{"id":6886,"date":"2026-09-14T10:03:14","date_gmt":"2026-09-14T03:03:14","guid":{"rendered":"https:\/\/pathlab.com.vn\/?p=6886"},"modified":"2026-09-14T10:20:26","modified_gmt":"2026-09-14T03:20:26","slug":"heart-failure","status":"publish","type":"post","link":"https:\/\/pathlab.com.vn\/en\/heart-failure\/","title":{"rendered":"Heart Failure: Symptoms, Causes, Classification, and Management"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Heart failure is a clinical syndrome that occurs when the heart cannot adequately meet the body&#8217;s need for blood and oxygen or must operate under increased pressure to maintain adequate circulation. It does not mean that the heart has \u201cstopped working.\u201d Rather, it is a condition that may progress over time and requires long-term monitoring and management.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In clinical practice, the <strong>Framingham criteria for heart failure<\/strong> are a classic clinical tool used to help identify heart failure based on specific signs and symptoms. However, modern diagnosis does not rely on the Framingham criteria alone. It combines medical history, physical examination, electrocardiography, laboratory testing, natriuretic peptides, and, when appropriate, assessment of cardiac function.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Guidelines such as the <strong>2021 ESC Guidelines for acute and chronic heart failure<\/strong> and the 2022 AHA\/ACC\/HFSA Guideline emphasize early detection, classification according to ejection fraction, and evidence-based treatment. The ESC has also subsequently published a focused update to the 2021 guideline.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">What Is Heart Failure?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Heart failure is a clinical syndrome in which a person may experience symptoms such as shortness of breath, fatigue, or swelling, together with objective evidence of structural or functional abnormalities of the heart.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The heart&#8217;s primary function is to pump blood throughout the body. When the heart&#8217;s ability to contract or fill is impaired, the body&#8217;s organs may not receive the blood supply they require. At the same time, pressure within the heart chambers may increase, leading to fluid congestion in the lungs or venous system.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Heart failure can result from various underlying conditions, including coronary artery disease, high blood pressure, heart valve disease, cardiomyopathy, or abnormal heart rhythms.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em>Read more: <a href=\"https:\/\/pathlab.com.vn\/en\/cardiovascular-diseases\/\">What Are Cardiovascular Diseases? Common Types and What to Know<\/a><\/em><\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Common Causes of Heart Failure<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Heart failure does not have a single cause. Identifying the underlying cause is important because it can influence the treatment and long-term monitoring strategy.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Coronary Artery Disease and Heart Attack<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Coronary artery disease can reduce blood flow to the heart muscle. If a heart attack occurs, part of the heart muscle may become damaged, reducing the heart&#8217;s ability to contract and potentially leading to heart failure.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">High Blood Pressure<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Long-term high blood pressure forces the heart to work harder. Over time, the heart muscle may undergo structural and functional changes, increasing the risk of heart failure.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Heart Valve Disease<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Narrowed or leaking heart valves can alter blood flow through the heart and cause the heart to work harder. If the condition persists, cardiac function may become impaired.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Cardiomyopathy<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Conditions that directly affect the heart muscle may reduce its ability to contract or impair its ability to relax and fill properly.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Abnormal Heart Rhythms<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Persistent rapid, slow, or irregular heart rhythms can interfere with the heart&#8217;s pumping efficiency and contribute to heart failure in some patients.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Signs and Symptoms of Heart Failure<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Symptoms of heart failure vary depending on the severity of the condition and the degree of fluid congestion. Common symptoms include:<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Shortness of Breath<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Shortness of breath may initially occur during physical activity and become more noticeable as the condition progresses. Some people may experience difficulty breathing when lying down or wake up at night feeling short of breath.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Fatigue and Reduced Exercise Capacity<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">People with heart failure may become tired more easily when walking, climbing stairs, or performing activities that they previously tolerated without difficulty.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Swelling of the Legs or Ankles<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">When the body retains fluid and sodium, fluid may accumulate in the lower parts of the body, particularly the legs and ankles.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Rapid Weight Gain Due to Fluid Retention<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Rapid weight gain over a short period, especially when accompanied by swelling or shortness of breath, may indicate fluid retention and should be evaluated.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Cough or Difficulty Breathing When Lying Down<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Some people may develop a persistent cough or experience worsening shortness of breath when lying down.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Not everyone with these symptoms has heart failure. Similar symptoms may occur in lung disease, kidney disease, anemia, and other medical conditions.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">What Are the Framingham Criteria for Heart Failure?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The <strong>Framingham criteria for heart failure<\/strong> are a clinical system developed from the Framingham Heart Study to help identify heart failure based on signs and symptoms.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Under the classic approach, heart failure is supported by the presence of <strong>two major criteria or one major criterion plus two minor criteria<\/strong>, provided that the minor criteria cannot be better explained by another condition.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Major Criteria<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Commonly cited major criteria include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Paroxysmal nocturnal dyspnea or orthopnea.<\/li>\n\n\n\n<li>Neck vein distention.<\/li>\n\n\n\n<li>Pulmonary crackles.<\/li>\n\n\n\n<li>Cardiomegaly.<\/li>\n\n\n\n<li>Acute pulmonary edema.<\/li>\n\n\n\n<li>A third heart sound (S3).<\/li>\n\n\n\n<li>Hepatojugular reflux.<\/li>\n\n\n\n<li>Certain hemodynamic findings or weight changes associated with treatment.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Minor Criteria<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Common minor criteria include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Ankle or lower-extremity edema.<\/li>\n\n\n\n<li>Dyspnea on exertion.<\/li>\n\n\n\n<li>Enlarged liver.<\/li>\n\n\n\n<li>Nocturnal cough.<\/li>\n\n\n\n<li>Pleural effusion.<\/li>\n\n\n\n<li>Tachycardia.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">The Framingham criteria have important historical value and may still be used in clinical research or as an aid to clinical recognition. However, they <strong>should not be used alone to self-diagnose heart failure<\/strong>.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"768\" src=\"https:\/\/pathlab.com.vn\/wp-content\/uploads\/2026\/09\/framingham-criteria.jpg\" alt=\"Framingham criteria\" class=\"wp-image-6887\" srcset=\"https:\/\/pathlab.com.vn\/wp-content\/uploads\/2026\/09\/framingham-criteria.jpg 1024w, https:\/\/pathlab.com.vn\/wp-content\/uploads\/2026\/09\/framingham-criteria-533x400.jpg 533w, https:\/\/pathlab.com.vn\/wp-content\/uploads\/2026\/09\/framingham-criteria-768x576.jpg 768w, https:\/\/pathlab.com.vn\/wp-content\/uploads\/2026\/09\/framingham-criteria-600x450.jpg 600w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">How Is Heart Failure Diagnosed Today?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Modern approaches to heart failure diagnosis combine <strong>symptoms, clinical signs, and objective evidence of structural or functional abnormalities of the heart<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Evaluation may include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Medical history and assessment of symptoms.<\/li>\n\n\n\n<li>Physical examination.<\/li>\n\n\n\n<li>Electrocardiography.<\/li>\n\n\n\n<li>Blood tests.<\/li>\n\n\n\n<li>BNP or NT-proBNP testing when appropriate.<\/li>\n\n\n\n<li>Echocardiography.<\/li>\n\n\n\n<li>Additional imaging or specialized tests when clinically indicated.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">The 2022 AHA\/ACC\/HFSA guideline provides an approach for evaluating people suspected of having heart failure, including clinical assessment, natriuretic peptide testing, and echocardiography when appropriate.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Classification of Heart Failure by Ejection Fraction<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">One important method of classification is based on the <strong>left ventricular ejection fraction (LVEF)<\/strong>.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Heart Failure with Reduced Ejection Fraction \u2013 HFrEF<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">HFrEF is generally defined as heart failure with an <strong>LVEF of 40% or less<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This group is commonly associated with impaired contraction of the left ventricle.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Heart Failure with Mildly Reduced Ejection Fraction \u2013 HFmrEF<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">HFmrEF refers to heart failure with an <strong>LVEF of 41\u201349%<\/strong>, together with appropriate evidence of increased filling pressures or other supporting findings.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Heart Failure with Preserved Ejection Fraction \u2013 HFpEF<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">HFpEF generally refers to heart failure with an <strong>LVEF of 50% or higher<\/strong>, together with appropriate evidence supporting the diagnosis of heart failure and increased filling pressures.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Importantly, <strong>a normal ejection fraction does not necessarily mean that the heart is completely healthy<\/strong>. A person can have heart failure despite preserved LVEF.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Heart Failure with Improved Ejection Fraction \u2013 HFimpEF<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Another category is HFimpEF, which generally refers to patients who previously had an LVEF of 40% or less and subsequently experience an improvement in LVEF to above 40%.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This classification is important for long-term management. The 2022 AHA\/ACC\/HFSA guideline emphasizes that patients with HFimpEF should generally continue guideline-directed heart failure treatment rather than stopping medication simply because their ejection fraction has improved.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">How Is Heart Failure Staged?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">In addition to classification by LVEF, the AHA\/ACC\/HFSA guideline uses stages A through D to describe the progression of heart failure.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Stage A: At Risk for Heart Failure<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">These individuals have risk factors such as hypertension, diabetes, obesity, or other cardiovascular risk factors but do not yet have symptoms or structural heart disease consistent with heart failure.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Stage B: Pre-Heart Failure<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">There are no current heart failure symptoms, but evidence of structural or functional heart abnormalities or relevant biomarkers is present.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Stage C: Symptomatic Heart Failure<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The person has structural heart disease accompanied by current or previous symptoms of heart failure.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Stage D: Advanced Heart Failure<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Symptoms significantly interfere with daily activities, are difficult to control, or may lead to repeated hospitalizations despite guideline-directed treatment.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Chronic Heart Failure and the 2021 ESC Guidelines<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The <strong>2021 ESC Guidelines for heart failure<\/strong> approach heart failure by evaluating symptoms, clinical signs, evidence of structural or functional cardiac abnormalities, and supportive diagnostic tests.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">An important point is that chronic heart failure can remain stable for a period of time but may also experience episodes of acute decompensation. Therefore, \u201cchronic heart failure\u201d does not mean that the condition is always stable or cannot worsen.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">When symptoms suddenly become more severe, such as marked shortness of breath, rapidly increasing swelling, or a significant decline in exercise tolerance, the patient should be evaluated to determine whether acute decompensated heart failure or another acute condition is present.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The ESC has subsequently published a <strong>2023 focused update<\/strong> to the 2021 heart failure guideline. Therefore, when consulting medical literature, it is important to distinguish the original 2021 guideline from later updates.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Treatment and Management of Heart Failure<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The goals of heart failure management extend beyond relieving symptoms. Treatment aims to reduce hospitalizations, slow disease progression, and improve outcomes when possible.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Depending on the type and underlying cause of heart failure, treatment may include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Treating the underlying cause.<\/li>\n\n\n\n<li>Controlling blood pressure.<\/li>\n\n\n\n<li>Managing diabetes and cardiovascular risk factors.<\/li>\n\n\n\n<li>Managing fluid congestion when necessary.<\/li>\n\n\n\n<li>Guideline-directed heart failure medications.<\/li>\n\n\n\n<li>Devices or interventional procedures in selected patients.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">For HFrEF, the 2022 AHA\/ACC\/HFSA guideline emphasizes four major medication classes as foundational therapy, including sodium-glucose cotransporter-2 (SGLT2) inhibitors. Certain medications may also have a role in HFmrEF and HFpEF depending on the individual clinical situation.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Patients should not start, stop, or change heart failure medications on their own based solely on information found online.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">What Should People with Heart Failure Monitor?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Heart failure management is a long-term process. Patients should:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Monitor symptoms and exercise tolerance.<\/li>\n\n\n\n<li>Attend scheduled follow-up appointments.<\/li>\n\n\n\n<li>Take medications exactly as prescribed.<\/li>\n\n\n\n<li>Manage blood pressure, blood glucose, and cardiovascular risk factors.<\/li>\n\n\n\n<li>Monitor body weight when advised by their healthcare provider.<\/li>\n\n\n\n<li>Follow dietary and fluid recommendations appropriate to their individual condition.<\/li>\n\n\n\n<li>Inform their healthcare provider if symptoms change.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">In particular, rapidly worsening shortness of breath, significantly increased swelling, rapid unexplained weight gain, chest pain, fainting, or sudden deterioration should prompt early medical assessment.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">When Does Heart Failure Require Emergency Care?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Certain symptoms may indicate an acute and potentially serious condition requiring urgent medical attention:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Severe or sudden shortness of breath.<\/li>\n\n\n\n<li>Chest pain or pressure.<\/li>\n\n\n\n<li>Fainting or near-fainting.<\/li>\n\n\n\n<li>Bluish lips or fingertips.<\/li>\n\n\n\n<li>Severe difficulty breathing when lying down.<\/li>\n\n\n\n<li>Rapidly worsening symptoms.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">In these situations, patients should not wait for their next scheduled appointment.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Heart failure is a <strong>complex clinical syndrome<\/strong> that may result from coronary artery disease, hypertension, heart valve disease, cardiomyopathy, or other underlying conditions.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The <strong>Framingham criteria for heart failure<\/strong> are a classic clinical tool based on major and minor criteria. However, modern heart failure diagnosis requires a combination of symptoms, clinical examination, and objective evidence obtained through appropriate diagnostic testing.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Classification according to LVEF into HFrEF, HFmrEF, HFpEF, and HFimpEF helps guide assessment and management. At the same time, the A-to-D staging system highlights the importance of <strong>preventing and detecting heart failure early<\/strong>, before the condition progresses to more symptomatic stages.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If you experience concerning symptoms such as shortness of breath, swelling, fatigue, or reduced exercise tolerance, seek medical evaluation rather than attempting to diagnose yourself based on a single criterion or test result. Identifying the underlying cause, determining the appropriate classification, and maintaining long-term follow-up are essential for effective heart failure management.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em>Register for <a href=\"https:\/\/pathlab.com.vn\/en\/product\/cardiovascular-risk-screening-package\/\">cardiovascular health screening<\/a><\/em><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Heart failure is a clinical syndrome that occurs when the heart cannot adequately meet the body&#8217;s need for blood and oxygen or must operate under increased pressure to maintain adequate circulation. It does not mean that the heart has \u201cstopped working.\u201d Rather, it is a condition that may progress over time and requires long-term monitoring&#8230;<\/p>\n","protected":false},"author":2,"featured_media":6889,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[636],"tags":[],"class_list":["post-6886","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-library"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v21.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Heart Failure: Symptoms, Causes, Classification, and Management<\/title>\n<meta name=\"description\" content=\"Learn about the Framingham criteria for heart failure, its symptoms, causes, classification, and management\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link 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