Heart Failure Early Signs and Symptoms

Reviewed on 6/29/2022

Things to Know About Early Symptoms and Signs of Heart Failure

Picture of a man bending down with his hand on his heart.
Shortness of breath is the main symptom of heart failure.
  • 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 Early Signs and Symptoms of Right-Sided 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.

Weight Gain and Increased Urination

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.

Frequent urination during the night (nocturia). 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).

Leg, Ankle, and Foot Swelling (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.

What Are the Early Signs and Symptoms of Left-Sided 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.

Shortness of Breath While Lying Flat and With Exertion

Shortness of breath while lying flat. 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.

Shortness of breath with 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.

Pleural Effusion and Paroxysmal Nocturnal Dyspnea

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

Dyspnea (Shortness of breath while sleeping.).

  • 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.

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.

What Are the Early Signs and Symptoms of Biventricular Heart 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.

What Are Compression Socks (Stockings)?

  • Compression stockings are specially made, snug-fitting, stretchy socks that gently squeeze your leg. 
  • Graduated compression or pressure stockings are tighter around your ankle and get looser as they move up your leg.
  • Compression sleeves are just the tube part, without the foot.
  • Pressure from compression socks helps the blood vessels work better in the legs. This allows the arteries that take oxygen-rich blood to the muscles can relax, so blood flows freely. The veins get a boost pushing blood back to the heart.
  • Compression stockings are a worm for comfort, to help prevent serious medical conditions, and compete better in sports. 
  • Compression stockings can:
  • Compression socks come in different sizes and strengths. Your doctor will decide which socks are best for you.
  • You can buy compression stockings over the counter (OTC), but if your doctor prescribes them, your insurance may cover the cost.
  • Compression stockings can be purchased at medical supply companies, online, and in many drug stores.
  • They can cost around $10 to as much as $100 per pair, depending on what kind you get.

People should who wear compression socks include:

  • People with or at risk for circulation problems, like blood clots in the leg (DVT), varicose veins, or diabetes
  • People who have  just had surgery
  • People who can't leave their bed or have a hard time moving their legs
  • People who stand all day at work
  • Athletes
  • Pregnant women
  • People who spend long stretches of time on airplanes, like pilots

7 Causes of Pitting Edema (Swelling)

The cause of fluid leaking into the surrounding tissues may be the result of several mechanisms, for example:

  • Too much force, or pressure inside the blood vessels
  • A force outside of the blood vessel causes the fluid to be drawn through it
  • The wall of the blood vessel is compromised and cannot maintain equilibrium, leading to a fluid loss.

Each of these three mechanisms may be associated with a variety of diseases or conditions, for example:

  1. Pregnancy
  2. Medications
  3. Liver disease
  4. Kidney disease
  5. Venous insufficiency
  6. Heart failure
  7. Idiopathic edema
Reviewed on 6/29/2022
Jameson, J. Larry, et al. Harrison's Principles of Internal Medicine, 20th Ed. New York: McGraw-Hill Education, 2018.