Symptoms of Heart Failure
The symptoms of heart failure can range from subtle to life-threatening, depending on the type, stage, and severity of the condition. Recognising the symptoms of heart failure early is vital for diagnosis, timely treatment, and preventing further damage to the heart and other organs. Since heart failure often develops gradually, individuals may dismiss early signs or attribute them to ageing, weight gain, or lack of fitness—delaying critical intervention.
Shortness of breath (dyspnoea) is one of the hallmark symptoms. It occurs when fluid backs up into the lungs due to the heart’s inability to pump blood efficiently. In early stages, breathlessness may be noticeable only during exertion, such as walking uphill or climbing stairs. As the condition progresses, people may experience shortness of breath even at rest or while lying flat (orthopnoea). Many patients begin to sleep with multiple pillows or find themselves waking in the night gasping for air—a condition known as paroxysmal nocturnal dyspnoea.
Fatigue and weakness are also common and often described as persistent and unexplained. These symptoms result from reduced blood flow to muscles and tissues, depriving the body of the oxygen and nutrients needed for normal activity. Simple tasks such as grocery shopping or walking short distances may become exhausting. This reduction in stamina severely affects quality of life and can lead to emotional distress and social isolation.
Symptoms of Heart Failure
Swelling (oedema) is another characteristic feature. It typically begins in the ankles and lower legs but can spread to the thighs, abdomen, and even the sacral area in individuals who are bedbound. The swelling occurs due to fluid retention, as the kidneys receive less blood flow and respond by holding onto sodium and water. In advanced stages, abdominal swelling (ascites) and rapid weight gain may signal severe fluid overload.
Persistent cough or wheezing, especially when lying down, may be a sign of fluid accumulation in the lungs. In some cases, the cough is dry and hacking, while in others it may produce white or pink-tinged frothy sputum—a sign of pulmonary oedema, which is a medical emergency.
Rapid or irregular heartbeat (palpitations) is another symptom, especially when the heart tries to compensate for its weakened state by beating faster or irregularly. Many patients with heart failure also develop arrhythmias such as atrial fibrillation, which can exacerbate symptoms and increase the risk of stroke.
Dizziness, light-headedness, or fainting may occur when the brain receives insufficient blood flow. These symptoms are particularly common in severe or rapidly progressing cases and may indicate dangerously low cardiac output. In some instances, fainting may be the first sign of heart failure or a related arrhythmia.
Weight changes—especially sudden weight gain of more than 2–3 kg over a few days—are often an early indicator of fluid retention. Monitoring daily weight is therefore a key part of managing heart failure, as it provides valuable information about the effectiveness of treatment and the possibility of impending decompensation.
Symptoms of Heart Failure
Reduced appetite and nausea can also develop due to fluid accumulation in the liver and gastrointestinal tract. This symptom is often accompanied by early satiety and discomfort in the upper abdomen. It can lead to nutritional deficiencies, further weakening the individual and complicating overall care.
In addition to these physical signs, cold extremities, pale or bluish skin, and slow capillary refill may be seen in advanced heart failure due to poor circulation. These peripheral signs suggest that the heart is struggling to meet the body’s basic metabolic demands.
Symptoms of heart failure vary slightly depending on whether the condition predominantly affects the left side, the right side, or both sides of the heart:
Left-sided heart failure usually causes pulmonary symptoms like breathlessness, cough, and fatigue.
Right-sided heart failure more often results in systemic symptoms such as swelling, abdominal bloating, and liver congestion.
Biventricular heart failure (affecting both sides) presents with a combination of pulmonary and systemic symptoms.
In children and infants, the symptoms of heart failure can look very different. Babies may struggle to feed, fail to gain weight, or breathe rapidly. In older children, reduced activity, chronic fatigue, and poor growth are often seen. Because children may not be able to articulate their symptoms clearly, these signs should prompt urgent evaluation.
Symptoms of Heart Failure
The presentation of heart failure is also influenced by its classification:
Heart failure with reduced ejection fraction (HFrEF) often presents with more pronounced fatigue and exercise intolerance due to poor cardiac output.
Heart failure with preserved ejection fraction (HFpEF) may present with more subtle symptoms, including exercise-induced breathlessness and fluid retention, particularly in older women with hypertension.
It’s important to note that the symptoms of heart failure may fluctuate. Patients may experience periods of relative stability followed by acute worsening, known as decompensated heart failure. Triggers for decompensation include poor medication adherence, dietary indiscretion (e.g., excess salt), new arrhythmias, infections, or progressive underlying disease.
Because many symptoms are nonspecific and overlap with other common conditions like asthma, anaemia, or kidney disease, heart failure is often misdiagnosed or under-recognised—especially in elderly or sedentary individuals. This underlines the importance of clinical vigilance and timely diagnostic testing.
Emotionally, the impact of symptoms can be profound. Constant fatigue, breathlessness, and hospitalisations often lead to anxiety, depression, and diminished mental well-being. Many patients express frustration over their loss of independence and social functioning. As a result, symptom management must include not only physical treatment but also psychological and emotional support.
Symptoms of Heart Failure
In summary, the symptoms of heart failure encompass a wide array of physical and psychological manifestations. Recognising them early and understanding their progression allows for better disease management, reduced hospital admissions, and improved quality of life. Ongoing education, regular monitoring, and communication between patient and care team are essential to stay ahead of symptom escalation.
