Congestive Heart Failure

High Performing recognition for treatment of heart failure from U.S. News & World Report

Recognized by U.S. News & World Report

UT Southwestern Medical Center has earned a "High Performing" rating from U.S. News & World Report for treatment of heart failure, placing us among the nation’s leading hospitals in this area of care.

UT Southwestern Medical Center’s heart failure specialists have the expertise and state-of-the-art technologies and techniques to properly diagnose and treat all severities of heart failure.

Using advanced diagnostic tools and evidence-based therapies, our heart failure team improves the lives of people who suffer from this condition.

AHA Get with the Guidelines badge for Honor Roll

What is Congestive Heart Failure?

Chronic heart failure (CHF, congestive heart failure, or heart failure) is a long-term, progressive condition in which the heart muscles become too weak or too stiff to pump enough blood to adequately supply the body with oxygen. Often, a buildup of fluid in the body results from this heart condition.

In some cases, the heart can’t effectively pump blood out of its chambers; in other cases, the heart muscle is too stiff (cardiomyopathy) for the heart to fill with blood. Right-sided heart failure causes blood to accumulate in the gastrointestinal tract and extremities, while left-sided heart failure causes blood to accumulate in the lungs.

Typically a chronic condition, heart failure is not the same as cardiac arrest or heart attack.

UT Southwestern’s Heart Failure Program gives patients direct access to the most cutting-edge diagnostic testing, medications, devices, and procedures available for this life-limiting condition.

A Nationally Recognized Team of Leaders

Eight of our physicians have earned American Board of Internal Medicine subspecialty certification in advanced heart failure and transplant cardiology – giving our team the level of expertise necessary to treat even the most complex and challenging conditions.

Our specialists offer a variety of both noninvasive and invasive diagnostic studies, which enable them to pinpoint the precise nature of every patient’s condition and tailor heart failure treatment to each unique diagnosis.

Importantly, each member of our team is strongly committed to educating patients about their conditions and working with them to develop personalized treatment plans based on their unique medical circumstances, preferences, and goals.

UT Southwestern is home to both a specialized Heart Care Unit at William P. Clements Jr. University Hospital and a dedicated Cardiac Rehabilitation Program. Cardiac rehabilitation is a critical component of recovery and can prevent future heart disease.

Risk Factors for Congestive Heart Failure

Congestive heart failure has a number of risk factors, such as:

Coronary artery disease
Hypertension (high blood pressure)
Diabetes
Cardiomyopathy
Certain heart rhythm disorders
Advanced age
African-American descent
Chronic alcohol and/or drug abuse
Hyperthyroidism or hypothyroidism
Prior chemotherapy and/or radiation therapy for cancer
Obesity
Pulmonary hypertension
Sedentary lifestyle
Previous heart valve disease
Previous coronary artery bypass graft surgery
Family history of heart failure

Congestive Heart Failure Symptoms

Although symptoms of congestive heart failure can appear suddenly, they usually come on gradually, over time.

Some heart failure symptoms are caused by fluid backing up in the lungs, abdomen, or extremities. Others reflect the heart’s reduced ability to deliver oxygen-rich blood to the body. Symptoms that persist or worsen despite treatment indicate that heart failure is becoming more advanced.

Heart failure symptoms can include:

Abnormal heart rhythm or palpitations
Chronic cough or wheezing
Decreased urine production
Difficulty sleeping
Fatigue or fainting spells
Feeling of fullness, loss of appetite, or abdominal pain
Fluid retention, which causes swollen extremities or abdomen (edema)
Loss of muscle mass
Nausea or vomiting
Shortness of breath upon exertion or when lying down
Sleep apnea
Weight gain

Patients diagnosed with heart failure who have been hospitalized at least twice in the past year should consider asking their doctors for a referral to UT Southwestern’s advanced heart failure specialists for an evaluation.

Diagnosing Congestive Heart Failure

UT Southwestern cardiologists can often make a preliminary diagnosis of heart failure by taking a detailed medical history and conducting a careful physical examination. Blood and urine tests can reveal problems with the liver and kidneys, measure lipids and thyroid function, and detect signs of diabetes.

Additional tests – most noninvasive – used to diagnose congestive heart failure might include:

Electrocardiogram (ECG or EKG): To look for underlying heart problems such as heart enlargement, abnormal cardiac rhythms, and coronary artery disease
Echocardiography (echo or cardiac ultrasound): To evaluate heart valve function, pumping capacity, and structural changes
Cardiac MRI: To evaluate the heart’s structure and function and look for scarring
CT imaging: To see detailed, cross-sectional views of the heart and cardiac arteries
Chest X-ray: To evaluate the structure of the heart and lungs
Cardiopulmonary stress test: To measure the heart’s aerobic capacity (level of fitness)
Cardiac catheterization/angiography: To look for blockages in the coronary arteries

Congestive Heart Failure Treatment

The treatment of heart failure can be viewed as a continuum. In general, early treatment focuses on lifestyle changes and optimization of basic medical therapies. The next steps in treatment might include more aggressive medical therapies or the installation of a device such as a pacemaker or implantable cardioverter-defibrillator (ICD).

For the small percentage of patients for whom heart failure continues to progress despite less aggressive treatments, our team of experts offers the most advanced surgical solutions, such as left ventricular assist devices and heart transplantation.

UT Southwestern offers heart failure treatments that include:

Lifestyle Changes

Quit smoking
Avoid alcohol, caffeine, and stress
Reduce fluid intake
Reduce the amount of salt in the diet

What Are the Most Common Medications for Heart Failure?

There are four “pillars” of heart failure treatment that work together to improve survival, help patients feel better, keep them out of the hospital, and improve heart function:

Angiotensin-receptor blockers (ARB) combined with a neprilysin inhibitor (ARNi)
- Angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARB) alone are alternatives
Beta blockers
Mineralocorticoid receptor blockers
Sodium-glucose Cotransporter-2 inhibitors (SGLT2i)

Additional medications include:

Vasodilators, such as isosorbide dinititrate and hydralazine to open arteries and improve blood flow
Diuretics to reduce water retention
Digoxin to regulate and strengthen the heartbeat
Ivabradine to slow the heart rate
Anti-arrhythmic drugs to regulate the heart rate

Congestive Heart Failure Surgery

Angioplasty and stenting: To improve blood flow in patients with coronary artery disease
Bi-ventricular pacemaker implantation: To regulate heart rhythm or help both sides of the heart contract at the same time
Cardioverter-defibrillator implantation: To regulate heart rhythm and prevent sudden cardiac death
Coronary artery bypass surgery: To improve blood flow in patients with blocked coronary arteries

For eligible patients whose heart failure continues to progress despite these treatments, UT Southwestern offers the most advanced solutions available, such as:

Left ventricular assist device (LVAD): A battery-operated, implanted device that helps the left ventricle pump blood through the body
Other types of mechanical circulatory assistance devices: Implanted devices that help the heart function
Heart transplantation: Replacing the diseased heart with a healthy donor heart

Support Services

UT Southwestern offers a wide range of resources to help patients with heart failure adopt helpful lifestyle modifications and comply with medical regimens. Our Heart and Lung Transplant Clinic cares for patients with advanced heart failure, ventricular assist devices, and pulmonary hypertension in a hospital-based outpatient setting.

Services include patient education, stress management, closely supervised cardiac rehabilitation, support resources, and long-term follow-up. All are designed to help patients stay out of the hospital, improve their well-being, and extend their lives.

Clinical Trials

As one of the nation’s top academic medical centers, UT Southwestern offers a number of clinical trials aimed at improving the outcomes of patients with cardiovascular disease.

Clinical trials often give patients access to leading-edge treatments that are not yet widely available. Eligible patients who choose to participate in one of UT Southwestern’s clinical trials might receive treatments years before they are available to the public.