Why Does Congestive Heart Failure Cause Weight Gain?

Dr. Christopher McGowan
July 29, 2022

The human body is incredibly complex, and doctors are constantly discovering new ways that different organs and body systems and genetic differences are connected and interdependent. Weight gain, for instance, is a function of metabolism and how the food we eat is either converted to energy or stored as fat. Yet the story is clearly much more complex than that, and the factors that play a role in weight gain extend to many different aspects of our health. One seemingly unrelated condition that may indeed have a role to play in weight gain is congestive heart failure.   

What is Congestive Heart Failure?   

Congestive heart failure (CHF), also sometimes referred to as simply heart failure, is the term for the signs and symptoms that occur when the heart is no longer able to pump blood through the circulatory system. It’s important to note that CHF is not the same thing as the heart stopping as in cardiac arrest. Congestive heart failure means that the heart isn’t pumping as much blood as the body needs for normal functions. This is typically a heart condition that develops over time and is treated as a chronic, long-term problem. When someone has congestive heart failure, the body attempts to compensate in several ways:

  • The heart stretches out and becomes larger in order to allow more blood to fill the heart and keep up with the body’s needs 
  • Muscle mass is added to the heart so that each pump is stronger and can push more blood
  • The endocrine system releases hormones that stimulate the heart to beat faster
  • Blood vessels become narrower, thereby increasing blood pressure in an effort to compensate for less pumping power
  • Blood is diverted from non-essential tissues and organs and is prioritized for the heart and brain

These sorts of temporary measures are part of the body’s natural instinct to survive and prolong life, but they ultimately can’t solve the underlying issues. Over time, heart failure will continue and worsen until even the compensatory measures are no longer effective. This phenomenon is also the reason why many people are totally unaware of any heart problems until long after the decline in functionality started; most of the time there are no clear symptoms until the body can no longer compensate. 

What Are the Symptoms of Heart Failure?   

The earliest stages of CHF may not lead to any discernible symptoms for most people, or they may be fairly mild. In some cases symptoms may occur and then go away for a while, but that shouldn’t be taken as an indication that the condition has been resolved. When symptoms do finally present, they may include manifestations that aren’t usually associated with heart problems. Below are some common symptoms of congestive heart failure: 

  • Shortness of breath: One of the most common symptoms is a feeling of breathlessness while active or even while lying flat or sleeping. This can also lead to difficulty sleeping and a feeling of restlessness.  
  • Coughing: Fluid build up in the lungs can cause persistent wheezing or coughing that produces white or blood-tinged mucus. 
  • Edema: When the heart can’t properly pump blood, it can back up in the veins and cause fluid to build up in tissues around the body. This kind of fluid retention is called edema and can cause swelling in the legs, feet, ankles, or abdomen. 
  • Fatigue: The diversion of blood to vital systems can lead to a persistent tiredness or fatigue that affects the ability to perform everyday activities like climbing stairs or carrying groceries. 
  • Nausea: Reduced blood flow to the digestive system can cause gastrointestinal problems like nausea, unexplained fullness, or a lack of appetite. 
  • Confusion: Changes to blood chemistry often lead to impaired thinking, confusion, memory loss, or disorientation. 
  • Palpitations: As the heart compensates by beating faster, the increased heart rate can disrupt the normal heart rhythm and lead to palpitations. This can feel like the heart is racing or throbbing.        

What is the Cause of Heart Failure?  

Congestive heart failure isn’t a disease itself but rather a syndrome, which means that it is a collection of signs and symptoms that develop from some underlying condition. Generally speaking, CHF is able to develop because the heart muscle is not elastic enough or too weak to pump blood effectively. There are a variety of risk factors and medical conditions that are capable of weakening or damaging the heart in this way:  

  • Coronary artery disease: Coronary artery disease is a form of heart disease that is the most common cause of congestive heart failure. Fatty deposits and cholesterol that build up in the arteries (atherosclerosis) reduce blood flow, and this can lead to high blood pressure, chest pain. Over time this contributes to heart failure and can eventually cause a heart attack. 
  • Heart attack: Technically known as myocardial infarction, a heart attack is an episode that occurs when blood flow to the heart stops and the heart muscle is damaged. It usually happens because of some kind of arterial blockage and can be deadly if not treated right away. The damage from a past heart attack can lead to heart failure and subsequently make another heart attack more likely.   
  • Hypertension: Hypertension is the medical term for high blood pressure, and there are a number of causes that are typically related to various lifestyle and genetic factors. When blood pressure is too high, the heart muscle has to pump harder in order to keep blood circulating through the body. This gradually weakens the muscle and makes heart failure more likely. 
  • Heart defect: Sometimes the cause of congestive heart failure can be explained by congenital heart defects in the valves or muscles of the heart. This can happen either because of a specific medical condition, genetics, heavy drug or alcohol use, or some types of medication.       
  • Myocarditis: Also known as inflammatory cardiomyopathy, myocarditis is inflammation of the heart muscle that is usually caused by a virus. In addition to weakening the heart, myocarditis can disrupt its electrical system and lead to arrhythmia, a rapid or irregular heartbeat.    

Congestive Heart Failure and Weight Gain         

Congestive heart failure is a serious health condition that can have a lot of consequences for many different areas of a person’s health. CHF can also lead to rapid weight gain, though it is hardly the biggest concern when all else is considered. However, according to the American Heart Association, weight gain may be one of the first warning signs of worsening heart failure and an alert to seek help from a healthcare provider. It typically manifests as a weight gain of more than three pounds in a 24-hour period or more than five pounds in a week. 

The main reason for congestive heart failure-related weight gain is edema, the buildup of extra fluid in the body. When the heart isn’t able to pump blood as effectively, it often means that not enough blood is reaching the kidneys. And because the kidneys are responsible for removing excess salt and water from the body, fluid accumulates in many places. As noted above, this can result in swollen legs and ankles as well as bloating in the abdomen. This kind of weight gain isn’t, however, related in any way to the kind that occurs for metabolic reasons.  

Treatment for Congestive Heart Failure

Unfortunately, the damage related to congestive heart failure is permanent and can’t be cured, largely because it has been developing over a long period of time. Treatment plans are typically aimed at improving symptoms and involve a series of lifestyle changes, medications, and surgical procedures (including heart transplant) when needed. Many of these treatments will also address any weight gain by default as the heart muscle is stabilized and regular drainage of fluid can commence.  

Weight gain that isn’t related to congestive heart failure is a very different situation, though it can feel similarly “incurable” for many people who have tried endless diets. The good news is that there are now revolutionary new advances in endobariatric medicine that can help you finally find the freedom you’ve been seeking. At True You Weight Loss, we provide a series of procedures that can help you sustainably lose weight so you can keep the weight off over the long term. If you’d like to learn more about our offerings, please contact us today to request a consultation!

Dr. Christopher McGowan
Dr. Christopher McGowan

Dr. Christopher McGowan, MD, a leader in endobariatrics, specializes in non-surgical obesity treatments and is triple-board-certified in Internal Medicine, Gastroenterology, and Obesity Medicine. Renowned for pioneering endoscopic sleeve gastroplasty (ESG) with over 2,000 procedures, his global influence and research contributions define him as a top expert.

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