Many symptoms of heart failure result from the congestion that develops as fluid backs up into the lungs and leaks into the tissues. Other symptoms result from inadequate delivery of oxygen-rich blood to the body's tissues. Since heart failure can progress rapidly, it is essential to consult a doctor immediately if any of the following symptoms are detected:
Fatigue. Patients may feel unusually tired.
Shortness of Breath (Dyspnea).
- Patients typically report that they feel out of breath after exertion. While this may begin only when climbing stairs or taking longer walks, it can eventually be present even when walking around the home. (Those who have chest pain or feel like a heavy weight is pressing on the chest should also be evaluated for possible angina.)
- Orthopnea refers to the shortness of breath patients may have when they lie flat at night. Patients may report that they need to use one or two pillows underneath their head and shoulders in order to be able to sleep. Sitting up with legs hanging over the side of the bed often relieves symptoms.
- Paroxysmal nocturnal dyspnea (PND) refers to sudden episodes that awaken a patient at night. Symptoms include severe shortness of breath and coughing or wheezing, which generally occur 1 - 3 hours after going to sleep. Unlike orthopnea, symptoms are not relieved by sitting up.
Fluid Retention (Edema) and Weight Gain. Patients may complain of foot, ankle, leg or abdominal swelling. In rare cases, swelling can occur in the veins of the neck. Fluid retention can cause sudden weight gain and frequent urination.
Wheezing or Cough. Patients may have asthma-like wheezing, or a dry hacking cough that occurs a few hours after lying down but then stops after sitting up.
Loss of Muscle Mass. Over time, patients may lose muscle weight due to low cardiac output and a significant reduction in physical activity.
Gastrointestinal Symptoms. Patients experience loss of appetite or a sense of feeling full after eating small amounts. They may also have abdominal pain.
Pulmonary Edema. When fluid in the lungs builds up, it is called pulmonary edema. When this happens, symptoms become more severe. These episodes may happen suddenly, or gradually build up over a matter of days:
- In addition to shortness of breath, patients sometimes have a cough that produces a pinkish froth.
- Patients may experience a bubbling sensation in the lungs and feel as if they are drowning.
- Typically, the skin is clammy and pale, sometimes nearly blue. This is a life-threatening situation, and the patient must go immediately to an emergency room.
Abnormal Heart Rhythms. Patients may have episodes of abnormally fast or slow heart rate.
Central Sleep Apnea. This sleep disorder results when the brain fails to signal the muscles to breathe during sleep. It occurs in up to half of people with heart failure. Sleep apnea causes disordered breathing at night. If heart failure progresses, the apnea may be so acute that a person, unable to breathe, may awaken from sleep in panic.