5 Signs of Heart Failure: Symptoms, Causes, and Treatment

• Heart failure is a condition where the heart is unable to pump blood throughout the body effectively.
• There are multiple causes of heart failure, including heart conditions like coronary artery disease, heart attack, and damaged heart valves or muscle.
• Treating heart failure is often done through a combination of medicines and lifestyle changes, though in some cases, surgery may be necessary.

Heart failure (also called congestive heart failure) is a condition where the heart is unable to pump blood throughout the body. This can happen when the heart can’t fill with enough blood, or because it’s too weak or stiff to pump effectively. This reduced blood flow can result in fluid buildup in organs, such as the lungs, or in other parts of the body, such as the legs or abdomen. Symptoms associated with heart failure include difficulty breathing, fatigue, heart palpitations, and can be fatal.

Heart failure can occur quickly (acute heart failure) or can happen gradually over weeks or months (chronic heart failure).

There are a few types of heart failure: left-sided heart failure, right-sided heart failure, and biventricular heart failure.

Left-Sided Heart Failure

Left-sided heart failure occurs when the left ventricle of the heart can’t pump enough oxygen-rich blood throughout the body – as a result, your organs don’t receive enough oxygen to function properly. Over time, blood backs up into the veins and pushes fluid into other areas, which can accumulate in the lungs, leading to pulmonary congestion.

There are two types of left-sided heart failure, systolic and diastolic: 

• Systolic heart failure (also called reduced ejection fraction) means the left ventricle is too weak to pump the blood effectively throughout the body.
• Diastolic heart failure (also called preserved ejection fraction) means the heart has become too stiff and can’t relax properly enough to allow the ventricle to fill with blood.

Right-Sided Heart Failure

Right-sided heart failure occurs when the right ventricle of the heart is too weak to pump enough blood to the lungs. This lack of blood flow can cause blood to back up into your blood vessels, which, over time, can result in fluid buildup in other parts of the body, such as the legs or abdomen.

Biventricular Heart Failure

This is a combination of left and right-sided heart failure. In some cases, left-sided heart failure can cause right-sided heart failure, which can lead to issues in both heart ventricles.

Symptoms of heart failure depend on the type of heart failure you’re experiencing. Usually, heart failure begins with mild symptoms, making it harder to notice. However, the condition can quickly worsen, so it’s important to recognize symptoms early.

Left-Sided Heart Failure Symptoms

Symptoms of left-sided heart failure include:

• Severe shortness of breath, especially when lying flat or performing physical activity
• Fatigue/​tiredness
• Swelling in legs, feet, or ankles
• Sudden weight gain, caused by excess fluid buildup
• Persistent cough or wheezing

If you begin to experience advanced heart failure, complications can include:

• Rapid or irregular heartbeat
• Enlarged heart
• Cardiogenic shock

Right-Sided Heart Failure Symptoms

Symptoms of right-sided heart failure include:

• Fluid buildup in the legs, feet, ankles, lower back, gastrointestinal tract, or liver (edema)
• Distended neck veins (also known as jugular venous distention)
• Shortness of breath
• Chest pain or discomfort
• Heart palpitations
• Nausea, bloating, or loss of appetite (if fluid builds up in the liver or there is congestion in the digestive system)

Biventricular Heart Failure Symptoms

Because this type of heart failure is a combination of left and right-sided heart failure, symptoms from both types are possible. Some common symptoms of biventricular heart failure include:

• Shortness of breath
• Cough
• Heart palpitations
• Fatigue
• Swollen abdomen
• Fluid buildup in the legs, abdomen, or around organs

The causes of heart failure are often multifactorial and impacted by health conditions like high blood pressure (hypertension) and diabetes. Some common causes of heart failure include:

• Coronary artery disease (coronary heart disease) is the most common cause
• Heart attack
• High blood pressure
• Heart rhythm issues (arrhythmias)
• Congenital heart disease
• Damage to the heart muscle or valves
• Viruses that cause myocarditis or inflammation of the heart muscle
• Cardiomyopathy

In some cases, factors such as obesity, overactive thyroid, drinking too much alcohol, or anemia could contribute to heart failure.

Risk factors for developing heart failure can include:

• Certain medical conditions, like coronary artery disease, high blood pressure, congenital heart defect, and cardiomyopathy
• Diabetes
• Obesity
• Heart valve disease
• Smoking tobacco
• Not getting enough physical activity
• Drinking too much alcohol
• Eating foods high in fat, cholesterol, and sodium

If left untreated, heart failure can result in complications, such as:

• Irregular heartbeat/​rhythms
• Kidney or liver damage, including kidney failure
• Pulmonary edema (fluid buildup in the lungs)
• Loss of energy
• Blood clots, which can lead to pulmonary embolism, peripheral artery disease, or stroke
• Respiratory distress (difficulty breathing)
• Death

To diagnose heart failure, your healthcare provider will ask about your symptoms, your medical history, and your family history. From there, they will perform a physical exam and determine if you have risk factors for heart failure, and may decide to run tests for confirmation to check overall heart health. If confirmed, further testing may be done to find the specific cause of heart failure.

Heart Failure Physical Exam

Some of the tests that may be given in a physical exam to determine heart failure include:

• Blood tests, to check for heart disease(s)
• Chest x‑rays, to check the condition of the lungs and heart
• Electrocardiogram, to test how fast or slow the heart is beating
• Echocardiogram, to check the size and structure of the heart and heart valves
• Ejection fraction test, to measure the amount of blood that leaves the heart each time it contracts
• CT scan of the heart, to get a more detailed image of the heart
• Heart MRI, to get a more detailed image of the heart and heart tissue
• Coronary angiogram, to spot potential blockages in the arteries

Stages of Heart Failure

If tests indicate that you are experiencing heart failure, then the next step will be for your healthcare provider to identify the stage. There are two main ways to describe the stages of heart failure: the New York Heart Association (NYHA) classification and the American Heart Association (AHA) classification.

For the NYHA classification, the stages are divided by numbers:

• Class 1: No heart failure symptoms
• Class 2: Daily activities can be done easily, but exertion can cause difficulty breathing
• Class 3: It’s hard to complete everyday activities
• Class 4: Shortness of breath happens even when resting (severe heart failure)

For the AHA classification, the stages are divided by letters:

• Stage A: Risk factors for heart failure are present, but not signs and symptoms
• Stage B: There is heart disease, but no symptoms of heart failure
• Stage C: There is heart disease and signs and symptoms of heart failure
• Stage D: Advanced heart failure, which will require specialized treatment

These stages of heart failure help your healthcare provider decide the appropriate treatment plan for you.

Treating heart failure will depend on the cause. Typically, the main treatments involve lifestyle changes and medication, though surgery may be considered. If a medical condition is causing heart failure, the focus will be on treating that condition.

Treatments for heart failure may improve symptoms and potentially reverse them, especially if diagnosed early.

Medications

Usually, a combination of medications will be used to treat heart failure. Specific medications will depend on the cause.

Some medications that may be administered include:

• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin II receptor blockers (ARBs)
• Angiotensin receptor plus neprilysin inhibitors (ARNIs)
• Beta blockers
• Diuretics
• Digozen
• Hydralazine and isosorbide dinitrate (BiDil)
• Positive inotropes
• Vericiguat
• Nonsteroidal anti-inflammatory drugs (NSAIDs)

Surgeries

In some cases, surgery to place a heart device may be used to treat a condition that is causing heart failure.

Surgeries or procedures that may be done include:

• Coronary artery bypass graft surgery: If you have severely blocked arteries, then healthy arteries are taken from other areas of the body, such as an arm or leg, and connected above or below the blocked artery to create a new pathway for blood flow.
• Heart valve repair/​replacement: If you have a damaged heart valve, surgery may be needed to replace or repair it.
• Cardiac resynchronization therapy (CRT): A specific heart failure treatment for those with lower heart chambers that don’t pump in sync with each other. A device is placed to help the chambers squeeze together, thereby improving blood flow.
• Heart transplant: If your heart cannot pump well enough to provide oxygen to your vital organs and other treatment options have failed, a heart transplant may be used as a last resort..

You can learn more about medications and surgeries for heart failure by visiting this resource.

Lifestyle Changes

In addition to medication, lifestyle changes are encouraged to help reduce the risk or manage symptoms of heart failure.

Lifestyle changes may include:

• Quitting smoking
• Limiting alcohol
• Staying physically active
• Managing stress through techniques such as meditation or yoga
• Eating a heart-healthy diet
• Getting enough sleep

It can be difficult to diagnose early signs of heart failure because symptoms are mild and can go undetected. However, being aware of potential symptoms, especially if you are at a higher risk for heart failure, can help you receive an early diagnosis and treatment before it becomes advanced. 

As a simple guide, the Heart Failure Society of America provides the acronym FACES to help identify potential early signs of heart failure. If you experience these symptoms, it’s best to make an appointment with your healthcare provider.

F: Fatigue

Fatigue can result from the heart not pumping enough blood throughout the body.

A: Activity limitation

If you struggle to do daily activities because you run out of breath easily, this could be an early sign of heart failure.

C: Congestion

Congestion can be caused by fluid buildup in the lungs, leading to wheezing, coughing, and difficulty breathing.

E: Edema or ankle swelling

If the heart’s ability to pump blood throughout the body is impaired, this can cause swelling in the lower extremities, such as the ankles, feet, and legs. This can also cause rapid weight gain.

S: Shortness of breath

Shortness of breath may be due to fluid in the lungs, which makes breathing harder. This is particularly concerning if you have trouble breathing when lying down.

If you believe you’re experiencing symptoms of heart failure, it’s best to see your doctor as soon as possible. While symptoms for heart failure can also be caused by other conditions, it’s important to get a proper diagnosis. If you already have heart failure and develop a new symptom or experience sudden weight gain, make an appointment to see a healthcare provider to ensure things are not getting worse. 

If you already have heart failure and begin to experience severe or worsening symptoms, call 911 immediately. Examples of severe symptoms may include:

• Severe shortness of breath/​breathlessness
• Chest pain
• Rapid or irregular heartbeat with shortness of breath and chest pain
• Fainting or severe weakness