What are the symptoms of heart failure?

Trouble with breathing or shortness of breath, which is known as dyspnea, is a common symptom of heart failure. This happens when excess fluid builds in the lungs, which is known as pulmonary edema. As the build up of fluid increases, it may cause difficulty in breathing that interferes with sleep.

The accumulation of fluid, known as edema, can cause swelling and weight gain, which can occur fairly quickly.

Fatigue is another symptom of heart failure. This occurs as fluid buildup increases and the heart's pumping capacity decreases. Heart failure patients tire increasingly easily. Initially, climbing stairs is difficult. Eventually, walking and getting dressed become difficult, too.

Linda Martinez
Cardiac Rehabilitation Specialist

The body’s tendency to hold onto salt and water cause most of the signs and symptoms. These signs and symptoms include:

  • Shortness of breath with exertion
  • Swelling of the feet and/or ankles
  • Difficulty falling asleep flat in bed (needing to prop oneself up in bed in order to sleep comfortably)
  • Awakening during the night feeling as if you cannot breathe
  • Swelling of the abdomen with a feeling of “bloating,” lack of appetite with this symptom.

All or some of these symptoms can be present. Some of these signs or symptoms can be present in other disease states as well. If you have these signs or symptoms, please see your doctor.

Dr. Francis X. Downey, MD
Cardiothoracic Surgeon

Usually heart failure is fairly benign or results in constitutional symptoms, meaning symptoms that affect the whole body, such as fatigue or a general decline in the ability to perform daily tasks.

For example, a patient can find it difficult to walk to the mailbox or mow the lawn, things they could do previously with little or no effort.

Common symptoms of heart failure include:

  • Shortness of breath
  • Cough
  • Feeling very tired and weak
  • Weight gain (from fluid buildup)
  • Swollen ankles, feet, belly, lower back and fingers
  • Trouble concentrating or remembering

The underlying condition of heart failure (heart muscle damage and weakness) cannot be cured, but symptoms can be managed. Good treatment and self-care can slow the progression of these symptoms.

Dr. Jennifer H. Haythe, MD
Cardiologist (Heart Specialist)

The symptoms of heart failure can vary and include shortness of breath with exertion, cough, chest heaviness, palpitations, waking up in the night short of breath, shortness of breath when lying down, needing pillows to prop one’s self up in bed, swelling of the feet and legs, swelling in the abdominal region, loss of muscle mass, nausea and fatigue.

The symptoms of heart failure include:

  • Weight gain of more than 2 pounds overnight or 5 pounds in a week
  • Shortness of breath after climbing a flight of stairs or getting dressed
  • Difficulty breathing when lying down
  • Cough
  • Weakness or tiredness
  • Swelling in your ankles or legs
  • Loss of appetite
  • Belly pain and fullness

(Note: All of these symptoms are common to many medical conditions and may not indicate heart failure. If you have any concerns, consult your doctor.)

Your symptoms depend on how weak your heart is and how well your heart is controlled. You may have one or all of the following symptoms of heart failure. Or you may have no symptoms at all. Some symptoms are:

  • Feeling tired; not able to carry out usual activities.
  • Shortness of breath, even at rest or when lying flat at night.
  • You may need to sleep on two to three pillows in order to breathe comfortably at night.
  • Swelling in your ankles, legs and abdomen (belly) or quick weight gain without eating more than usual. You may suddenly gain as much as two to three pounds in one day.
  • Your belly may feel tender or painful and you may have some nausea.
  • Pounding heart beats or a fast or irregular rhythm at times (especially when lying on your left side).
  • Dizziness and weakness; you may even feel faint.

As heart failure gets worse, you may notice some or all of the following symptoms: sudden weight gain (3 to 4 pounds in 1 to 2 days or 2 pounds overnight), swelling of the legs and ankles, swelling/bloating/pain in the belly, trouble sleeping unless propped up on 2 or more pillows, shortness of breath, frequent dry/hacking cough, loss of appetite. You may also get tired from very little effort. This happens when your blood flow is sluggish. You may wake up feeling tired or get drowsy in the afternoon. This is even more likely if you aren't breathing well when you sleep. Your family may notice snoring or louder snoring than before. Many of these symptoms happen for other reasons too. So your doctor will check your heart and lungs and, if needed, order a blood test (and/or a sleep study) to help find out the cause.

Heart failure often comes on gradually with increasing shortness of breath, especially with activity and exertion. The shortness of breath may become worse when lying supine. Some people may awaken feeling short of breath with improvement after they get up to “get some air.”

Swelling with excess fluid (edema) in the legs may become gradually worse and may extend to swelling in the abdomen. Weakness, nausea and other feelings may be present. Cough, rapid breathing and bluish discoloration (cyanosis) of the hands, feet and lips may happen.

Because there are many causes of heart failure, your physician will run tests such as a chest X-ray, electrocardiogram, blood tests and other studies to determine the cause. Some underlying causes are specifically treatable. Some causes of heart failure cannot be treated but may respond to treatments such as diuretics to remove excess fluid and other medications which improve the effectiveness of the pumping action of the heart. Some causes of heart failure may be corrected or improved with surgery. If other treatments fail, then treatment with heart transplantation may be an option.

Dr. Sean P. Pinney, MD
Cardiologist (Heart Specialist)

Symptoms of heart failure depend on the progression of the condition. Chronic heart failure describes the long-term effects of the condition. Acute heart failure refers to the sudden onset of heart failure and is potentially life threatening.

Chronic heart failure symptoms are lasting and include:

  • Fatigue
  • Shortness of breath
  • Swelling (edema) in the feet, ankles and legs
  • Irregular heartbeat

Acute heart failure symptoms are sudden and possibly life threatening. Symptoms include:

  • Severe shortness of breath
  • Rapid heartbeat and palpitations, which may cause the heart to stop beating
  • Sudden fluid retention
  • Sudden and severe chest pain

If any of these symptoms occurs, seek immediate medical attention.

Joan Haizlip, MSN
Cardiologist (Heart Specialist)

The symptoms of congestive 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

The hallmark of heart failure is shortness of breath. This initially occurs with exertion but as it progresses, the shortness of breath will occur when reclining. It may then also be associated with awakening suddenly from sleep or sleeping/propping up on pillows. Additionally, a chronic cough may indicate fluid in the lungs. Wheezing may occur as well.

Other symptoms of heart failure include fatigue and diminished energy. Fluid retention leading to swelling of the feet and ankles may occur.

Dr. Nasir Z. Sulemanjee, MD
Cardiologist (Heart Specialist)

Symptoms of heart failure for both men and women can be mild to severe. Your symptoms might include:

  • Trouble breathing — Some people have to sleep sitting up or cannot sleep because of trouble breathing.
  • Pain or tightness in the chest — Call your doctor right away if this happens.
  • Swelling (edema) in your feet, ankles, legs or abdomen (stomach).
  • Sudden weight gain — This means your body may be holding on to fluid.
  • Tiredness or weakness — You are not able to carry out your normal routine.
  • Other symptoms — Frequent dry cough, loss of appetite, nausea or vomiting, and abdominal tenderness.

The main symptoms of congestive heart failure are shortness of breath and fluid retention. Weight gain, ankle swelling, weakness and problems with walking and climbing stairs are common.

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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.