Illustration of human heart

Symptoms of Heart Failure: What They Look Like and Mean

JANUARY 15, 2024


Heart failure (HF) is a common condition that develops when your heart cannot pump enough blood to meet the needs of your body. It’s a chronic and progressive condition, meaning it can persist over time and may worsen if not properly managed

Knowing the signs and symptoms of heart failure allows you to seek timely medical treatment and manage your condition effectively. Because the symptoms of heart failure often mimic symptoms associated with other conditions, we’ll dig deeper and offer tips on how to differentiate them — and when to seek professional care.

Common Symptoms of Heart Failure

Symptoms associated with heart failure can range from mild to severe. They can also easily mimic those of conditions like a heart attack. If you experience new or worsening symptoms, seek medical treatment right away. Symptoms may include:

  • Shortness of breath (dyspnea) 
  • Swelling (edema) or fluid retention (ascites)
  • Rapid or irregular heartbeat
  • Fatigue and weakness
  • Reduced ability to exercise
  • Persistent cough or wheezing 
  • Cognitive issues
  • Weight changes

Symptoms of Heart Failure: A Closer Look

Let’s take a closer look at each of the most common symptoms of heart failure, what causes them and when to seek medical care. 

Shortness of Breath (Dyspnea) 
According to the American Heart Association Journal, “The shortness of breath in heart failure is caused by the decreased ability of the heart to fill and empty, producing elevated pressures in the blood vessels around the lung.”

One way to distinguish breathlessness caused by HF versus other causes is if you have difficulty breathing while lying down.

  • When to call your doctor. If you find you need to prop up your head with pillows, you wake at night and can’t catch your breath, or you notice coughing at night when lying down. 

Swelling (Edema) 
Swelling is caused by too much fluid in your tissue and typically shows up first in your legs, ankles and feet. You may experience swelling with HF because your kidneys are trying to compensate for not getting enough blood from the heart. This can cause the body to hold onto salt and water, which leads to swelling and increased pressure on the veins. 

While edema refers to general swelling typically found in the extremities, another form of swelling, ascites, can happen when fluid builds up in the space in the abdomen that houses various internal organs. 

  • When to call your doctor. If the swelling in your ankles, feet or stomach is new or is getting worse, or if you feel bloated and have a loss of appetite or nausea. 

Irregular Heartbeat (Arrhythmia)
When you have HF, your heart is under a tremendous amount of strain. When the heart is not pumping well, fluid can back up into the left side of the heart and trigger a type of arrhythmia called atrial fibrillation (AFib)

On the flip side, patients with AFib are at increased risk of developing HF. Symptoms of AFib include an irregular or racing pulse. Your doctor can perform an echocardiogram (EKG) to diagnose Afib or other arrhythmia. 

  • When to call your doctor. If you experience new or worsening symptoms like a slow heartbeat, irregular heartbeat or heart palpitations, it can feel like your heart is racing, thumping or skipping beats. 

Fatigue and Weakness
More than feeling winded after a jog, fatigue in HF is defined in one study as “persistent tiredness and the perception of difficulty performing daily activities because of this persistent tiredness.” It can happen for multiple reasons, including because your body’s tissues and organs are not getting enough oxygen-rich blood. Fatigue in HF patients can occur after any activity, whether moderate or even at rest. 

  • When to call your doctor. If you’re having more trouble sleeping than usual, or if you feel the need to sleep more than you typically do. 

Reduced Ability to Exercise
This goes hand in hand with fatigue, but it’s not in your head if you’re finding it harder to do physical tasks that used to be easy. HF can cause your muscles to tire more quickly. It’s what researchers call skeletal muscle fatigability. It’s a real, measurable decrease in your muscles’ strength and power over time.

This type of muscle fatigue tends to be most pronounced in the legs and increases as your HF progresses. 

  • When to call your doctor. If you find you’re more tired than usual doing physical activities, or if things that used to be easy now leave you worn out. 

Persistent Cough or Wheezing
When the heart cannot keep up with the supply of blood needed to keep the lungs functioning properly, fluid can leak into the lungs. When fluid builds up in the air sacs (alveoli), your body naturally coughs to relieve the congestion. This can lead to a persistent cough or wheezing, often with white or pink blood-tinged phlegm (often called a cardiac cough). 

  • When to call your doctor. If you have a constant hacking cough that’s new or worsening. 

Cognitive Issues
HF can cause the levels of substances in your blood, like sodium, to change. This may result in reduced blood flow to the brain, leading to memory loss, confusion and disorientation. 

  • When to call your doctor. Call your doctor immediately if you or your caregivers notice any cognitive changes. 

Weight Changes
Weight can fluctuate during various life stages, but the ups and downs are often exacerbated in HF patients. When blood flow to your stomach is reduced, it can make it harder for your body to absorb nutrients, and you could notice weight loss. Extra fluid retention, on the other hand, could lead to weight gain. 

  • When to call your doctor. If you see a sudden weight gain of more than two to three pounds in 24 hours or five pounds in a week, schedule an appointment with your provider. 

Keep Track of Your Symptoms

One of the most important things you can do after an HF diagnosis is to keep track of your symptoms daily, as well as any metrics that can give you insight into what’s happening in your body. Your care team will want to know if things have changed since your last visit. 

Key symptoms and metrics to track include: 

  • Breathlessness. Note any changes in how often you feel short of breath, especially if it happens when doing an activity that previously didn’t cause you any trouble.
  • Swelling. It’s important to note any new or worsening swelling. Measure and record the size of the swollen area if possible. Track your fluid and sodium intake to ensure you’re following your doctor’s recommendations. 
  • Heartbeat changes. If you have periodic episodes of racing heart or irregular heartbeats, note what happened and how long the episode lasted. 
  • Fatigue levels. Record when you feel the most fatigued (time of day, activities) and note whether fatigue got in the way of your daily routine. 
  • Weight gain/loss. Track your weight daily so you can see any sudden fluctuations.  
  • Blood pressure. Both high and low blood pressure readings can be significant in HF management. Keep track of your numbers by recording your blood pressure at the same time each day. 
  • Diet. HF patients typically adhere to a low-sodium, heart-healthy diet. This can be one of the most challenging changes to make. Keeping a food diary is an important part of sticking to a healthy eating regimen. 

It can feel overwhelming to keep track of all this data. Apps like Cormeum offer a convenient way to log and manage all these vital health metrics in one place. With daily reminders, an easy interface and the ability to share information directly with your health care team, you can stay on top of your symptoms and better manage your HF.