What Are Types of Heart Failure?

Reviewed by: HU Medical Review Board | Last reviewed: October 2019 | Last updated: January 2021

Heart failure (HF) is a complex syndrome with physiological signs and symptoms caused by the heart not functioning properly. HF affects the duration of a person’s lifespan. The diagnosis of heart failure, according to established guidelines, is based on several criteria including the presence of symptoms and signs, evidence of cardiac dysfunction on diagnostic tests, and/or a favorable response to treatment.1

Heart failure classifications

There are different types of heart failure and they are classified by specific characteristics including symptoms and functional limitations (how it affects you). Your provider will ask you questions and use different tests to identify the type of heart failure you have before starting a treatment plan.1

Heart failure onset

One way to classify heart failure is by the time of onset when the HF begins. Acute heart failure is the rapid onset of new or worsening signs and symptoms requiring immediate intervention. It can arise due to an allergic reaction, a blood clot, or a heart attack among other causes.1

The term heart failure generally describes people with established chronic heart failure. Chronic heart failure develops slowly. It is a condition in which the heart has difficulty pumping enough blood through the body. It can be caused by coronary artery disease, heart attack, or high blood pressure. It is most common in people over age 65. Symptoms can include shortness of breath, fatigue, and swelling of the feet, ankles, and abdomen.2

The two sides of the heart

The left ventricle (LV) is the main pumping chamber of the heart. It is larger than the other chambers and plays a fundamental role in normal heart function. When there is HF on the left-side, the heart has to work harder to squeeze out the same amount of blood. This is referred to as left ventricular heart failure. It is the most common type of HF. An echocardiogram is generally used to evaluate the ejection fraction (EF) of the left ventricle.1,3

The right ventricle (RV) normally pumps blood out of the heart into the lungs where it is replenished with oxygen. Right-sided heart failure can be the result of chronic left-sided failure. As the left ventricle fails, increased fluid pressure reverts back through the lungs into the right ventricle, causing blood to back up in the veins. This leads to swelling and results in damage to the right side of the heart.3 Right-sided heart failure can also be caused by long-standing lung disease.

Biventricular heart failure is when both sides of the heart are affected. This can result in similar symptoms as left and right-sided heart failure, including shortness of breath and swelling due to a build-up of fluid. It is rare for heart failure to develop on the right side first unless it occurs as a result of lung disease. Most often, LVHF contributes to the strain on the right side that causes HF to develop on both sides.3,9

Chronic heart failure

Chronic Heart Failure, also called congestive heart failure (CHF), occurs when the heart cannot fill properly or pump blood forward causing fluid to build up into the tissues of the body. This can result in congestion or swelling. The typical symptoms are shortness of breath and fatigue. Not everyone with CHF will have congestion, some people only experience fatigue and decreased activity tolerance. Those who experience congestion may have swelling in the ankles and legs, abdomen, or lungs. Shortness of breath and pulmonary edema 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 may result in even more fluid retention and subsequent swelling.3

Ejection fraction

Ejection fraction (EF) describes the pumping ability of the heart, a muscle that contracts and relaxes with every beat. The EF represents the percentage of blood pumped out of the heart each time it contracts. A normal EF is 55-70%. When the pumping ability of the heart is impaired, the ejection fraction measurements decline.4-5

Diastolic heart failure

Also known as heart failure with preserved ejection fraction (HFpEF), diastolic HF develops when the left ventricle becomes rigid or stiff and cannot relax between beats and is thus unable to properly refill with blood. About half of people with heart failure have diastolic heart failure or HFpEF. Diastolic heart failure is most common in older people and in women.4,6 It is often classified as a disease of comorbidities. This means that there are often other underlying medical conditions that can lead to the development of diastolic HF.

Systolic heart failure

Also known as heart failure with reduced ejection fraction (HFrEF), systolic HF develops when the left ventricle doesn’t contract normally. This means the heart no longer pumps with enough force to squeeze sufficient blood into circulation. Conditions like high blood pressure, arrhythmias, coronary artery disease, and abuse of alcohol and drugs can contribute to the development of systolic heart failure.7

Decompensated heart failure

Decompensated heart failure (DHF) occurs when patients with heart failure develop worsening signs and symptoms, usually congestion. Patients may have weight gain, worsening shortness of breath, swelling in their legs or abdomen, nausea, or poor appetite and shortness of breath or cough when lying down. Decompensated heart failure can also cause fatigue, making you feel more tired when doing everyday activities. This can interfere with carrying out household activities or any strenuous tasks at work. Patients with DHF may need to be admitted to the hospital for treatment.

Acute vs. chronic heart failure

People with acute heart failure (AHF) have no previous signs and symptoms of heart failure. AHF can present with rapid swelling and fluid retention characterized by sudden weight gain. Coughing, wheezing and shortness of breath, as well as an irregular heartbeat, could be symptoms of acute heart failure. In some cases, it is related to pre-existing cardiomyopathy. AHF often requires unexpected hospital admission.8 Treatment options include medication, surgery, implanted medical devices, as well as recommended lifestyle modifications.

Chronic heart failure describes the heart’s inability to pump enough blood through the body to provide a sufficient supply of oxygen. This is caused by a weaker than a normal heart. Chronic HF is most common in men and risk factors include age, high blood pressure, being overweight, and the presence of metabolic disorders like diabetes. Chronic HF, as its name describes, is a long-term condition that will get worse over time. It generally cannot be cured but it can be medically managed.9

End-stage heart failure

End-stage heart failure is also known as advanced heart failure or refractory heart failure. It occurs when treatment is no longer working because the heart muscle is too damaged and can no longer pump effectively. Patients with end-stage heart failure have symptoms despite being on medications and have frequent hospitalizations. Symptoms of end-stage heart failure include dyspnea (shortness of breath) at rest, chronic coughing or wheezing, edema (swelling), nausea or lack of appetite, rapid heart rate, and confusion or impaired thinking.11-12

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