What Is Heart Failure Exacerbation?
January 13, 2026
A heart failure exacerbation (also called a flare-up) happens when heart failure symptoms suddenly get worse. This can happen when the heart becomes stressed, leading to the body holding onto extra fluid. Exacerbations can be serious, but many can be prevented with early care.
What Causes a Heart Failure Exacerbation?
Many things can trigger a flare-up, including:
Uncontrolled High Blood Pressure: High blood pressure can make the heart work harder than it needs to. Keeping blood pressure at a safe number makes it easier for the heart to pump.
Use of Common Over-the-Counter Medications: NSAIDS (including ibuprofen, Aleve, Advin, Excedrin, Motrin) and some ingredients in cold medicines (such as phenylephrine and pseudoephedrine) can interfere with heart failure treatments, cause the body to hold onto extra fluid or place stress on the heart. Effervescent tablets (such as Alka-Seltzer) can be loaded with sodium so always check the label or ask a pharmacist if the OTC medicine is ok for heart failure.
Eating Too Much Salt: Salt causes the body to hold onto extra water. Too much salt can lead to swelling, shortness of breath, and sudden weight gain.
Missing Heart Failure Medications: Medications help the heart work better and remove extra fluid. Missing doses can cause symptoms to come back quickly.
Illness or Infection: Colds, flu, pneumonia, and other infections can force the heart to work harder.
Dehydration: Dehydration can lead to kidney problems and other issues, which can affect your heart. Drink 32-64 ounces of water consistently, every day.
Stress: Stress and strong emotions can raise blood pressure and put extra strain on the heart.
Not Following Fluid Limits: Drinking more fluid than recommended can cause a buildup of fluid in the lungs and body.
Other Health Problems: Abnormal heart rhythms including atrial fibrillation, kidney problems, anemia, or uncontrolled high blood pressure can also trigger an exacerbation.
Sudden Change in Altitude: Traveling to an area with significantly higher altitude, or lower oxygen levels, can force the heart and lungs to work harder. This increases heart rate, blood pressure, and fluid in the lungs.
Substance Use: Drinking alcohol excessively or using substances including tobacco and nicotine, opioids, or other illegal drugs.
Common Signs of a Heart Failure Exacerbation
A heart failure exacerbation is a sign that the heart is under stress and needs attention. Knowing the symptoms can help you act fast:
Sudden weight gain (2–3 pounds in a day or 5 pounds in a week)
Shortness of breath that is worse than usual
Needing to sleep upright, or being unable to lay flat without feeling shortness of breath
Coughing more than normal
Swelling in the legs, feet, or stomach
Feeling very tired or weak
Losing your appetite
If you notice any of these symptoms, call your doctor right away.
How Doctors Treat a Heart Failure Exacerbation
Getting help early can often keep you out of the hospital. Your doctor may recommend:
Adjusting your medications
Extra diuretics to remove fluid
Checking your heart and lungs
Blood tests to see what caused the flare-up
A short stay in the hospital if symptoms are severe
Knowing the triggers and symptoms can help you act quickly and stay healthier. With the right habits and regular care, many flare-ups can be prevented. You can help prevent flare-ups in the future with small daily habits, including:
Follow a low-salt diet
Keep track of your daily weight
Take your medications every day
Stay active as recommended
Avoid smoking and limit alcohol
Keep all follow-up appointments
Report new symptoms right away
