Congestive Heart Failure (cont.)

Congestive Heart Failure Symptoms

People with congestive heart failure (CHF) sometimes do not suspect a problem with their heart.

• The early symptoms are often shortness of breath, cough, or a feeling of not being able to get a deep breath.
  
  
• If you have a known breathing problem, such as asthma, chronic obstructive pulmonary disease (COPD), or emphysema, you may think you are having an "attack" or worsening of that condition.
  
  
• If you usually do not have breathing problems, you may think you have a cold, flu, or bronchitis.
  
  
• To make matters worse, any or several of these conditions may coexist along with congestive heart failure.

Congestive heart failure has the following 3 major symptoms:

•  Exercise intolerance
  
  
  • A person may be unable to tolerate exercise or even mild physical exertion that he or she may have been able to do in the past. The body needs oxygen and other nutrients during physical activity. A failing heart cannot pump enough blood to provide these nutrients to the body.
    
    
  • The ability to exercise, even to walk at a normal pace, may be limited by feeling tired (fatigue) and having shortness of breath.
    
    
  • Ordinary activities, such as sweeping, vacuuming, pushing a lawnmower, or even walking about the house, may be difficult or impossible.

The shortness of breath that accompanies these activities usually gets better with rest.

• Shortness of breath
  
  
  • If a person has CHF, he or she may have difficulty breathing (dyspnea), especially when he or she is active.
    
    
  • When CHF worsens, fluid backs up into the lungs and interferes with oxygen getting into the blood, causing dyspnea at rest and at night (orthopnea). 
    
    
  • If a person has CHF, he or she may awaken at night short of breath and have to sit or stand up to get relief. This is called paroxysmal nocturnal dyspnea.
    
    
  • Several pillows may help with a more comfortable sleep. A person may also prefer sleeping in a recliner rather than in a bed.
    
    
  • As the buildup of fluid in the lungs becomes very severe, a frothy, pink liquid may be coughed up.   
     
• Fluid retention and swelling
  
  
  • Puffy swelling (edema) in the legs, the feet, and the ankles may occur, particularly at the end of the day or after prolonged sitting or standing.  
    
    
  • Often, the swelling is more noticeable in the ankles or on the lower leg in the front where the bone is close to the skin.
    
    
  • Press down on the skin in the puffy areas; the indentation where the finger pressed may be visible for a few minutes. This is called pitting edema. Nonpitting edema is not caused by heart failure. Pitting edema is not synonymous with heart failure; it can have other causes, including liver and kidney failure.
    
    
  • Swelling may be so severe as to reach up to the hips, scrotum, abdominal wall, and eventually the abdominal cavity (ascites).
    
    
  • Daily weight checks are mandatory in persons with heart failure because the amount of fluid retention is usually reflected by the amount of increasing shortness of breath and weight gain. Persons with heart failure should know what their dry weight is or what they weigh when they feel good with no pitting edema.

Congestive heart failure usually does not cause chest pain. Remember, though, that other serious conditions that do cause chest pain, such as angina and myocardial infarction, can coexist with heart failure.

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