Also Known As
Heart Failure
CHF
This article was last reviewed on
This article waslast modified on October 10, 2017.
What is congestive heart failure?

Congestive heart failure (CHF), also called heart failure, is a condition in which the heart can no longer pump blood as efficiently as it used to. This causes blood and other fluids to back up in the body – particularly in the liver, lungs, hands, and feet.

The heart has two sides and four chambers. The right side of the heart receives oxygen-depleted blood from the body and sends it to the lungs. The left side of the heart receives oxygen-rich blood from the lungs and pumps it out to the body.

CHF is a serious, progressive condition that is usually chronic and can be life-threatening. It may affect the right side, left side, or both sides of the heart. In people with CHF, reduced amounts of oxygen and nutrients are delivered to the body's organs, which can cause damage and loss of function.

There are a number of different causes for CHF. Most often, the heart has been damaged, either by high blood pressure (hypertension), previous heart attacks, or direct damage to the heart muscle (termed cardiomyopathy). CHF can also occur when there is damage to the valves within the heart or with scarring in the pericardium, the membrane surrounding the heart. Rarely, CHF occurs when the heart is forced to beat more forcefully than normal, as in severe hyperthyroidism, and cannot keep up with the demand. The risk of CHF is increased in those who are overweight, have diabetes, smoke, or who abuse alcohol or cocaine.

CHF is common in the elderly as the heart becomes less efficient with age. The National Heart, Lung and Blood Institute estimates that about 5.7 million people in the United States have heart failure. For people over the age of 65, it is one of the most common causes of hospitalization.

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About Congestive Heart Failure
  • Signs and Symptoms

    If blood backs up from the right side of the heart, symptoms of CHF typically start with swelling of the legs and ankles that gets worse when the person stands and improves when the person lies down. If blood backs up from the left side of the heart into the lungs, it can cause shortness of breath and coughing, especially during exercise (such as walking up stairs) or when lying down flat in bed. Many people with heart failure have symptoms related to blood backing up on both the right and left sides of the heart.

    In addition to swelling (edema) and shortness of breath, symptoms can include:

    • Heart palpitation or rapid pulse
    • Weakness and fatigue
    • Decreased stamina, inability or reduced ability to perform physical exercise
    • Coughing or wheezing
    • Sudden weight gain
    • Loss of appetite
    • Nausea
  • Tests

    An initial evaluation for congestive heart failure (CHF) may include:

    • A medical history, including an evaluation of risk factors such as age, family history, coronary artery disease (CAD), diabetes, and high blood pressure
    • A physical examination—a healthcare practitioner may listen to the heart and lungs with a stethoscope to detect fluid buildup and look for swelling of the hands, feet, and legs.

    Additionally, a combination of laboratory and non-laboratory tests may be used to assess CHF.

    Laboratory tests that may be ordered include:

    There are two relatively new tests that may be used for people diagnosed with heart failure to help predict the course of the disease (prognosis). Galectin-3 and ST2 are tests that measure the levels of these proteins in blood. Elevated levels of these biomarkers may be used to indicate if a person with heart failure is at increased risk for complications and needs more aggressive treatment.

    Non-laboratory tests may include:

    • An electrocardiogram (ECG or EKG)—a test that looks at the heart's electrical activity and rhythm
    • Chest X-ray—may show whether the heart is enlarged or if fluid is present in the lungs


    Based on the findings of these tests, other procedures may be necessary, including:

    • An exercise stress test
    • Nuclear heart scan—a radioactive compound is injected into the blood to evaluate blood flow and show images of narrowed blood vessels around the heart.
    • Echocardiography—ultrasound imaging of the heart
    • Cardiac catheterization—in this procedure, a thin flexible tube is inserted into an artery in the leg and threaded up to the heart; it allows the physician to evaluate pressure and blood flow within the chambers of the heart.
    • Coronary angiography—this test is performed during cardiac catheterization; X-rays of the coronary arteries, which supply blood to the heart, are taken after injecting a radiopaque dye to help diagnose coronary artery disease.


    For more information on these, visit the National Heart, Lung and Blood Institute: How is Heart Failure Diagnosed?

  • Treatment

    CHF is usually a progressive disease. Treatment is aimed at stabilizing the condition and treating the symptoms. This usually includes controlling salt intake, limiting water retention, and eliminating smoking and alcohol. Regulating these external problems will also help control blood pressure – a primary concern in heart diseases.

    A healthcare practitioner will treat any underlying causes of a person's CHF and monitor the affected person closely. It is important to monitor weight gain as this can be an indication of fluid retention.

    For more information on treatment measures, including medications, surgical procedures, and devices as well as prevention and prognosis, see the following web resources:

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Heart Disease
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Elsewhere On The Web

Heart Rhythm Society: Patient Resources
American Heart Association: What is heart failure?
Mayo Clinic: Heart Failure
View Sources

NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used. To access online sources, copy and paste the URL into your browser.

Sources Used in Current Review

(2015 November 6 Updated). What Is Heart Failure? National Heart, Lung, and Blood Institute [On-line information]. Available online at http://www.nhlbi.nih.gov/health/health-topics/topics/hf. Accessed March 2016.

Dumitru, I. and Baker, M. (2016 Jan 11 Updated). Heart Failure. Medscape Drugs and Diseases [On-line information]. Available online at http://emedicine.medscape.com/article/163062-overview. Accessed March 2016.

Friedman, E. (2015 April 1). Diuretics and Heart Failure. Medscape Drugs and Diseases [On-line information]. Available online at http://emedicine.medscape.com/article/2145340-overview. Accessed March 2016.

Editorial staff (2014 March Updated). Heart Failure. Familydoctor.org [On-line information]. Available online at http://familydoctor.org/familydoctor/en/diseases-conditions/heart-failure.printerview.all.html. Accessed March 2016.

Mayo Clinic Staff (2015 August 18 Updated). Mayo Clinic [On-line information]. Available online at http://www.mayoclinic.org/diseases-conditions/heart-failure/basics/definition/CON-20029801?p=1. Accessed March 2016.

Satou, G. and Halnon, N. (2015 May 3 Updated). Pediatric Congestive Heart Failure. Medscape Drugs and Diseases [On-line information]. Available online at http://emedicine.medscape.com/article/2069746-overview. Accessed March 2016.

Genzen, J. et. al. (2015 November Updated). Heart Failure. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/HeartFailure.html?client_ID=LTD. Accessed March 2016.

(February 2013) Heart Failure: Diagnosis, Definition, and Risk Stratification. Mayo Medical Laboratories. Available online at http://www.mayomedicallaboratories.com/articles/features/heart-failure/index.php. Accessed March 2016.

Grandin W, et al. Galectin-3 and the Development of Heart Failure after Acute Coronary Syndrome: Pilot Experience from PROVE IT-TIMI 22. Clinical Chemistry January 2012 vol. 58 no. 1 267-273. Available online at http://www.clinchem.org/content/58/1/267.full. Accessed March 2016.

Dieplinger B, et al. Increased Soluble ST2 Predicts Long-term Mortality in Patients with Stable Coronary Artery Disease: Results from the Ludwigshafen Risk and Cardiovascular Health Study. Clinical Chemistry March 2014 vol. 60 no. 3 530-540. Available online at http://www.clinchem.org/content/60/3/530.long. Accessed March 2016.

Sources Used in Previous Reviews

Clinical Chemistry: Principles, Procedures, Correlations. Bishop M, Duben-Engelkirk J, Fody E, eds. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2000.

Clinical Chemistry: Theory, Analysis, and Correlations. Kaplan L, Pesce A, eds. 2nd ed. St. Louis: The C. V. Mosby Company; 1989.

MedlinePlus Medical Encyclopedia. Heart Failure. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000158.htm. Accessed October 2008.

eMedicineHealth.com. Congestive Heart Failure. Available online at http://www.emedicinehealth.com/congestive_heart_failure/page5_em.htm#Exams%20and%20Tests. Accessed October 2008.

MayoClinic.com. Heart failure: Symptoms. Available online at http://www.mayoclinic.com/health/heart-failure/DS00061/DSECTION=symptoms.

(Updated 2012 January 9). What Is Heart Failure? National Heart Lung and Blood Institute [On-line information]. Available online at http://www.nhlbi.nih.gov/health/health-topics/topics/hf/. Accessed April 2012.

(Updated 2012 March 29). About Heart Failure. American Heart Association [On-line information]. Available online at http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/About-Heart-Failure_UCM_002044_Article.jsp. Accessed April 2012.

Dumitru, I. and Baker, M. (Updated 2012 February 7). Heart Failure. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/163062-overview. Accessed April 2012.

Schreiber, D. and Nix, D. (Updated 2012 January 10). Natriuretic Peptides. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/761722-overview. Accessed April 2012.

(2011 November 16). Heart Failure. JAMA Patient Page V 306 (19) [On-line information]. Available online at http://jama.ama-assn.org/content/306/19/2175.full.pdf. Accessed April 2012. 

Mayo Clinic staff (2011 December 23) Heart failure [On-line information]. Available online at http://www.mayoclinic.com/print/heart-failure/DS00061/DSECTION=all&METHOD=print. Accessed April 2012.

Jugdutt, B. (2010 July 22). Cardiovascular Therapy, Heart Failure in the Elderly: Advances and Challenges. Medscape Today News from Cardiovasc Ther. V (5):695-715 [On-line information]. Available online at http://www.medscape.com/viewarticle/723852. Accessed April 2012.

George Blakney Ph.D , FCACB. Clinical Chemist. Royal Alexandra Hospital, Edmonton, Alberta, Canada.

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