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Heart failure—the disease—is gradual, progressive, and chronic. Heart failure symptoms can be described with the same three words.
Symptoms of heart failure develop gradually—sometimes they are not even noticeable to the person. Heart failure is not a sudden, traumatic event. Neither are the symptoms.
Heart failure is progressive. Its symptoms keep getting worse unless you do something about it. Survival rates increase when patients take the right medications and make lifestyle changes that improve heart health. Changes start with a sensible diet and regular exercise.
Heart failure is chronic. Its symptoms will last as long as you live. The condition is not curable, but it is treatable, and best of all, it’s largely preventable.
Symptoms usually appear as the heart gets weaker, but it’s possible to have heart failure and not know it. Symptoms may be mild or severe, depending on the degree of heart failure and the side of the heart affected.
Limits on Physical Activity
Physicians determine functional status (limits on physical activity) by using the New York Heart Association Classification for Heart Failure. It is based on the patient’s ability to perform everyday activities and his or her quality of life.
Symptoms and Causes
Every symptom is caused by a specific heart failure malfunction. Here are the most commonly reported symptoms, as described by the AHA and other organizations.
- Shortness of breath (dyspnea): This results from fluid accumulating in the lungs. It happens, says the AHA, because blood backs up in the vessels that return blood from the lungs to the heart. The heart simply can’t keep up with blood supply. Congestion causes rales (noises in the lungs that sound like crackles). Rales can be heard using a stethoscope. The symptom can develop when exercising or when lying down and may be worse at night.
- Shortness of breath (bendopnea): The motion of bending over at the waist increases pressure within the chest and heart. When shortness of breath happens within 30 seconds of bending over, it is a symptom in nearly one-third of advanced heart failure patients.
- Persistent wheezing or coughing: As with shortness of breath, the coughing/wheezing is a result of fluid building up in the lungs. The cough might produce white or pink mucus. A pinkish color indicates the presence of blood. These symptoms could be worse when you are lying down.
- Swelling (edema): This comes from excess fluid seeping through blood vessel walls into body tissues, especially in the legs, ankles, and feet (shoes may feel tight), but also in the abdomen. The kidneys are not able to get rid of sodium and water, which also causes fluid retention in tissues.
- Difficulty sleeping: When fluid backs up in the lungs, you may wake up with shortness of breath, coughing, or wheezing.
- Unusual weight gain: Salt and water retention may occur. As heart failure worsens, you may experience a weight gain of two to three pounds in a day or five pounds in one week.
- Lack of appetite: You might feel sick to your stomach or have a feeling of being full. In either case, it’s because less blood is flowing to the digestive system.
- Pale, cool hands and feet: This results from less blood flowing to extremities because more blood is going to vital organs.
- Decreased urination: This symptom may develop in severe heart failure when the kidneys are not receiving enough blood to produce urine.
- Abdominal swelling/bloating: In addition to swelling or bloating due to fluid retention, symptoms might include nausea and a poor appetite.
- Irregular heartbeat (arrhythmia): This is a change in the pattern or efficiency of electrical signals. The condition is particularly noticeable when you lie on your left side. A pounding heart may also be a symptom.
- Increased heart rate: The heart beats faster to make up for its loss in pumping capability.
- Poor memory, drowsiness, confusion: These symptoms may be a sign that the condition is worsening. They can occur from low cardiac output (reduced blood flow). A change in the level of sodium also can cause confusion.
- Fatigue, activity limitations: Less blood flow to major organs and muscles can cause fatigue and shortness of breath, preventing patients from normal daily activities.
- Frequent nighttime urination: This often happens at night when the legs are elevated and kidneys recognize excess water within bloodstream.
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