What is congestive heart failure (CHF)?

If a doctor has diagnosed your loved one with congestive heart failure (CHF), it means that because their heart is too weak to pump enough oxygenated blood throughout the body, their circulation has become seriously compromised, which causes blood and other fluids to pool (congest) in certain areas and tissues of the body. CHF is not a disease, but rather, the result of an underlying medical condition or conditions.

What are the symptoms of congestive heart failure?

The most common symptom of CHF is edema, which is a medical term for swelling. People with CHF may experience swelling in their legs and feet, in their abdomen, or in their chest. Other possible symptoms of CHF include shortness of breath, chronic cough, loss of appetite, weight gain, increased urination (especially at night), and confusion.

The most serious symptoms occur when someone has blood and fluid congestion around the heart and lungs, or other internal organs. This requires close monitoring.

What are the symptoms of congestive heart failure getting worse?

Doctors diagnose congestive heart failure in four progressive stages. The interchangeable medical terms could be “Stage I, II, III, and IV” or “Class A, B, C, and D.” A patient can slow their progression with the tips below, but it’s not possible to get better than you are currently, or to make the heart stronger.

Download our guide on "Living with Heart Failure."

Stages of CHF

Stage I (Class A): Your loved one may not notice any symptoms at this stage. When making this diagnosis, the doctor likely considered risk factors—some are within your loved one’s control, like diet, exercise, smoking, and alcohol use. Other risk factors could include underlying medical conditions or a family history of heart disease, high blood pressure, or diabetes.

Stage I Tips: Encourage your loved one to improve the risk factors that are within their control. Stay active and maintain a healthy lifestyle, and get regular monitoring such as blood tests, blood pressure checks, and any other testing the doctor orders.

Stage II (Class B): At this stage, the doctor has seen some mild evidence of cardiovascular disease. Your loved one still will be comfortable at rest, but may experience mild symptoms such as shortness of breath when they’re moving.

Stage II Tips: Encourage your loved one to remain active within their comfort level because moderate exercise can slow the progression of CHF. Limit activity that provokes symptoms, however, and don’t get over-exerted. Help your loved one comply with all of the doctor’s orders for maintaining a healthy lifestyle, taking medication on schedule, and getting regular testing. Keep legs elevated or wear compression stockings to help reduce swelling.

Keep daily records that will help the doctor monitor your loved one’s condition and adjust treatment as needed. At home, use a scale, blood pressure cuff, and a heart rate monitor every day, and record changes in your loved one’s weight, vital signs, and activity level. Ask the doctor for guidelines for when a change in condition warrants a phone call to the doctor’s office—such as sudden weight gain.

Stage III (Class C): At this stage, the doctor has seen evidence of moderately severe cardiovascular disease that limits your loved one’s activity due to symptoms such as shortness of breath, heart palpitations, and fatigue. Your loved one should still remain comfortable at rest.

Stage III Tips: Help your loved one maintain healthy habits such as eating a heart-healthy diet (below) and quitting smoking and alcohol. Discuss safe exercise options with the doctor, and follow all doctor’s orders for lifestyle, medication, and testing. Continue keeping home records to share with the doctor.

Stage IV (Class D): This is the final stage of CHF, when your loved one will show signs of severe cardiovascular disease. Physical activity will be drastically limited, and your loved one may even be uncomfortable at rest. It’s normal to lose the desire to eat or drink at this end stage; no need to insist on food or water if your loved one refuses it.

Stage IV Tips: Discuss treatment options with your doctor that may reduce symptoms and make your loved one more comfortable. Depending on your loved one’s age, risk factors, and overall health, treatment options may include a heart pump, defibrillator, heart surgery, or intravenous medication.

When your loved one decides to discontinue treatment, hospice care—also called palliative care—can help keep your loved one comfortable and help the whole family with caregiving, quality of life, and preparing for loss.

Diet Tips for Congestive Heart Failure

  • Keep salt intake under 1,500 to 2,000 milligrams per day. Check food labels for “sodium,” and avoid high-potassium salt substitutes. High-sodium foods to limit or avoid include: seasoning mixes, baked desserts, processed foods in a can or box, sauces, gravies, soy sauce, bottled salad dressing, pickles, olives, condiments, cheese, deli meats, bacon, hot dogs, battered and fried foods, and smoked meats.
  • Opt for fresh foods instead: fresh or frozen vegetables, fruit, meat, poultry, and fish.
  • Use herbs and aromatics for great flavor: onion, garlic, shallot, celery, bell pepper, lemon, lime, parsley, chives, ginger, chili peppers, curry, basil, bay leaf, oregano, dill, etc.
  • Avoid fatty foods and fast foods. Check labels to avoid saturated fat and “trans” fats. Opt for fish and lean meats over red meat. Prepare and order fish and meats grilled, baked, or broiled.

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