much more often. You will also have tests to check your heart function.

Knowing your body and the symptoms that your heart failure is getting worse will help you stay healthier and out of the hospital. At home, watch for changes in your heart rate, pulse, blood pressure, and weight.

Weight gain, especially over a day or two, can be a sign that your body is holding on to extra fluid and your heart failure is getting worse. Talk to your doctor about what you should do if your weight goes up or you develop more symptoms.

Limit how much salt you eat. Your doctor may also ask you to limit how much fluid you drink during the day.

Other important changes to make in your lifestyle:

  • Ask your doctor how much alcohol you may drink.
  • Do not smoke.
  • Stay active. Walk or ride a stationary bicycle. Your doctor can provide a safe and effective exercise plan for you. Do not exercise on days when your weight has gone up from fluid or you are not feeling well.
  • Lose weight if you are overweight.
  • Lower your cholesterol by changing your lifestyle.
  • Get enough rest, including after exercise, eating, or other activities. This allows your heart to rest too.


Your doctor will ask you to take medicines to treat your heart failure. Medicines treat the symptoms, prevent your heart failure from getting worse, and help you live longer. It is very important that you take your medicine as your health care team directed.

These medicines:

  • Help the heart muscle pump better
  • Keep your blood from clotting
  • Lower your cholesterol levels
  • Open up blood vessels or slow your heart rate so your heart does not have to work as hard
  • Reduce damage to the heart
  • Reduce the risk of abnormal heart rhythms
  • Replace potassium
  • Rid your body of excess fluid and salt (sodium)

It is very important that you take your medicine as you have been told. Tell your health care provider right away if you think you are having side effects or want to stop or change any of your medications. Do not take any other drugs or herbs without first asking your provider about them. Drugs that may make your heart failure worse include:

  • Ibuprofen (Advil, Motrin)
  • Naproxen (Aleve, Naprosyn)

The following surgeries and devices may be recommended for some people with heart failure:

  • Coronary bypass surgery (CABG) or angioplasty with or without stenting may help improve blood flow to the damaged or weakened heart muscle.
  • Heart valve surgery may be done if changes in a heart valve are causing your heart failure.
  • A pacemaker can help treat slow heart rates or help both sides of your heart contract at the same time.
  • A defibrillator sends an electrical pulse to stop life-threatening abnormal heart rhythms.


Severe heart failure occurs when treatments no longer work. Certain treatments may be used when a person is waiting for a heart transplant:

  • Intra-aortic balloon pump (IABP)
  • Left ventricular assist device (LVAD)

At a certain point, the health care provider will decide whether it is best to keep treating heart failure aggressively. The patient, along with his or her family and doctors, may want to discuss palliative or comfort care at this time.

Outlook (Prognosis):

Often, you can control heart failure by taking medicine, changing your lifestyle, and treating the condition that caused it.

Heart failure can suddenly get worse due to:

  • Angina (lack of blood flow to the heart muscle)
  • Eating high-salt foods
  • Heart attack
  • Infections or other illnesses
  • Not taking medicines correctly
  • New, abnormal heart rhythms

Most of the time, heart failure is a chronic illness that gets worse over time. Some people develop severe heart failure. Medicines, other treatments, and surgery no longer help at this stage.

People with heart failure may be at risk for dangerous heart rhythms. These people often receive an implanted defibrillator.

When to Contact a Medical Professional:

Call your health care provider if you develop:

  • Increased cough or phlegm
  • Sudden weight gain or swelling
  • Weakness
  • Other new or unexplained symptoms

Go to the emergency room or call the local emergency number (such as 911) if:

  • You faint
  • You have fast and irregular heartbeat (especially if you also have other symptoms)
  • You feel a severe crushing chest pain

Most cases of heart failure can be prevented by living a healthy lifestyle and taking steps aimed at reducing your risk for heart disease.


Goodlin SJ,, Bonow RO. Care of patients with end-stage heart disease. In: Mann DL, Zipes DP, Libby P, et al. eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 31.

Mann DL Management of Patients with Heart Failur with Reduced Ejection Fraction. In: Mann DL, Zipes DP, Libby P, et al. eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 25.

Mant J, Al-Mohammad A, Swain S, Laramee P. Guideline Development Group. Management of chronic heart failure in adults: synopsis of the National Institute For Health and Clinical Excellence guideline. Ann Intern Med. 2011;155(4):252-259. PMID: 21844551. Available at:

Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013 Oct 15;128(16):e240-327. Epub 2013 Jun 5. PMID: 23741058. Available at:

Review Date: 8/12/2014
Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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