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Heart failure is a condition that develops when your heart doesn’t pump enough blood for your body’s needs. This can happen if your heart can’t fill up with enough blood. It can also happen when your heart is too weak to pump properly. The term "heart failure" does not mean that your heart has stopped. However, heart failure is a serious condition that needs medical care.
More than 6 million adults in the United States have heart failure, according to the Centers for Disease Control and Prevention. Children can also have heart failure, but this health topic focuses on heart failure in adults.
Heart failure can develop suddenly (the acute kind) or over time as your heart gets weaker (the chronic kind). It can affect one or both sides of your heart. Left-sided and right-sided heart failure may have different causes. Most often, heart failure is caused by another medical condition that damages your heart. This includes coronary heart disease, heart inflammation, high blood pressure, cardiomyopathy, or an irregular heartbeat . Heart failure may not cause symptoms right away. But eventually, you may feel tired and short of breath and notice fluid buildup in your lower body, around your stomach, or neck.
Heart failure can damage your liver or kidneys. Other complications include pulmonary hypertension or other heart conditions, such as an irregular heartbeat, heart valve disease, and sudden cardiac arrest.
Your doctor will diagnose heart failure based on your medical and family history, a physical exam, and results from imaging and blood tests.
Currently, heart failure is a serious condition that has no cure. However, treatment such as healthy lifestyle changes, medicines, some devices and procedures can help many people have a higher quality of life. Visit the Living With section to learn more.
Visit The Heart Truth to learn about heart disease in women.
Chronic (long-term) heart failure is often caused by other medical conditions that damage or overwork your heart. Acute (sudden) heart failure can be caused by an injury or infection that damages your heart, a heart attack, or a blood clot in your lung.
To understand heart failure, it helps to know how the heart works. The right side of your heart gets oxygen-low blood from your body. It pumps the blood to your lungs to pick up oxygen. The left side of your heart pumps oxygen-rich blood to the rest of your body.
This animation describes heart failure and some of its causes. Medical Animation Copyright © 2021 Nucleus Medical Media Inc. All rights reserved.
Left-sided heart failure is more common than right-sided heart failure. There are two types of left-sided heart failure, each based on how well your heart can pump. This measurement is called the ejection fraction. Visit the Diagnosis section to learn more about the ejection fraction.
In heart failure with reduced ejection fraction (HFrEF), the left side of your heart is weak and can’t pump enough blood to the rest of your body. Chronic (long-term) conditions that damage or weaken the heart muscle are the main cause of heart failure with reduced ejection fraction. For example, coronary heart disease or a heart attack can prevent your heart muscle from getting enough oxygen (shown below). Other causes of this type of heart failure include faulty heart valves, an irregular heartbeat, or heart diseases that you are born with or inherit.
In heart failure with preserved ejection fraction (HFpEF), the left side of your heart is too stiff to fully relax between heartbeats. That means it can't fill up with enough blood to pump out to your body. High blood pressure and other conditions that make your heart work harder are the main causes of heart failure with preserved ejection fraction. Conditions that stiffen the chambers of the heart such as obesity and diabetes are also causes of this type of heart failure. Over time, your heart muscle thickens to adapt, which makes it stiffer.
Visit the Diagnosis section to learn more about heart failure with preserved or reduced ejection fraction and how doctors diagnose it.
Over time left-sided heart failure can lead to right-sided heart failure.
In right-sided heart failure, your heart can't pump enough blood to your lungs to pick up oxygen. Left-sided heart failure is the main cause of right-sided heart failure. That’s because left-sided heart failure can cause blood to build up on the left side of your heart. The build-up of blood raises the pressure in the blood vessels that carry blood from your heart to your lungs. This is called pulmonary hypertension, and it can make the right side of your heart work harder.
Congenital heart defects or conditions that damage the right side of your heart such as abnormal heart valves can also lead to right-side heart failure on its own. The same is true for conditions that damage the lungs, such as chronic obstructive pulmonary disease (COPD).
Many factors can raise your risk of heart failure. Some factors you can control, such as lifestyle habits. Others you cannot, including your age, race, or ethnicity. Your risk of heart failure goes up if you have more than one of these factors.
To screen for heart failure, your doctor will determine your risk factors. If you’re at high risk, your doctor may measure your blood levels of certain molecules that rise during heart failure. Visit the Diagnosis section to learn more.
You can take the following steps to lower your risk of developing heart failure. The sooner you start, the better your chances of preventing or delaying the condition.
Symptoms of heart failure depend on the type of heart failure you have and how serious it is. If you have mild heart failure, you may not notice any symptoms except during hard physical work. Symptoms can depend on whether you have left-sided or right-sided heart failure. However, you can have symptoms of both types. Symptoms usually get worse as your heart grows weaker.
Heart failure can lead to serious and life-threatening complications.
One of the first symptoms you may notice is feeling short of breath after routine activities like climbing stairs. As your heart grows weaker, you may notice this while getting dressed or walking across the room. Some people have shortness of breath while lying flat.
In addition, people who have left-sided heart failure may have the following symptoms.
Older adults who do not get much physical activity may not experience shortness of breath. But they may feel tired and confused.
People who have right-sided heart failure may also have the following symptoms:
Heart failure can cause the following serious complications:
Your doctor will diagnose heart failure based on your medical history, a physical exam, and test results. Your doctor may also refer you to a cardiologist for these tests and treatment. A cardiologist is a doctor who specializes in diagnosing and treating heart diseases.
Bring a list of your symptoms to your doctor’s appointment, including how often they happen and when they started. Also, bring a list of any prescription and over-the-counter medicines you take. Let your doctor know if you have any risk factors for heart failure.
During your physical exam, your doctor will:
This animation discusses some of the tests used to diagnose heart failure. These tests may include an electrocardiogram to look at your heart’s electrical activity, an echocardiogram to measure how well your heart is working and look at the structure, and a chest X-ray to see if your heart is enlarged or there is fluid in your lungs. Other tests may include blood tests and an exercise, or stress test. Medical Animation Copyright © 2021 Nucleus Medical Media Inc. All rights reserved.
Blood tests
Your doctor may order blood tests to check the levels of certain molecules, such as brain natriuretic peptide (BNP). These levels rise during heart failure. Blood tests can also show how well your liver and your kidneys are working.
Tests to measure your ejection fraction
Your doctor may order an echocardiography (echo) or other imaging tests to measure your ejection fraction. Your ejection fraction is the percent of the blood in the lower left chamber of your heart (the left ventricle) that is pumped out of your heart with each heartbeat. Ejection fraction tells your doctor how well your heart pumps. This helps your doctor diagnose the type of heart failure you have and guide your treatment.
If your ejection fraction is somewhere in between (41% to 49%), you may be diagnosed with heart failure with borderline ejection fraction.
Other tests
Heart failure has no cure. But treatment can help you live a longer, more active life with fewer symptoms. Treatment depends on the type of heart failure you have and how serious it is but usually includes heart-healthy lifestyle changes and medicines. You may need a procedure or surgery for some types of serious heart failure. Because heart failure often gets worse over time, it is important for you and your caregivers to discuss your long-term treatment goals with your healthcare team.
Your healthcare team will also treat any medical condition that caused or worsens your heart failure.
This video describes possible treatments for heart failure, including lifestyle changes, medicines such as diuretics to get rid of excess fluid, or a heart procedure or surgery. Medical Animation Copyright © 2021 Nucleus Medical Media Inc. All rights reserved.
Your healthcare team may include a cardiologist (a doctor who specializes in treating heart conditions), nurses, your primary care doctor, pharmacists, a dietitian, physical therapists and other members of your cardiac rehabilitation team, and social workers.
Your doctor may recommend these heart-healthy lifestyle changes alone or as part of a cardiac rehabilitation plan:
Learn more about these healthy lifestyle changes in our Heart-Healthy Living Health Topic.
Your doctor may prescribe medicines based on the type of heart failure you have, how serious it is, and your response to certain medicines.
Left-sided heart failure
The following medicines are commonly used to treat heart failure with reduced ejection fraction.
Currently, the main treatment for heart failure with preserved ejection fraction are diuretics. Your doctor also may prescribe blood pressure medicines to help relieve your symptoms.
Right-sided heart failure
If you have right-sided heart failure, your doctor may prescribe medicines to remove extra sodium and fluid from your body, and medicines to relax your blood vessels.
If your heart failure with reduced ejection fraction worsens, you may need one of the following medical devices:
You may also need heart surgery to repair a congenital heart defect or damage to your heart. If your heart failure is life-threatening and other treatments have not worked, you may need a heart transplant.
For people with heart failure and preserved ejection fraction, there are no currently approved devices or procedures to improve symptoms. Researchers are continuing to study possible treatments.
If you have heart failure, you will likely have to follow a treatment plan for the rest of your life. Even with treatment, heart failure often gets worse over time. However, you can take steps to have a higher quality of life.
Following your treatment plan can help relieve symptoms and make daily activities easier. It also can lower the chance that you’ll have to go to the hospital.
Take your medicines as your doctor prescribes. Tell your doctor if you have side effects from any of your medicines. He or she might adjust the dose or change the type of medicine you take to reduce side effects.
Watch for signs that heart failure is getting worse, such as new or worsening symptoms. Weight gain, ankle swelling, or increasing shortness of breath may mean that fluids are building up in your body. Ask your doctor how often you should check your weight and when to report weight changes.
Your symptoms may suddenly get worse. Ask your doctor when to make an office visit or get emergency care. Keep the following handy:
Living with heart failure may cause fear, anxiety, depression, and stress. Talk to your healthcare team or a professional counselor. They can help you find or learn ways to cope.
We lead or sponsor many studies on heart failure. See if you or someone you know is eligible to participate in our clinical trials and observational studies.
To learn more about clinical trials at the NIH Clinical Center or to talk to someone about a study that might fit your needs, call the Office of Patient Recruitment 800-411-1222.
Learn more about participating in a clinical trial.
View all trials from ClinicalTrials.gov.
Visit Children and Clinical Studies to hear experts, parents, and children talk about their experiences with clinical research.
Find additional information about Heart Failure in the following resources.
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