Heart Failure
Heart failure is a condition where the heart can’t pump blood as well as it should. When the heart doesn’t pump effectively, the body may not receive enough oxygen-rich blood to meet its needs.
Heart failure doesn’t mean the heart has stopped. It means the heart muscle has become weaker or stiffer. As a result, fluid can build up in the lungs, legs, or abdomen. Heart failure is common, especially in older adults, and it requires ongoing care to help you feel your best and prevent complications.
Symptoms
Symptoms can vary depending on the severity of the condition and which side of the heart is affected. Some people notice mild changes at first. Others develop symptoms more quickly.
Common symptoms include:
Shortness of breath during activity or when lying flat
Swelling in the feet, ankles, legs, or abdomen
Rapid weight gain from fluid buildup
Fatigue or low energy
Persistent cough or wheezing, sometimes with white or pink-tinged mucus
Increased need to urinate at night
Reduced ability to exercise
Call 9-1-1 right away if you have:
Severe shortness of breath that makes it hard to speak
Chest pain or pressure
Fainting or sudden confusion
These symptoms may signal a medical emergency.
Causes & Risk Factors
Heart failure develops when the heart cannot pump enough blood to meet the body’s needs. Some conditions directly damage or strain the heart. Other factors can increase the likelihood of heart failure.
Causes
Heart failure develops when the heart muscle becomes too weak or too stiff to pump blood effectively.
Common direct causes include:
Coronary artery disease: Narrowed heart arteries reduce blood flow to the heart muscle.
Heart attack: Damage from a heart attack can weaken part of the heart muscle.
Long-standing high blood pressure: The heart works harder to push blood against high pressure. The muscle may thicken or weaken.
Heart valve disease: Leaky or narrowed valves force the heart to work harder.
Cardiomyopathy: Diseases of the heart muscle can reduce pumping strength.
Certain infections or toxins: These can damage heart muscle cells.
In some people, the heart becomes stiff rather than weak. The heart may pump normally, but doesn’t relax well between beats, limiting filling.
Risk Factors
Some factors increase the chance of developing heart failure.
Modifiable risk factors
High blood pressure
Coronary artery disease
Diabetes
Smoking
Obesity
Physical inactivity
Excess alcohol use
Non-modifiable risk factors
Older age
Family history of heart disease
Prior heart attack
Certain inherited heart conditions
Heart failure is more common in some communities, including Black adults in the United States. Differences in access to care, blood pressure control, and other health conditions contribute to these patterns.
Diagnosis
Clinicians diagnose heart failure based on symptoms, a physical exam, and testing.
Common tests include:
Blood tests: These check kidney function and measure natriuretic peptides (BNP or NT-proBNP). These hormones rise when the heart is under stress.
Chest X-ray: Shows heart size and signs of fluid in the lungs.
Electrocardiogram (ECG): Records the heart’s electrical activity.
Echocardiogram: An ultrasound of the heart. It shows how well the heart pumps and whether the valves work properly.
An echocardiogram helps measure ejection fraction, which estimates how much blood the heart pumps with each beat. Some people have reduced ejection fraction. Others have preserved ejection fraction but still have symptoms.
Diagnosis usually involves more than one test. Your clinician will also review your medical history and risk factors.
Treatment
The goals of treatment are to relieve symptoms, reduce fluid buildup, slow disease progression, and lower the risk of hospitalization. Treatment plans are individualized. Not every person needs every therapy.
Lifestyle Changes
Lifestyle steps support heart function and reduce strain on the heart.
Limiting sodium to help reduce fluid retention
Monitoring daily weight to detect fluid changes early
Staying physically active with a safe, guided plan
Quitting smoking
Limiting alcohol
Managing stress
Keeping blood pressure, cholesterol, and diabetes under control
Your clinician may recommend tracking symptoms and weight at home.
Medications
Medications are a key part of treatment. Many people take more than one medication. Medications are often started at low doses. Your clinician may slowly increase the dose to reach the amount that works best for you.
Common types include:
ACE inhibitors, ARBs, or ARNI medications to relax blood vessels
Beta blockers to slow the heart rate and reduce workload
Mineralocorticoid receptor antagonists to block certain hormones
SGLT2 inhibitors, which can improve heart outcomes in many patients
Diuretics, often called “water pills,” to reduce fluid buildup
If you also have atrial fibrillation or other rhythm problems, you may need additional medications. Some people require blood thinners to reduce the risk of blood clots, depending on their heart rhythm and other factors.
Medication plans depend on heart function, kidney health, blood pressure, and other conditions. Your clinician will adjust doses carefully.
Procedures
Some people benefit from device-based or surgical treatments.
These may include:
Implantable cardioverter-defibrillator (ICD) to treat dangerous heart rhythms
Cardiac resynchronization therapy (CRT) to improve coordinated heart pumping
Valve repair or replacement
Coronary artery procedures to improve blood flow
Advanced therapies such as left ventricular assist devices (LVAD) or heart transplant in severe cases
These treatments are used in selected patients based on specific findings.
Living With/Prevention
Heart failure is a chronic condition. Many people live full lives with proper care and monitoring.
Regular follow-up visits help track symptoms, adjust medications, and monitor kidney function and electrolytes. Let your clinician know if you notice sudden weight gain, swelling, or increased shortness of breath.
You can lower your risk of developing heart failure by:
Controlling high blood pressure
Managing diabetes
Treating coronary artery disease
Staying physically active
Maintaining a healthy weight
Avoiding tobacco
If you already have heart failure, staying engaged in your care can improve your quality of life and reduce hospital visits. Small, consistent steps can make a meaningful difference in how you feel each day.
Take steps to live well with heart failure
Find guidance on symptoms, medications, and lifestyle changes that support heart health.
References
Bozkurt B, Coats AJS, Tsutsui H, et al. Universal definition and classification of heart failure: A report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure. J Card Fail. 2021;27(4):387-413. doi:10.1016/j.cardfail.2021.01.022
Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79(17). doi:10.1016/j.jacc.2021.12.012
National Heart, Lung, and Blood Institute. Treatment. Heart failure. Accessed February 27, 2026.