Symptoms of heart failure often begin slowly. At first, they may only occur when you are very active. Over time, you may notice breathing problems and other symptoms even when you are resting. Heart failure symptoms may also begin suddenly; for example, after a heart attack or other heart problem.  Common symptoms include:

Patients with heart failure 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 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 should call 9-1-1 or  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 send a signal to the breathing muscles, telling them to breathe. 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.