Acute Heart Failure: Types, Symptoms, and How It's Different from Chronic Congestive Heart Failure

Medically Reviewed By Angela Ryan Lee, MD, FACC

Acute heart failure describes the sudden onset or worsening of heart failure symptoms. This can occur in people who already have a heart failure diagnosis or in people with no history of heart failure. Prompt treatment can help manage symptoms of acute heart failure. Symptoms of both acute and chronic congestive heart failure can include difficulty breathing, shortness of breath while lying flat, and swelling in the lower legs and feet. During a physical exam, doctors may also observe bulging in the jugular vein and fluid buildup in the lungs.

This article provides an overview of acute heart failure, including its differences from chronic congestive heart failure. It also discusses acute heart failure symptoms, causes, and treatments.

What are the types of acute heart failure?

Close-up of someone checking a person's blood pressure with cuff
Photography by Eddie Pearson/Stocksy United

Acute heart failure can happen for the first time in someone with no known heart failure. This is called de novo acute heart failure.

In most cases Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source of this type, blood flow to the heart has slowed down due to a blockage in an artery. This causes the heart muscle to weaken and become less able to pump blood.

Acute heart failure can also be an exacerbation of known chronic congestive heart failure. It is then known as acute decompensated chronic heart failure (ADCHF).

People with chronic congestive heart failure may have frequent flares or exacerbations of their heart failure, requiring hospitalization for management. The majority Trusted Source International Journal of Obesity Peer reviewed journal Go to source of people who are hospitalized for acute heart failure have ADCHF.

In either case, acute heart failure happens when the heart cannot adequately pump blood to the rest of the body. This results in a backup of blood flow or signs of reduced circulation to organs.

Acute heart failure vs. chronic congestive heart failure

Acute heart failure differs from congestive heart failure (CHF).

Chronic congestive heart failure is a chronic condition in which the heart does not pump blood as effectively as it should. Symptoms worsen gradually over time, but they can be managed with treatment and prevention steps.

Acute heart failure describes heart failure symptoms that occur suddenly. They may be new symptoms or a rapid worsening of existing symptoms. Prompt treatment is necessary and may include hospitalization.

Learn more about CHF causes and risk factors.

What are the symptoms of acute heart failure?

Symptoms of acute heart failure are similar to those of chronic CHF, but they typically occur more suddenly and severely.

As with CHF, acute heart failure symptoms can fall into two primary categories: congestion and reduced perfusion. Perfusion describes how well blood is flowing to your organs.

Congestion symptoms of heart failure

When heart failure causes congestion, blood and fluid can back up in the lungs and body. This can cause symptoms including:

  • shortness of breath
  • cough
  • abdominal pain and swelling
  • trouble sleeping while lying flat
  • swelling in the lower legs, including the feet and ankles
  • loss of appetite
  • weight gain

Reduced blood flow symptoms of heart failure

If the heart has a weakened ability to pump blood, it can make it difficult for blood to reach vital organs. This can cause symptoms including:

What causes acute heart failure?

Most often, heart failure of any type is a secondary effect of an underlying condition that causes heart damage. With acute heart failure, each type is associated with different causes.

De novo acute heart failure causes

A 2017 review Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source explains that de novo acute heart failure often results from a partial or complete blockage in an artery. This slows blood flow to the heart and weakens the muscle tissue of the heart.

Other possible causes of de novo acute heart failure include:

Acute decompensated chronic heart failure causes

ADCHF is an exacerbation of existing chronic heart failure. Possible causes of ADCHF include Trusted Source International Journal of Obesity Peer reviewed journal Go to source :

Learn more about types of heart disease.

How do doctors diagnose acute heart failure?

Because acute heart failure is a serious medical condition, doctors must work quickly to make a diagnosis. This often takes place in a hospital when the person is admitted.

However, diagnosing acute heart failure can be challenging. This is because some symptoms are similar to those of other cardiovascular conditions, such as lung disease.

Tests for acute heart failure

The 2021 European Society of Cardiology guidelines for diagnosing acute heart failure list tests doctors may perform to confirm an acute heart failure diagnosis. These include:

  • electrocardiogram (ECG), to evaluate heart rhythm and look for signs of reduced blood flow
  • echocardiogram, or echo, to evaluate heart and valve function and structure
  • chest X-ray, to look for fluid buildup in the lungs
  • blood tests to measure substances called natriuretic peptides, which can help rule out a diagnosis of heart failure
  • blood tests to measure a heart protein called serum troponin, which can help rule out an acute coronary syndrome

Learn more about what to expect during an ECG.

What are treatments for acute heart failure?

Prompt treatment is necessary for acute heart failure to improve the likelihood Trusted Source International Journal of Obesity Peer reviewed journal Go to source of a successful outcome. In some cases, hospitalization may be required for access to critical care.

Depending on the type of acute heart failure a person is experiencing, doctors will work to manage the primary symptoms through a variety of treatments.

  • Diuretics: These medications can help reduce fluid buildup and congestion in the lungs.
  • Vasodilators: In cases when blood cannot reach distant blood vessels, vasodilators can help improve blood flow.
  • Oxygen therapy: This can include portable oxygen, but more severe cases may require a breathing tube.
  • Inotropic drugs: These medications can help control the strength of your heart function.

In cases when acute heart failure occurs as a result of an underlying condition, doctors will also take treatment steps to address the root cause.

Long-term chronic heart failure care

After stabilizing the symptoms of acute heart failure, doctors will discuss a long-term care plan. Several types of medications can help manage chronic heart failure symptoms, including Trusted Source AHA/ASA Journals Peer reviewed journal Go to source :

  • beta-blockers
  • diuretics
  • angiotensin-converting enzyme (ACE) inhibitors
  • mineralocorticoid receptor antagonists (MRAs)
  • SGLT2 inhibitors

Your doctor can discuss the benefits and risks of these treatments, including potential side effects.

There is no cure for heart failure. However, with your cardiologist and care team, you can work to find treatment to manage the progression of symptoms.


Acute heart failure is the sudden onset of heart failure symptoms. Acute decompressed chronic heart failure (ADCHF) describes rapidly worsening symptoms in someone with a heart failure diagnosis. When heart failure symptoms are new, the condition is called de novo acute heart failure.

In cases when acute heart failure causes fluid buildup, symptoms may include swelling in the lower limbs, shortness of breath, and weight gain. When heart failure reduces blood flow to organs, symptoms may include difficulty breathing, discolored lips, and fatigue.

Both types of acute heart failure require prompt evaluation to improve the likelihood of successful treatment. Contact a doctor or seek emergency care right away if you experience symptoms of acute heart failure, particularly if you have an existing heart failure diagnosis.

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Medical Reviewer: Angela Ryan Lee, MD, FACC
Last Review Date: 2023 Feb 23
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