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(Congestive) Heart Failure

Many people mistakenly believe that heart failure means that the heart has stopped or is about to stop. According to the Center for Heart Failure and the Heart Failure Society of America, heart failure (or congestive heart failure) simply means that the heart is not pumping blood through the body as well as it should.


Symptoms of heart failure can sometimes be hard to identify. They can include difficulty breathing, fatigue, and—in more severe cases—congestion in the lungs and swelling of the legs and feet. That is why heart failure is sometimes called congestive heart failure.

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What causes heart failure?

Heart failure often occurs when another problem or disorder makes the heart weak or stiff so it doesn't pump or relax normally. The most common cause of heart failure is a heart attack.  Other causes of heart failure include:

  • High blood pressure (hypertension)
  • Thyroid disease
  • Heart valve disease
  • Alcohol use
  • Myocarditis (infection of the heart muscle)
  • Idiopathic dilated cardiomyopathy (the heart muscle functions poorly, but the exact cause is not known)
The heart squeezes (contracts) and then relaxes with each heartbeat. When the heart does not squeeze well, this is called systolic dysfunction. When the heart is stiff and does not relax well, this is called diastolic dysfunction. Patients can have systolic dysfunction, diastolic dysfunction or both.
One way to measure the heart’s ability to contract is by checking its ejection fraction. The ejection fraction is the percentage of blood the heart squeezes out in one beat. A normal ejection fraction is between 50 and 70 percent. A low ejection fraction is often less than 35-40 percent.

What Are The Symptoms of Heart Failure?

Common symptoms of heart failure include:
  • Difficulty breathing
  • Cough
  • Loss of energy, or fatigue
  • Rapid weight gain from fluid retention
  • Swelling of the legs and feet
  • Loss of appetite
  • Bloating (swelling) in the abdomen
  • Difficulty sleeping 

What is the Staging System and How Does It Work?

The American College of Cardiology and the American Heart Association developed a staging system to identify patients during the course of their heart disease. The staging system includes specific treatments targeted to each stage, which can improve symptoms and chances of survival from heart failure. Understanding the staging system can help you have a meaningful conversation with your health care provider as you plan your care.
  • Stage A: You may have heart failure risk factors including high blood pressure, coronary disease, diabetes, drug or alcohol abuse, or a family history of cardiomyopathy. Even if you have no active heart disease or symptoms, you have some risk—and you may be able to take action to ward off more serious heart disease or heart failure.
  • Stage B: You may have heart disease of some kind, including a structural disorder of the heart, which is not yet causing symptoms. You may be able to identify actions that will reduce your risk of developing symptoms. 
  • Stage C: You have heart disease, with some prior or current heart failure symptoms. At this stage, you can work with your health care provider to control symptoms.
  • Stage D: You have advanced heart disease (also known as end-stage heart failure), with symptoms that are still active despite medical therapy. You may be eligible for advanced procedures like ventricular assist devices or heart transplantation. 
Doctors classify the severity of patients with heart failure in Stage C or D according to how severe their symptoms are. The most common classification system, the New York Heart Association (NYHA) Functional Classification, places patients in one of four categories based on how much they are limited by their heart failure symptoms during physical activity.
  • Class I: No symptoms and no limitation of ordinary physical activity.
  • Class II: Mild symptoms and slight limitation during ordinary activity. Patients are comfortable at rest.
  • Class III: Marked limitation in activity due to symptoms, even during less-than-ordinary activity. Patients are only comfortable at rest.
  • Class IV: Severe limitations. Patients experience symptoms even while at rest. 

Contact Us Today

For more information regarding heart failure or to obtain a consultation, please contact the Bluhm Cardiovascular Institute at 1-866-662-8467 or request a first time appointment online.

Clinical Trials

For more information regarding clinical trials related to heart failure, please visit the Clinical Trials Unit of Northwestern, send an email or call 312-926-4000.
Last UpdateNovember 18, 2013