Are Congestive Heart Failure and a Heart Attack the Same?

By Your Health Magazine Health Information Team

No. Congestive heart failure and a heart attack are not the same. Congestive heart failure is a condition in which the heart cannot pump or fill well enough to meet the body’s needs, often causing fluid buildup. A heart attack is an emergency in which blood flow to part of the heart muscle becomes blocked. A heart attack can cause heart failure, but either condition can occur without the other.

Heart Failure vs. Heart Attack: The Main Differences

Feature	Congestive Heart Failure	Heart Attack
What happens	The heart cannot pump or fill effectively enough to supply the body.	Blood flow to part of the heart muscle is suddenly reduced or blocked.
Typical course	Often develops gradually, although symptoms can worsen suddenly.	Usually an acute medical emergency.
Common symptoms	Shortness of breath, fatigue, swelling and difficulty lying flat.	Chest discomfort, upper-body pain, shortness of breath, sweating, nausea or light-headedness.
Primary concern	Inadequate circulation and fluid buildup.	Damage or death of heart muscle from loss of blood flow.
Usual care	Long-term treatment and monitoring, with emergency care if symptoms suddenly become severe.	Immediate emergency treatment to restore blood flow and limit heart damage.

What Is Congestive Heart Failure?

Heart failure, also called congestive heart failure, does not mean the heart has stopped. It means the heart is too weak or stiff to pump or fill normally. The resulting circulation problems may allow fluid to collect in the lungs, legs, feet, abdomen or other tissues. The National Heart, Lung, and Blood Institute’s heart failure overview explains that the condition may affect one or both sides of the heart and may develop suddenly or over time.

Common heart failure symptoms include:

Shortness of breath during activity, at rest or while lying flat
Unusual fatigue or weakness
Swelling in the ankles, feet, legs or abdomen
Rapid weight gain related to fluid buildup
Persistent coughing or wheezing
Reduced ability to exercise or complete normal activities
Difficulty concentrating or confusion, particularly in older adults

Heart failure can result from coronary artery disease, longstanding high blood pressure, heart valve disease, cardiomyopathy, abnormal heart rhythms and other conditions that damage or overwork the heart.

What Happens During a Heart Attack?

A heart attack, medically called a myocardial infarction, happens when part of the heart muscle does not receive enough blood and oxygen. Coronary artery disease is the most common cause. Without prompt treatment, the affected heart muscle begins to suffer permanent damage.

According to the Centers for Disease Control and Prevention’s guidance on heart attacks, possible warning signs include:

Pressure, squeezing, fullness, heaviness or pain in the center or left side of the chest
Pain or discomfort in one or both arms, the shoulders, back, neck or jaw
Shortness of breath, with or without chest discomfort
Cold sweating
Weakness, light-headedness or faintness
Nausea or vomiting
Unusual or unexplained tiredness

Symptoms are not always sudden or severe. They may begin gradually, come and go or resemble indigestion. Some people, particularly older adults and people with diabetes, may have mild symptoms or a “silent” heart attack. A heart attack is also different from cardiac arrest, which occurs when the heart suddenly stops pumping effectively.

How Can a Heart Attack Lead to Heart Failure?

During a heart attack, prolonged loss of oxygen can permanently injure part of the heart muscle. If the damage is extensive, the heart may no longer pump strongly enough to meet the body’s needs. Heart failure can develop during the heart attack, shortly afterward or months to years later.

However, having a heart attack does not automatically mean a person will develop heart failure. The outcome depends on factors such as the location and extent of the injury, how quickly blood flow is restored, previous heart health and other medical conditions. Likewise, many people develop heart failure without ever having a recognized heart attack.

Heart attack and heart failure also share risk factors, including high blood pressure, diabetes, smoking, high cholesterol, obesity and coronary artery disease. MedlinePlus provides a broader overview of heart diseases, risk factors and treatments.

How Doctors Tell the Conditions Apart

Symptoms alone cannot reliably distinguish heart failure from a heart attack because both may cause shortness of breath, fatigue, nausea or chest discomfort. Medical testing is important.

When a heart attack is suspected, clinicians commonly use an electrocardiogram, or EKG, and blood tests for troponin, a protein released when heart muscle cells are injured. These tests may be repeated because changes can develop over time. The NHLBI’s heart attack diagnosis information describes how EKGs, blood tests and imaging help evaluate possible heart damage.

Evaluation for heart failure may include a medical history, physical examination, blood tests, chest imaging and an echocardiogram. An echocardiogram shows the heart’s structure and movement and can measure its ejection fraction—the percentage of blood pumped from the left ventricle with each contraction. A normal-looking ejection fraction does not always rule out heart failure because some people have a heart that pumps normally but is too stiff to fill properly.

How Treatment Differs

Heart attack treatment is time-sensitive and focuses on restoring blood flow, limiting heart muscle damage and treating complications. Depending on the situation, hospital care may include medicines, coronary angioplasty and stent placement, or bypass surgery.

Heart failure usually requires ongoing management. Treatment depends on its cause and type and may involve heart-healthy lifestyle changes, prescription medicines, treatment of related conditions, implanted devices or procedures. People with heart failure should follow their healthcare team’s instructions for medications, symptom monitoring, activity and follow-up care.

Advanced heart failure can be life-limiting, and some patients benefit from palliative or hospice support focused on comfort and quality of life. Families caring for someone with severe disease may find it helpful to learn about recognizing signs of impending death from congestive heart failure.

When to Seek Care

Call 911 immediately if you or someone else has possible heart attack symptoms, including new chest pressure or pain, pain spreading to the arm or jaw, unexplained sweating, sudden shortness of breath, fainting or severe weakness. Do not drive yourself to the hospital. Emergency medical personnel can begin assessment and treatment on the way.

Emergency care is also appropriate for severe breathing difficulty, chest pain, collapse, fainting or rapidly worsening symptoms in someone with heart failure. When it is unclear whether symptoms are caused by heart failure, a heart attack or another emergency, it is safer to call 911.

Contact a healthcare professional promptly for new or worsening ankle or leg swelling, increasing shortness of breath, difficulty sleeping flat, rapid fluid-related weight gain or a noticeable decline in activity tolerance. A primary care clinician or cardiologist can evaluate these changes and determine whether testing or treatment adjustments are needed.