Heart failure

Heart failure (HF), also known as congestive heart failure (CHF) and (congestive cardiac failure) (CCF), is a complex syndrome of a group of signs and symptoms that commonly include shortness of breath, excessive tiredness, and leg swelling. It may cause shortness of breath when exercising or while lying down, and may wake a person up at night.[4][12][13] Notably, chest pain including angina is not typically caused by heart failure, but can occur if the heart failure is caused by a heart attack.[14][15] The severity of the heart failure is measured by the severity of symptoms with exercise.[8] Other diseases that may have symptoms similar to heart failure include obesity, kidney failure, liver problems, anemia, and thyroid disease.[8]

Heart failure
Other namesCongestive heart failure (CHF), congestive cardiac failure (CCF)[1][2]
A man with congestive heart failure and marked jugular venous distension. External jugular vein marked by an arrow.
SymptomsShortness of breath, feeling tired, leg swelling[3][4]
DurationUsually lifelong
CausesHeart attack, high blood pressure, abnormal heart rhythm, excessive alcohol use, infection, heart damage[4][5]
Risk factorsSmoking, sedentary lifestyle, exposure to second-hand smoke[6]
Diagnostic methodEchocardiogram[7]
Differential diagnosisKidney failure, thyroid disease, liver disease, anemia, obesity[8]
MedicationDiuretics, cardiac medications[7][9]
Frequency40 million (2015),[10] 1–2% of adults (developed countries)[5][11]
Deaths35% risk of death in first year[4]

Common causes of heart failure include coronary artery disease, heart attack, high blood pressure, atrial fibrillation, valvular heart disease, excessive alcohol use, infection, and cardiomyopathy.[4][5] These cause heart failure by changing either the structure or the function of the heart, or both.[16][17][18][4] There are different types of heart failure: right-sided heart failure that affects the right heart, left-sided heart failure that affects the left heart, and biventricular failure that affects both sides of the heart.[19] Left-sided heart failure can occur with reduced ejection fraction or with a preserved ejection fraction.[4] Heart failure is not the same as cardiac arrest in which blood flow stops altogether due to failure of the heart to pump effectively.[20][21]

Diagnosis is based on symptoms, physical findings, and echocardiography. Blood tests, and chest radiography may be useful to determine the underlying cause.[7]

Treatment depends on the severity and cause.[7] In people with chronic stable mild heart failure, treatment commonly consists of lifestyle changes such as stopping smoking, physical exercise, and dietary changes, as well as medication.[9][22] In those with heart failure due to left ventricular dysfunction, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, or valsartan/sacubitril along with beta blockers are recommended.[7][23] For those with severe disease, aldosterone antagonists, or hydralazine with a nitrate may be used.[7] Diuretics may also be prescribed to prevent fluid retention and its resulting shortness of breath.[9] Sometimes, depending on the cause, an implanted device such as a pacemaker or an implantable cardiac defibrillator may be recommended.[7] In some moderate or severe cases, cardiac resynchronization therapy (CRT)[24] or cardiac contractility modulation may be of benefit.[25] A ventricular assist device (for the left, right, or both ventricles), or occasionally a heart transplant may be recommended in those with severe disease that persists despite all other measures.[9]

Heart failure is a common, costly, and potentially fatal condition,[26] and it is the leading cause of both hospitalization and readmission amongst older adults.[27][28] Heart failure often results in more drastic detrimental health effects compared to failure of other similarly complex organs such as the kidneys or liver.[29] In 2015, it affected about 40 million people globally.[10] Overall around 2% of adults have heart failure[26] and in those over the age of 65, this increases to 6–10%.[5][30] Rates are predicted to increase.[26] The risk of death is about 35% the first year after diagnosis, while by the second year the risk of death is less than 10% for those who remain alive.[4] This degree of risk of death is similar to some cancers.[4] In the United Kingdom, the disease is the reason for 5% of emergency hospital admissions.[4] Heart failure has been known since ancient times, with the Ebers papyrus commenting on it around 1550 BCE.[12]

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