Causes and Risk Factors of Congestive Heart Failure

Congestive heart failure (CHF) occurs when your heart muscles become damaged and can’t pump enough oxygen-rich blood to the rest of your organs. Several underlying health conditions can raise your risk of CHF, such as high blood pressure, coronary artery disease, and diabetes.

This condition affects more than 6 million adults in the United States, so knowing what can cause CHF can help you understand how to prevent it from developing.

One common cause of congestive heart failure is the thickening or stiffening of the heart’s walls. This often occurs due to uncontrolled hypertension (high blood pressure), which narrows the arteries (blood vessels in the heart). As the arteries become narrower and less flexible, it becomes harder for blood to circulate, worsening heart function.

Coronary artery disease (CAD) occurs when plaque, a buildup of cholesterol and other substances, forms in the walls of the arteries around the heart. This reduces blood flow and greatly increases the risk of a heart attack. Reduced blood flow from CAD can weaken the heart over time, potentially leading to CHF.

Heart valve disease occurs when one or more of your heart’s four valves—tricuspid, pulmonary, mitral, or aortic—don’t function properly. These valves help to keep blood flowing in the right direction. Problems arise when the valves don’t open or close fully, affecting blood flow and putting strain on the heart. Advanced heart valve disease can lead to congestive heart failure.

An arrhythmia is an irregular heartbeat that occurs when the heart’s rate or rhythm is abnormal. Heart rhythm problems (like atrial fibrillation) can lead to congestive heart failure because the heart beats too quickly to properly fill with blood before pumping it out to the rest of the body. This ineffective pumping causes blood to back up in the veins that send blood to the lungs. As a result, fluid accumulates in the legs, ankles, and feet, contributing to weight gain related to CHF.

Congenital heart defects happen when the heart or blood vessels don’t develop properly before birth. These structural problems can range from mild to severe and may affect the heart’s ability to pump blood efficiently or lead to improper blood flow. Because the heart’s anatomy is altered, it may need to work harder to maintain adequate circulation. Both children and adults living with congenital heart disease are at a higher risk for congestive heart failure.

Obesity can contribute to a greater risk of high blood pressure and changes to the heart structures because of fat accumulation around the heart. This can result in a condition known as heart failure with preserved ejection fraction (HFpEF), where the heart has difficulty relaxing and filling with blood. People with HFpEF and obesity may have lower exercise capacity compared to others.

Genetics can play a role in your risk of developing congestive heart failure. Some heart conditions that increase the risk of CHF, like hypertrophic cardiomyopathy (HCM) or dilated cardiomyopathy (DCM), tend to run in families. These conditions affect your heart muscle’s ability to pump blood effectively, which can lead to heart failure over time. If you have a family history of these conditions, you may be at higher risk for CHF.

Your healthcare provider may recommend genetic testing if you have a family history of heart disease. Testing can help to identify any genetic mutations that could increase your risk and help guide treatment options if you develop CHF.

Heart failure can affect anyone, but some people are at higher risk than others, such as:

• Adults over the age of 65
• Black communities
• People with underlying health conditions, such as high blood pressure, diabetes, and obesity

Certain groups of people are underrepresented in clinical trials for heart failure. For instance, Black people and Indigenous communities have only been included in a handful of studies that help researchers understand treatment options for heart failure. In a recent review of clinical trials for CHF, many studies did not report information about racial or ethnic background, making it difficult to know how well treatments work across different populations.

Many factors can increase your risk of developing congestive heart failure, such as:

• Sleep apnea, which can cause low oxygen levels and strain the heart
• Metabolic syndrome, which can raise the risk of heart failure
• Cancer treatments like chemotherapy and radiation, which can harm heart tissue
• Infections like HIV or COVID-19, which can cause inflammation that weakens the heart
• Overactive thyroid, which speeds up your metabolism and can cause your heart to work too hard
• Eating a high-fat diet, which can clog your arteries
• Smoking, which damages your arteries and reduces oxygen to the heart
• Living a sedentary lifestyle, which can contribute to obesity, high blood pressure, and diabetes

Congestive heart failure occurs when the heart can’t pump enough oxygen-rich blood to the body. Heart failure can develop suddenly or gradually due to conditions like high blood pressure, coronary artery disease, diabetes, or heart attack.

Other risk factors include arrhythmias, valve disease, congenital defects, and lifestyle factors such as obesity and smoking. If you have any of these conditions, ask your healthcare provider about what you can do to reduce your risk of CHF.