Heart failure

In people with heart failure, the heart isn't able to pump enough blood around their body. As a result, their organs and muscles do not get enough oxygen. Heart failure can be acute, like after a heart attack, or it may develop over time.

At a glance

  • In people with heart failure, the heart isn't able to pump enough blood around their body. As a result, their organs and muscles do not get enough oxygen.
  • Common signs are shortness of breath, difficulty breathing, exhaustion and a build-up of fluid.
  • Heart failure can be acute or gradually develop over time, usually as a result of another condition.
  • The treatment of heart failure includes medication, physical exercise and treating the underlying disease.
  • Not smoking, not drinking too much alcohol, and staying as physically active as possible can help to reduce strain on the cardiovascular system.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

Heart failure: older man sitting on a rock holding his heart with one hand. His face is tense and he is grimacing with pain.

What is heart failure?

In people with heart failure, the heart isn't able to pump enough blood around their body. As a result, their organs and muscles do not get enough oxygen. Heart failure is also referred to as cardiac insufficiency or congestive heart failure (CHF).

Heart failure can be acute, like after a heart attack, known as acute heart failure, or in the case of chronic heart failure, it may develop over time, for example because of permanently high blood pressure or coronary artery disease.

What are the signs of heart failure?

Heart failure can cause various symptoms. The most common symptoms are:

  • shortness of breath and difficulty breathing
  • tiredness and exhaustion
  • a build-up of fluid in the feet, ankles or legs or – less commonly – in the genital area or abdomen (belly)

Other possible symptoms include a rapid heartbeat, urinating often at night, difficulties concentrating and a dry cough. People may also gain weight due to the build-up of fluid.

But these kinds of symptoms can have a number of other causes. A lot of people who have heart failure also have other medical conditions. It can therefore sometimes be hard to recognize early signs of heart failure.

What causes heart failure?

Heart failure is usually caused by another health problem. These are the most common causes: 

In coronary heart disease (CHD, also called coronary artery disease, or CAD), the arteries that supply the heart with oxygen-rich blood are too narrow. This can prevent the heart from getting enough blood, resulting in heart failure. This in turn can lead to a heart attack. In a heart attack, one of these blood vessels is blocked so suddenly that no blood can get through to part of the heart, and muscle tissue dies.

Constant high blood pressure can damage the blood vessels, causing them to lose their elasticity. The heart then has to work against higher resistance. This constant strain makes the heart muscle grow larger and thicker, which makes the muscle harden or the heart chambers become larger, leading to heart failure.

Why is high blood pressure dangerous?

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Heart failure can also be caused by conditions affecting the heart muscle, the heart valves or the sac around the heart (pericardium). Alcohol abuse, drug abuse, and certain medications also increase the risk of heart failure.

What are the risk factors for heart failure?

The main risk factors for heart failure are:

Risk factors for heart failure are type 2 diabetes, smoking, heart attack, excessive alcohol consumption, being severely overweight (obesity), coronary heart disease (CHD) and high blood pressure.

How common is heart failure?

Heart failure mainly occurs in older people. It usually arises after the age of 65, and the risk increases with age. More than 10% of people over the age of 70 suffer from heart failure.

Over 10% of people over 70 suffer from heart failure

How does heart failure develop?

There are four stages of heart failure, based on how severe it is:

Symptom-free (asymptomatic) heart failure

There are no symptoms, but certain tests can detect that the heart isn't performing as well as it should.

Mild heart failure

More strenuous physical exercise like climbing stairs or walking uphill causes symptoms like exhaustion or shortness of breath. But light physical exercise doesn't cause any symptoms.

Moderate heart failure

Even everyday activities and light physical exercise, like walking on a level surface, can cause symptoms.

Severe heart failure

Symptoms occur at rest or during even the slightest physical exercise. The person affected can only lie down if their upper body is elevated. Some people with severe heart failure are bedridden.

The way in which heart failure continues to develop over time varies from person to person, depending on things like what is causing it and whether they have other medical conditions. In some people the symptoms can be kept under control for many years. But for others the heart becomes weaker rather quickly. 

Important: Advanced heart failure can really affect people's quality of life because it is difficult or even impossible to carry out normal activities.

If heart failure suddenly gets a lot worse, it can become life-threatening and hospital treatment may be needed. A sudden turn for the worse is characterized by symptoms like shortness of breath following even light exercise or at rest, especially while lying down.

How is heart failure diagnosed?

If someone is thought to have heart failure, they first of all have a general consultation with their doctor. Possible signs of heart failure include trouble breathing, exhaustion, swelling due to water retention, abnormal heart sounds (murmurs), or crackling sounds when breathing. In order to diagnose heart failure properly, though, doctors have to do further examinations. These include the following:

  • an ECG (electrocardiogram) to measure the electrical activity of the heart and the heartbeat,
  • a blood test to measure various blood parameters, and
  • an ultrasound scan of the heart (echocardiogram or “echo test”).

Echo tests allow doctors to see how effectively the heart is pumping blood and how well the heart valves are working.

It’s also important to try to find out what is causing the heart failure so that any underlying diseases can be treated.

For more detailed information, for example about the forms of heart failure, visit gesundheitsinformation.de.

How is heart failure treated?

The treatment of heart failure is made up of several parts:

  • Treating the underlying disease: If the heart failure developed because of another type of cardiovascular disease, such as high blood pressure, that underlying disease is treated too.
  • Medication: Medication such as beta blockers, ACE inhibitors and diuretics can reduce the burden on the heart and relieve the symptoms. The exact medication used will depend on the type of heart failure.
  • Physical exercise: There are special heart exercise programs for people with heart failure, with a focus on individually adjusted training to build up their stamina and muscles. These programs can improve physical fitness and quality of life.

There are also various things people with heart failure can do themselves to reduce the strain on their cardiovascular system (heart and blood vessels). These include: not smoking, not drinking too much alcohol, and staying as physically active as possible. People with advanced heart failure can reduce the amount of fluids they drink every day, and regularly monitor their body weight. This can help prevent swelling due to water retention, as well as reduce exhaustion.

In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG). As at:

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