Heart Failure Symptoms

Symptoms of congestive heart failure often begin slowly. Initially, they only occur when you are very active. Over time, you may notice breathing problems and other symptoms even when at rest. Symptoms of congestive heart failure can also occur 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 run out of breath after exertion. At first, this may begin only when climbing stairs or taking longer walks. Eventually, it can also occur when walking at home. Those who have chest pain or feel that a heavy weight is pressing on their chest should also be screened for possible angina.
  • Orthopnea refers to the shortness of breath that patients can have when lying flat at night. Patients may report having to use a pillow or two under their head and shoulders to sleep. Sitting up with legs hanging over the side of the bed often relieves symptoms.
  • Paroxysmal nocturnal breathlessness (PND) refers to sudden episodes that wake a patient up at night. Symptoms include severe shortness of breath and coughing or wheezing. These usually occur 1-3 hours after falling asleep. Unlike orthopnea, the symptoms are not relieved by sitting up.

Fluid Retention (Edema) and Weight Gain

  • Patients complain of swelling on the foot, ankle, leg or abdomen. In rare cases, swelling may occur in the veins of the neck. Fluid retention can lead to 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 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 suffer from loss of appetite or a feeling of satiety after eating small amounts. They may also have abdominal pain.

Pulmonary Edema

When fluid accumulates in the lungs, it is called pulmonary edema. When this happens, the symptoms become worse. These episodes can occur suddenly or gradually build up over the course of days:

  • In addition to shortness of breath, patients sometimes have a cough that produces a pinkish froth.

  • Patients may feel a bubbling sensation in the lungs and feel like they are drowning.

  • Typically, the skin is clammy and pale, sometimes almost blue. This is a life-threatening situation, and the patient should call 9-1-1 or go to the emergency room immediately.

Abnormal Heart Rhythms

  • Patients may have episodes of abnormally fast or slow heart rate.

Central Sleep Apnea

  • This sleep disorder occurs when the brain does not send a signal to the respiratory muscles telling them to breathe. It occurs in up to half of people with heart failure. Sleep apnea causes disturbed breathing at night. If the heart failure progresses, the apnea can be so acute that a person who cannot breathe wakes up in panic.