Difference Between Heart Failure and Heart Attack

Medically Reviewed by James Beckerman, MD, FACC on June 30, 2023
4 min read

Heart failure and heart attack are both forms of heart disease. They have some common causes. But they also differ in key ways.

Most heart attacks happen suddenly when one of the arteries leading to the heart becomes blocked and cuts off the blood flow. Without oxygen, the heart muscles start to die.

Heart failure, on the other hand, usually develops gradually. The heart muscle becomes weaker and has trouble pumping blood to nourish the cells in your body. This is a chronic condition that gradually gets worse. But medications can help you live longer and better with it.

Heart attacks can lead to heart failure by weakening the heart's pumping ability. Sometimes, heart failure comes on suddenly after a heart attack. Usually the symptoms are severe at first. This is called acute heart failure. But you can get better quickly with treatment and medication.

Coronary artery disease is at the root of both heart attack and heart failure. This happens when a build-up over time of plaque from fat and other substances makes your arteries grow narrower or harder.

Causes of heart attack

Usually you have a heart attack after a piece of the plaque breaks off. It then forms a blood clot, which stops the flow of blood.

Sometimes, a spasm in a coronary artery can trigger a heart attack even if you don't have hardening of the arteries.

Very rarely, a heart attack might happen because of a tear in the walls of the coronary artery. This is called spontaneous coronary artery dissection.

Causes of heart failure

Over time, if your heart is pushing blood through a narrow, blocked space, it becomes weaker. If it's not able to get enough blood supply, it can start to fail.

Heart failure can also stem from other conditions. They include:

Symptoms of a heart attack vary from person to person. They also can be different for men and women. But some signs of heart attacks are more common than others. They include:

  • Pain or feeling of pressure in the center of the chest. It might feel like the area is being squeezed or like heartburn. The pain may last for several minutes or come and go. It can be mild or severe. Chest pain is the most common symptom. But some people don't have it at all.
  • Pain and discomfort in your upper body, such as your neck, jaw, arms, back and stomach above your belly button.
  • Trouble breathing.
  • Nausea or vomiting, lightheadedness, feeling very tired and breaking out in a cold sweat. This is more common in women, as is shortness of breath.

If you have heart failure, you'll likely notice more than one of these classic symptoms:

  • Shortness of breath (especially when lying down)
  • Wheezing or coughing
  • Fast or irregular heartbeat
  • Tiredness
  • Swelling around your ankles, legs, or stomach and weight gain from retaining fluid
  • Confusion

Heart attacks need to be treated right away. Call 911 even if you only suspect you're having one. Paramedics will probably give you blood-thinning aspirin to prevent any more clots and nitroglycerin to help blood flow.

Your long-term treatment will depend on the cause, but many people recover well from a heart attack.

You may need a procedure to open the blocked artery. With percutaneous coronary intervention, a surgeon threads a tube into the blocked artery. Then they expand a tiny balloon attached to the end of the tube to open the artery. At the same time, they may put a tiny mesh tube called a stent in to keep the artery propped open.

Your doctor could suggest coronary artery bypass grafting. The surgeon takes out a healthy blood vessel and attaches it to the damaged vessel to create a detour for the blood.

Your doctor will probably prescribe some long-term medications. They include drugs to lower blood pressure and cholesterol.

They may also suggest you learn how to manage your underlying heart disease through diet and exercise.

Doctors prescribe many of the same drugs used for heart attacks for heart failure. This includes drugs to lower blood pressure or to slow your heart rate. Often, you'll take diuretic pills to get rid of extra water. That will ease swelling and shortness of breath.

Lifestyle changes like quitting smoking, losing weight, cutting salt, and exercising also can help make things easier on your heart.

As heart failure gets worse, you may need surgery to get a device that will help your heart. For instance, a pacemaker implanted in your heart can keep your heart pumping in rhythm. An implanted defibrillator can steady heartbeats. For very advanced heart failure, you may need a pump to keep your heart working.

In severe cases, a heart transplant may be possible.