By Rebeca Schiller 

 Medically reviewed by Anthony Pearson, MD

Congestive heart failure can be passed on from generation to generation. Several hereditary factors put people at higher risk if their family members have congestive heart failure, such as high blood pressure, coronary artery disease, cardiomyopathy, and complications from diabetes.1 A number of conditions can also lead to congestive heart failure, including diseases that directly affect the heart like rheumatic fever and infections such as endocarditis or myocarditis.

What is Congestive Heart Failure?

Congestive heart failure occurs when the heart is unable to pump oxygen- and nutrient-rich blood to the cells that need it to function properly in the body. Both sides of the heart can be affected by heart failure, and its inability to function optimally can lead to a number of issues, including:2 

• Blood and fluid backing up into the lungs

• Edema (fluid buildup) in the lower extremities of the body (legs, ankles, and feet)

• Fatigue and shortness of breath

Demographically, heart failure is more common in adults 65 years of age or older. Groups that are more likely to develop heart failure include Blacks, overweight or obese individuals, and men.2 

There are four stages of heart failure, ranging from high risk of developing heart failure to advanced heart failure. (Depending on what classification system is used, it is possible to move up or down a stage.) For this reason, it is important to detect heart failure early so that treatment can be started to slow down the disease’s progression.3 

Common Causes and Risks

According to the American Heart Association, the majority of people who develop heart failure have or had some other issue with their heart. The most common ones that could lead to heart failure include a previous heart attack, coronary heart disease, and high blood pressure.4 Diabetes, obesity, and valvular heart disease could also contribute to heart failure.5

Certain risk factors are also known to increase the chances of having CHF, including:5 

• Smoking

• Consuming high-fat, high-cholesterol foods

• Not getting sufficient exercise

• Excessive alcohol consumption

Genetics

Hereditary factors may also play a part in heart failure since many conditions that lead to CHF are passed down through generations.

To determine whether heart disease is inherited (which may contribute to heart failure), a thorough family history that includes collecting information concerning each family member’s medical history, specifically if anyone in the family has a heart condition, died suddenly from that condition, or has other heart-related medical issues.6 

People with immediate family members who have an autosomal dominant condition like heart disease have a 50% risk of inheriting the genetic mutation that causes it.6 

Other inherited conditions that can lead to heart failure include:3

• High blood pressure

• Diabetes

• Family history of cardiomyopathy

Heart Failure Symptoms

Common symptoms of heart failure include:7

• Dyspnea (shortness of breath) at rest, sleeping; difficulty breathing while lying flat on the back

• Persistent coughing or wheezing that produces white or blood-specked mucous

• Fluid buildup in the legs, ankles, feet or abdomen and sudden weight gain

• Fatigue where simple activities lead to feeling tired all the time

• Lack of appetite or nausea

• Confusion or memory loss

• Increased heart rate

If you have a family history of heart disease or experience any of these symptoms, notify your healthcare provider and seek medical help. 

Familial Hypertrophic Cardiomyopathy

Familial hypertrophic cardiomyopathy is a genetic heart condition passed down from a parent who is affected. The condition involves thickening of the heart muscle in any wall of the heart. This hinders the blood flow from the heart, which may produce a heart murmur (an abnormal heart sound).8 

Symptoms vary even among members with the condition in the same family. While some may not show any symptoms, others may have chest pain, shortness of breath, especially after any kind of physical activity, heart palpitations, lightheadedness, dizziness, and fainting.8 This condition may cause life-threatening arrhythmia, sudden death, and heart failure.8

Familial Dilated Cardiomyopathy

Familial dilated cardiomyopathy, also a genetic form of heart disease, affects the heart’s muscular tissue (the myocardium), which becomes thin and weakened in at least one chamber of the heart.9 This causes the open area of the chamber to become enlarged (dilated). The heart becomes unable to pump blood as efficiently as usual. To compensate, the heart attempts to increase the amount of blood being pumped through the heart, which leads to further thinning and weakening of the cardiac muscle. Over time, this condition results in heart failure.

Familial dilated cardiomyopathy affects both adults and children. The genetic form of this condition account for 40% of all dilated cardiomyopathy cases.10 It usually takes many years for symptoms of familial dilated cardiomyopathy to cause health problems. Symptoms typically begin in mid-adulthood, but can occur at any time from infancy to late adulthood. 

Signs of this disease include arrhythmia, fatigue, shortness of breath, fainting, and swelling of the lower extremities. In some cases, the first sign of the disorder is sudden cardiac death. The severity of the condition varies among affected individuals, even within the same family.8

Congenital Heart Disease

Congenital heart disease includes all structural abnormalities of the heart that occur in the womb and exist at birth. Heart failure is a common cause of mortality among people with this disease.11

One possible cause of congenital heart disease is a viral disease that the mother carries while pregnant. Some heart defects can be linked to alcohol and drug abuse. Sometimes the condition can be passed down. 

Among newborn babies, structural heart abnormalities are common, appearing in 10 infants per 1000 live births.12 Congenital heart disease may not be evident at infancy. More than a quarter of congenital heart diagnoses occur when the child is older or later on in adulthood. 

As a result of advances in surgical procedures for complex congenital heart disease, survival rates for children have improved. Newborn survival rates is at 90%, with 96% of children with congenital heart disease surviving their first birthday and reaching the age of 16.12 The median age of survival for adults with the condition has increased from 37 years old to in 2002 to 57 years old by 2007.

Diabetes

Diabetes can predispose someone to heart failure, especially in people with preserved ejection fraction (the left ventricle is not able to fill properly with blood during the filling phase). People with diabetes are at a higher risk of developing heart failure, and vice versa.13

The risk of developing heart failure is high for people with diabetes due to the unusual cardiac metabolic handling of glucose and free fatty acids in these individuals. Over a period of time, high blood sugar levels can lead to damage to the blood vessels and the nerves that control the heart, increasing the risk for heart failure.

People with diabetes typically have other conditions such as hypertension and high LDL cholesterol and triglycerides, which can contribute to the increased risk of heart failure.14 Antidiabetic medications can also raise hospitalization and mortality risk for heart failure in people who have diabetes with or without pre-existing heart failure.13

Arrhythmias

Cardiac arrhythmia is when the heart beats erratically—either too fast or too slow. Among the many heart disorders, arrhythmia is the most common.

Patients with heart failure are susceptible to arrhythmias. A 2017 study noted that six million people in the United States have heart failure and that hospitalizations are often linked to supraventricular arrhythmia (SVA), which occur in the atria or the area above the ventricles.15

Factors that can cause arrhythmia include: 

• A recent heart attack

• Scarred heart from a previous heart attack

• Heart disease

• Genetics

• High blood pressure

• Blocked arteries

• Diabetes

• Thyroid disorders

• Severe stress

• Some medications and supplements

• Smoking

• Drug abuse

• Excessive caffeine and alcohol consumption

Hypertension

Hypertension, or high blood pressure, can increase the risk of heart failure. When blood is forced through inelastic and narrowed arteries, the heart's workload is increased. Over time, the heart thickens and becomes enlarged and less efficient at pumping blood throughout the body.16

Genes may play a part in high blood pressure. Family history of hypertension, combined with poor diet and smoking, can also increase the risk.17  

In 2016, 82,735 deaths were attributed to high blood pressure. The death rate increased by 18% during a 10-year span, from 2006 to 2016.18

Other Conditions

Congestive heart failure can also be caused by other conditions, including: 

• Infections such as viral infections like rubella and systemic viral infections like HIV, which can cause progressive damage to the heart

• Alcohol or substance abuse

• Chemotherapy drugs

• Amyloidosis

• Sleep apnea

• Toxic exposure

If you are experiencing chest pain, shortness of breath, or any related symptoms from any of these conditions, seek immediate medical attention. 

Sources

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MedlinePlus. Heart failure.

Cleveland Clinic. Heart failure: understanding heart failure management and treatment.

American Heart Association. Causes and risks for heart failure.

Centers for Disease Control and Prevention. Heart Failure.

Cirino AL, Ho CY. Genetic testing for inherited heart disease. Circulation. 2013 Jul 2;128(1):e4-8. doi: 10.1161/CIRCULATIONAHA.113.002252

Warning signs of heart failure. American Heart Association. 

MedlinePlus Genetics. Familial hypertrophic cardiomyopathy.

About cholesterol. Centers for Disease Control and Prevention.

Mestroni L, Brun F, Spezzacatene A, Sinagra G, Taylor MR. Genetic causes of dilated cardiomyopathy. Prog Pediatr Cardiol. 2014;37(1-2):13-18. doi: 10.1016/j.ppedcard.2014.10.003

Fahed AC, Roberts AE, Mital S, Lakdawala NK. Heart failure in congenital heart disease: a confluence of acquired and congenital. Heart Fail Clin. 2014 Jan;10(1):219-27. doi: 10.1016/j.hfc.2013.09.017

Stout KK, Broberg CS, Book WM, Cecchin F, Chen JM, Dimopoulos K, Everitt MD, Gatzoulis M, Harris L, Hsu DT, Kuvin JT, Law Y, Martin CM, Murphy AM, Ross HJ, Singh G, Spray TL; American Heart Association Council on Clinical Cardiology, Council on Functional Genomics and Translational Biology, and Council on Cardiovascular Radiology and Imaging. Chronic Heart Failure in Congenital Heart Disease: A Scientific Statement From the American Heart Association. Circulation. 2016 Feb 23;133(8):770-801. doi: 10.1161/CIR.0000000000000352

Rosano GM, Vitale C, Seferovic P. Heart failure in patients with diabetes mellitus. Card Fail Rev. 2017;3(1):52-55. doi: 10.15420/cfr.2016:20:2

Centers for Disease Control and Prevention. Diabetes and your heart.

Masarone D, Limongelli G, Rubino M, Valente F, Vastarella R, Ammendola E, Gravino R, Verrengia M, Salerno G, Pacileo G. Management of Arrhythmias in Heart Failure. J Cardiovasc Dev Dis. 2017 Feb 28;4(1):3. doi: 10.3390/jcdd4010003

American Heart Association. How high blood pressure can lead to heart failure.

Centers for Disease Control and Prevention. Know your risk for high blood pressure.

Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019 Mar 5;139(10):e56-e528. doi: 10.1161/CIR.0000000000000659

By Rebeca Schiller
Rebeca Schiller is a health and wellness writer with over a decade of experience covering topics including digestive health, pain management, and holistic nutrition.