Heart Failure Exacerbations


Heart failure exacerbations are when heart failure symptoms get worse. This needs to be treated.


As heart failure worsens, symptoms get worse. Symptoms also get worse due to problems with treatment or another illness. Examples are:

Risk Factors

Things that raise the risk of heart failure exacerbations are:

  • High blood pressure
  • Being obese or overweight
  • Kidney problems
  • Taking certain medicines, such as non-steroidal anti-inflammatory drugs (NSAIDs)
  • Eating foods high in salt and fat


Symptoms may be a worsening of heart failure symptoms or new symptoms. They may be:

  • Problems breathing
  • Dry, hacking cough
  • Problems sleeping
  • Sudden weight gain
  • Increased swelling of the feet, ankles, and legs
  • Swollen belly


The doctor will ask about symptoms and history of heart failure. A physical exam will be done. Blood and urine will be tested.

The doctor will do tests to view heart and see how it is working. This can be done with:


Treatment depends on what is making symptoms worse. Causes will need to be treated.

Treatment options may be:

Lifestyle changes, such as:

  • Quitting smoking
  • Not drinking alcohol
  • Reaching and keeping a healthy weight
  • A low fat, low sodium diet
  • Regular physical activity

Medicines may need to be changed. New medicine may be given, such as:

  • Diuretics—to remove fluid build-up in the body
  • Nitrates—to ease blood flow
  • Digoxin—to help the heart pump
  • Beta blockers—to slow heart rate and lower blood pressure
  • Calcium channel blockers—to lower blood pressure
  • Angiotensin-converting enzyme (ACE) inhibitors—to widen blood vessels

Medicine may also be given to:

  • Thin the blood
  • Manage chest pain
  • Lower cholesterol

The heart may need extra support to work well. Surgery options may be:

  • An implanted device such as pacemaker or cardiac defibrillator—to help the heart beat at a healthy rhythm
  • Coronary artery bypass (CABG) surgery—to relieve blockages in blood vessels to the heart


Exacerbations cannot always be prevented.


American Heart Association
Heart Failure Association of America


Heart and Stroke Foundation of Canada


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Heart failure: rehabilitation. EBSCO Nursing Reference Center website. Available at: https://www.ebscohost.com/nursing/products/nursing-reference-center. Accessed July 30, 2021.
Hirayama A, Goto T, et al. Association of obesity with severity of heart failure exacerbation: a population-based study. J Am Heart Assoc. 2018;7(6):e008243.
Treatment options for heart failure. American Heart Association website. Available at: https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure. Accessed July 30, 2021.
Last reviewed July 2021 by EBSCO Medical Review Board Dan Ostrovsky, MD
Last Updated: 7/30/2021

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