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8 Early Signs and Symptoms of Heart Failure

Heart Failure Symptoms Related Articles

Early Symptoms and Signs of Heart Failure Facts

  • Heart failure is a condition whereby the heart muscle is unable to adequately pump blood throughout the body.
  • There are a variety of illnesses and diseases that affect the heart's pumping capability.
  • Heart failure causes signs and symptoms due to the excess accumulation of fluid within the tissues of the body.
  • When the heart muscle becomes weak and cannot adequately pump blood into the arteries, blood "backs up," and pressure in the blood vessels causes water to leak out of blood vessels into the tissues of the body, which may cause heart failure.

What Are the Signs and Symptoms of Right Heart Failure?

When the right ventricle cannot pump blood adequately, blood backs up into the veins that return blood to the right heart. Fluid then leaks out of veins and capillaries.

1. Weight Gain

  • Weight gain is common with an increase in fluid retention. This may come on gradually or relatively quickly. One way to measure the effectiveness of treatment is to monitor your daily weight is.

2. Leg Swelling or Peripheral Edema

  • Since the legs are the most dependent part of the body, fluid often will first accumulate in the feet and ankles, causing them to swell. This is called dependent edema. The person's shoes may not fit,  and socks may cause an indentation in the skin after they have been worn for a couple of hours. The more fluid that accumulates and the more severe heart failure, the more the legs will swell. If the person is confined to a bed or a chair, the swelling may also be noted in the buttocks or small of the back.
  • When heart failure is severe there can be enough excess fluid and edema that the swelling will extend into the abdomen and involve other organs, such as the liver. This condition is referred to as anasarca.
  • Often, affected individuals will notice that the swelling in the legs is better in the morning when they wake. Swelling increases during the day as the legs are used more. Sleeping or lying down helps decrease edema in the feet and legs.

3. Increased Urination

  • When excess fluid is mobilized, the kidneys recognize the extra water within the bloodstream and they may produce more urine. This often occurs at night when the legs are elevated leading to frequent nighttime urination (nocturia).


Heart Disease: Symptoms, Signs, and Causes See Slideshow

What Are the Signs and Symptoms of Left Heart Failure?

As the left side of the heart (left atrium and ventricle) fails to pump blood adequately, a backup of fluid occurs in the lungs. Water seeps out of the tiny capillary blood vessels into the lungs. This makes it difficult for oxygen to be absorbed and creates shortness of breath.

1. Shortness of Breath on Exertion

  • Shortness of breath with exertion is referred to as dyspnea on exertion. Dyspnea on exertion occurs because the lungs cannot supply enough oxygen and the heart cannot adequately pump oxygen-rich blood to the body. Initially, the shortness of breath may occur when walking long distances or up flights of stairs, but as the heart failure progresses, less activity may produce more symptoms.

2. Fatigue and Exercise Intolerance

  • Persons with heart failure may also notice fatigue and the decreased ability to perform activities or exercise. These complaints tend to be progressive and often arise slowly, so that the person may not be aware of the gradual change in exercise function until daily activities become a chore.

3. Shortness of Breath When Lying Flat (Orthopnea)

  • People who have left heart failure may experience shortness of breath when lying flat (orthopnea). The person will start using two or three pillows to prop themselves up while in bed so that they can breathe easier. If the shortness of breath is more severe, the person may begin sleeping in a chair or recliner.

4. Paroxysmal Nocturnal Dyspnea (PND)

  • Heart failure can cause a person to suddenly waken in the middle of the night with the sensation of shortness of breath, suffocating, and wheezing. The person may need to sit at the edge of the bed to catch his or her breath, and sometimes, feel the need to get up and go to an open window to get more air. Standing or sitting up tends to resolve the shortness of breath after many minutes.

5. Pleural Effusions

  • Pleural effusions (water that accumulates between the lung and the rib cage) may develop, increasing the severity of shortness of breath.

What Are the Signs and Symptoms of Biventricular Failure?

  • When both the right and left sides of the heart fail to pump adequately, the symptoms and signs of both right and left heart failure develop. The person may complaint of swelling in the legs and feet as well as shortness of breath.

Health Solutions From Our Sponsors

Congestive Heart Failure Causes

Congestive heart failure (CHF) is a syndrome that can be brought about by several causes such as:

  • Damaged heart valves
  • Blocked blood vessels going to the heart
  • Drugs like alcohol or cocaine
  • Infections
  • High blood pressure
Reviewed on 1/17/2019
Medically reviewed by Robert J. Bryg, MD, Board Certified Internal Medicine with subspecialty in Cardiovascular Disease


Kasper D, et al. Harrison’s Principles of Internal Medicine. 19th edition. McGraw Hill Education. 2015.

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