Chest PainWhat is Congestive Heart Failure

Congestive heart failure occurs when your heart muscle doesn’t pump blood as well as it should. The main pumping chambers of your heart (the ventricles) may become stiff and not fill properly between beats. In some cases, your heart muscle may become damaged and weakened, and the ventricles stretch (dilate) 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.

An ejection fraction measures how well your heart is pumping, classifies heart failure, and guides treatment. In a healthy heart, the ejection fraction is 50 percent or higher – more than half of the blood that fills the ventricle is pumped out with each beat. Heart failure can occur even with a normal ejection fraction, such as if the heart muscle becomes stiff from conditions like high blood pressure.

Heart failure can involve both sides of your heart. Generally, heart failure begins with the left ventricle — your heart’s main pumping chamber.

Types of heart failure include:

Left-sided heart failure – Fluid may back up in your lungs, causing shortness of breath.

Right-sided heart failure – Fluid may back up into your abdomen, legs and feet, causing swelling.

Systolic heart failure – The left ventricle can’t contract vigorously, indicating a pumping problem.

Diastolic heart failure – The left ventricle can’t relax or fill fully, indicating a filling problem.


Heart failure signs and symptoms may include:

  • Shortness of breath (dyspnea) when you exert yourself or when you lie down
  • Fatigue and weakness
  • Swelling (edema) in your legs, ankles, and feet
  • Rapid or irregular heartbeat
  • Reduced ability to exercise
  • Persistent cough or wheezing with white or pink blood-tinged phlegm
  • Increased need to urinate at night
  • Swelling of your abdomen (ascites)
  • Very rapid weight gain from fluid retention
  • Lack of appetite and nausea
  • Difficulty concentrating or decreased alertness
  • Sudden, severe shortness of breath and coughing up pink, foamy mucus
  • Chest pain

Possible Causes

The following conditions can weaken your heart and cause heart failure:

  • Coronary artery disease and heart attack
  • High blood pressure (hypertension)
  • Faulty heart valves
  • Damage to the heart muscle (cardiomyopathy)
  • Myocarditis
  • Congenital heart defects
  • Abnormal heart rhythms (heart arrhythmias)
  • Chronic diseases – diabetes, HIV, hyperthyroidism, hypothyroidism, or a buildup of iron (hemochromatosis) or protein (amyloidosis)

Risk Factors

Some risk factors for heart failure include:

  • High blood pressure
  • Coronary artery disease
  • Heart attack
  • Diabetes
  • Certain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs); certain anesthesia medications; some antiarrhythmic medications; certain medications used to treat high blood pressure, cancer, blood conditions, neurological conditions, psychiatric conditions, lung conditions, urological conditions, inflammatory conditions and infections; and other prescription and over-the-counter medications.
  • Sleep apnea
  • Congenital heart defects
  • Valvular heart disease
  • Viruses
  • Alcohol misuse
  • Tobacco use
  • Obesity
  • Irregular heartbeats


Potential complications of heart failure may include:

  • Kidney damage or failure
  • Heart valve problems
  • Heart rhythm problems
  • Liver damage


Lifestyle changes you can make to help prevent heart failure include:

  • Not smoking
  • Controlling certain conditions, such as high blood pressure and diabetes
  • Staying physically active
  • Eating healthy foods
  • Maintaining a healthy weight
  • Reducing and managing stress