Symptoms
- Fatigue or weakness (often the earliest symptom of CHF)
- Shortness of breath with or without activity
- Orthopnea, or difficulty breathing while lying flat, often graded in severity by how many pillows are required to breath comfortably when sleeping
- Paroxysmal nocturnal dyspnea (waking up from a sound sleep short of breath)
- Rapid or irregular pulse
- Edema or swelling of legs, feet and ankles, abdomen, liver, spleen and lungs
- A chronic dry cough or cough bringing up blood-tinged foamy material
- Nocturia, or an increase in urination at night
- Palpitations, or feeling the heart beat
- Oliguria, or decreased urine output
- Unexplained or unintentional rapid weight gain
- Distended or swollen neck veins
- Loss of appetite or indigestion
- Cold, diaphoretic (sweaty), dusky colored skin.
- Changes in behavior such as restlessness, confusion, decreased attention span, and memory
Physical examination and diagnostic tests
Your doctor will perform an extensive history and physical. The history is extremely important as it may give clues as to the cause. The physical examination will reveal signs such as a rapid or irregular heart rate; a rapid respiratory rate (e.g., how fast you breathe); abnormal breathing sound heard with a stethoscope and called rales made by fluid in the lungs, and heart sounds indicating abnormal function. Neck veins may be distended; feet or ankles may be swollen; liver may be enlarged.
Chest x-rays are useful for assessing heart enlargement and fluid accumulation within or around the lungs. Electrocardiograms (ECG or EKG) and echocardiograms rae done to search for a cause for the CHF. These tests are effective for assessing the development of arrhythmias and whether there is evidence of prior heart disease. Echocardiograms, in particular, assess valve and heart wall motion. Frequently, blood and urine tests are also ordered as part of the diagnostic evaluation. One test is called BNP (brain type naturetic peptide), a hormone produced by the heart when it is under stress from heart failure or some pulmonary (lung) conditions. Other tests called troponins are often done to find out if the heart is currently under stress from a heart attack or virus (low levels of BNP and troponins are usually present, but acute injury or failure causes rises). Thyroid function and other endocrine function as well as liver and kidney function will also be checked.
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