What Is Congestive Heart Failure?

By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.

Congestive heart failure, a condition in which the heart has weakened and can no longer efficiently circulate blood throughout the body, afflicts approximately 5.7 million people in the United States; sadly, it plays a role in approximately 1 out of every 9 deaths.

If you or a loved one has been diagnosed with heart failure, know that it’s not a death sentence, that there’s hope…There are treatments and lifestyle approaches that can help improve quality of life and lessen risk of having a future cardiac event. Let’s look more closely at those options, along with the causes and symptoms of this disease:

What Causes Congestive Heart Failure?

Congestive heart failure is usually the culmination of years of cardiovascular disease, as the heart simply wears out from years of expending more energy than it can produce. When that energy deficit reaches a critical point, heart failure begins.

This energy starvation can be traced to a wide range of causes—longstanding high blood pressure, working extra hard to pump blood through narrowed arteries, and trying to repair tissues that have become damaged or diseased through infection or heart attack being just three of them. Congenital heart defects, diabetes, nutrient deficiencies, alcohol abuse, and chronic stress also can contribute to heart failure.

What Are the Symptoms of Congestive Heart Failure?

One of the biggest heart failure symptoms is edema, or fluid retention.

As blood flow slows, fluid builds up in the in the veins, causing swelling. One way to monitor for this is to push on your feet and ankles with your thumb or finger each evening and see if any of the depressions spring back to shape. If they don’t you should see your doctor.

Other heart failure symptoms include—

  • Shortness of breath, especially when lying down
  • Tiredness, feeling run down
  • Persistent wheezing or cough (caused by fluid build-up in the lungs, or pulmonary congestion)
  • Swollen ankles, feet and legs due to fluid build-up (edema)
  • Increased heart rate
  • Nausea or lack of appetite
  • Confusion, inability to think clearly

Although both men and women experience similar symptoms when it comes to heart failure, women tend to have more trouble catching their breath during exercise. If you are a woman over 40 years of age and experience unusual shortness of breath during exercise—or shortness of breath without exertion—ask your doctor for an echocardiogram test. This is especially important if you also have hypertension or mitral valve prolapse.

Heart Failure Diagnosis and Classification

To diagnose congestive heart failure, your cardiologist will perform an echocardiogram. This noninvasive procedure allows your doctor to see (and hear) the size, structure, and function of your heart.

During the echo, we’re specifically evaluating your ejection fraction (EF)—the percentage of blood that the heart is able to expel on each contraction. Healthy hearts have EFs of 50 or higher. Hearts with an EF of 40 or lower are considered to be failing.

The magnitude of failure is classified according to a four-stage scale:

  • Stage 1: Ordinary physical activity causes no shortness of breath, fatigue, or palpitations
  • Stage 2: Patients are comfortable at rest, but may experience shortness of breath, fatigue, or palpitations with ordinary physical activity
  • Stage 3: Patients are comfortable at rest, but any physical activity—ordinary or less—causes shortness of breath, fatigue, or palpitations
  • Stage 4: Patient experiences shortness of breath, fatigue, and palpitations while at rest; symptoms worsen with exertion

Heart Failure Concerns Unique to Women

Despite the fact that a little more than half of people living with congestive heart failure are women, the disease is often under-diagnosed and undertreated. This may be due to a tendency among women to not associate their symptoms with heart troubles, but it is equally likely—if not more so—that doctors may be unfamiliar with some of the following risk factors, which are unique to women.

Higher Risk of Diastolic Dysfunction and Failure

There are two types of heart failure: systolic and diastolic. Each corresponds to a different phase of the heartbeat.

Systolic heart failure is the heart’s inability to contract forcefully enough to circulate blood. The risk factors for systolic heart failure are similar in both men and women: a history of coronary artery disease, previous heart attack, and long-term high blood pressure.

Diastolic heart failure is the inability of the heart to stretch and fill with blood between contractions. It is caused by diastolic dysfunction (DD)—a problem less easily detected during an echocardiogram, yet the primary cause for heart failure in women. Because physicians may not detect this early stage DD, disease can progress for years without treatment.

It’s been suggested that women experience a higher incidence of DD because they are more prone to mitral valve prolapse and because their blood vessels are smaller. Women with hypertension need to be especially wary of DD due to this difference.

High Blood Pressure During Pregnancy

It happens rarely, thankfully, but post-partum cardiomyopathy can cause heart failure in women of child-bearing age. Typically the condition presents during the last month of pregnancy and up to five months after delivery. Post-partum cardiomyopathy is thought to be the result of pregnancy-induced high blood pressure and pre-eclampsia (hypertensive crisis), but more research is needed.


Acute Emotional Trauma

Sudden onset heart failure that’s caused by emotional distress is referred to as “broken heart syndrome (BHS)” or “stress cardiomyopathy,” and it affects women far more than men.

The heartbreak experienced upon the sudden death of a loved one is one example of BHS; however, the syndrome also can be brought on by life-threatening feelings experienced during events that bring on fierce surges of adrenaline. Though these sudden feelings can cause symptoms that are similar to those of a heart attack, most tests will return normal results. The only physiological indication of BHS heart failure is a peculiar pattern that can be seen in an echocardiogram, in which the left ventricle balloons outward in an unusual way.

Downplaying Symptoms as the “Pains of Aging”

Though you may expect the opposite, women will downplay their symptoms of physical discomfort more often than men, dismissing them as a normal result of caring for children, aging parents, and spouses. As a result, many women become vitally exhausted and place unnecessary and unusual stress on the heart, which can lead to dysfunction.

It is essential that women share their physical limitations. Often, what may seem a minor symptom for you can be a major clue for your doctor—and an important part of preserving your health, or even your life.

Effective Heart Failure Treatments

The good news is that appropriate treatment can help heart failure patients reduce and manage their symptoms, and improve their quality of life. The most effective therapies will include these conventional and alternative options:

Anti-Inflammatory Diet

All heart failure treatments must begin with a diet rich in foods that help reduce oxidation and arterial inflammation, lower blood pressure, and improve blood flow. These lessen energy demand in the heart, which means, it will be better able to deliver life-giving nutrients even in a weakened state. Learn about my PAMM Diet.

Nutritional Supplementation with the Awesome Foursome

Cells throughout the body—but especially in the heart—need adequate levels of coenzyme Q10, magnesium, L-carnitine, and D-ribose in order maximize energy production. Supplementing with these nutrients helps ensure that the heart has the raw materials required to produce and burn ATP, the most basic form of energy. This is critically important in failing hearts, which cannot produce adequate energy to pump efficiently.

Drug Therapies and Natural Alternatives

Traditional congestive heart failure treatment centers on medications like digoxin (digitalis), diuretics, ACE inhibitors, beta blockers, and nitroglycerine. These pharmaceuticals help relax artery walls, lower blood pressure, control heart rate, improve blood flow, and reduce the amount of energy consumed in the heart—but their long-term use also creates side effects.

More natural alternatives can help heart failure patients avoid the nutrient depletion, weakness, fatigue, lung congestion, vision disturbances, arrhythmias, gastrointestinal distress, headaches, and depression associated with long-term use of such heart failure medications. Options include:

  • Hawthorne berry. This herb is used in Europe as a substitute for the blood pressure and anti-arrhythmic drug digoxin (digitalis). Do not use digoxin and hawthorne berry together, as they have a similar effect on the heart.
  • Mineral supplements. If you don’t have kidney problems, you can reduce your reliance on calcium channel blockers by taking magnesium, potassium, and calcium. Secondarily, supplemental potassium and magnesium can help offset the minerals lost due to diuretic use. Food sources, such as raisins, prunes, apricots, bananas, potatoes, oranges, spinach, avocados, turkey, fish, chicken, and peas, are recommended in addition to supplements.
  • Ginger tea. Ginger tea and uva ursi extract may help those with mild fluid retention.
  • CoQ10, squid or fish oil, garlic, and L-arginine. Use these nutrients as an alternative to ACE inhibitors.

Beta Blockers

Beta blockers are among the safest of all drugs prescribed to lower blood pressure, prevent heart damage, and relieve angina. They are one of the only cardiac drugs that shouldn’t be replaced with a more natural alternative.

NOTE: do not reduce or stop taking your medications without your doctor’s consent and guidance.


© 2017 HeartMD Institute. All rights reserved.

Leave a Reply


  1. Georgia H.

    on January 28, 2018 at 4:11 pm

    January 25, 2018
    Dear Dr Sinatra,
    I am writing first and foremost to thank you. We have never met but, through your book, you have kept me alive. For the past 17 years I have kept myself going using only the supplements listed in your book.
    When I was fifty years old, I developed cardiomyopathy. The left ventricle was damaged, resulting in significant arrhythmia and an ejection rate of less than 20%. For the next 10 years, I was prescribed several cardiac medications but had to discontinue each because of life-limiting reactions to it. I have serious sensitivities to chemicals, including prescription medications. My allergist suggested that I read your book. I did, and for the past 17 years your advice has kept me going. I am under the care of a cardiologist who has resignedly accepted my decision not to use prescription medications, and I have an implanted defibrillator.
    I am now seventy-seven. The last two years have been difficult. My heart has weakened and I have had two bouts of CHF. Attached is a list of the supplements I am using.

    I have a workaholic personality and have enjoyed every minute of my career as a reading teacher and specialist. As of last May, I was still teaching two days a week in a teacher-mentoring position and writing phonic programs, which I am in the process of publishing. Perhaps I am being greedy, but my colleagues also feel that I have more to give. If you see something that could be added to support my heart at this time, I would be most grateful for your advice.
    Thank you again for your dedication to both your direct and indirect patients. Thank you for all the time and energy you have invested – first in building your unprecedented awareness of your patients and then in your research and publications, of which I am a very grateful beneficiary.
    Georgia H.

    The supplements being used are:
    * CoQ 10 Ubiquinone 2: 2 x per da
    Ubiquinol 1: 3 x per da
    *L-Carnitine >1/2 tsp
    *D-Ribose 1 1/4 tsp
    *Potassium 99 mg
    …….. *These 4 items are taken every 4 hrs/5 x da
    Omega 3 [Contained in Omegq Q Plus 100]
    Furosemide [Begun last year.]
    Neo 40: Nitric Oxide blend made from beet root, hawthorn. L-citruline, sodium nitrate
    Hawthorn Berry
    Pomegranate Juice
    Breo Bronchial Dilator [Begun last year.]
    Oxygen Therapy [Begun this year.]
    H2O2 Vaporizer Therapy [Begun this year.]

  2. Inge Roeder

    on July 22, 2018 at 6:46 pm

    Dear Dr. Sinatra
    I Have read your books and followed you supplement regime an still do. I was born in Germany an my parents and grandparents have used Homeopathic remedies..I’m close to 82 but since 1994 suffered from AF. which cost me a minor stroke 2 years ago. I decided to contact a Homeopath which has his own clinic and he told me keep going with the supplements and take a Homeopathic remedy called CYTISUS SCOPARIUS I followed his advice and feel wonderful. I did some researches on this remedy and could see why I feel good no more AF.
    Thank Dr. Sinatra for all your advice
    Inge Roeder

  3. Jason D.

    on August 4, 2018 at 7:01 am

    Very high heartbeat all the time.constant…to point hurts chest ,side n sometimes hurts stomach.n my face goes numb n loud ringing in ears.

  4. Ron Reagan

    on March 9, 2019 at 5:47 pm

    I have recently undergone a procedure that implanted a mitrol valve clip in my heart. I have been told that I have CHF and I am also eperiencing A-Fib. I am 78 years of age and have always been very active, running, hicking, biking and golf.
    Is D-Ribose a good choice for me? What other suggestions would you have for my condition?

  5. Marvin

    on February 16, 2021 at 10:19 am

    Dr. Sinatra, I am dealing with a Covid-19 residual
    symptom of nocturnal palpitations that wake me up
    every night while in deep sleep. I can get to sleep
    easily … but I keep waking up with the palpitations
    when I fall back to sleep. Will your product D-Ribose
    help in preventing these nocturnal palpitations ?

  6. HeartMD Editor

    on February 19, 2021 at 6:19 pm

    Hi Marvin, Dr. Sinatra’s recommendations for heart palpitations can be found at https://heartmdinstitute.com/heart-health/what-is-a-heart-palpitation/. In response to your comment, he says “CoEnzyme Q10 supports endothelial function which should help this problem. But you MUST see your physician and get a referral to see a cardiologist. Myocarditis is a complication of Covid-19 and an echocardiogram should be done to evaluate the heart post-Covid. For now, a little Mag and CoQ10 should be fine but only after you get clearance from your physician.” Best wishes.

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