Heart failure (congestive): see symptoms and causes

According to a survey conducted by the Brazilian Society of Cardiology (SBC), every year in the country, about 50 thousand people die due to cardiac complications.

One of the most common diseases related to the heart is heart failure, a condition in which the heart cannot keep up with the workload required by the body.

Heart failure can be treated and cured when diagnosed early. It is also possible to reduce the risks of this disease with healthy lifestyle habits.


What is heart failure?

Heart failure is a disease that affects the heart muscle, making it difficult to work and causing the organ to fail to supply enough blood to the body .

This disease is common to occur in older people, in the third age, but any age group may be susceptible to having it. It can affect the left or right side of the chest.

Other diseases such as high blood pressure, cardiomyopathy, congenital heart disease, coronary heart disease, anemia , alcoholism can favor the change in the heart.

There are risk factors that cause the disease to manifest itself, such as diabetes , high blood pressure , heart attack, sleep apnea , obesity , alcohol and tobacco use and some medications.

The specialist who can diagnose and indicate the best treatment for her is the cardiologist. Among the general treatments are the practice of physical activity, blood pressure control, care for stress , use of medications and surgery in some cases.

Heart failure is curable when diagnosed early, but in case of advanced condition, unfortunately not, although there are treatments that can offer a good quality of life to the patient

When left untreated, it can lead to complications such as kidney damage and life-threatening.

In the International Statistical Classification of Diseases and Health-Related Problems (ICD-10) the disease can be found by the codes:

  • I50 – Heart failure;
  • I50.0 – Congestive heart failure;
  • l50.1 – Left ventricular failure;
  • I50.9 – Heart failure, unspecified


The heart works as a kind of muscle pump, which carries blood continuously to the rest of the body. The organ has four chambers, two on the right and two on the left.

Of these chambers, two are superior and are called atria, and the other two are called ventricles.

The atria on the right side drive blood from the rest of the body, which arrives deoxygenated, and sends it to the lungs through the right ventricle. There, the liquid receives oxygen to distribute to tissues and cells throughout the body. In oxygenated blood.

This blood, containing oxygen, goes from the lungs to the left atrium, passes through the left ventricle and then travels to the rest of the body.

For the heart to function properly, the four chambers need to beat in an organized and synchronized way.

When does heart failure occur?

In case of heart failure, the heart muscle is unable to pump blood to the body.

In the beginning, the heart will try to compensate for this lack of pumping in other ways, expanding, developing more muscle mass or trying to speed up the beats.

But these other forms do not solve the problem, so the first symptoms of heart failure start to appear, such as fatigue , breathing problems, among others.

When the heart does not have enough strength to pump blood to the body, it tries to compensate in other ways – by increasing the rate of beating and the effort or by retaining fluids to increase the amount of blood.

In this case, swelling also occurs, especially in the feet and legs.


Heart failure can occur on the left and right side of the chest, having different types. Are they:

Left-sided heart failure

It is on the left side of the chest that the left ventricle works, responsible for providing most of the energy for pumping the heart.

It is essential for the beating function to continue to be done normally. There are two types of failure that can occur on the left side:

Heart failure with reduced ejection fraction or systolic failure

In this case, the left ventricle of the heart loses its ability to contract, so the heart is unable to pump and push blood into the body with the necessary strength.

Heart failure with preserved ejection fraction or diastolic failure

Also known as diastolic dysfunction, in this case, the left ventricle becomes rigid, losing the ability to relax.

This prevents the heart from filling with blood during the relaxation phase, called diastole, with each beat (which normally happens).

Heart failure on the right side

The right ventricle is responsible for pumping blood from the body (low in oxygen) from the heart to the lungs so that they are replenished with oxygen.

Insufficiency on the right side only occurs when there has already been a failure on the left side, due to increased pressure caused by the failure in the left ventricle. In this case, there is a return of blood to the lungs, then damaging the right side of the heart.

Gradually, the right ventricle loses its pumping power, in this, blood starts to accumulate in the veins, causing swelling in the legs, ankles, abdomen and liver.

Peripartum cardiomyopathy or peripartum cardiopathy

Peripartum cardiomyopathy is a rare condition of heart failure, which appears in pregnant women.

It is characterized by a weakening of the cardiac muscle, which ends up generating the failure. Its most apparent symptoms are shortness of breath after exertion or lying down, coughing and swelling of the legs.

It can occur at the end of pregnancy or in about 45 days after delivery, it has the same symptoms and risk factors as common heart failure.

The treatment is also the same, but in terms of medication, some care is needed regarding the type of medication and its side effects.

Recovery from the condition occurs smoothly in up to 60% of cases.

Acute and chronic insufficiency

Depending on the intensity of the insufficiency it can be called classified as acute or chronic:

Acute heart failure

This type of failure manifests itself suddenly and urgently, the patient has severe symptoms and needs to seek help quickly. It is also known for decompensated insufficiency.

Chronic heart failure

Unlike acute, which occurs suddenly, chronic heart failure takes time to develop and can take years.

The patient can only notice the presence of the disease when he notices swelling in the feet, legs, cough, shortness of breath accompanied by abdominal pain.

What is congestive heart failure?

There are differences between the terms heart failure and congestive heart failure.

According to the cardiologist, Emilton Lima Júnior, the term “heart failure” is more generic and covers all types of failure, whereas the term “congestive heart failure” refers to a specific type, in which it involves the malfunctioning of the heart as as a whole, affecting the left and also the right ventricle.

The causes of both can be the most varied, but the main one today is arterial hypertension, closely followed by ischemia of the heart (reduced blood flow to the organ).

Causes of heart failure

Heart failure is the result of joint problems that affect the heart, but any disease that may affect the heart or blood circulation can also cause the failure.

Some of them are:

High blood pressure

High blood pressure is characterized by the force that the blood makes against the artery wall, when the pressure is measured the diagnosis of high blood pressure (or hypertension) occurs when the number is above 14 by 9 (140 X 90 mmHg).

It is one of the main causes of heart failure and is related to 2 changes in the heart: more effort for the organ to work and, also, an enlarged (hypertrophied) heart.

These situations can overload the organ, leading to heart failure.

High blood pressure is a condition that acts silently, showing its symptoms when it is more advanced. That is why it is always necessary to measure the pressure, to monitor how it is and, if any changes are found, seek medical help.

Heart attack

One of the consequences of a heart attack is heart failure. This is because when an infarction occurs it can cause damage to the muscles, causing the formation of a contracted fibrous tissue, which reduces the heart’s ability to pump blood.


Diabetes when controlled does not present risks for other diseases, but when there is no necessary care, it can cause, among other conditions, heart failure.

Along with hypertension, diabetes is one of the main causes of heart risks.

This can happen because when sugar (glucose) is in excess in our blood, it gradually causes damage to blood vessels, which can intensify to a picture of heart failure.

Coronary heart disease (CAD)

When the arteries become clogged with fatty substances it is an indication that coronary heart disease (CAD) is occurring.

This disease is characterized by the formation of a fatty plaque in the arteries that, in the long run, impairs circulation.

As plaque accumulates, it can result in heart failure.


Cardiomyopathy is a disease that causes the heart muscle not to function properly, due to a wear and tear on the structure and function of the heart’s muscles.

When this happens, it affects the blood supply to the body, which ends up being done in a difficult way, which can cause heart failure.

Congenital heart disease

This condition occurs during pregnancy, while the heart is still forming. Therefore, it is characterized by a set of malformations that affect the functioning of the heart, so that the organ needs to work harder. Depending on the situation, heart failure may develop.


Myocarditis is an inflammation that occurs in the cardiac muscle on the left side, its complications can influence the development of heart failure.

It can be triggered or favored by viruses, bacterial, fungal and parasitic infections, in addition to other conditions, such as:

  • Autoimmune diseases (for example, lupus);
  • Insect bites;
  • Allergies;
  • Treatment with chemotherapy or radiation therapy;
  • Use of drugs and alcohol.

Genetic influence

When a family member (father, mother, grandfather, grandfather) was diagnosed with heart failure, there is a greater risk that other people will suffer from heart failure due to genetic predisposition.


The use of some types of medication can influence heart failure, so you need to be careful and read the package insert or talk to the doctor. Some of them are:

  • Non-steroidal anti-inflammatory drugs (NSAIDs);
  • Certain anesthetic medications;
  • Some antiarrhythmic drugs;
  • Medicines used to treat cancer,
  • Medicines used in blood disorders (leukemia, lymphoma).

Risk factors

The risk factors and causes of heart failure are close, ranging from high blood pressure to smoking:

High pressure

When a person has high blood pressure, the heart works harder than it should in its normal state, which can influence heart failure.

Heart attack

When a heart attack occurs, the heart becomes weaker due to damage to the heart muscle, so the heart does not pump enough blood. Those who have a history of heart attack may have heart failure.


In general, when you reach old age, the heart increases its size a little, this causes the walls to become thicker. During the resting period, the heart rate per minute is lower compared to a younger heart.

When we get older, our body responds over time. Some organs may not work as well as before, including the heart, which may develop heart failure due to its loss of capacity.


Diabetes is the excess of sugar (glucose) that circulates in our blood and that can impair the functioning of the heart.

When there is excess sugar in the blood, it gradually causes damage to the blood vessels, impairing the functioning of the heart, which can lead to heart failure.

Read more: What are the symptoms of diabetes?

Some medications

Patients who use anti-inflammatory drugs, anesthetics and to treat cancer or lymphomas, for example, are more at risk of suffering from heart failure.

Sleep apnea

Sleep apnea causes breathing to decrease while we sleep, with a variation in heart rate and pressure. This type of problem can weaken the heart over time, leading to heart failure.

Use of alcohol

Consuming alcoholic beverages in excess can harm not only the liver, but also the heart due to the weakening of the heart muscle, in this way it can lead to heart failure.

Tobacco use

Smoking causes an acceleration in the oxidation of cholesterol, favoring the formation of atherosclerosis plaque (accumulation of substances and fat in the arteries) that influences the possibility of infarction.

As if this were not enough, smoking affects the functioning of the lung and heart, allowing a picture of heart failure.

Read more: Smoking is the biggest cancer risk factor in men


When the individual is overweight, the heart needs to make a greater effort to pump blood, overloading this organ and being able, over time, to generate heart failure.

Irregular heartbeat (arrhythmia)

Depending on the health history of each person, it may occur that the heart works at different rates, in some moments more accelerated and others slower.

This condition is not normal and is usually influenced by other illnesses that the individual may have.

The sudden change in heart rate can, in the long run, weaken heart activity, leading to heart failure.

Other diseases

Some other diseases can also cause or favor heart failure, including:

  • Anemia;
  • Hyperactive thyroid;
  • Pulmonary hypertension;
  • Renal insufficiency;
  • Chagas disease;
  • Rheumatic disease.
  • Neurological conditions;
  • Psychiatric conditions;
  • Urological conditions;
  • Inflammatory conditions;
  • Infections.


Heart failure can manifest with symptoms that do not seem severe, such as tiredness or shortness of breath, depending on the person. But some of them are quite characteristic like irregular heartbeat, coughing up mucus, among others:

Shortness of breath, fatigue and weakness

Feeling short of breath after some light physical activity or at rest is a sign that something is wrong.

This is due to the accumulation of fluid and congestion in the lungs, which are unable to exchange oxygen, reducing nutrition to the body. Along with shortness of breath it is common for weakness to manifest and subsequently fatigue.

Weight gain and swelling

It is common for heart failure to cause weight gain, this is due to the accumulation of fluid in the lungs and the rest of the body.

Swelling also happens because the heart is unable to distribute blood to vital organs, such as the kidneys and liver, thus accumulating in certain parts of the body along with other fluids, causing swelling in the legs, ankles, feet and abdomen.

Irregular heartbeat

Heart failure causes the heart to have to work bent to compensate for the difficulty in pumping blood.

These beats can occur irregularly, sometimes faster and sometimes calmer, leading to the feeling that the heart is beating or accelerating too much.

Persistent cough and swelling of the abdomen

When a cough appears and, even after weeks, it persists, it is a sign to better observe the symptoms that come with it. Among them, wheezing or swelling in the abdomen.

Lack of appetite and nausea

Eating little and feeling full or lacking the desire to eat are some of the signs of heart failure. It is also accompanied by nausea, which becomes frequent mainly at times of feeding.

Chest pain

The cough can persist for weeks and come with pink or yellow mucus. As the cough is frequent, it ends up being common that there are chest pains due to the effort caused by the act of coughing.

These two symptoms together can mean the development of heart failure.

How is the diagnosis made?

The specialist who can diagnose and decide the best treatment in case of heart failure is the cardiologist or general practitioner .

To confirm heart failure, according to the Guidelines for the Diagnosis of HF, the professional must check the presence of at least 1 major and 2 minor criteria:

Larger criteria

You must present at least 1 of the major criteria:

  • Paroxysmal nocturnal dyspnea (difficulty breathing while sleeping);
  • Distension of neck veins (enlarged veins);
  • Pulmonary sounds (sounds produced by the lungs);
  • Cardiomegaly (abnormal growth of the heart);
  • Acute lung edema (excess fluid in the lung);
  • Third canter gallop (heartbeat at different times);
  • Increased venous pressure (pressure on the right side of the chest).

Minor criteria

At least 2 of the following tables are required:

  • Edema of limbs (swelling in the body);
  • Night cough (excessive coughing at night);
  • Dyspnea on exertion (difficulty breathing);
  • Hepatomegaly (swelling of the liver);
  • Pleural effusion (excess fluid in the lung);
  • Tachycardia (increased heart rate).


The consultation can also draw the picture through the patient’s medical history, diseases that exist in the family, lifestyle etc.

In addition to examining the patient, some tests are requested by the cardiologist to assist in the diagnosis and choice of treatment type:


In this examination it is possible to observe the organ and its entire structure.

To do this, a gel is applied to the patient’s chest, then a device travels across the surface of the skin and is able to transmit an image of the heart and lungs. This image is displayed on a monitor, where the doctor can assess the health of the heart.

It is a quick and painless exam, being currently the most indicated in the field of cardiology due to its low cost and any age group can perform it.

Electrocardiogram (ECG)

The electrocardiogram or ECG is an examination that the patient lies on a stretcher and electrodes (similar to small patches) are placed and distributed across the chest.

After being connected to a device, the electrodes begin to assess the heartbeat, transforming them into a kind of graph. Through this generated graph, the doctor is able to identify the problems and assess the heart rate.

The procedure is quick, done in about 5 minutes, and painless.

Read more: What is the Electrocardiogram for?

Coronary angiography

Also known as coronary angiography and cardiac catheterization, the examination needs to be done under anesthesia, in which, after applying it, a catheter is inserted in the groin or arm region.

Through the bloodstream, it is carried to the heart in the coronary arteries.

A contrast is injected into the arteries, allowing them to be more visible to be analyzed by x-ray .

The procedure is carried out in about 20 minutes to an hour.

Chest radiology

It consists of an x-ray examination concentrated in the chest region.

Using ionizing radiation (electromagnetic waves), it produces an image of a part of the body, in this case, the chest.

After this exam is ready, the doctor uses the images to identify the presence of cardiovascular diseases by means of the size of the heart or liquids accumulated in the organ.


Blood tests can be ordered when the diagnosis is not clear enough to the specialist and other causes need to be ruled out.

Complete blood count , creatinine , urea, albumin, electrolytes, dextrose and liver function tests are generally recommended .

Other exams

There are still other options for tests to be performed by the doctor, if necessary for diagnosis. They can be:

  • Pulmonary function tests;
  • Effort trial;
  • Cardiac magnetic resonance imaging;
  • Multicut computed tomography (multicut CT).

Is there a cure?

Some cases, yes, but it depends on the type .

Some types of heart failure can be cured, such as peripartum heart disease and in some cases of inflammation of the heart muscle, called myocarditis.

According to the cardiologist, Emilton Lima Júnior, even in these situations with a potential for cure, these diseases can be very serious and can leave sequelae and lead to the patient’s death.

Treatment for heart failure

Allied to medications, some treatments help to improve the patient who has heart failure. In the short term, it is possible to improve symptoms and prevent other diseases, such as kidney dysfunction.

In the long term, it is possible to improve cardiac functions and quality of life, also preventing other diseases.

Treatment for heart failure has evolved more and more since heart transplantation, including new medications and equipment.

Read more: Brazilians create molecule that can treat heart failure

But, even so, most patients end up having their life very shortened from the diagnosis or have their quality of life very compromised in their last years of life. Among the treatments are:

Oxygen therapy

Oxygen therapy is a type of treatment indicated for those who have a low level of oxygen in the blood and need to correct air deficiency for the body to function normally.

In general, oxygenation is done through masks or catheters positioned at the entrance of the nose, bringing O2 in high concentration to the lungs.

The treatment can be short and punctual, until the condition stabilizes, or prolonged, requiring several inhalations during the week.

Implantable devices

In some cases, the heart alone is unable to function, in which case support is needed to help keep the heart beating.

There are different devices that can be implanted to help the heart, they generally have similar characteristics: they are small, have a battery and are inserted with the use of anesthesia in external parts of the body, not being visible.

Some of the options are:

  • Pacemakers;
  • Cardiac resynchronization treatment (CRT);
  • Implantable defibrillators (ICD);
  • Left ventricular assist devices (DAVE).


Medicines can be used to relieve symptoms and aid treatment.

Diuretics, nitrates or digoxin, in addition to beta-blockers, aldosterone antagonists and ACE inhibitors, may be recommended.

But the doctor must make the diagnosis and then recommend the use of the medication.

Blood pressure control

Adopting a diet with lots of fruits, vegetables and cereals is great for controlling blood pressure.

Fat, excess sugars, red meat and preserved food should be avoided. Salt should also be reduced in seasonings, the ideal consumption is a shallow teaspoon for food.

Don’t forget to drink 1.5 to 2 liters of water to keep your body hydrated and balanced.

The use of medications and medical follow-up, as well as physical activity, helps in the correct maintenance of blood pressure.

Physical activity

The practice of physical activity has many benefits in the rehabilitation of heart problems, as it favors the proper functioning of the heart and the pulmonary and muscular systems.

Low-impact activities, such as walking, weight training , water aerobics, etc. are indicated .


When heart failure is advanced and treatment does not show satisfactory results, the option is to perform cardiac surgery.

Depending on the case and the state of the patient, the options for surgery are:

  • Heart transplantation (implantation of a new organ);
  • Application of ventricular assist devices (use of artificial heart); Cardiac resynchronization (implantation of electrodes in the heart);
  • Valve surgery (replaced heart valves that do not work);
  • Myocardial revascularization (connection of veins and arteries) also known as a bypass.


Drug treatment for heart failure usually consists of using medications that are determined depending on each case by the specialist.

But ACE inhibitors, angiotensin receptor blockers, diuretics, cardiotonics and beta-blockers are common.

  • Levosimendana (Simdax);
  • ECA inhibitors ( Renitec , Ramipril , Naprix );
  • Angiotensin receptor blockers ( Brasart BBC , Diovan Amlo Fix , Atacand );
  • Diuretics ( Chlorana , Diurezin , Diurix );
  • Cardiotônicos (Monocordil, Cincordil, Simdax);
  • Beta-blockers ( Carvedilol , Selozok , Ictus ).


NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained on this site is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.


The sooner the presence of heart failure is identified, the better the response to treatment. Unfortunately there is no cure, but it is possible to live well with the condition if the right care is taken.

Mortality rates among those who have already been hospitalized are 30% in 1 year.

When the failure is advanced and chronic, the risk of death can vary from 10% to 40%, per year.

Patients with monitoring of the condition, who are able to reduce the aggravating risk factors, may have a good quality of life.

Complications: what are the risks of heart failure?

When there is no search for treatment, complications can occur in the case and develop other conditions such as high blood pressure, heart attack, enlargement of the heart, abnormal heart valves and diabetes:

Liver damage

Heart failure causes a change in the activity of the heart, it causes the blood to return to the organ, congesting it. Gradually, the pressure in the veins of the whole body increases, including those of the liver.

In this way, the hepatic veins begin to work harder, causing the organ to be damaged.

Kidney damage or failure

When heart failure occurs, in some cases it can reduce the blood flow that is sent to the kidneys, which can cause kidney failure.

Heart attack (myocardial infarction)

The heart muscle needs oxygen-rich blood for the walls of the heart to function properly, so the muscle has its own vessels.

It can occur from some clotting vessel, leading to a heart attack – which can damage the heart muscle.


To prevent heart failure, changes in eating behavior and lifestyle need to be made. Adopting healthy habits and having medical monitoring are the best options.

Read more: Does taking aspirin every day help prevent heart disease?

Among the tips are:

Do not smoke

Smoking harms health in a number of ways, but with heart failure, smoking reduces the heart’s ability to pump blood. The greater the consumption of cigarettes, the greater the damage caused to the heart muscle.

Reduce stressful situations

When we are stressed, we cause an increase in cardiac arrhythmia . So, in stressful situations, take a deep breath and try to calm yourself down so as not to further harm your health.

Practice physical activities

Practicing physical activities, from swimming, running, walking, weight training, among others, can bring many benefits, especially for the heart.

The practice of at least 30 minutes of exercise 3 times a week is enough to bring improvements to the body.

Eat well

Take care of your diet, avoid industrialized foods , rich in fat and sugars, which can favor diseases in the long run.

Give preference to fruits, vegetables and vegetables so that your immunity gets stronger and thus avoid getting sick.

Control other diseases

It is important to properly care for other diseases, such as diabetes and hypertension, so that they do not develop and cause other diseases, such as heart failure, to arise and develop as well.

Read more: 6 hours a night is the minimum sleep time to avoid heart disease

Don’t abuse alcohol

Excessive alcohol is bad for health, especially for heart activities. So get a grip, you can drink but in moderation and common sense.

Living together

It is possible to live normally in the event of a diagnosis of heart failure, for this it is necessary to take extra care in some points:

Focus on physical activity

Be sure to practice physical activities, they help in strengthening muscles, in the immune system, in resistance, metabolism, stress relief and in cardiac health.

Decrease the salt

During your diet, use only a shallow teaspoon of salt (5g) in the food. Excess sodium retains water and causes the heart to work redoubled. In this way, it promotes shortness of breath and swelling in the feet, legs and ankles.

Read more: Know the dangers of excess sodium in the diet

Put a limit on fats

Set a limit on the amount of fat you can consume in your diet. Fats have a high harmful potential for increasing heart disease.

Attention to members that swell

Depending on the medications used to treat heart failure, some parts of the body may swell, most commonly occurring in the legs, ankles and feet. Stay tuned and if you notice swelling, try to rest and raise your legs for 15 to 20 minutes.

Beware of alcohol

Excessive alcohol is already very bad for heart activity, but when using medicines for heart failure it is necessary to be more careful, as they can interact with the medication, which may increase the risk of abnormal heartbeats.

Eat well

Have a balanced and quality diet, including fruits, vegetables, and cereals of your choice. Avoid fatty and industrialized foods, prefer lean proteins , in relation to dairy products opt for those with low fats, such as yogurt.

It looks like smoking

Smoking severely damages the blood vessels of those who have heart failure, reducing the amount of oxygen in the blood and making the heart have to work faster.

Cut the cigarette, if necessary seek medical help to remove this habit and not further harm your health.

Common questions

What are the main causes of heart failure?

Heart failure can be caused mainly by diseases such as high blood pressure, coronary heart disease, cardiomyopathy, congenital heart disease, myocarditis and anemia.

It is a condition that can be caused by another disease that is affecting the body (as mentioned above). Because the first disease manages to damage the heart, this prevents the organ from being able to perform its activity correctly by supplying oxygen to the body, resulting in a picture of heart failure.

What is the life expectancy for a person with heart failure?

It depends on when the diagnosis of the disease is made, as it is he who will determine the life expectancy. But, on average, up to 40% of patients who are diagnosed with chronic heart failure die within five years. In acute cases, with hospitalization, about 30% die within 1 year.

What are the risks of heart failure?

The risks of heart failure can range from a heart attack (myocardial infarction), to abnormal heart valves, enlargement of the heart (cardiomyopathy), high blood pressure (hypertension), diabetes and genetic influence.

Heart failure is a serious condition, but if diagnosed early it can be treated and the patient is able to have a good quality of life.

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