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What Are the Symptoms and Causes of Heart Failure?

Occurs when heart doesn't pump blood properly; treatments help

An older woman with heart failure clutches her chest in pain.

Occurs when heart doesn't pump blood properly; treatments help

The term “heart failure” can be a bit misleading. Heart failure doesn’t mean the heart has completely failed to work. It means the heart has lost its ability to pump blood properly to the rest of the body. The average heart pumps about 2,000 gallons of blood throughout the body to deliver a constant supply of oxygen to your cells.


To understand how heart failure happens, it helps to know how the heart works. The heart has four chambers – two on the right and two on the left. The right upper chamber, called an atrium, takes in oxygen-poor blood from the body and sends it through the lower right chamber, called a ventricle, where it receives oxygen from the lungs. This oxygen-rich blood travels from the lungs to the left atrium and on to the left ventricle, which pumps it back to the rest of the body.


Most of the time, heart failure happens when the left ventricle becomes enlarged and cannot efficiently pump blood. This is called systolic heart failure. Diastolic heart failure is when the left ventricle cannot properly fill with oxygen-rich blood. In addition, fluid may build up in the lungs and interfere with breathing. This condition is called congestive heart failure.


According to the National Heart, Lung and Blood Institute, heart failure causes include coronary artery disease (heart disease), heart attack, high blood pressure and diabetes. Family history and lifestyle habits, such as smoking, being overweight and lack of exercise, may increase the risk of heart failure. Age is also a risk factor. Heart failure tends to occur most often after age 65.

Symptoms of heart failure

Heart failure can exist for years before symptoms develop. In the early stage of heart failure, the heart may try to compensate for this by pumping faster, or the body may react by narrowing blood vessels to maintain blood pressure. Patients may not notice any changes in how they feel, but these measures are only temporary. Early symptoms include shortness of breath and fatigue during physical activity. As the disease progresses, symptoms occur during everyday activities as well.


In addition to fatigue and shortness of breath, symptoms of heart failure include:


  • Swelling of the feet or ankles due to fluid build-up
  • Weight gain
  • Weakness
  • Lightheadedness


“Heart failure is a chronic and progressive condition, and as it worsens, patients may feel symptoms even at rest,” says Ajay Srivastava, MD, a cardiologist who specializes in advanced heart failure at Scripps Clinic John R. Anderson V Medical Pavilion in La Jolla. “Patients with advanced heart failure may require implantable pumps or other medical devices to help their hearts pump blood.”

Heart failure diagnosis and treatment

If heart failure is suspected, your doctor will perform a physical exam, including blood pressure and heart rate, and talk with you about your symptoms and medical history. Your doctor may also order blood tests and imaging exams, including:


  • Electrocardiogram (EKG or ECG) to record electrical functions, such as heart rate, heartbeat rhythm, and strength and timing of electrical signals in the heart
  • Stress EKG to detect reduced blood flow to the heart while you are exercising, usually on a treadmill
  • Echocardiogram (ECHO) to create moving pictures of the heart’s chambers and valves using sound waves
  • Cardiac blood pool scan to determine how well the heart pumps blood to the rest of the body.


The doctor also may recommend a cardiac catheterization procedure, which uses a thin, flexible tube called a catheter that is inserted into a blood vessel to measure pressure within the heart.


Heart failure treatment depends on the severity of the condition, the patient’s health and other considerations. If heart failure is diagnosed early, lifestyle changes, such as losing weight, eating a heart-healthy diet, exercising and quitting smoking, can help. 


In many cases, heart failure treatment may include medications to manage symptoms or help slow the progression of the disease. If medication is not enough, a surgical procedure may be recommended.


“Scripps cardiologists use a variety of advanced procedures to treat heart failure,” says Dr. Srivastava. “Many of these can be performed using minimally invasive surgical techniques, which can mean smaller incisions and a faster recovery time.”


Medical procedures to help treat heart failure may include:


  • Cardiac resynchronization therapy (CRT), which increases the heart’s pumping efficiency
  • Implantable cardiac defibrillator (ICD) to keep the heart beating at a healthy rate
  • Pacemaker implantation, which uses a small battery-powered device to create a healthy heartbeat and rhythm
  • Ventricular assist devices (VADs), including left ventricular assist devices (LVADs) that improve the circulation of oxygen-rich blood
  • Transcatheter aortic valve replacement (TAVR), a minimally invasive procedure that doesn’t require a traditional chest incision and “open” surgery.
  • Heart valve repair or replacement that can be performed through robotic-assisted minimally invasive surgery.


Annual physical exams are a first step to diagnosing and treating heart conditions in their earliest stages. If you have not had your annual check-up, or you have any symptoms of heart disease, make an appointment with your doctor.