Heart failure

Heart failure
SynonymsChronic heart failure (CHF), congestive cardiac failure (CCF)[1][2][3]
The major signs and symptoms of heart failure
SymptomsShortness of breath, feeling tired, leg swelling[4]
DurationUsually lifelong
CausesHeart attack, high blood pressure, abnormal heart rhythm, excessive alcohol use, infection, heart damage[4][5]
Risk factorsSmoking, sedentary lifestyle
Diagnostic methodEchocardiogram[6]
Differential diagnosisKidney failure, thyroid disease, liver disease, anemia, obesity[7]
MedicationDiuretics, cardiac medications[6][8]
Frequency40 million (2015),[9] 2% of adults (developed countries)[5][10]
Deaths35% risk of death in first year[4]

Heart failure (HF), also known as chronic heart failure (CHF), is when the heart is unable to pump sufficiently to maintain blood flow to meet the body's needs.[11][12][13] Signs and symptoms of heart failure commonly include shortness of breath, excessive tiredness, and leg swelling.[4] The shortness of breath is usually worse with exercise, while lying down, and may wake the person at night.[4] A limited ability to exercise is also a common feature.[14] Chest pain, including angina, does not typically occur due to heart failure.[15]

Common causes of heart failure include coronary artery disease including a previous myocardial infarction (heart attack), high blood pressure, atrial fibrillation, valvular heart disease, excess alcohol use, infection, and cardiomyopathy of an unknown cause.[4][5] These cause heart failure by changing either the structure or the functioning of the heart.[4] The two types of heart failure - heart failure with reduced ejection fraction (HFrEF), and heart failure with preserved ejection fraction (HFpEF) - are based on whether the ability of the left ventricle to contract is affected, or the heart's ability to relax.[4] The severity of disease is graded by the severity of symptoms with exercise.[7] Heart failure is not the same as myocardial infarction (in which part of the heart muscle dies) or cardiac arrest (in which blood flow stops altogether).[16][17] Other diseases that may have symptoms similar to heart failure include obesity, kidney failure, liver problems, anemia, and thyroid disease.[7] Heart failure is diagnosed based on the history of the symptoms and a physical examination, with confirmation by echocardiography.[6] Blood tests, electrocardiography, and chest radiography may be useful to determine the underlying cause.[6]

Treatment depends on the severity and cause of the disease.[6] In people with chronic stable mild heart failure, treatment commonly consists of lifestyle modifications such as stopping smoking,[8] physical exercise,[18] and dietary changes, as well as medications.[8] 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.[19][6] For those with severe disease, aldosterone antagonists, or hydralazine with a nitrate may be used.[6] Diuretics are useful for preventing fluid retention and the resulting shortness of breath.[8] Sometimes, depending on the cause, an implanted device such as a pacemaker or an implantable cardiac defibrillator (ICD) may be recommended.[6] In some moderate or severe cases, cardiac resynchronization therapy (CRT)[20] or cardiac contractility modulation may be of benefit.[21] A ventricular assist device or occasionally a heart transplant may be recommended in those with severe disease that persists despite all other measures.[8]

Heart failure is a common, costly, and potentially fatal condition.[5] In 2015 it affected about 40 million people globally.[9] Overall around 2% of adults have heart failure[22] and in those over the age of 65, this increases to 6–10%.[5][10] Rates are predicted to increase.[22] 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.[14]


Heart failure is a pathophysiological state in which cardiac output is insufficient to meet the needs of the body and lungs.[4] The term "congestive heart failure" is often used, as one of the common symptoms is congestion, or build-up of fluid in a person's tissues and veins in the lungs or other parts of the body.[4] Specifically, congestion takes the form of water retention and swelling (edema), both as peripheral edema (causing swollen limbs and feet) and as pulmonary edema (causing breathing difficulty), as well as ascites (swollen abdomen). This is a common problem in old age as a result of cardiovascular disease, but it can happen at any age, even in fetuses.

The term "acute" is used to mean rapid onset, and "chronic" refers to long duration. Chronic heart failure is a long-term condition, usually kept stable by the treatment of symptoms. Acute decompensated heart failure is a worsening of chronic heart failure symptoms which can result in acute respiratory distress.[23] High-output heart failure can occur when there is an increased cardiac output. The circulatory overload caused, can result in an increased left ventricular diastolic pressure which can develop into pulmonary congestion (pulmonary edema).[24]

Heart failure is divided into two types based on ejection fraction, which is the proportion of blood pumped out of the heart during a single contraction.[25] Ejection fraction is given as a percentage with the normal range being between 50 and 75%.[25] The two types are:

1) Heart failure due to reduced ejection fraction (HFrEF). Synonyms no longer recommended are "heart failure due to left ventricular systolic dysfunction" and "systolic heart failure". HFrEFe is associated with an ejection fraction of less than 40%.[26]

2) Heart failure with preserved ejection fraction (HFpEF). Synonyms no longer recommended include "diastolic heart failure" and "heart failure with normal ejection fraction".[4][18] HFpEF occurs when the left ventricle contracts normally during systole, but the ventricle is stiff and does not relax normally during diastole, which impairs filling.[4]

Other Languages
Afrikaans: Hartversaking
العربية: قصور القلب
беларуская (тарашкевіца)‎: Сардэчная недастатковасьць
bosanski: Zatajenje srca
ދިވެހިބަސް: ހިތް ފޭލްވުން
Esperanto: Kora malsufiĉo
한국어: 심부전
Bahasa Indonesia: Gagal jantung
македонски: Срцева слабост
Bahasa Melayu: Kegagalan jantung
Nederlands: Hartfalen
日本語: 心不全
norsk nynorsk: Hjartesvikt
ଓଡ଼ିଆ: ହୃଦ୍‌ପାତ
Plattdüütsch: Hartslappde
Simple English: Heart failure
slovenčina: Srdcové zlyhanie
slovenščina: Srčno popuščanje
српски / srpski: Zatajenje srca
srpskohrvatski / српскохрватски: Zatajenje srca
svenska: Hjärtsvikt
Tiếng Việt: Suy tim
中文: 心臟衰竭