What are the symptoms of congestive heart failure?

Roger K. Muse, MD
Clinical Cardiac Electrophysiology
Congestive heart failure is an extremely dangerous condition. Watch Roger Muse, MD, cardiac electrophysiologist with Metropolitan Methodist Hospital, explain how congestive heart failure is a major cause of mortality. 
Dr. Mehmet Oz, MD
Cardiology (Cardiovascular Disease)

Common symptoms of congestive heart failure are shortness of breath, fatigue, coughing, and swelling due to a build up of fluids. To learn more about this condition, watch this animation.

Johns Hopkins Medicine
Congestive heart failure is progressive and should not be confused with a heart attack, which involves sudden tissue death of the heart muscle. Although heart failure may occur suddenly in some cases, gradual loss of function is more common. Fatigue, shortness of breath on exertion and increased frequency of nighttime urination develop and worsen over time.

Failure of the left side of the heart (left-sided failure) is most common. It leads to increased pressure in the pulmonary veins in the lungs, which forces fluid into the surrounding microscopic air sacs (alveoli) that transfer oxygen to the bloodstream. As the alveoli fill with fluid, they no longer work properly, which limits the amount of oxygen available to the body and produces the most characteristic symptoms of congestive heart failure: fatigue and shortness of breath. In right-sided failure, the increased pressure in the veins returning blood from the rest of the body combined with the compensatory retention of sodium and water leads to fluid accumulation and swelling in the abdomen, liver and legs. Often, both left-and right-sided heart failure occur together.

CHF symptoms include:
  • Shortness of breath and wheezing after limited physical exertion. In advanced cases shortness of breath occurs even at rest, and attacks of severe breathlessness disturb sleep (left-sided failure).
  • Severe fatigue and weakness.
  • Dry cough or cough that produces frothy or bloody sputum (left-sided failure).
  • Frequent urination during the night (right-sided failure).
  • Swelling of the ankles and feet
  • Rapid weight gain due to fluid retention (right-sided failure).
  • Abdominal pain and a feeling of fullness (right-sided failure).
  • Swollen neck veins (right-sided failure).
  • Loss of appetite (anorexia); nausea and/or vomiting.
  • Irregular or rapid heartbeat.
  • Anxiety; in severe cases irritability, restlessness, and mental confusion may occur. 
Farzanna S. Haffizulla, MD
Internal Medicine
Symptoms of congestive heart failure are a result of pulmonary or lung congestion. Symptoms may include the following (in no particular order of progression or presentation):
  1. Cough (typically non-productive) with or without wheezing
  2. Fatigue
  3. Shortness of breath at rest or worse on exertion
  4. Palpitations
  5. Sudden weight gain
  6. Edema (may see lower extremity swelling)
  7. Increase abdominal girth over a short period of time
  8. Chest pain or chest pressure
  9. Inability to sleep flat at night. May require more pillows to elevate head to sleep comfortably (called orthopnea)
  10. Waking up suddenly in the middle of the night gasping for air (called "PND" or paroxysmal nocturnal dyspnea)
  11. Confusion or irritability
Joan Haizlip, MSN
Cardiology (Cardiovascular Disease)

The symptoms of heart failure may be mild or severe.  It all depends on how badly the heart (pump) is weakened.

Some symptoms are:

  • shortness of breath (dyspnea)
  • unable to lie flat (orthopnea)
  • swelling in the feet and legs (edema)
  • confusion
  • fatigue
  • weight gain
Discovery Health

There are many symptoms of congestive heart failure:

  • The most common symptom is shortness of breath or difficulty breathing (dyspnea). It's caused by pulmonary edema. There are many different types of dyspnea. You could have shortness of breath only with exercise, but as the disease progresses, it will take less exertion to produce dyspnea.
  • There is also shortness of breath while at rest and while when lying down (orthopnea). While lying down, blood from the elevated legs might return to the heart and cause pulmonary edema. This symptom is relieved by sitting up. Many people try sleeping on several pillows or in a chair to alleviate this. Sometimes there is intermittent shortness of breath at night (paroxysmal nocturnal dyspnea). Pulmonary edema causes this, as does depression of breathing during the sleep state.
  • Coughing.
  • Edema occurs most often in the legs. This usually increases during the day simply due to gravity increasing the amount and pressure of blood in the veins, pushing more fluid out. It improves when the legs are elevated. Diuretics (fluid pills) can eliminate the excess fluid. Edema occurs in many other areas, such as the abdominal cavity, the chest cavity, the pericardium, and in the stomach and intestines, which causes nausea and loss of appetite.
  • Fluid retention often results in weight gain.
  • A common symptom is fatigue, which may be related to reduced blood flow to organs and muscles. Sometimes CHF reduces blood flow to the brain and causes confusion, especially in the elderly.
  • Chest pain is a symptom of angina and heart attacks, both causes of CHF.
  • A severe and abrupt onset or worsening of CHF is Acute pulmonary edema, which can lead to dangerously low levels of oxygen in the blood. This can be life threatening. Symptoms include severe shortness of breath, a cough that can be blood tinged (hemoptysis), profuse sweating and anxiety. Acute pulmonary edema requires immediate treatment.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.