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Congestive heart failure

Overview of congestive heart failure

Congestive heart failure (CHF) describes a condition in which your heart’s ability to pump blood gradually declines. Heart failure occurs over time and can cause fatigue and breathlessness.

Patients with cardiovascular conditions can trust high quality care and humankindness at Dignity Health. Find a doctor to learn more about our services for congestive heart failure.


The signs and symptoms of congestive heart failure vary somewhat from person to person. In general, people with congestive heart failure experience:

  • Shortness of breath with physical exertion (that goes away when you rest)
  • Fatigue
  • Increased urge to urinate, especially at night
  • Weakness
  • Weight gain
  • Feeling like you sleep better if you prop yourself up on a few pillows
  • Chest pain or congestion

If heart failure progresses, you may eventually start to notice more symptoms, such as:

  • An irregular heartbeat (arrhythmia)
  • A wet-sounding cough
  • Wheezing or panting
  • Swelling of the feet or legs
  • Shortness of breath at rest
  • Fainting
  • Cyanosis (blue skin)


Heart failure can be caused by any condition that reduces the pumping power or efficiency of your heart muscle. Over time, heart failure causes fluid to build up around the heart. This stage of heart failure is called congestive heart failure (or CHF).

The heart is one of the most powerful muscles in the body. It is made up of four chambers: two atria in the upper half, and two ventricles in the lower half. The ventricles are responsible for pumping oxygen-rich blood to your body’s organs and tissues, while the atria receive blood that has already circulated.

Heart failure primarily develops when the ventricles can no longer function properly, causing blood and fluid to back up in your lungs, abdomen, liver, and lower body.

Issues with the ventricles are typically caused by overworking or damaging the heart muscle, which makes it weak and unable to pump blood effectively. Heart failure can be caused by a heart attack, and it often occurs due to untreated heart disease. A few common causes of congestive heart failure include:

  • Hypertension (high blood pressure)
  • Heart valve disorders
  • Coronary artery disease (hardening of the arteries)
  • Arrhythmias
  • Substance abuse, including the use of anabolic steroids
  • Smoking
  • Obesity
  • Untreated anemia


Congestive heart failure can be described based on its severity (or stage) and the specific chamber of the heart affected.

When the atrium and ventricle on the left side of the heart are affected, there are two potential types of heart failure: systolic or diastolic.

  • Systolic heart failurerefers to the failure of the left ventricle to contract (squeeze) normally, reducing the heart muscle’s power to force blood into circulation.
  • Diastolic failure, or diastolic dysfunction, refers to the inability of the ventricle to fill with blood. This can happen if the muscle in the left ventricle becomes stiff and can’t relax enough to fill the heart with blood between each heartbeat.

Issues with the right side of your heart are less common, but occur when the right ventricle cannot pump blood to your lungs, causing blood to back up in your blood vessels, lower extremities, abdomen, and other vital organs.

Heart failure typically begins in the left side of the heart and then moves to affect the right side if not treated.

Once heart failure begins, it is also classified by severity, into four classes:

  • Class 1: Early-stage heart failure may not show any symptoms, and activity level may be normal.
  • Class 2: Class 2 heart failure may cause some symptoms to begin during an activity such as physical exercise.
  • Class 3: Once heart failure reaches Class 3, it will cause significant discomfort during activity, including mild activities such as standing and walking for short distances.
  • Class 4: Class 4 heart failure causes significant disability. Symptoms such as shortness of breath, weakness, and fatigue are present even at rest, and even minor physical activity is challenging. People with Class 4 heart failure are typically bedridden.

Class 1 and 2 heart failure can often be managed with medications and lifestyle changes such as diet and exercise.

Class 3 and 4 treatment can be complicated, and it may not be possible to reverse or adequately treat symptoms of this degree of heart failure without a heart transplant.

Risk factors

Heart failure may be the result of another health condition influencing your heart’s ability to pump blood effectively. Annual checkups can help lower your risk for heart problems, including high blood pressure (hypertension), coronary artery disease, and valve conditions, which are some of the most common causes of heart failure.

Because heart failure cannot typically be reversed, regular examination is also vital in identifying symptoms early, before the condition can progress.

Common risk factors include:

  • Hypertension (high blood pressure).
  • Coronary artery disease and blocked arteries, which can reduce blood flow to the heart.
  • Valve conditions, including infections, disorders, and congenital disabilities. If your valves do not open and close properly, your heart will be less efficient at regulating the flow of blood and may not pump effectively.
  • Diabetes.
  • Thyroid disorders.
  • Obesity.
  • Severe infections.
  • Severe allergic reactions.
  • Age (heart failure becomes more likely with age).
  • Gender (men are at higher risk on average than women).
  • High-stress occupations or history of anxiety.


To reduce your risk of congestive heart failure, you should live a heart-healthy lifestyle by eating healthy, unprocessed foods, limiting sodium intake, getting plenty of exercise, not smoking or stopping smoking, and not taking illicit drugs. As little as one hour of exercise per week can substantially reduce the risk of heart failure.

You should also treat any underlying heart conditions, such as hypertension or high cholesterol.

The information contained in this article is meant for educational purposes only and should not replace advice from your healthcare provider.