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What Is Congestive Heart Failure?

Reviewed by: HU Medical Review Board | Last reviewed: October 2019

Congestive heart failure (CHF) and chronic heart failure are terms that are both used to describe heart failure (HF). The predominant symptom of heart failure is congestion. Congestion is caused when blood backs up and pools in the tissues of the body. This can result in swelling, also known as edema. The fluid can collect in the ankles and legs, but also in other parts of the body including the lungs. This can cause difficulty breathing, shortness of breath, and pulmonary edema which can lead to respiratory distress if not treated promptly. Heart failure can also affect the kidneys' ability to process and eliminate sodium and water. This can result in further retention and additional swelling.1-2

Congestive heart failure can be classified as systolic or diastolic and becomes more common with advanced age. Systolic heart failure, also known as heart failure with reduced ejection fraction, occurs when the left ventricle fails to contract normally. This decrease in pumping function leads to less blood pumped out into circulation. Diastolic heart failure is also known as heart failure with preserved ejection fraction. This happens when the left ventricle is no longer able to relax after each contraction because the muscle has stiffened or become rigid. This interferes with the heart's ability to fill with blood between each contraction.1-2


When the heart muscle is weaker than normal or has a defect, blood is unable to circulate normally. As circulation slows, the blood in the veins making the return trip to the heart can back up or pool. This causes swelling, also known as edema. When the buildup of fluid in the circulation pools in the body’s tissues it is called congestion. This is where the name congestive heart failure comes from.

When the kidneys have less blood passing through them it causes a decrease in their filtering of fluid that is released into the urine. This affects their ability to properly eliminate sodium and water. Fluid can collect in the lungs which can cause shortness of breath and interfere with breathing. This is called pulmonary edema and if left untreated can cause respiratory distress.1 Fluid in the lungs can also cause shortness of breath when lying down, which is called orthopnea. Congestion can develop in the lungs, the liver, around the eyes and legs, and other parts of the body. Symptoms of congestion depend on what part of the body is retaining fluid.

Who is impacted by congestive heart failure

Congestive heart failure can affect people of all ages, from infants to children and adults. It is most common in older adults.3 CHF can be caused by coronary artery disease, high blood pressure, infections, and numerous other things. It is also associated with lifestyle habits including drug and alcohol abuse, high salt intake, and a sedentary lifestyle. It can be made worse by comorbid conditions like diabetes, obesity, and thyroid dysfunction. CHF can also arise from an unknown cause(s).5

Symptoms of congestive heart failure

Symptoms may vary by age. Having shortness of breath (dyspnea), a cough, or feeling unable to take a deep breath, especially when lying down (orthopnea), can be symptoms of congestive heart failure. Inhaling can feel more difficult because the fluid in the lungs can make it harder for the airways to expand. Symptoms can mimic having a cold or the flu. They generally get worse with exertion (engaging in physical activity). Children may appear fatigued or slower than their friends. Infants may sweat or breathe rapidly while feeding. This can interfere with calorie intake and problems with normal weight gain.3-4

As with all medical conditions, if you experience sudden changes in the way you feel contact your health care team and seek emergency medical treatment as directed by your physician.

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