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Heart Failure Exacerbations


Heart failure exacerbations are a worsening of symptoms.


Symptoms may be made worse by trouble with the treatment plan, other illness, or progression of disease. Examples include:

  • Uncontrolled high blood pressure
  • A buildup of fluids and sodium
  • Health problems that make the heart work harder, such as anemia
  • Hormonal problems
  • Infection, such as pneumonia

Risk Factors

Factors 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 that are high in salt and fat


People with heart failure exacerbations have heart failure symptoms that have gotten worse. It may include one or more of the following:

  • Shortness of breath that happens with activity, when lying flat, or when bending down
  • Dry, hacking, cough
  • Trouble sleeping
  • Sudden weight gain more than 2 to 3 pounds in 24-hour period
  • Increased swelling of the feet, ankles, and legs
  • Enlarged belly


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

Tests will be done to view your heart and see how it is working. This can be done with:

  • Electrocardiogram (ECG)
  • Echocardiogram—to measure how well your heart is pumping out blood. It can estimate an ejection fraction. It will be compared to earlier tests to look for changes.
  • Coronary angiography


Treatment steps will depend on what is making your symptoms worse. Infections or other medical conditions will need to be treated. Medical care can help to support your heart until the issue has passed.

Your overall treatment plan may also need to be changed. Keep in touch with your care team. Let them know how your treatment plan is working. Some steps include:

Lifestyle Changes

To help ease stress on the heart:

  • Do not drink alcohol.
  • Quit smoking.
  • Lose weight or stay at a healthy weight.
  • Eat healthful foods. Choose foods that are low in fat and sodium.
  • Exercise regularly.


Medicines may need to be changed. New medicine may be needed. Options include:

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

You may also be given medicine to:

  • Thin the blood
  • Manage chest pain
  • Lower cholesterol

Note: Non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen can worsen your heart failure. Talk to your doctor about other medicines you may be able to take.


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

  • Pacemaker surgery— to support your heart. For example, a pacemaker or cardiac defibrillator can help your heart beat at a healthy rhythm.
  • Coronary artery bypass (CABG) surgery—to relieve severe blockages in blood vessels. These blood vessels deliver blood to the heart muscle.

Your care team may begin to talk to you about a heart transplant. You will need to be added to a wait list for a donor heart. This is not an option for everyone.


Exacerbations cannot always be prevented. Following your care plan can help your heart stay as healthy as possible.


American Heart Association

Heart Failure Association of America


Health Canada

Heart and Stroke Foundation of Canada


Acute heart failure. EBSCO DynaMed website. Available at: Updated February 20, 2019. Accessed April 24, 2019.

Heart failure: rehabilitation. EBSCO Nursing Reference Center website. Available at: Updated November 9, 2018. Accessed May 1, 2019.

Treatment options for heart failure. American Heart Association website. Available at: Updated April 30, 2017. Accessed April 24, 2019.

Last reviewed May 2019 by EBSCO Medical Review Board Peter Oettgen, MD  Last Updated: 10/16/2019