Heart Failure - At a Glance


What is heart failure?
Heart failure is a common and serious condition that develops slowly over time. Your heart becomes weakened and can not pump enough blood to meet the needs of your body.
Learn more.

Causes and Risk Factors

What are the causes and risk factors of heart failure?
The causes of heart failure vary with age and family history. Some risk factors include coronary artery disease, high blood pressure, and valvular disease. Learn more.


What are the symptoms of heart failure?
Symptoms include fatigue, shortness of breath with or without exercise, wheezing, or a dry hacking cough after lying down. Learn more.


How is heart failure diagnosed?
In addition to a physical exam, your doctor may use blood tests, x-rays, an ECG test, an echocardiogram, or other tests to diagnose heart failure. Learn more.


How is heart failure treated?
Treatments for heart failure include lifestyle changes, medications, surgery, and cardiac resynchronization therapy. Learn more.

Success Stories

What is it like to have a heart failure device?
Patients with heart failure share their treatment stories. Learn more.



What Is Heart Failure?
Heart failure is a common and serious medical condition. Despite its misleading name, a heart with heart failure doesn't suddenly stop working. Instead, heart failure develops slowly as the heart muscle gradually weakens. The "failure" refers to the heart's inability to pump enough blood to meet the body's needs.

In a healthy heart, the chambers contract and relax in a coordinated way, or in synchrony. Think of how your hand makes a fist. The fingers open and close together. (Learn more about the heart chambers.)

For people heart failure, their hearts do not pump as strongly as they should and so blood does not circulate as well as it should. In other words, pumping function declines.



Sadie Edwards - Heart Failure Patient“My heart was getting weaker. I couldn’t walk a block without stopping. It got so embarrassing that I would stop and pretend that I was waiting for someone. It just got worse and worse and worse." Sadie Edwards 



With heart failure, your body generally tries to compensate for any physical problem, including reduced pumping function. Sometimes the body's responses help in the short term, but they cause even more problems over the long term. As a result, heart failure is progressive, meaning that it gets worse over time. Doctors try to slow the progression and reduce the symptoms of heart failure.


Healthy to Heart Failure - Watch the Video [00:23]




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Problems Heart Failure Can Cause
Below is a partial list of the problems heart failure can cause. Each problem, in turn, causes other problems:

  • Inadequate blood flow to tissues. When blood flow to the tissues is inadequate, you may have fatigue and shortness of breath, which in turn can cause a faster heart rate.
  • Inadequate blood flow to the kidneys. If the kidneys do not receive enough blood, you may have water retention, tissue swelling, and high blood pressure. All of these problems can cause the heart to work even harder.
  • Release of hormones. If your body releases certain hormones, your blood pressure may go up, causing your heart to work harder.
  • Enlarged heart. If the heart becomes enlarged, the timing and coordination of your heartbeats may be interrupted, causing even more problems with pump function.

To understand heart failure, it is helpful to review the heart's anatomy.

How common is heart failure?
Heart failure is a common health problem today:

  • 22 million people around the world1 (more than 5.5 million in the United States2) have heart failure.
  • Heart failure is one of the leading causes of hospitalization for people aged 65 and older.2
  • One out of every five people at 40 years old in the U.S. will develop heart failure in their lifetime.2

Why are more people diagnosed with heart failure today? Overall we live longer today, and heart failure mostly affects older people. Also, people who have other heart problems – such as, heart attacks – get better treatment today. They live longer, too, but they are more likely to have heart failure because of damage to their heart muscle. Thus, people with heart or blood vessel problems are more prone to heart failure. As doctors improve the care for people with heart failure, many patients can live better and longer lives.

How serious is heart failure?
Many people live for years with symptoms of heart failure. However, heart failure is a serious, progressive disease that can eventually cause or contribute to death. The symptoms of heart failure occur because the heart muscle has suffered damage and can't keep up with the body's needs. The heart's enlargement and inability to pump tend to increase with time.

Also, heart failure patients can be more prone to abnormal heart rhythms, which increase the risk of sudden death. From 1993-2003, deaths from heart failure increased 20.5%.2 People with heart failure usually die of either pump failure or sudden cardiac death.


Watch the Video: Sudden Cardiac Death [00:13]



Many heart failure deaths occur suddenly. You may have heard this problem described as cardiac arrest or sudden cardiac death (SCD).

What happens when someone has a sudden death event? The electrical impulses telling the heart to contract are sent too quickly through the heart muscle. The heartbeat becomes so rapid and chaotic that blood cannot move through the heart's chambers. Blood is not pumped out to the brain and other organs. The person then passes out from lack of oxygen in the brain. If untreated, the person can die within a few minutes.

A person with heart failure is six to nine times more likely to experience sudden death than someone who does not have heart failure.2

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Causes and Risk Factors

What are the causes and risk factors of heart failure?
The causes of heart failure vary with age and family history. However, the causes have one thing in common – they somehow damage the heart muscle and it no longer pumps as well as it should. The risk factors below are general guidelines. For example, not everyone who has had a heart attack will develop heart failure. But heart attack survivors are certainly at higher risk. Any one, or a combination, of these high-risk factors can lead to heart failure.

Coronary Artery Disease and Heart Attack
Your heart muscle has its own blood vessels, called coronary arteries, that carry oxygen-rich blood to the heart walls. What happens when a clogged vessel interrupts blood flow to the heart muscle?

The severity of a heart attack depends on how much heart muscle is damaged and how long the muscle went without oxygen. If you have had a heart attack, you are five times as likely to develop heart failure.3

High Blood Pressure
High blood pressure has two primary results:

  • Higher pressure in the vessels due to narrow blood vessels
  • A heart that must work harder as it pumps against this higher pressure

Your body can tolerate high blood pressure for a while, but over time it can cause:

  • An enlarged heart
  • Thickening of the heart muscle

If you have high blood pressure, you are twice as likely to develop heart failure.3

Valvular Disease
The heart valves control the flow of blood leaving the heart. Sometimes the valves are abnormal:

  • A narrowing of the valves causes a backup of blood.
  • Improper closing of the valves allows blood to leak back into the heart.

Over time, this inefficient blood flow causes physical changes in the heart's size and shape.

Enlarged Heart
When the heart becomes enlarged (called cardiomyopathy), it can weaken the heart muscle and cause it to pump with less force. Causes of an enlarged heart include drug abuse, alcohol abuse, or viral infections.

Illustration of Heart Failure

Other Concerns
Two other factors may contribute to heart failure:

  • Diabetes. Diabetes is linked to obesity, high blood pressure, and coronary artery disease. These conditions also can contribute to heart failure.
  • Alcohol abuse. Too much alcohol can damage the heart muscle and lead to high blood pressure, which is also a risk factor for heart failure.


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What are the symptoms of heart failure?
The symptoms of heart failure are most noticeable when you exert yourself. Mowing the lawn, exercising, or even walking from one room to another can cause enough symptoms that most heart failure patients have to cut back on activities.

Breathing Difficulties
Problems with breathing are among the most common symptoms of heart failure. Some breathing problems occur when fluid backs up in the lungs and the surrounding tissues (sometimes known as congestive heart failure). This fluid backup can cause:

  • Breathlessness after mild exercise
  • Asthma-like wheezing or dry cough a few hours after lying down

If breathing problems occur when you lie flat, you may need to elevate your head or sit in a recliner to sleep. Advanced stages of heart failure can cause a feeling of suffocation.

Water Retention
If too little blood reaches your body's tissues, they retain fluid and begin to swell. Swelling happens first in your feet, then in your ankles and legs, and finally in your abdomen. As the tissues retain salt and water, you might gain weight even if you're eating less.

Fatigue occurs because the muscles in your body receive too little oxygen. The more you exert yourself, the greater the fatigue.

Other Symptoms
Other symptoms of heart failure may include:

  • Heart palpitations
  • Difficulty concentrating
  • Dizziness
  • Fainting spells

You may also have difficulty sleeping. At night when you lie down, you may need to urinate more often. Also, fluid backs up into the lungs. Thus, sleep is often interrupted by:

  • Trips to the bathroom
  • Coughing spells
  • Shortness of breath

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How is heart failure diagnosed?
Early diagnosis is critical to early treatment, which can delay the onset of some symptoms. Your doctor may use a number of the methods listed below to determine if you have heart failure. The results from any or all of these tests help doctors determine the severity of heart failure and how best to treat the condition.

These results can also help doctors rank heart failure symptoms according to the New York Heart Association (NYHA) classification system. Class I refers to mild cases with the fewest symptoms. Class IV refers to severe cases with the most symptoms.

Physical Exam
Your doctor will start with a physical exam, asking you about:

  • Your medical history
  • Any symptoms you may have

Your doctor will also check for:

  • Heart enlargement
  • Irregular heart sounds 
  • Abnormal sounds in the lungs
  • Swelling or tenderness of the liver
  • Water retention

To confirm a heart failure diagnosis, your doctor might order some of the tests described below.

Blood Tests
Laboratory blood tests can show how well your kidneys and other organs are functioning.

Chest X-Rays
A chest x-ray can show whether you have an enlarged heart or fluid around your lungs.

Electrocardiogram (ECG)
The electrocardiogram (ECG) can show problems in the way your heart is beating. During an ECG, a number of wires (called leads) are attached to various places on your chest, allowing the doctor to see the electrical pattern of your heartbeat.

This test (also called an echo) uses ultrasound to create images of your heart as it is beating. The echo helps your doctor learn about your:

  • Heart valve function
  • Heart wall thickness
  • Blood flow through the heart

The echocardiogram also provides your doctor with another important heart measurement: ejection fraction (also called EF). Ejection fraction helps doctors gauge heart failure severity because it measures the percent of blood pumped out of the ventricles during each beat. A normal ejection fraction is approximately 50%. A person with heart failure often has an ejection fraction less than 40%.3

Exercise Test
A 6-minute walk test or other exercise test shows how quickly you:

  • Develop symptoms
  • Reach your exercise limit

In a heart (or cardiac) catheterization, is when one or more catheters are inserted into a blood vessel in your leg, with X-ray guidance. Catheterization can help determine the:

  • Extent of coronary artery disease
  • Amount of blood flowing through your blood vessels and heart

Electrophysiology (EP) Study An electrophysiology (EP) study can show if you are at higher risk for sudden death. The test involves checking how electrical impulses travel through the heart muscle.


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How is heart failure treated?
Early diagnosis and treatment of heart failure are very important. Heart failure cannot be cured, but many treatment options exist. Treatment may help to:

  • Allow you to live a more normal life
  • Reduce symptoms
  • Reduce your need for hospitalization
  • Reduce the risk of death
  • Prevent the disease from progressing

The different categories of heart failure therapy include:

  • Lifestyle changes
  • Medications
  • Implantable devices
  • Surgeries

Cardiac resynchronization therapy (CRT) is one treatment option for some heart failure patients. A CRT device helps a heart failure heart (“cardiac”) beat more like a normal heart (“resynchronization”) using electrical pulses timed together (“therapy”).

As is true for all types of therapy, the choice of heart failure therapy – and its effects – can vary from one person to another. Talk to your doctor about which treatment options may be right for you.

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Success Stories

Image of Patient Bud LillyWhat is it like to have to live with heart failure?
Bud Lilly shares his life with heart failure.



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Note: Individual symptoms, situations, and circumstances may vary. Please consult your physician or qualified healthcare provider regarding your condition and appropriate medical treatment. The information provided is not intended to be used for medical diagnosis or treatment, or as a substitute for professional medical advice.

1. Congestive Heart Failure: Major World Markets, Devices (Pacemakers, ICD, LVAD and Artificial Heart Markets). Kalorama Information. 2008.
2. AHA. Heart and Stroke Statistics - 2010 Update, American Heart Association
3. Lloyd-Jones DM. The risk of congestive heart failure: sobering lessons from the Framingham Heart Study. Current Cardiol Rep. 2001;3:184-190.

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