Topic Overview

If you have heart failure, symptoms start to happen when your heart cannot pump enough blood to the rest of your body.

Shortness of breath

While shortness of breath is the most common symptom of heart failure, it may be difficult or impossible to distinguish it from shortness of breath caused by other health problems such as emphysema or severe anemia. Your doctor can help you determine why you have been feeling short of breath.

People with heart failure experience shortness of breath in many different ways. You might feel that:

• You can’t catch your breath.
• You feel tightness in your chest.
• You feel tired when you walk.
• You need to stop a lot when you walk.
• It gets worse when you lie flat, and it may wake you up at night.

Shortness of breath from exertion or exercise. If your shortness of breath isn’t severe, you may notice it only when you are exerting yourself, and sometimes only during more intense exertion. The medical term for this symptom is dyspnea (say “DISP-nee-uh”).

When heart failure develops gradually, your shortness of breath also may develop gradually, which can make it hard to notice. But people with more severe heart failure may have shortness of breath with minimal exertion.

Shortness of breath while lying down. People with more severe heart failure may experience shortness of breath when they lie down. The medical term for this symptom is orthopnea (say “or-THAWP-nee-uh”). The severity of this symptom usually depends on how flat you are lying—the flatter you lie, the more you feel short of breath.

To gauge the severity of this symptom, doctors often ask people how many pillows they need to lie on to avoid feeling short of breath in bed. For example, “three-pillow” orthopnea is worse than “two-pillow” orthopnea, because you have less tolerance for lying flat.

The reason you may have orthopnea is that when you lie flat, the blood that ordinarily pools in the veins of your legs is reentering your bloodstream. If you have heart failure, your heart may not be able to keep up with the increased amount of blood returning to the heart, so fluid builds up inside the lungs and causes shortness of breath.

Shortness of breath while sleeping. Some people with heart failure wake up in the middle of the night with severe shortness of breath. The medical term for this symptom is paroxysmal nocturnal dyspnea (PND). This may occur with waking up coughing and/or wheezing, having a rapid heart rate, and a feeling of being suffocated.

In general, people who experience PND don’t feel increased shortness of breath when they first lie down. But after several hours of lying down, they awake with shortness of breath, which often occurs suddenly. People who experience PND often have to sit up on the side of the bed, and they may feel a need to open a window to get more air. The shortness of breath generally goes away after a few minutes of sitting up.

Being very tired (fatigue)

You might feel that:

• You have less energy and feel more tired than usual.
• You can’t exert yourself like you could before.

You might also have low exercise capacity. This can be harder to describe. It is a symptom that people with heart failure often don’t even notice because they have gradually reduced the level at which they exert themselves.

For example, they may stop walking up the stairs, or they may drive to the store instead of walking. Some people at first deny that they have been experiencing this symptom. It is only after doctors ask them about changes in their activities that they realize they have been avoiding physical exertion. This decrease in your ability to exert yourself physically is what doctors call low exercise capacity.

Swelling in ankles or feet

People with heart failure often experience swelling in their ankles or feet. You might notice that:

• It gets worse at the end of the day or after you stand for long periods.
• It hurts.
• Pressure leaves impressions in your skin.
• Shoes no longer fit.

The degree of swelling you experience depends on how well your body is compensating for heart failure and how much sodium and water your body retains. In some cases the swelling is mild and merely bothersome, while in other cases it can be severe and painful if the skin becomes taut and sensitive.

The medical term for this swelling in the legs is pedal edema—”pedal” refers to the feet and “edema” refers to the buildup of excess fluid. Heart failure often causes what doctors call “pitting edema,” meaning that applying pressure to the swollen skin leaves an indentation in the skin. Doctors often test for edema by pressing their thumb to the skin and seeing whether it leaves an impression. You may see this yourself if you take off your shoes and socks and find that your socks have left an impression in the skin of your ankles and feet.

You may notice more severe swelling if you have been eating too much salt, which causes your body to retain fluid. Elevating your feet or wearing supportive stockings can help relieve the swelling.

Sudden weight gain

Weight gain may be the first noticeable sign that you have developed heart failure or that your heart failure is getting worse. The amount of weight gained varies greatly among people with heart failure, and it reflects the amount of sodium and water the body has retained.

A sudden weight gain may mean that excess fluid is building up in your body because your heart failure is getting worse. It is a symptom of sudden heart failure.

Your doctor will probably ask you to weigh yourself every day. Know when to call your doctor if you suddenly gain weight.

Your doctor likely will work with you to manage changes in weight caused by fluid retention. For example, if you have a weight increase of2 lb (0.91 kg), your doctor may recommend taking an additional diuretic that day.