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American Heart Association



National Heart, Lung, and Blood Institute

Heart Failure

The heart is the body’s pump. When it can’t pump well enough to meet the body’s needs, it is called heart failure (HF). The heart itself doesn’t fail, but “fails” to supply the body with enough blood and oxygen. The pumping action of the heart decreases. Blood flow slows down. This causes excess fluid (edema) in tissues throughout the body. The term congestive heart failure, used in the past, is due to the excess fluid or congestion. Heart failure needs a doctor’s diagnosis and care!

Signs &





& Self-Care



Image of man holding his chest in pain.

•  Shortness of breath.

•  Feeling very tired or weak.

•  Dry cough or a cough with pink, frothy mucus.

•  Swelling of the lower legs, ankles, and feet. Your shoes can suddenly feel too tight.

•  Decreased appetite and nausea.

•  Rapid weight gain over several days or weeks without an increase in food intake. You could gain up to 1 pound a day.

•  A fast heartbeat. Sometimes the heartbeat is irregular.

•  Feeling anxious or restless.

•  A feeling of suffocation. This is caused by fluid that collects in the lungs. It can be difficult to lie flat. You may need to sleep on 2 or more pillows. You may wake up suddenly from sleep feeling short of breath.

Anything that damages the heart muscle or makes it work too hard can cause heart failure. This includes:

•  One or more heart attacks. This is the number 1 cause.

•  Advanced coronary artery disease.

•  High blood pressure that is not controlled.

•  High blood pressure in the lungs (pulmonary hypertension).

•  Alcohol and/or drug abuse.

•  Severe or chronic lung disease (e.g., emphysema).

•  Diabetes, especially if it is poorly controlled.

•  Pericarditis. This is a swelling or thickening of the lining that surrounds the heart. This can restrict the heart’s pumping action.

•  Abnormal heart valves. Causes include rheumatic heart disease and heart defects present at birth.

•  Abnormal heart rhythm.

•  A viral infection. This is rare and happens only if the infection affects the heart and causes cardiomyopathy, a muscle disease of the heart.

Image of women sitting on ground, holding her chest in pain.

Ways to Diagnose Heart Failure:

•  A medical history and physical exam. Blood and urine tests.

•  A chest X-ray to see if the heart is enlarged and if the lungs are congested.

•  An ECG (also called EKG) to look for an enlarged heart, heart muscle damage, and abnormal heart rhythms.

•  An echocardiogram. This test uses sound waves to show the heart’s size, shape, and movement.

•  An exercise stress test.

•  A cardiac catheterization. This test diagnoses coronary artery disease and checks for past heart attacks.

Call Health Care Provider For:

•  A new onset of shortness of breath or fatigue when you do your normal activities or lie down.

•  A new onset of swelling in the ankles and feet and it is harder to breathe when you lie down flat.

•  Coughing up pink or frothy mucus with mild shortness of breath.

•  An unexplained weight gain of 3 to 5 pounds.

•  Having heart failure and you have symptoms of a cold or flu. These may add stress to your heart.

•  Having heart failure and your symptoms worsen.

Get Immediate Care For:

•  Severe shortness of breath (you are too short of breath to say a few words) with or without wheezing (a high pitched whistling sound).

•  Heart Attack Warning Signs

This website is not meant to substitute for expert medical advice or treatment. Follow your doctor’s or health care provider’s advice if it differs from what is given in this guide.


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