Classification and stages

By Vanessa Caceres 

 Medically reviewed by Richard N. Fogoros, MD

Heart failure is what happens when your heart is not pumping enough blood throughout the body. It does not mean the heart has stopped working. Instead, it means your heart is not strong enough to pump blood properly or is not able to fill up with a sufficient amount of blood. This article discusses the different types of heart failure.

Verywell / Jessica Olah

Heart Failure Overview

There are about 6.2 million adults in the United States with heart failure.1 Heart failure can be acute, which means it happens quickly. Or it can develop over time as your heart becomes weaker. This is considered chronic heart failure.

Heart failure often occurs because of another medical condition that causes heart damage, including:

• Cardiomyopathy, or diseases of the heart muscle

• Valvular heart disease

• Coronary heart disease, or a buildup of plaque in the coronary arteries

• Diabetes

• Heart inflammation

• High blood pressure

• Long periods of tachycardia (rapid heart rate)

Heart failure can affect other parts of the body, including the kidneys and liver. This is why it is so important to see a doctor for heart failure and manage it properly. With the right treatments, many people with heart failure can live a long, fulfilling life.

Types of Heart Failure

There are several anatomical types of heart failure:

• Left-sided heart failure

• Right-sided heart failure

• Biventricular heart failure

You have probably also heard of congestive heart failure. This is not a type of heart failure; rather, it is a symptom that can occur with any of the three types listed above.

It is also possible to have more than one type of heart failure.

Left-Sided Heart Failure

The left side of your heart pumps blood throughout the body. With left-sided heart failure, the left ventricle, also known as the lower left chamber, does not pump blood as well as it normally should or cannot fill with blood properly. Left-sided heart failure is the most common type of heart failure.23

Symptoms of Left-Sided Heart Failure

Symptoms include:4

• Chest pain

• Exercise intolerance

• Fast or irregular heartbeat

• Chronic cough or wheezing

• Fatigue

• Edema (swelling in the tissues, such as in ankles or wrists)

• Shortness of breath

• Rapid weight gain

• Weakness

Diagnosis and Typing

A type of measurement called ejection fraction is used to assess how effectively the heart pumps blood. An ejection fraction measurement can help indicate the type of left-sided heart failure you have:3

• Systolic heart failure is used to indicate that the left ventricle muscle cannot pump blood well. The ejection fraction is below normal. This is also called heart failure with reduced ejection fraction.

• Diastolic heart failure is used to indicate that the left ventricle does not fill with blood as it should during the diastolic phase. The ejection fraction is normal or close to normal. This is also called heart failure with preserved ejection fraction. With diastolic heart failure, the left ventricle pumps properly but pumps out less blood than it normally would.

It is useful to know your ejection fraction if you have heart failure. Here's what the ejection fraction numbers mean:5

• An ejection fraction of 55% to 70%: The heart is pumping normally. You may have a normal heart function or heart failure with preserved ejection fraction.

• An ejection fraction of 40% to 54%: The heart's pumping ability is a little below normal.

• An ejection fraction of 35% to 39%: The heart has a moderately below-normal pumping ability. This indicates mild heart failure with reduced ejection fraction.

• An ejection fraction of less than 35%: The heart's pumping ability is severely below normal. There is very often moderate to severe heart failure with reduced ejection fraction.

Treatment

Although left-sided heart failure cannot be cured, there are treatments to help manage it. Treatments are usually tailored depending on the cause of the heart failure. Treatments for left-sided heart failure include:6

• Making lifestyle changes, such as getting more physical activity and eating a heart-healthy diet

• Reducing salt intake to help avoid or reduce a buildup of fluid in the body

• Taking medications such as angiotensin-converting enzyme (ACE) inhibitors, SGLT2 inhibitors, beta-blockers, and diuretics. There are many types of medications used for left-sided heart failure.

• Having surgery to help repair a blocked artery or a narrow or leaky heart valve

Right-Sided Heart Failure

Left-sided heart failure is a frequent cause of right-sided heart failure. However, other conditions can cause right-sided heart failure, including certain lung diseases like chronic obstructive pulmonary disease or pulmonary hypertension.3

Symptoms of Right-Sided Heart Failure

Symptoms of right-sided heart failure are similar to those of left-sided heart failure, although they can be more severe. These symptoms include:7

• Weakness and fatigue

• Shortness of breath, even after a short amount of activity

• Edema—swelling in the feet, ankles and legs, abdomen, and/or chest

• Chest pain and/or discomfort

In addition, right-sided heart failure can produce symptoms related to congestion of the abdominal organs, and may cause more fluid retention than usually seen with left-sided heart failure. These symptoms include:

• Ascites (abdominal distention due to fluid accumulation)

• Poor appetite

• Nausea and vomiting

• Swelling in the lower back

• Swollen, painful liver

Treatment

Treatments for right-sided heart failure will depend on its cause. Common treatments include:8

• Surgical repair if the cause is valvular heart disease

• Use of medications

• Lifestyle changes such as a low-fat/low-sodium diet and gentle aerobic exercise

• In severe cases, a heart transplant

Like left-sided heart failure, right-sided heart failure does not have a cure. However, you can use the various treatments to help manage it.

Biventricular Heart Failure

Heart failure more commonly occurs on the left side of the heart but then can expand to the right side. Biventricular heart failure is used to describe heart failure that is present in both the left and right sides of the heart.2 The symptoms include fatigue, shortness of breath, and swelling. You would follow the treatments as recommended by your doctor, including medications, surgery, and lifestyle changes.

What About Congestive Heart Failure?

You may hear some health professionals use the term congestive heart failure, or CHF. CHF is actually not a separate kind of heart failure, but it is a descriptive term that can be used with any of the three types of heart failure discussed earlier. When the chief symptoms of heart failure of any type are caused by excessive fluid accumulation, leading to symptoms of lung congestion and edema, the doctor is likely to refer to it as congestive heart failure.9

Heart failure is different from cardiac arrest, a term used to describe when the heart stops beating.

Treatment

Treatments for congestive heart failure include:

• Taking medications like ACE inhibitors, diuretics, and vasodilators

• Having surgery to replace heart valves or open clogged arteries

• Following a low-sodium diet and avoiding or limiting caffeine

Doctors may monitor and treat other conditions that are linked to congestive heart failure, including sleep apnea.10

Sources

Centers for Disease Control and Prevention. Heart failure.

InformedHealth.org. Types of heart failure.

University of Michigan Health. Heart failure types.

Baptist Health. Left sided heart failure.

Cleveland Clinic. Ejection fraction.

Cleveland Clinic. Heart failure: Understanding heart failure.

Cleveland Clinic. Right-Sided Heart Failure.

American Heart Association. Treatment options for heart failure.

Johns Hopkins Medicine. Congestive heart failure: Prevention, treatment and research.

Johns Hopkins Medicine. Congestive heart failure. Prevention, treatment, and research.

Centers for Disease Control and Prevention. About heart disease.

American Heart Association. Classes of heart failure.

By Vanessa Caceres
Vanessa Caceres is a nationally published health journalist with over 15 years of experience covering medical topics including eye health, cardiology, and more.