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What Is Congestive Heart Failure, Exactly?


Even though congestive heart failure is a commonly used term, the details can get a bit confusing when you really dig into what it means. That’s because “congestive heart failure” isn’t a separate condition from “heart failure,” Dana Weisshaar, M.D., a cardiologist at Kaiser Permanente in Santa Clara, California, ​​tells SELF. Rather, the term is used to describe a type of heart failure that results in fluid retention, or congestion, throughout the body. Oftentimes, heart failure causes fluid buildup, which is responsible for many of its hallmark symptoms. And this can have serious consequences—90% of people who are hospitalized due to heart failure are admitted because of the symptoms resulting from congestion, research shows.

However, even though congestive heart failure is seen frequently, medical professionals do not use the term synonymously with any type of heart failure, Dipti Itchhaporia, M.D., program director of heart failure disease management at Hoag Memorial Hospital Presbyterian and president of the American College of Cardiology, tells SELF. In fact, most medical experts have moved away from using this differentiator at all. “It’s a little bit of an archaic term now. We just tend to use heart failure as the term.”

So, why is it important to understand these nuances of heart failure, anyway? For one, the condition is common. About 6.2 million adults in the U.S. have heart failure, according to the Centers for Disease Control and Prevention (CDC).

Still a bit iffy on what congestive heart failure means for your health? Ahead, SELF asked cardiologists to break down what to know about a diagnosis, from symptoms to congestive heart failure treatment.

What is congestive heart failure, and how is it different from other types of heart failure?

First, it’s helpful to understand what’s going on in the body when a person develops heart failure in general. Despite what the name implies, heart failure means that your heart can’t pump enough oxygen-rich blood to keep your body running as it should—not that the organ stopped working, according to the CDC. If your heart isn’t functioning properly, everyday tasks like walking up a few stairs can become difficult, especially if you feel short of breath.

When your heart struggles like this, it can affect your other organs too. “Many people with heart failure cannot eliminate fluids normally and hold onto volume rather than urinate out extra fluids,” Jennifer Haythe, M.D., associate professor of medicine and co-director of Columbia Women’s Heart Center, tells SELF. In this case, your kidneys don’t receive enough blood to filter extra fluid in your body into your urine, resulting in the “congestion” that characterizes congestive heart failure, according to the American Heart Association. This can happen suddenly (acute heart failure) or over time (chronic heart failure).

It’s important to note that not everyone with heart failure will develop fluid overload. “I prefer to make the distinction that not all heart failure is congestive,” Dr. Weisshaar says.

What are common congestive heart failure symptoms?

Congestive heart failure symptoms can overlap with those of other types of heart failure—but you might also have some specific signs that there’s extra fluid in your body.

According to the Mayo Clinic and the National Heart, Lung, and Blood Institute (NHLBI), some common heart failure symptoms include:

  • Feeling very fatigued and weak when doing everyday activities.
  • A rapid or irregular heart rate, even when you’re relaxing.
  • Nausea, to the point where you can lose your appetite.
  • Chest pain, or feeling tightness and heaviness in your chest.
  • Bluish lips or fingers, which happens when your blood is extremely low in oxygen.

University of Michigan experts say fluid buildup can lead to the following symptoms of congestive heart failure:

  • Being short of breath and winded during exercise or at rest because of the extra fluid in your lungs.
  • Coughing and wheezing for no apparent reason.
  • Swelling throughout your body, particularly in your ankles, feet, legs, and abdomen.
  • Rapid weight gain that cannot be explained otherwise. If you gain two pounds in a day or five pounds in a week, that is a potential sign heart failure is becoming worse, according to the AHA. It’s worth talking to your doctor anytime your weight experiences sudden fluctuations.

What are some congestive heart failure causes?

According to the Mayo Clinic and the NHLBI, the most common congestive heart failure causes include: 

  • High blood pressure, which describes how forcefully your blood pushes against the walls of your arteries. Chronically high blood pressure can cause heart damage.
  • Coronary artery disease, which happens when the arteries in your heart become narrow, restricting blood flow.
  • Heart attack, which develops when part of the heart’s muscle doesn’t receive enough blood. This often occurs suddenly and can permanently damage your heart.
  • Diabetes, which can damage your blood vessels and the nerves in your heart.
  • Endocarditis, which is when harmful pathogens like bacteria get into your blood and infect previously-damaged heart tissue.
  • Metabolic syndrome, which means you have several risk factors that increase your risk for heart disease. These include high blood pressure, a larger waistline, high blood sugar, high triglycerides (fat in your blood), and low HDL (“good”) cholesterol levels.
  • Heart valve disease, which is when at least one of your four valves doesn’t fully open or close.
  • Congenital heart defects, which is when parts of your heart don’t form properly. This generally happens before you’re born and makes your heart work harder.
  • Heartbeat irregularities, which means your heart beats too fast, too slow, or in an odd rhythm.

What are the stages of congestive heart failure?

The American College of Cardiology and the American Heart Association, classify heart failure using a four-stage system ranging from stages A through stage D.2 These apply to all types of heart failure, including congestive heart failure:

  • Stage A: In this stage, you simply have a variety of risk factors, such as hypertension (high blood pressure), diabetes, or a family history of heart disease,3 that increase your chances of developing heart failure. At this point, you don’t have heart failure yet.
  • Stage B: In this stage, your heart’s valves, walls, or chambers have become damaged from events like a prior heart attack, according to Mount Sinai, but you haven’t yet developed heart failure.
  • Stage C: Now, you’re starting to show signs of heart failure. For example, you may develop congestion and become short of breath easily.
  • Stage D: This is when heart failure becomes serious, so you could have symptoms even if you take congestive heart failure medication to treat your condition. People in this stage may need more advanced treatments, such as a heart transplant or a mechanical pump to assist the heart.

How do you get diagnosed with congestive heart failure?

If you’re experiencing any symptoms of heart failure, you should schedule an appointment with a cardiologist or a primary care doctor (the latter can refer you to a specialist if you need one). Your doctor should ask about your medical history to identify potential heart failure risk factors, such as diabetes or high blood pressure. You can expect to have a physical exam where your doctor listens to your heart and breathing and examines your neck vein, which can help your doctor identify congestion, according to Stanford Medicine.

Additionally, your doctor may recommend imaging, such as X-rays, to look for warning signs like areas of fluid buildup. If you have signs of congestion, like a swollen leg, shortness of breath, or bloated abdomen, you may be tested for a hormone called B-type natriuretic peptide, or BNP, according to the Cleveland Clinic.

Your BNP levels increase as your heart becomes stretched by fluid overload, Dr. Haythe says. BNP levels tend to rise as heart failure becomes worse and are lower when the condition is more stable. So, high BNP levels could be a sign of fluid retention resulting from heart failure.

What are some congestive heart failure treatments?

Your exact congestive heart failure treatment plan will vary depending on your stage of heart failure. With that in mind, your cardiologist will likely recommend a combination of lifestyle changes (we’ll dig into more of those below), such as exercising for at least 150 minutes per week, and taking prescription medications if necessary.

To relieve congestion specifically, doctors usually prescribe diuretics.4 These are sometimes called water pills because they help your body remove excess salt and water by making you urinate more frequently so fluid doesn’t build up, according to the Mayo Clinic. Taking diuretics can help your heart pump more effectively, while also relieving congestion symptoms, like labored breathing and leg and ankle swelling. Along with prescribing diuretics to help your body get rid of extra fluid, your doctor also may recommend a low-salt diet to prevent further fluid retention, Dr. Haythe says.

Is it possible to prevent congestive heart failure?

Because heart failure happens for many reasons (some of which are outside of your control), it’s not always possible to prevent it. But doing what you can to care for your overall health can go a long way in helping your heart run smoothly.

Here are some lifestyle habits that can help keep your heart healthy, according to the CDC:

  • Exercise: Aim to get 2 hours and 30 minutes of moderately intense physical activity per week, such as dancing, jogging, or kickboxing.
  • Determine your healthy weight: Higher amounts of body fat are associated with heart failure risk factors such as cardiovascular disease, diabetes, and high blood pressure. Talk to your doctor about what weight range may be the healthiest for you.
  • Stop smoking cigarettes: Give up tobacco products if you use them.
  • Pay attention to nutrition: Try focusing on foods found in the Mediterranean diet, for example, whole grains, fruits, vegetables, nuts, and lean proteins like fatty fish and lentils. A study of 25,000 people assigned female at birth found that those who followed the Mediterranean diet reduced their risk of having a cardiovascular event (such as heart disease) by 28%, according to a 2018 paper published in JAMA Network Open.
  • Limit your alcohol consumption: Drink alcohol in moderation, which equals no more than two drinks per day for people assigned male at birth and no more than one drink per day for people assigned female at birth.
  • Have a yearly check-up: See your doctor every year if you can to make sure your blood pressure, cholesterol, and blood sugar levels are in a healthy range.
  • Treat other medical conditions: Manage heart failure risk factors such as high cholesterol by following the treatment plan your doctor recommends.

Understanding heart failure in children

Most people who develop heart failure are adults, but children can develop heart failure too—though it’s rare. In fact, only about 1 in 100,000 children have heart failure. Kids typically develop heart failure because of congenital heart disease rather than medical conditions that occur over time. Dilated cardiomyopathy, which is when the heart becomes enlarged, the heart muscle becomes thin, or the heart becomes weak, is one of the most common causes of heart failure in children.

In other situations, children who are otherwise healthy may develop heart failure because of a condition called fulminant myocarditis, which can be brought on when a virus that might typically cause a cold or cough infects the heart and causes it to become weak. Often, cases of myocarditis among children are mild and many times someone might not even be aware they have myocarditis, Seth Hollander, M.D., a pediatric cardiologist and associate section chief of heart failure and transplantation at Stanford Children’s Health, explains. Children with preexisting heart problems—such as those who have had heart surgery in infancy or early childhood—can also experience heart failure. Most of these children regularly see a cardiologist, who should be able to pick up on signs of heart failure during a physical exam, patient history, or through performing tests.

When a child has heart failure, the symptoms can be less obvious than they are in adults, so it can be harder to recognize. “Children often present with very common and subtle symptoms like abdominal pain, decreased appetite, fatigue, and even irritability,” Dr. Hollander tells SELF. “This can pose a major challenge to parents and health care providers because the conditions that usually cause these symptoms are generally quite mild.”

Dr. Hollander recommends speaking with your child’s primary care doctor if they’re experiencing symptoms like unexplained weight loss or if they’re enduring weeks of fatigue or irritability without another obvious cause or explanation. From there, the doctor may refer your child to a pediatric cardiologist who will run tests to reach an official diagnosis.

What does a congestive heart failure prognosis look like?

Getting diagnosed with congestive heart failure doesn’t mean you can’t continue to do the things you enjoy. There are numerous congestive heart failure medications, and combining those with lifestyle changes can help you remain active and hopefully live a longer life. Managing other underlying health conditions if you have them, keeping up with regular appointments, and visiting your doctor if you develop new symptoms can all help get your heart back on track.

By: Self