What is heart failure? How to spot the signs + why it’s different from cardiac arrest

Fatigue, abdominal swelling, protruding neck veins. Did you know these are all possible symptoms of heart failure?

While many of us know how to spot a heart attack, we’re less likely to know how to spot heart failure, says Dr. Ian Hamilton, medical director at BlueCross BlueShield of Tennessee.

“Heart failure is not cardiac arrest, which is when the heart stops beating,” says Dr. Hamilton.

What is heart failure?

Dr. Hamilton: Heart failure, also known as congestive heart failure (CHF), happens when the pump function of the heart isn’t working like it should. Over time:

The heart muscle becomes less able to contract or fill with blood, and it can’t keep up with the body’s demand.
That causes blood to return to the heart faster than it can be pumped out, which causes congestion.
That results in not enough oxygen-rich blood delivered to the body’s other organs.

One way providers gauge heart failure is by measuring a heart’s ejection fraction. This is the percent of blood the heart is able to squeeze out of its left ventricle back into the body.

A normal ejection fraction is between 50-60%.
Anything below 50% is cause for concern.
If you get down to less than 20%, you’ll be terribly incapacitated, to the point you’ll have trouble even getting up from chair.

How common is heart failure?

Dr. Hamilton: Heart failure is very common. Nearly 5 million Americans are living with CHF, and Tennessee’s death rate from heart failure is 11% higher than the national average. Part of the reason heart failure is so common is that you can develop it from more than one cause.

What are the causes of heart failure?

Dr. Hamilton: Heart failure can be caused by:

Coronary artery disease, especially in the elderly
Untreated high blood pressure (hypertension)
Valvular heart disease
Cardiomyopathy (a catch-all for several less common causes of heart failure)
Chronic alcohol use
Diabetes
Rare diseases (sarcoidosis, amyloidosis)
Abnormal thyroid function
Longstanding arrhythmia (irregular heartbeat)

When you have an issue like coronary artery disease, each heart attack takes away some muscle tissue. That decreases the heart muscle’s ability to contract and increases your risk of heart failure.

6 tips for preventing a second heart attack

What are the signs of heart failure?

Dr. Hamilton: Common signs of heart failure include:

Shortness of breath
Lightheadedness
Fatigue at rest or with minimal exertion
Unintentional weight loss
Protruding neck veins
Abdominal swelling
Exercise intolerance (having trouble getting out of a chair)
Volume overload (excess body water)
Irregular heartbeat
Hypotension (low blood pressure)
Inadequate blood flow to other organs (lungs, kidneys, etc.)

What can you do to prevent heart failure?

Dr. Hamilton: Do the same things you’d do to reduce your risk of coronary artery disease:

Exercise regularly
Eat a healthy diet for your heart
Keep cholesterol levels normal or low
Drink alcohol in moderation, if at all
Visit your primary care provider (PCP) regularly

Regular PCP visits ensure your blood pressure is checked regularly, as well as your thyroid if that’s a concern. If your blood pressure is high, take your medications as prescribed and make any needed dietary changes. Both can make a big difference in protecting you against heart failure.

More from Dr. Hamilton on heart health

Ashley Brantley

Ashley Brantley has been writing about food, culture and health for more than a decade, and has lived in three of Tennessee’s four major cities (Memphis, Nashville and Knoxville).