Conditions & Treatments

Heart Failure

Heart failure, also called congestive heart failure, is a condition in which the heart cannot pump enough oxygenated blood to meet the needs of the body's other organs.

Heart Failure

What is heart failure?

Heart failure, also called congestive heart failure, is a condition in which the heart cannot pump enough oxygenated blood to meet the needs of the body's other organs. The heart keeps pumping, but not as efficiently as a healthy heart. Usually, the heart's diminished capacity to pump reflects a progressive, underlying condition.

What causes heart failure?

Heart failure may result from any or all of the following:

  • Heart valve disease caused by past rheumatic fever or other infections

  • High blood pressure (hypertension)

  • Active infections of the heart valves and/or heart muscle (for example, endocarditis or myocarditis)

  • Previous heart attack(s) (myocardial infarction). Scar tissue from prior damage may interfere with the heart muscle's ability to pump normally.

  • Coronary artery disease. Narrowing of the arteries that supply blood to the heart muscle.

  • Cardiomyopathy or another primary disease of the heart muscle

  • Congenital heart disease or defects (present at birth)

  • Cardiac arrhythmias (irregular heartbeats)

  • Chronic lung disease and pulmonary embolism

  • Certain medications

  • Excessive sodium (salt) intake

  • Anemia and excessive blood loss

  • Complications of diabetes

How does heart failure affect the body?

Heart failure interferes with the kidney's normal function of eliminating excess sodium and waste products from the body. In congestive heart failure, the body retains more fluid, resulting in swelling of the ankles and legs. Fluid also collects in the lungs, which can cause profound shortness of breath.

What are the symptoms of heart failure?

The following are the most common symptoms of heart failure. However, each individual may experience symptoms differently. Symptoms may include:

  • Shortness of breath during rest, exercise, or while lying flat

  • Weight gain

  • Visible swelling of the legs and ankles (due to a buildup of fluid), and, occasionally, swelling of the abdomen

  • Fatigue and weakness

  • Loss of appetite, nausea, and abdominal pain

  • Persistent cough that can cause blood-tinged sputum

The severity of the condition and symptoms depends on how much of the heart's pumping capacity has been compromised.

The symptoms of heart failure may resemble other conditions or medical problems. Always consult your health care provider for a diagnosis.

How is heart failure diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for heart failure may include any, or a combination of, the following:

  • Chest X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

  • Echocardiogram (also called echo). A noninvasive test that uses sound waves to evaluate the motion of the heart's chambers and valves. The echo sound waves create an image on the monitor as an ultrasound transducer is passed over the heart.

  • Electrocardiogram (ECG or EKG). A test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and can sometimes detect heart muscle damage.

  • BNP testing. B-type natriuretic peptide (BNP) is a hormone released from the ventricles in response to increased wall tension (stress) that occurs with heart failure. BNP levels rise as wall stress increases. BNP levels are useful in the rapid evaluation of heart failure. In general, the higher the BNP levels, the worse the heart failure.

Treatment for heart failure

Specific treatment for heart failure will be determined by your health care provider based on:

  • Your age, overall health, and medical history

  • Extent of the disease

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

The cause of the heart failure will dictate the treatment protocol established. If the heart failure is caused by a valve disorder, then surgery may be performed. If the heart failure is caused by a disease, such as anemia, then the underlying disease will be treated. Although there is no cure for heart failure due to damaged heart muscle, many forms of treatment have been used to treat symptoms very effectively.

The goal of treatment is to improve a person's quality of life by making the appropriate lifestyle changes and implementing drug therapy.

Treatment of heart failure may include:

  • Controlling risk factors:

    • Quitting smoking

    • Losing weight (if overweight) and increasing moderate exercise

    • Restrict salt and fat from the diet

    • Avoiding alcohol

    • Proper rest

    • Controlling blood sugar if diabetic

    • Controlling blood pressure

    • Limiting fluids

  • Medication, such as:

    • Angiotensin converting enzyme (ACE) inhibitors. This medication decreases the pressure inside the blood vessels and reduces the resistance against which the heart pumps.

    • Angiotensin receptor blockers (ARB). This is alternative medication for reducing workload on the heart if ACE inhibitors are not tolerated.

    • Diuretics. These reduce the amount of fluid in the body.

    • Vasodilators. These dilate the blood vessels and reduce workload on the heart.

    • Digitalis. This medication helps the heart beat stronger with a more regular rhythm. 

    • Antiarrhythmia medications. These help maintain normal heart rhythm and help prevent sudden cardiac death.

    • Beta-blockers. These reduce the heart's tendency to beat faster and reduce workload by blocking specific receptors on heart cells.

    • Aldosterone blockers. Medication that blocks the effects of the hormone aldosterone which causes sodium and water retention.

  • Biventricular pacing/cardiac resynchronization therapy. A new type of pacemaker that paces both pumping chambers of the heart simultaneously to coordinate contractions and to improve the heart's function. Some heart failure patients are candidates for this therapy.

  • Implantable cardioverter defibrillator. A device similar to a pacemaker that senses when the heart is beating too fast and delivers an electrical shock to convert the fast rhythm to a normal rhythm.

  • Heart transplantation

  • Ventricular assist devices (VADs). These are mechanical devices used to take over the pumping function for one or both of the heart's ventricles, or pumping chambers. A VAD may be necessary when heart failure progresses to the point that medications and other treatments are no longer effective. 

Treatment Programs


Massachusetts General Hospital understands that a variety of factors influence patients' health care decisions. That's just one reason why we're dedicated to ensuring patients understand their diagnosis and treatment options. Because a single option might not serve all patients, we offer a wide range of coordinated treatments and related services across the hospital. Patients should consult with their primary care doctor or other qualified health care provider for medical advice and diagnosis information.

Select a treatment program for more information:



Digestive Healthcare Center

  • Weight Center
    The Massachusetts General Hospital Weight Center is a fully integrated center within the Digestive Healthcare Center that supports the spectrum of needs for people of all ages seeking help with obesity and weight loss.
Heart Center

  • Resynchronization and Advanced Cardiac Therapeutics Program
    The Resynchronization and Advanced Cardiac Therapeutics Program at the Massachusetts General Hospital Corrigan Minehan Heart Center offers cardiac resynchronization therapy, or the use of a specialized pacemaker to treat patients with heart failure.
  • Corrigan Women's Heart Health Program
    The Elizabeth Anne and Karen Barlow Corrigan Women's Heart Health Program at the Massachusetts General Hospital Corrigan Minehan Heart Center cares for women of all ages through prevention and early detection of heart disease.
  • Heart Failure and Cardiac Transplant Program
    The Heart Failure and Cardiac Transplant Program at the Massachusetts General Hospital Corrigan Minehan Heart Center evaluates and manages a range of heart disease conditions that result in heart failure.
Imaging

  • Heart Imaging
    The Heart Imaging Program at Massachusetts General Hospital Imaging provides comprehensive diagnostic cardiac imaging, using state-of-the-art CT and MRI technology and with expert interpretation by specialty-trained cardiovascular radiologists.
MassGeneral Hospital for Children

  • Psychology Assessment Center
    The pediatric neuropsychology specialists at Massachusetts General Hospital’s Psychology Assessment Center provide neuropsychological assessments to aid in the diagnosis and treatment of neurological, medical, genetic and developmental disorders.
Transplant Center

  • Transplant Psychiatry Program
    The Transplant Psychiatry Program in the Massachusetts General Hospital Transplant Center is an important part of the comprehensive and life-long care provided to transplant patients and donors.
  • Heart Transplant Program
    The Heart Transplant Program at the Massachusetts General Hospital Transplant Center offers comprehensive treatment, transplantation and management options for patients with congestive heart failure.
  • Transplant Infectious Disease Program
    The Transplant Infectious Disease Program, part of the Massachusetts General Hospital Transplant Center, is a part of the life-long care provided to organ, bone marrow and stem cell transplant recipients and others with increased risk for infections.
Benson Henry Institute for Mind Body Medicine

  • Cardiac Wellness Program: Reduce Cardiac Risk
    Heart disease is the number one cause of death in the U.S. for both men and women. Although genetics plays a role in the development of heart disease, lifestyle choices have been proven to significantly influence the health of your heart. The more risk factors you have, the greater your chance of having a heart attack or stroke. This program is held at MGH West in Waltham, MA.
General and Gastrointestinal Surgery

  • Bariatric and Metabolic Surgery Program
    The Bariatric and Metabolic Surgery Program at Massachusetts General Hospital offers a full spectrum of safe and effective surgical procedures for obesity, weight disorders and metabolic disease.

The following related clinical trials and research studies are currently seeking participants at Massachusetts General Hospital. Search for clinical trials and studies in another area of interest.

New technology keeps heart failure patients healthy and at home

Specialists at Massachusetts General Hospital are now able to statistically identify which inpatients have heart failure and then facilitate connecting these patients to care.

A strongman's second chance

In 2008, the Massachusetts General Hospital Transplant Center completed the most heart transplants in the region. Personal trainer and strongman competitor, Jim Murphy, is one shining example of the great successes of the program.

Monitoring patients remotely

New wireless technology allows Heart Center clinicians to keep tabs on heart failure patients wherever they are

At home heart failure care

A new clinical trial at the Massachusetts General Hospital Heart Center gives patients the power to monitor their hearts and change their medication dosing daily to prevent the symptoms of heart failure.

MGH goes red for women’s heart health

MGH Hotline 2.18.11 Just in time for Valentine’s Day, the MGH Heart Center and Corrigan Women’s Heart Health Program brought attention to hearts everywhere by celebrating “Go Red for Women” month with a series of events and activities to raise awareness of heart disease in women.

Improved Clinical Outcomes for CRT Patients

Jagmeet Singh, MD, Director of the Cardiac Resynchronization Therapy Program at the Massachusetts General Hospital Heart Center, discusses his team’s recent study about multidisciplinary care (MC) versus conventional care (CC) in CRT (cardiac resynchronization therapy) patients.

Mass. General Patient First in New England to Receive Nerve Stimulator to Treat Heart Failure

Anita Levy, 59, arrived at Massachusetts General Hospital in 2012 with severe heart failure. The mother of four, grandmother of eight and wife of 38 years, was starting to lose hope. After trying a number of therapies without success, her doctors informed her she was a candidate for a new clinical trial.

Study demonstrates the feasibility of evaluating myofibers after stem cell therapy in the heart

A team of researchers at the Massachusetts General Hospital Institute for Heart, Vascular and Stroke Care has taken a giant leap toward the possibility of noninvasively assessing the efficacy of stem cell therapy in the heart.

Stephanie Moore, MD, describes your risk for heart failure if you have a family history of this condition

Stephanie Moore, MD, cardiologist in the Heart Failure and Cardiac Transplant Program at the Mass General Heart Center says if a close relative suffered from heart failure, you should be screened for other health issues that can put you at higher risk. Learn more about the early signs of heart failure and the various treatments available, from medications to pacemakers to transplants.

Frank Robinson's Story

Watch 46-year-old Frank Robinson tell the story of his life-saving experience at Mass General after a massive coronary.

Innovative care at the Corrigan Minehan Heart Center

Learn more about the latest treatment options for this condition at the Corrigan Minehan Heart Center.