Heart Failure

Symptoms

In the earliest stages of heart failure, you may not have any symptoms. Shortness of breath with exertion and fatigue often develop when the weakened heart is not pumping enough blood to meet your body's needs for oxygen and nutrients.

The body's efforts to make up for heart failure eventually cause symptoms to get worse.

Classic symptoms of heart failure

Symptom	What is it?	More information
Shortness of breath from exertion (dyspnea)	Not being able to catch your breath Having tightness in the chest Being winded Feeling tired while walking Needing to stop frequently when walking	Shortness of breath
Shortness of breath while lying down (orthopnea); shortness of breath while sleeping (paroxysmal nocturnal dyspnea)	Shortness of breath that gets worse when you lie flat or that wakes you up at night	Shortness of breath
Weight gain	Weight gain from fluid buildup	Weight gain
Swelling in the feet or ankles	Swelling that gets worse at the end of the day or after standing for long periods Possible pain Pressure may leave indentations in skin. Shoes may no longer fit.	Swelling in the feet and ankles
Fatigue or inability to exercise well	Having less energy, feeling more tired than usual. Not being able to exert yourself physically as much as you could in the past	Fatigue
Abdominal swelling	Tenderness Pain	Abdominal swelling
Weight loss, decrease in appetite, and decreased muscle strength	Weakness	Cardiac cachexia
Increase in urination	Frequent urination, often worse at night	Urination
Cough	Dry, hacking cough Worse when lying down	Cough

Heart failure is classified as:

• Systolic heart failure, which means your heart does not pump well enough.
• Diastolic heart failure, which means your heart does not relax properly to fill up with blood.

Heart failure may affect one or both sides of the heart. Right- and left-sided heart failure often are present at the same time. If mainly the left side of the heart is affected, it may not be able to pump enough blood to all of the organs in the body (left-sided heart failure), including the heart itself, and can lead to fluid buildup in the lungs. Blood may back up behind the right ventricle as well (right-sided heart failure) and cause fluid to build up in the legs.

Heart failure is grouped according to symptoms. It is important to be familiar with these groups because they may be referred to during the course of your care.

Heart failure classification system

Class I	Physical activity is not limited and does not cause significant fatigue, heart palpitations, trouble breathing, or chest pain.
Class II	Physical activity is somewhat limited. You are comfortable at rest, but ordinary activity causes fatigue, heart palpitations, trouble breathing, or chest pain.
Class III	Physical activity is markedly limited. You are comfortable at rest, but less-than-ordinary activities cause fatigue, heart palpitations, trouble breathing, or chest pain.
Class IV	All physical activity causes discomfort. Symptoms also are present at rest. Minor physical activity always makes symptoms worse.

A newer classification system defines heart failure based on the typical progression of the disease using stages A to D.²

Stages of heart failure

Stage	Definition	Examples
A	High risk for developing heart failure but no structural heart disorders	This may include people who have high blood pressure, coronary artery disease, diabetes, a history of drug or alcohol abuse, a personal history of rheumatic fever, or a family history of cardiomyopathy.
B	Structural heart disorders but no symptoms of heart failure	This may include people who have structural changes to the left ventricle, have heart valve disease, or have had a heart attack.
C	Past or current symptoms of heart failure and underlying structural heart disease	This may include people who have shortness of breath or fatigue caused by left ventricular systolic dysfunction or who are without symptoms (asymptomatic) and are receiving treatment for prior symptoms of heart failure.
D	End-stage disease requiring specialized treatment strategies	This includes people who are frequently hospitalized for heart failure or who cannot be safely discharged from the hospital; who are in the hospital awaiting heart transplantation; who are at home receiving continuous intravenous support for symptom relief or are being supported with a mechanical circulatory assistive device; or who are in a hospice setting for the management of heart failure.

Sudden heart failure

Sudden heart failure causes rapid fluid buildup in the lungs (congestion, pulmonary edema). Symptoms develop suddenly and may include:

• Severe shortness of breath.
• An irregular or rapid heartbeat.
• Coughing up foamy, pink mucus.

Sudden heart failure is a medical emergency and requires immediate care.

Complications

Long-standing heart failure can cause complications, such as:

• An irregular heartbeat.
• A stroke.
• A heart attack.
• A blood clot in the leg (deep vein thrombosis).
• A blood clot in the lung (pulmonary embolism).
• Anemia.
• Cognitive impairment.
• Mitral valve regurgitation.

These complications often can be prevented or treated with medicine or other treatment.

More information Less common symptoms of heart failure

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Author:	Douglas Dana Robin Parks, MS	Last Updated: October 23, 2006
Medical Review:	Adam Husney, MD - Family Medicine Caroline S. Rhoads, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
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