Congestive heart failure: Stages, symptoms, and causes

Congestive heart failure (CHF) undermines the heart’s job of pumping blood around the body. Over time, this failing causes the organs to receive less blood.

In this article, we look at how CHF progresses over time and what the outlook is for people with this condition. We also examine the causes, symptoms, and treatment options.


There are four different stages of heart failure: A, B, C, and D.

Progression to the next stage is linked with a reduction in 5-year survival rates.

Stage A

High risk of developing HF due to having other conditions strongly associated with HF developing.

Examples of these conditions include chronic high blood pressure, diabetes, and coronary artery disease.

People at this stage have no problems with the structure of the heart or how their heart works. They will have also never shown any signs or symptoms of HF.

Stage B

People at this stage will have developed structural heart disease that is strongly linked with the development of HF. This includes having an enlarged left ventricle or having had a heart attack.

However, people at this stage will still have never shown any signs or symptoms of HF.

Stage C

People at this stage will be showing or will have shown symptoms of HF linked to an underlying structural heart disease.

This category includes those who are experiencing fatigue or difficulty breathing due to problem with the left ventricle contracting. It all also include people who no longer show symptoms but are currently undergoing treatment for previous symptoms of HF.

Stage D

People at this stage will have advanced structural heart disease, and will display significant symptoms of HF even when at rest.

This stage is very serious and requires specialist treatmentm, such as mechanical circulatory support, continuous inotropic infusion, cardiac transplant, or hospice care.


The most common type of CHF is left-sided CHF, which occurs when the left ventricle of the heart cannot pump blood effectively to the rest of the body. This can cause fluid to build up in the lungs and make breathing diffficult as it progresses.

There are two kinds of left-sided heart failure:

  • Systolic heart failure, when the left ventricle cannot to contract normally, limiting the heart’s ability to pump blood to the rest of the body.
  • Diastolic failure, when the muscle in the left ventricle stiffens. If the muscle cannot relax, the heart ventricle will not be able to fully fill with blood between heartbeats.

Right-sided CHF is less common. It happens when the right ventricle has cannot pump blood to the lungs as effectively. This can lead to the blood backing up in the blood vessels, which may cause fluid retention in the lower legs and arms, abdomen, and other organs.

A person can have left-sided and right-sided CHF at the same time. However, CHF usually begins in the left side and spreads to the right side if left untreated.

To prevent or slow the progression of CHF:

  • maintain a healthy weight
  • get enough exercise – some people may need to follow a modified exercise regime in consultation with a doctor
  • manage stress through meditation, therapy, and other healthy methods
  • eat a heart-healthy diet low in trans fats, rich in whole grains, and low in sodium and cholesterol
  • monitor blood pressure regularly
  • get vaccinated for the flu and pneumococcal pneumonia

Additionally, people who already have CHF should avoid caffeine, get adequate rest, track changes in their symptoms, avoid very cold or hot temperatures, and wear loose-fitting clothing.

Left untreated, CHF can be fatal. Even with adequate treatment, CHF may get worse over time, triggering problems throughout the body.


CHF is more likely to occur in people who have other conditions that weaken the heart. The risk is also increased by several lifestyle factors that are bad for the heart.

Risk factors for CHF include:

  • congenital heart defects, appearing early in children and infants
  • high blood pressure or cholesterol
  • obesity
  • asthma
  • chronic obstructive pulmonary disease and coronary heart disease
  • other cardiovascular conditions
  • heart infection
  • reduced kidney function
  • a history of heart attacks
  • irregular heart rhythms
  • abuse of alcohol or drugs
  • smoking
  • older age


CHF describes a cluster of symptoms, not a single disease.

The American College of Cardiology and the American Heart Association define heart failure according to how it has progressed. This classification is not meant to replace the New York Heart Association functional classification system but rather complement it.

When the kidneys are deprived of a good blood supply, they struggle to filter fluids to make urine. This causes fluid to build up in parts of the body, particularly in the liver, eyes, lungs, and legs. Congestive heart failure gets its name from the “congestion” of this excess fluid.

  • Angioplasty to open a blocked artery: Sometimes the doctor will place a stent to help the vessel remain open.
  • Coronary artery bypass surgery: This reroutes some of the blood vessels so the blood can travel round the body, avoiding diseased or blocked blood vessels.
  • Valve replacement surgery: A doctor will replace an inefficient or diseased valve with a mechanical valve or one grown from living tissue.
  • Heart transplant: This may be the only option in people with severe CHF that is not well managed with other therapies.

Not everyone with CHF is a candidate for a transplant, and the wait for one can be long.

A recipient must be healthy enough for the surgery. Surgery on the heart can be extremely dangerous, so doctors typically urge people to attempt lifestyle remedies and take medication before trying heart surgery or implantable devices.

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