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HomeHealth articlesstages of congestive heart failureWhat Are the Four Stages of Congestive Heart Failure?

Stages of Congestive Heart Failure - Clinical Manifestations, Causes, Diagnosis, and Treatment

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Congestive heart failure is a condition when the heart fails to pump blood. This article is an overview of the stages of congestive heart failure.

Medically reviewed by

Dr. Muhammad Zohaib Siddiq

Published At November 15, 2022
Reviewed AtNovember 15, 2022


Congestive heart failure may also be referred to as heart failure. Congestive heart failure is a life-threatening condition. The heart does not pump an efficient amount of blood to the rest of the body, including the brain. Even though the name suggests that the heart is failing or the heart is not working, congestive heart failure refers to the weakness of the heart to contract adequately.

An underlying mechanical problem in the heart results in the heart not being able to meet the demands of the body. The heart tries its best by beating faster or contracting more rapidly and, assembling the bodily needs, turns very weak. Due to this weakening of the heart, the blood returns to the heart more quickly than pumping blood. Hence, the blood in the heart gets congested or backed up, or accumulated. When this happens, vital organs of the body, including the brain, are devoid of blood and oxygen, resulting in organ failure or organ damage.

What Are the Clinical Manifestations of Congestive Heart Failure?

Congestive heart failure is a condition that does not have clear-cut and definitive signs in each patient. There are multiple possible clinical manifestations experienced by patients suffering from heart failure.

Mentioned below are the expected signs and symptoms that may be seen in an individual going through congestive heart failure.

  • Shortness of breath.

  • Fatigue.

  • Weakness in legs.

  • Swelling of the ankles and feet.

  • Weight gain.

  • Increased urinary output.

  • Dry cough.

  • Bloated.

  • Loss of appetite.

  • Nausea.

  • Hard abdomen.

  • Decreased ability to perform exercises.

  • Swelling of the stomach.

What Are the Causes of Congestive Heart Failure?

There is a risk of cardiovascular changes as one grows older. Several conditions, if left untreated, may slowly but surely lead to congestive heart failure. There is no established cause for the development of this cardiac anomaly as of today, and thus various causes have been identified for congestive heart failure.

Mentioned below are a few causes of congestive heart failure.

  • Coronary artery disease.

  • Cardiomyopathy.

  • Congenital heart disease or heart disease at birth.

  • High blood pressure is called hypertension.

  • Arrhythmia or abnormal heart rhythm.

  • Heart attack.

  • Kidney disorders.

  • Obesity and being overweight.

  • Excess use of tobacco and tobacco-related products.

  • Chemotherapy.

  • Recreational drugs and certain medications.

  • Uncontrolled diabetes mellitus.

  • High levels of cholesterol.

  • Family history of congestive heart failure.

  • Smoking.

  • Excessive intake of alcohol.

  • Radiation therapy.

What Are the Different Stages of Congestive Heart Failure?

Congestive heart failure is a disease that does not become worse in a fraction of a second. Instead, congestive heart failure is a chronic condition and develops in four stages, namely- stage A, stage B, stage C, and stage D. The first stage indicates a high risk of congestive heart failure, whereas the last stage is parallel to the advancement of heart failure.

  • Stage A or pre-heart failure stage, develops mainly due to a familial tendency of this condition along with comorbidities such as diabetes, coronary artery disease, rheumatic fever, cardiomyopathy, and hypertension.

  • Stage B gives a clear diagnosis of malfunctioning of the left ventricle of the heart, even if the patient does not have a family history of any cardiac disease.

  • Stage C comprises all the signs and symptoms of congestive heart failure.

  • Stage D, or advanced congestive heart failure, is when the patient does not have a chance to recover even after accurate treatment and thus is the final stage of the heart’s life.

How to Diagnose Congestive Heart Failure?

There is no standard or single test to diagnose a case of congestive heart failure. Instead, the healthcare provider will conduct several exams, post a thorough medical history examination and physical evaluation, and then subject the patient to multiple diagnostic tools.

  • The electrocardiogram is a simple test that provides critical information about the heart’s rhythm.

  • Chest x-ray and radiographs of other chest structures to check for any related damage.

  • B-type natriuretic peptide or BNP test is a hormonal test that marks the seriousness of congestive heart failure. It also gives some idea about the prognosis for the same.

  • A portable device that measures the electrical impulses in the heart, such as a Holter monitor, may be worn.

  • A treadmill test or TMT puts the heart through controlled levels of exercise and exertion to check the heart's performance. In recent years, a drug that induces the same effect of training and effort has been ingested and replaced by the treadmill test.

  • Cardiac catheterization.

  • Echocardiography.

  • Magnetic resonance imaging of the heart.

  • A complete blood picture.

How to Treat Congestive Heart Failure?

There is no specific treatment for congestive heart failure. The main aim of managing this condition is to relieve the patient from the clinical signs and symptoms experienced. This will slow down the underlying damage. The authentic line of treatment is decided by multidisciplinary doctors and depends strongly on the stage and cause of congestive heart failure.

Some of the treatment modalities and management plans are mentioned below.

  • Prevention is better than cure. Prevent an unhealthy lifestyle and stick to a heart-smart lifestyle to avoid an episode of congestive heart failure or any other cardiovascular disease.

  • Medications such as vasodilators can be prescribed.

  • Diuretics help in fluid retention in the body.

  • Aldosterone inhibitors improve the life of the heart by enhancing heart functioning.

  • Digitalis glycosides strengthen the muscles of the heart.

  • Tranquilizers help in reducing anxiety in cardiovascular patients.

  • Bypass surgery may be required in case the coronary arteries are heavily blocked.

  • Heart valve replacement can also be suggested if there is extended damage to the heart vessels.

  • Patients with congestive heart failure are ideal candidates for placement in a pacemaker.

  • Implantable loop recorder.

  • The last resort to treat congestive heart failure is a heart transplant which has a success rate of approximately 75 % to 89 %.


Congestive heart failure is when the heart turns weak because it cannot meet the body's demands. It is a chronic disease of the heart and develops in four stages. This condition can be avoided by leading a heart-healthy diet and indulging oneself in a heart-smart lifestyle. With proper care and treatment modalities, congestive heart disease will not stop a patient from living everyday life. Patients must regularly follow up with the cardiologist post-treatment. Being active and taking medications on time is the key to returning to ordinary life.

Frequently Asked Questions


How Long Does a Patient With Congestive Heart Failure Usually Live?

Most patients who are diagnosed with congestive heart failure will survive for at least five years. 35 percent of individuals will survive for ten years. A chronic, developing condition that affects the heart's capacity to circulate blood throughout the body is called congestive heart failure (CHF).


Is Congestive Heart Failure a Dangerous Condition?

Congestive heart failure is a life-threatening condition in which the heart is unable to pump blood as effectively as it should. People with heart failure may experience severe symptoms, and some may require a heart transplant or a ventricular assist device (VAD).


What Are the Four Symptoms of Congestive Heart Failure?

The symptoms of congestive heart failure include:
 - Breathing difficulty while moving or when resting down.
 - Swelling of the ankles, feet, and legs.
 - Weakness and fatigue.
 - Irregular or rapid heartbeat.


Can Congestive Heart Failure Be Recovered?

Heart failure does not indicate that the heart will stop functioning. It indicates that the heart muscle is not pumping sufficient blood to meet the body's needs. Heart failure is incurable. The cardiac muscle damage may get better, but it will not disappear.


What Is the First Stage of Congestive Heart Failure?

Stage 1 is referred to as pre-heart failure. Persons who have any family history of the disease or any medical issues may increase the risk of getting congestive heart failure. There are no noticeable symptoms seen in this stage. It can be managed through lifestyle and medications.


How Can Congestive Heart Failure Can be Managed Effectively?

Trans fat, cholesterol, and sugar-rich foods should be avoided. In order to lose weight, if necessary, lower daily caloric consumption. Regular exercise is advised. The doctor may recommend a regular cardiovascular exercise regimen to improve health and increase strength.


What Is the Most Popular Treatment for Congestive Heart Failure?

Heart failure is primarily treated with medications; however, for certain patients, surgery may be helpful. Some common surgeries that can improve heart failure include:
 - Bypass surgery.
 - Heart valve surgery.
 - Heart transplant surgery.


What Is the Prognosis for Congestive Heart Failure?

The prognosis of congestive heart failure is influenced by the underlying causes, the degree of the condition, and other health issues. Most patients who are diagnosed with congestive heart failure may live for five years, on average. Thirty percent of individuals may survive for ten years.


What Are the Signs and Symptoms of Congestive Heart Failure?

The signs and symptoms of congestive heart failure includes:
 - Breathing difficulty while moving or when resting down.
 - Swelling of the ankles, feet, and legs.
 - Weakness and fatigue.
 - Irregular or rapid heartbeat.
 - Reduced capacity to exercise.
 - Persistent coughing or wheezing with blood-tinged mucus that is either white or pink.
 - Abdomen-related swelling.


What Distinguishes Congestive Heart Failure From Regular Heart Failure?

The chronic progressive conditions of congestive heart failure (CHF) and heart failure are defined by a weak heart that is unable to pump enough blood to meet the body's energy requirements. Heart failure in its early stages without congestion is frequently referred to as heart failure. Congestion occurs throughout the body as a result of the fluid accumulation brought on by the developing heart injury in the feet, arms, lungs, and other organs, and this condition is known as congestive heart failure.


Can Congestive Heart Failure Occur Suddenly?

Yes, acute heart failure symptoms can appear suddenly, while other symptoms may appear gradually over weeks or months (chronic heart failure).


Do Congestive Heart Failure Cause Sudden Death?

Congestive heart failure patients are six to nine times more likely to develop sudden cardiac arrest than patients with ventricular arrhythmias. Due to its protracted period of time without detection, CHF is particularly hazardous.


How Can One Diagnose Congestive Heart Failure?

The diagnostic test for congestive heart failure includes:
 - Electrocardiogram (also known as EKG, ECG, or stress test) (also known as EKG, ECG, or stress test).
 - Computed tomography.
 - Echocardiogram.
 - Magnetic resonance imaging (MRI scan).
 - Positron emission tomography (PET scan).
 - Heart and artery catheterization or biopsy.


Is Walking Good for Congestive Heart Failure Patients?

For those with congestive heart failure, walking is one of the greatest and most convenient types. An aerobic activity is walking makes the heart beat more quickly and breathe harder. There are numerous ways that walking benefits people with congestive heart failure:
 - Reduce the chance of suffering a heart attack, especially the chance of developing a second heart attack.
 - Walking also enhances lung function and strengthens their hearts.


What Are the Foods to Avoid for Congestive Heart Failure Patients?

Avoid processed and cured meats because they contain a lot of salt. Unseasoned burgers and steaks, in particular, pose a risk for clogged arteries due to their high-fat content. Instead, try to consume more fish, especially salmon, tuna, trout, and cod, than red meat.


Is Heart Failure Classed as a Terminal Illness?

Heart failure is a dangerous, chronic illness that often worsens over time. It frequently leads to death and can significantly reduce the activities people can engage in. However, it is quite challenging to predict how each person's illness would develop. It is extremely unpredictable.
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Dr. Muhammad Zohaib Siddiq
Dr. Muhammad Zohaib Siddiq



stages of congestive heart failure
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