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Medical Author:

Terrence X O'Brien, MD, FACC

Medical Editor:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Based on a clinical study, it was determined that one in every five people will develop heart failure in his or her lifetime. Some of the most common risk factors for heart failure include:

• Age
• Hypertension
• Physical inactivity
• Diabetes
• Obesity
• Smoking
• Metabolic syndrome
• Family history of heart failure
• Enlargement of the left ventricle
• Some types of valvular heart disease, including infection
• Coronary artery disease
• High cholesterol and triglycerides
• Excessive alcohol consumption
• Prior heart attack
• Certain exposures, such as to radiation and some types of chemotherapy
• Infection of the heart muscle (usually viral)

Symptoms and Signs

People with congestive heart failure sometimes do not suspect a problem with their heart or have symptoms that may not obviously be from the heart.

• Early symptoms may include shortness of breath, cough, or a feeling of not being able to get a deep breath, especially when lying down.
• If a person has a known breathing problem, such as asthma, chronic obstructive pulmonary disease (COPD), or emphysema, they may they are having an "attack" or worsening of that condition.
• If a person usually does not have breathing problems, they may think they have a cold, flu, or bronchitis.
• Any or several of these above conditions may coexist along with congestive heart failure.

Congestive heart failure can have the following 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 before. 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, or even to walk at a normal pace, may be limited by feeling tired (fatigue) and having shortness of breath.
• Shortness of breath
• If a person has congestive heart failure, he or she may have difficulty breathing (dyspnea), especially when he or she is active. Ordinary activities, such as sweeping or even walking around the house, may be difficult or impossible. The shortness of breath that accompanies these activities usually gets better with rest.
• When congestive heart failure 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 congestive heart failure, he or she may awaken at night short of breath and have to sit or stand up to get relief. This condition is known as 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. Often, the swelling is more noticeable in the ankles or on the lower leg in the front where the bone, the tibia, is close to the skin.
• Pitting edema can occur when pressing down on the skin in the puffy areas. The indentation where the finger pressed may be visible for a few minutes. Pitting edema is not synonymous with heart failure; it can have other causes, including liver and kidney failure. Nonpitting edema is generally not caused by heart 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 necessary in persons with heart failure because the amount of fluid retention is usually reflected by the amount of weight gain and increasing shortness of breath. Persons with heart failure should know their dry weight, which is what they weigh when they feel good with no pitting edema.

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