Graph showing a warning sign.

Warning Signs of Heart Failure: 5 Symptoms You Shouldn’t Ignore

APRIL 02, 2024


About 6.7 million Americans over age 20 live with heart failure. What’s more, according to the Journal of Cardiac Failure, the lifetime risk of heart failure has increased by 24%, meaning one in four people will develop heart failure in their lifetime. 

Knowing the most common warning signs of heart failure is important even if you don’t currently have heart failure. Catching the condition early is key to disease management and living the best possible life with heart failure. 

This blog post will outline common heart failure risk factors and delve into five symptoms you should not ignore.

Risk Factors of Heart Failure

The risk for heart failure increases as you age (with a sharp uptick after age 65), but the disease can strike at any age. Common risk factors of heart failure include a prior history of heart issues, including: 

  • Coronary artery disease
  • Heart attack
  • A history of damage to the heart valve (valvular heart disease)
  • Enlarged heart (cardiomyopathy)
  • Heart disease at birth 
  • Family history of enlarged heart

Other conditions can also put you at greater risk of heart failure, including: 

Lifestyle factors also play a role. A study in the journal Circulation evaluated British adults’ smoking, sleep and exercise habits, among other factors, and found “an unfavorable lifestyle was associated with elevated risk of heart failure across different genetic risk categories.” 

Early Warning Signs of Heart Failure

Heart failure symptoms may be easy to dismiss, especially as we age. Things like fatigue are easy to chalk up to other causes. That’s why the Heart Failure Society of America has developed an acronym — FACES — to help patients recognize heart failure in its earliest stages. 

F – Fatigue. You notice you’re running out of gas more easily than you used to. Perhaps you can’t do daily tasks without stopping in the middle for a rest. 
A – Activity limitation. You may run out of breath while doing daily activities that did not use to wear you out. 
C – Congestion. Fluid buildup in the lungs can cause wheezing, coughing or other breathing difficulties. 
E – Edema (ankle swelling). Fluid buildup in the ankles, legs and abdomen is a common sign of heart failure. This may also lead to weight gain. 
S – Shortness of breath. It may be harder to breathe, especially when lying down. 

If you’re experiencing any of these early warning signs of congestive heart failure, it’s important to schedule an appointment with your health care provider right away. 

5 Symptoms of Heart Failure You Should Not Ignore

It’s easy for heart failure symptoms to be confused with other conditions. It’s essential to pay close attention to any changes in your symptom profile and your body, especially if you have conditions with symptoms that may mask the onset of heart failure. 

It’s easy to forget what symptoms are present or how bothersome they are. Get in the habit of keeping a symptom journal, either on paper or via an app on your phone. Seeing your symptoms in black and white can help you track their progress and raise a red flag if they are worsening. 

These symptoms, according to the American Heart Association, should trigger concern for patients with heart failure and those who have not yet been diagnosed. 

1. Shortness of breath (dyspnea)

What it feels like. Shortness of breath after a tough workout or period of physical exertion is normal. If you’re gasping for air while doing regular tasks or find you need to prop yourself up while sleeping to catch your breath, you may be experiencing heart failure. 

When to seek medical care. If shortness of breath is a new symptom, if you notice it is getting worse, or if you have severe and persistent shortness of breath, seek medical care right away. 

2. Swelling in the legs or abdomen

What it feels like. Excess fluid buildup (edema) most commonly appears in the feet, ankles and legs. However, swelling can also appear in other areas, like fingers or the abdomen. Swelling due to heart failure may also cause weight gain. 

When to seek medical care. If the swelling in your body is new, sudden or unrelated to an injury, medication or separate condition, it’s important to seek treatment as soon as you can. 

3. Persistent coughing or wheezing

Viral infections, including COVID-19, have left many with coughs that last days, even weeks after the infection has cleared. Given all the reasons you may have a cough, figuring out the root cause can be difficult. 

What it feels like. A cough due to heart failure is frequent and persistent and may produce mucus or pink, blood-tinged sputum. You may also experience a dry, hacking cough when lying flat in bed. 

When to seek medical care. If your cough sticks around, gets worse or is accompanied by bloody mucus. 

4. Appetite, nausea and weight changes

What it feels like. You may experience nausea or a feeling of constantly being full, which could even be accompanied by bloating. You might feel like this even if you haven’t eaten much, which can result in weight loss and muscle loss

When to seek medical care. These symptoms often indicate worsening heart failure. Consult with your doctor right away if you notice appetite changes or nausea. Sudden weight loss or gain can be a sign of newly developing heart failure. Drastic changes on the scale should trigger an immediate call to your provider.

According to the AHA, if you gain more than two to three pounds in 24 hours, you should be evaluated immediately. 

5. Fatigue, tiredness and confusion

What it feels like. Heart failure fatigue goes beyond a poor night of sleep or overdoing certain tasks. Heart failure patients often get worn out doing everyday activities like walking up stairs or running errands. It can also feel like weakness, sleepiness after eating or having trouble catching your breath. You may also experience moments of brain fog or disorientation. 

When to seek medical care. Schedule an appointment with your health care provider as soon as you notice fatigue or sleep issues (like sleeping too much or not being able to sleep). Your loved ones may be the first to notice cognitive changes. It’s easy to brush these off as “senior moments,” but it’s important to let your doctor know if you’re having memory issues, brain fog or disorientation. 

Is It Heart Failure or Something Else? 

If you are experiencing any of these symptoms but have not been diagnosed with heart failure, it’s important to make an appointment with your health care provider. Your doctor will take into account your symptoms, health history and results from diagnostic tests to make an official diagnosis. 

If you or someone you know is experiencing any of the symptoms in this article, it is crucial to seek medical help immediately. While many factors can contribute to heart failure, making lifestyle changes, working with a doctor, and seeking out social support can make it possible to live and thrive with heart failure.