Centers of Excellence

Heart & Vascular Center

Heart Failure

What is Congestive Heart Failure (CHF)?

Congestive heart failure, known simply as heart failure, happens when the heart no longer pumps sufficient blood to the body's organs. During congestive heart failure, the heart can still circulate blood, but not efficiently, leading to a patient experiencing shortness of breath, swelling in legs and ankles, fatigue, weakness, loss of appetite and a cough.

Congestive heart failure is often caused by high blood pressure, congenital heart disease, coronary artery disease or valvular heart disease. When arteries narrow, the heart weakens or heart tissue becomes stiff, and the symptoms of congestive heart failure can worsen.

Treatment for congestive heart failure includes lifestyle changes and surgery.

Heart Failure Information

How Common is Congestive Heart Failure?

Almost 2% of all Americans (nearly six million) suffer from congestive heart failure. The number continues to grow, making heart failure the number-one reason for hospitalization in Americans 65 and older.

What Causes Congestive Heart Failure?

Common causes of congestive heart failure come from other medical conditions that weaken the heart muscle or the arteries in and around the heart. The most common include:

Another contributing cause of heart failure is cardiomyopathy, which describes any disorder that affects the heart muscle. Three forms of cardiomyopathy are:

  • Hypertrophic cardiomyopathy is an uncommon, often familial, condition that involves abnormal thickening of the left ventricle and stiffening of the heart, due to a genetic mutation in key proteins involved in heart muscle contraction
  • Dilated cardiomyopathy, the most common type of cardiomyopathy, refers to a markedly enlarged heart with an impaired ability to pump blood. This also can be caused by genetic mutations or other secondary factors, such as viruses or toxins
  • Restrictive cardiomyopathy occurs when the heart muscle becomes stiff due to progressive fibrosis or accumulation of abnormal substances and is unable to properly fill with blood
Risk Factors for Congestive Heart Disease

The likelihood of developing congestive heart failure increases with age, mainly due to risk factors having more time to take hold. Lifestyle choices and medical conditions play a role in heart failure risk factors. Those include:

  • High blood pressure
  • High cholesterol
  • Unhealthy diet
  • Diabetes
  • Obesity
  • Tobacco or recreational drug use
  • Stress
  • Sedentary lifestyle
Congestive Heart Failure Symptoms

Common symptoms of heart failure may slowly progress or suddenly start, indicating signs of congestive heart failure. If left untreated, congestive heart failure symptoms progressively worsen over time. Common symptoms of heart failure include:

  • Swelling, often in the legs and ankles
  • Shortness of breath, especially during physical activity or when lying down
  • Weight gain
  • Weakness and fatigue
  • Nausea, abdominal pain and loss of appetite
  • Ongoing cough
  • Weight gain of more than two pounds overnight or five pounds in a week

All of these symptoms are common to many medical conditions and may not indicate heart failure. If you experience any of these symptoms or have concerns, consult your doctor.

How is Congestive Heart Failure Diagnosed?

Congestive heart failure diagnosis is achieved through a comprehensive assessment of the heart muscle, including a doctor's evaluation of the heart's pumping action and thickness of its walls. This testing helps doctors with the diagnosing of heart failure and can determine the underlying cause. Diagnostic tests for congestive heart failure may include:

What Are the Stages of Congestive Heart Failure?

Patients can expect four congestive heart failure stages, from those at risk of developing heart failure to advanced levels of congestive heart failure.

  1. Based on risk factors, family history and/or medical conditions, a patient is deemed at a high risk of developing congestive heart failure.
  2. Symptoms may not have presented in this stage, but a doctor has found systolic left ventricular dysfunction and an echocardiogram reads a diminished ejection fraction, often 40% or less.
  3. At this point some symptoms of congestive heart failure have presented and a doctor has made a congestive heart failure diagnosis.
  4. The final stage of congestive heart failure shows worsening symptoms that are often unresponsive to treatments.
How is Congestive Heart Failure Treated?

Congestive heart failure treatment aims to improve and extend quality of life for patients. Congestive heart failure is treated and managed through a combination of lifestyle modifications and a wide range of therapies, including medication and interventions, intended to help the heart work more effectively while alleviating heart failure symptoms. Pacemakers and ventricular assist devices can make it easier for the heart to pump blood and remain in rhythm. For some patients with advanced heart failure, a heart transplant may be an option.

Lifestyle Changes

Congestive heart failure patients can improve their quality of life with healthy lifestyle improvements. A heart-healthy diet that includes:

  • Weight loss and physical activity
  • Fat and salt reduction
  • Blood pressure control
  • Smoking and alcohol cessation

Medical Therapies

Doctors rely on a mix of medical therapies designed to improve heart function while reducing symptoms, such as:

  • Dilate blood vessels and reduce the workload on the heart
  • Decrease pressure inside the blood vessels
  • Reduce fluid in the body
  • Help the heart beat stronger and more regularly

Read more about medications used in the treatment of heart failure/cardiomyopathy.

Non-Surgical Procedures

Surgical Interventions

Clinical Trials

Physicians and surgeons at Brigham and Women’s Hospital are leaders in the science of heart failure management and cardiac transplantation, and provide access to a range of clinical trials of experimental therapies that may benefit heart failure patients.

  • Metabolic therapy to reduce heart failure readmissions
  • Iron deficiency treatment that contributes to cardiac dysfunction
  • Long-acting nitrates to improve activity level in patients with heart failure and preserved heart function
  • Implantable devices to monitor heart function

Learn more about our research and clinical trials.

For patients and their family members who have familial cardiac diseases such as hypertrophic cardiomyopathy, the Heart and Vascular Genetics Program offers evaluation by a specialist and blood testing for genetic cardiac disorders.

Experienced Care for Heart Failure

Our board-certified physicians and surgeons in the Heart & Vascular Center are leaders in the evolution of advanced care for heart failure. Our team behind the discovery of defibrillation and cardiac resynchronization were the first to use ACE inhibitors to stop the progression of heart failure and performed the first successful artificial heart transplant and the first ventricular assist device implantation in New England.

We provide comprehensive inpatient and outpatient care to adults with complex heart failure caused by cardiomyopathy and other life-threatening heart diseases. Our multidisciplinary team of cardiologists, interventional cardiologists, electrophysiologists, cardiac surgeons, cardiac anesthesiologists, radiologists, nurse practitioners and social workers work together to achieve the best plan of care for our patients. Together, the team tailors therapies to each patient’s needs, offering the latest medical, interventional, and surgical approaches to congestive heart failure treatment.

Our Advanced Heart Failure/Cardiomyopathy Program offers patients access to many clinical trials as well as innovative therapies and programs, including:

  • Implantable hemodynamic monitors that allow patients to transmit cardiac information from home to physicians for adjustment of therapies
  • New left ventricular assist devices which are smaller, quieter and more comfortable for continuous support of circulation
  • New hybrid therapies that combine percutaneous interventions (injected or absorbed through the skin) and open surgical procedures (conventional or minimally invasive) for safe, effective and durable therapy with minimal surgical trauma
  • Our ACT (advanced cardiac therapy) Unit, which provides complex monitoring and intervention in a comfortable, inpatient setting
  • Our Clinical Cardiovascular Genetics Program, the first of its kind in New England, offering evaluation and blood testing for genetic cardiac disorders
  • Our Diastolic Heart Failure Program, which evaluates heart failure patients who have normal heart contraction

What to Expect at the Heart & Vascular Center

The Heart & Vascular Center is located in the Shapiro Cardiovascular Center, across the street from our main 75 Francis Street entrance. The center brings together the full range of services in one location, fostering seamless and coordinated care for all cardiovascular patients.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Watkins Clinic for pre-operative information and tests.

The day of surgery, your care will be provided by surgeons, anesthesiologists and nurses who specialize in surgery for patients with CHD. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.

During your surgery, family and friends can wait in the Shapiro Family Center. Staff members will provide surgery updates and caregivers who leave the hospital will be contacted by cell phone.

Additional Resources

Carolyn Ho, MD, Medical Director of the Cardiovascular Genetics Center at Brigham and Women's Hospital (BWH), discusses the role of genetics in the development of heart diseases such as hypertrophic cardiomyopathy. Read the Advancing Care for Inherited Heart Disease video transcript.

Learn more about Brigham and Women's Hospital

For over a century, a leader in patient care, medical education and research, with expertise in virtually every specialty of medicine and surgery.

About BWH

Learn more about Brigham and Women's Hospital

For over a century, a leader in patient care, medical education and research, with expertise in virtually every specialty of medicine and surgery.

About BWH