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Heart Failure Exacerbations

  • Amy Scholten, MPH
Publication Type:


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.

Severe symptoms may need hospital care. Those who have frequent hospitalizations may be referred to special care programs. They will focus on multiple ways to managing heart failure.

Treatment options may be:

Lifestyle changes, such as:

  • Quitting smoking and vaping
  • 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 to:
  • Remove fluid build-up in the body
  • Ease blood flow
  • Help the heart pump
  • Slow heart rate
  • Lower blood pressure
  • 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.





  • Acute heart failure. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/acute-heart-failure.
  • Heart failure: rehabilitation. EBSCO Nursing Reference Center Plus website. Available at: https://www.ebsco.com/health-care/products/nursing-reference-center-plus.
  • 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.
  • Life's essential 8. American Heart Association website. Available at: https://www.heart.org/en/healthy-living/healthy-lifestyle/lifes-essential-8.
  • 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.
  • 8/21/2023 DynaMed Systematic Literature Surveillance https://www.dynamed.com/management/heart-failure-structured-management-and-education: Heidenreich Paul A., Bozkurt Biykem, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines, Journal of the American College of Cardiology, 2022;79(17) :e263-e421.


  • Dan Ostrovsky, MD
Last Updated:

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.