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What Causes Heart Failure?

Heart failure can have many causes. The most common causes are heart attack and narrowing of the arteries that bring blood and oxygen to the heart. This is called coronary artery disease (CAD) or coronary heart disease.

Coronary Heart Disease

Coronary heart disease is a condition in which a waxy substance called plaque builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart muscle.

Plaque narrows the arteries and reduces blood flow to your heart muscle. The buildup of plaque also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow. Coronary heart disease can lead to chest pain or discomfort called angina, a heart attack, and heart damage.

Conditions that damage or overwork the heart muscle can cause heart failure. Over time, the heart weakens. It isn't able to fill with and/or pump blood as well as it should. As the heart weakens, certain proteins and substances might be released into the blood. These substances have a toxic effect on the heart and blood flow, and they worsen heart failure.

Heart failure can also be caused by other heart ailments, such as:

  • Heart valve disease
  • Some heart rhythm problems
  • Heart problems that start before or at birth (called congenital)

Other causes of heart failure include:

  • Diabetes
  • High blood pressure
  • Other heart conditions or diseases
  • Other factors

Diabetes

Diabetes is a disease in which the body's blood glucose (sugar) level is too high. The body normally breaks down food into glucose and then carries it to cells throughout the body. The cells use a hormone called insulin to turn the glucose into energy.

In diabetes, the body doesn't make enough insulin or doesn't use its insulin properly. Over time, high blood sugar levels can damage and weaken the heart muscle and the blood vessels around the heart, leading to heart failure.

High Blood Pressure

Blood pressure​ is the force of blood pushing against the walls of the arteries. If this pressure rises and stays high over time, it can weaken your heart and lead to plaque buildup.

Blood pressure is consider high if it stays at or above 140/90 mmHg over time. (The mmHg is millimeters of mercury—the units used to measure blood pressure.) If you have diabetes or chronic kidney disease, high blood pressure is defined as 130/80 mmHg or higher.

Other Factors

Other factors also can injure the heart muscle and lead to heart failure. Examples include:

  • Alcohol abuse or cocaine and other illegal drug use
  • HIV/AIDS
  • Thyroid disorders (having either too much or too little thyroid hormone in the body)
  • Too much vitamin E
  • Treatments for cancer, such as radiation and chemotherapy

What are the Signs and Symptoms of Heart Failure?

The most common signs and symptoms of heart failure are:

  • Shortness of breath or trouble breathing
  • Fatigue (tiredness)
  • Swelling in the ankles, feet, legs, abdomen, and veins in the neck

All of these symptoms are the result of fluid buildup in your body. When symptoms start, you may feel tired and short of breath after routine physical effort, like climbing stairs.

As your heart grows weaker, symptoms get worse. You may begin to feel tired and short of breath after getting dressed or walking across the room. Some people have shortness of breath while lying flat.

Fluid buildup from heart failure also causes weight gain, frequent urination, and a cough that's worse at night and when you're lying down. This cough may be a sign of acute pulmonary edema. This is a condition in which too much fluid builds up in your lungs. The condition requires emergency treatment.

Illustration of heart failure symptoms

Source: National Heart, Lung, and Blood Institute; National Institutes of Health; U.S. Department of Health and Human Services.

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HEART FAILURE