By Shamard Charles, MD, MPH 

 Medically reviewed by Jeffrey S. Lander, MD

Congestive heart failure (CHF) and heart failure are chronic progressive conditions characterized by a weakened heart that is unable to pump enough blood to meet the body’s energy needs.

Heart failure often refers to early-stage weakening of the heart without congestion. As the damage to the heart progresses, it causes fluid to build up in the feet, arms, lungs, and other organs, which is referred to as congestion, throughout the body. This stage of heart failure is called CHF.

This article will discuss different types of heart failure and the factors that put you at the greatest risk for developing the disease. 

Verywell / Theresa Chiechi

Heart Failure vs. Congestive Heart Failure: What's the Difference?

Heart failure affects people of all ages, from children and young adults to the middle-aged and older adults. About 6.2 million adults in the United States are currently living with heart failure, and over 64 million people are dealing with some form of heart failure worldwide.1

Approximately 550,000 new cases are diagnosed in the United States each year, but many more remain undiagnosed as the initial symptoms of heart failure can be subtle and mimic similar symptoms seen in other conditions.

Congestive heart failure (CHF) refers to the inadequate functioning of the heart muscle such that fluid builds up in the lungs, abdomen, feet, and arms (hence the term "congestive"). The condition can either be acute (meaning it occurs suddenly, with a sharp rise) or chronic (which means it occurs over the long term).

Untreated heart disease can be aggressive and fatal. The five-year survival rate is about 50% for all stages. In 2018, heart failure led to nearly 400,000 deaths, according to death certificate data, with the highest prevalence of disease primarily in the South and Midwest.2

Signs of Heart Failure and Congestive Heart Failure

Most cases of heart failure and CHF are chronic and develop over time. Symptoms to watch for are:3

• Chest pain, especially while you are exerting yourself

• New or increased dyspnea or shortness of breath

• Dizziness, light-headedness, or feeling like you may faint

• Sudden weight gain

• New or increased swelling of the legs, ankles, or feet

• Sudden fatigue or weakness especially while doing normal physical activities

Causes of Heart Failure and Congestive Heart Failure

Heart failure and CHF are typically caused by other conditions that damage the heart. Some of these conditions are:3

• Coronary artery disease (CAD): This is the most common type of heart disease. In CAD, cholesterol and fatty deposits block the heart's blood vessels, causing the heart to work hard to pump blood. Over time, the heart begins to fail.

• Past heart attacks (myocardial infarction): The heart tissue is damaged during a heart attack, even mild ones. This damaged tissue doesn’t work as well, impacting the heart's ability to pump.

• High blood pressure (hypertension): If you have uncontrolled high blood pressure, your heart is working harder to overcome that pressure and may become damaged over time.

• Obesity: Obesity puts you at higher risk of conditions like type 2 diabetes and sleep apnea. If you are obese you are also more likely to develop high blood pressure, high cholesterol levels, and cardiomyopathy, which are all independent major risk factors for CHF.

• Diabetes: High blood sugar (glucose), especially when uncontrolled, can damage the blood vessels and nerves that control the heart. People with diabetes also tend to have higher rates of obesity and hypertension, which are independent risk factors for CHF.

• Valvular heart disease: If one or more of the heart valves become damaged, it can impair the ability of the heart to pump blood efficiently, leading to CHF.

• Hyperthyroidism (overactive thyroid): Excess thyroid hormone levels can raise blood pressure and heart rate, which puts stress on the heart. This can cause it to become damaged over time.

• Other conditions such as severe anemia (lack of healthy red blood cells to move oxygen throughout the body) and abnormal heart rhythms (arrhythmias)

When the heart is weakened, it has difficulty pumping blood forward, so blood and fluid back up into the lungs. Fluid in the lungs can cause shortness of breath, a common symptom of congestive heart failure.

If the heart is having serious difficulty with pumping, then you might experience edema—a buildup of blood fluid in the feet, ankles, and legs.

Types of Heart Failure

There are several anatomical types of heart failure that can lead to CHF. Both the right and left sides of the heart can fail, but left-sided heart failure is much more common than right-sided heart failure.

Most of the heart’s pumping power comes from the left side. The left side of the heart receives oxygenated blood from the lungs and pumps it to the rest of the body. If the large and powerful chambers of the left ventricle and left atrium begin to fail, the left side of the heart has to work harder to pump blood.

Over time, blood can build up in the pulmonary veins, leading to shortness of breath and trouble breathing, especially during physical activity.4 If left untreated, the right side of the heart may begin to fail as well.

There are two types of left-sided heart failure: heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF).

Heart Failure With Reduced Ejection Fraction

Heart failure with reduced ejection fraction (HFrEF), once called systolic heart failure, occurs when the left side of the heart loses its ability to contract and becomes unable to meet the body’s oxygen and nutrient needs over time.4

Heart Failure With Preserved Ejection Fraction

In heart failure with preserved ejection fraction (HFpEF), formerly known as diastolic heart failure, the left side of the heart retains its ability to pump but the stiffening of the heart muscle does not allow it to relax during beats.4

Losing the ability to relax during beats means that the left ventricle chamber loses its capacity to adequately fill with blood, so when it pumps, less blood is pushed out.

Right-Sided Heart Failure

Right-sided heart failure develops when the right side of the heart does not pump blood as well as it should, causing blood to back up into the venous system and limiting how much blood the heart can pump per minute. Right-sided heart failure is most commonly caused as a sequelae (a condition that follows another) to left-sided heart failure and presents with more severe symptoms.5

Types of Heart Attacks

A heart attack, also known clinically as myocardial infarction, is a form of acute coronary syndrome (ACS). It occurs when a significant blockage in the coronary arteries restricts blood flow to the heart. 

The main types of heart attacks include:6

• Non-ST segment elevation myocardial infarction (NSTEMI)

• ST-segment elevation myocardial infarction (STEMI)

NSTEMI

An NSTEMI occurs when the obstruction doesn't completely stop the blood flow. While some cells die, others survive.

Of note, an NSTEMI does not cause abnormal elevations of the ST segment of an electrocardiogram (ECG). NSTEMIs are less severe than STEMIs because they inflict less damage to the heart. 

STEMI

When people think of a heart attack, they are usually thinking of a STEMI. A STEMI is characterized by severe chest pain or a feeling of pressure on the chest due to complete or near-complete blockage of a major artery of the heart. This results in the death of the myocardium (heart muscle tissue). A STEMI is the most deadly form of a heart attack (myocardial infarction). 

The ST segment of STEMI refers to the normally flat section of an ECG that is abnormally elevated during this cardiovascular event. 

Could I Have a Heart Problem?

Risk Factors for Heart Failure and Congestive Heart Failure

Anyone can develop heart failure. Some factors, like your lifestyle, are modifiable, meaning you can make changes to reduce your risk. Others, like genetics, are unalterable, and you cannot change them. The following risk factors may increase your chance of developing heart failure:7

• Conditions straining the heart: Any medical condition that weakens the heart like diabetes, hypertension, and coronary artery disease.

• Age: People 65 years or older have a higher risk of heart failure because aging can weaken and stiffen your heart. 

• Family history and genetics: If members of your immediate family have had early heart disease it may be a sign that there are genetic mutations in your family’s DNA that puts you at higher risk of developing heart disease. 

• Lifestyle habits: Smoking, heavy alcohol use, eating an unhealthy diet, living a sedentary lifestyle, using recreational drugs (such as cocaine), and lack of exercise may raise your risk of heart failure.

• Other medical conditions: Conditions such as human immunodeficiency virus (HIV), COVID-19, chronic kidney disease, and sleep apnea, can weaken or stiffen the heart leading to heart failure. Cancer treatments such as chemotherapy and radiation can also injure the heart. Some medications to treat these conditions may also cause arrhythmias which can cause heart failure. 

• Racial and social makeup: Black Americans are more likely to have heart failure than people of other races, but the reasons for this are unknown. It seems that race or ethnicity is not a risk factor in and of itself. Instead, research points to the differences in the social and environmental conditions between Black Americans and other populations as the major reason why these disparities are evident.1

• Sex: Heart failure is common in both men and women, although men often develop heart failure at a younger age than women.1

Can Congestive Heart Failure Run in Families?

Heart failure can run in families. Hereditary cases are usually characterized by early symptoms of heart failure in a first-degree relative like a brother, father, or mother. Genetic testing may be useful in elucidating the genes at play that put your family at risk.

When to See a Healthcare Provider

If you are experiencing chest pain, shortness of breath, sudden swelling of the arms or legs, or fatigue on exertion, you may want to get checked by a healthcare professional.

Heart failure and CHF are chronic, progressive conditions that can often be managed with timely treatment, so do not wait to be seen by a healthcare professional if you experience any of the aforementioned symptoms.

How Heart Failure Is Diagnosed

A diagnosis of heart failure or CHF is made by a doctor who specializes in the diagnosis and treatment of heart-related conditions, called a cardiologist. Your cardiologist will take a complete medical history, conduct a physical exam, and may order a variety of tests, including blood work and imaging tests.

The following tests and scans may be performed to help diagnose heart failure:8

• Natriuretic peptide tests: Measures levels of B-type natriuretic peptide (BNP) or N-terminal prohormone of B-type natriuretic peptide (NT-proBNP), which are released into the blood by the heart

• Echocardiogram: Determines the percent of blood that is pumped out of the heart with each heartbeat and evaluates the structure and function of the heart

• Electrocardiogram (EKG): Provides a tracing of the heart’s electrical activity

• Stress test: Measures how the heart responds to exercise or chemically induced stress in a controlled environment

• Cardiac catheterization: Shows the interior of the arteries in your heart to see if they are blocked and allows for measurement of right and left heart pressures

• Other imaging tests such as cardiac computed tomography (CT) scan, cardiac magnetic resonance imaging (MRI), or nuclear heart scan can be used to show how well the heart is working.

Prevention

The best way to prevent heart failure and CHF is to follow the heart healthy guidelines put forth by the American Heart Association and the U.S. Preventive Services Task Force, which call for eating a low-sodium diet that consists of fruits and vegetables, routine exercise preferably five 30-minute, sweat-breaking sessions per week, no smoking, and limited alcohol intake.9

Summary

Congestive heart failure (CHF) and heart failure are both conditions that are characterized by a weakening of the heart, such that the organ is unable to pump enough blood to meet the body’s energy needs. CHF refers to the stage where the weakened heart causes fluid to build up in the feet, arms, lungs, and other organs, leading to congestion through the body. Lifestyle changes and aggressive medical care are critical to optimizing heart function and minimizing your symptoms.

Sources

Lippi G, Sanchis-Gomar F. Global epidemiology and future trends of heart failure. AME Med J. 2020;5:15-15. doi:10.21037/amj.2020.03.03

Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics—2020 update: a report from the American Heart Association. Circulation. 2020;141(9):e139-596. doi: 10.1161/CIR.0000000000000757

Centers for Disease Control and Prevention. Heart failure. 

American Heart Association. Types of heart failure.

Harjola VP, Mebazaa A, Čelutkienė J, et al. Contemporary management of acute right ventricular failure: A statement from the heart failure association and the working group on pulmonary circulation and right ventricular function of the European society of cardiology. Eur J Heart Fa. 2016;18(3):226-41. doi:10.1002/ejhf.478

American Heart Association. What is a heart attack?

NIH. Heart failure.

Heidenreich P, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure. J Am Coll Cardiol. 2022;79(17)e263–e421. doi:10.1016/j.jacc.2021.12.012

National Heart, Lung and Blood Institute. Heart failure.

By Shamard Charles, MD, MPH
Shamard Charles, MD, MPH is a public health physician and journalist. He has held positions with major news networks like NBC reporting on health policy, public health initiatives, diversity in medicine, and new developments in health care research and medical treatments.