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The essential facts: Heart failure signs and symptoms
Heart failure can often show itself in surprising ways. Learn how to spot symptoms and what to do if you get diagnosed.
“Heart” and “failure” are two words you probably never want to hear together. But if you do, know this: Heart failure simply means the heart isn’t pumping as well as it should be.1,2 Is it serious? It can be. But it’s also manageable for many people.
“Just because you have heart failure doesn’t mean you can’t have a normal, healthy life,” says Louis Gleckel, MD. He’s the chief of cardiology and internal medicine at ProHEALTH, part of Optum, in Lake Success, New York.2,3 “It is a treatable health problem.”
And it is important to stay on top of your treatment. Heart failure is one of the leading reasons people older than 65 go to the hospital.3 It can cause problems with your liver, kidneys and blood pressure. It can also affect your heart rate.4
It’s not always easy, though, to know when your heart might be struggling. Learn some of the easy-to-miss signs of heart failure so you can get ahead of it. And find plenty of tips that help prevent it in the first place. Here’s what you need to know.
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What is heart failure?
A healthy heart pumps nourishing blood to cells throughout the body. If you have heart failure, your heart isn’t quite strong enough to get all that blood where it needs to go. That means your heart has to beat faster to make up for it. It may also get bigger to help it pump more strongly.1
But eventually, your heart and body reach a point where they can no longer keep up. This is when symptoms of heart failure begin to show. The signs of chronic heart failure may go undetected for years. That’s why it’s important to stay on top of your doctor visits. Routine bloodwork can help your doctor spot possible signs of heart failure.1
There are different types of heart failure, including:13
- Systolic left-sided heart failure, where the left side can’t pump normally
- Diastolic left-sided heart failure, where your left side can’t relax normally
- Right-sided heart failure, where the left-side of the heart fails and weakens the right side
- Congestive heart failure, where blood backs up into veins and tissues, and your lungs may fill with fluid
Who is most at risk of heart failure?
Anyone can have heart failure. But the risk increases as you age.2 About 1 in 5 Americans aged 40 and older will have heart failure in their lifetime. More than 6 million Americans have heart failure.5
People with heart failure often have had another heart problem, like:
- A previous heart attack
- Weak heart muscles
- Coronary artery disease (blood vessels to the heart are blocked)
- High blood pressure2,3
What are some surprising symptoms of heart failure?
Many symptoms of heart failure may not seem to be related to your heart at all. If you notice any of these, check in with your doctor:
It’s harder to breathe when you’re lying down. When you lie down, fluid and blood move into your chest area. A healthy heart easily pumps out the extra fluid. But when you have heart failure, your heart is too weak to clear it out. This means fluid sits on your chest longer, putting pressure on your lungs. It may happen suddenly, waking you up. You may have to prop yourself up with multiple pillows to help you fall and stay asleep. And you may wake up in the morning feeling tired and anxious.6,7
Frequent coughing or wheezing. You might chalk this up to a lingering cold or other known lung problem. But as fluid builds up in the lungs, you have a cough and may have trouble breathing. When you breathe, your breath might make a whistling sound. You might even notice white or pink blood-tinged mucus.6 (Mucus is fluid from the inside of your nose, mouth and other parts of the body.)
Swelling in the feet, ankles and legs. When your heart can’t keep all your blood moving like usual, fluid can pool throughout the body. This happens when the blood returning to the heart is backed up. Or your kidneys might not be working as well as they should. Other common spots for swelling include the stomach and veins in the neck.6,7
Frequent urinating. Again, you may wonder what a lot of bathroom trips have to do with your heart. This is your body’s way to help get rid of some of the excess fluid in your body.7
No appetite or nausea. You may eat much less because you feel full or sick. This can be a sign of poor blood flow to your digestive organs. You might also have pain around your stomach.6
You have memory problems and feel confused. This can be caused by less blood flow to the brain. Family and friends may be the first to notice this.6
What are some other common signs of heart failure?
Common signs include:
Shortness of breath. This symptom usually occurs when you’re more active. But it can also happen when you’re doing things you’ve always done, like walking up the stairs to bed.6
“For any change in breathing, see a doctor,” says Dr. Gleckel. It’s one of the first signs and main symptoms of heart failure.3
Heart palpitations. Your heart may feel like it’s racing or throbbing as it works harder to pump.
Tiredness and general weakness. Everyone gets tired now and again, but it becomes a concern when it lasts all day. This can make it hard to walk, shop or climb stairs.6
Weight gain. Again, this can be due to fluid retention. If you have a rapid change in weight, like gaining three or more pounds in a day, call your doctor immediately.8
Blue-tinged fingertips and lips. This is a sign that your oxygen levels might be low.7
Living with heart failure
Once you’ve been diagnosed with heart failure, your doctor will work on the right treatment plan for you. You’ll talk about ways to:
- Reduce symptoms
- Slow down the illness
- Improve your quality of life9
Treatment plans usually include:
- Cardiac rehabilitation
- Changes in your habits
- Devices and surgeries
We’ll talk about all of these below.
“People can live a much longer lifespan when their heart failure is controlled by medication,” Dr. Gleckel says. There are several types of medicines that can help. These medicines can prolong your life and improve your heart’s ability to work properly.10
Your doctor will likely prescribe one or more of these medications:
Aldosterone antagonists. They help your kidneys produce more urine to flush salt and water out of your body. This eases pressure on your heart. These medications include spironolactone (Aldactone®) and eplerenone (Inspra®).
Angiotensin-converting enzyme (ACE) inhibitors. They relax the blood vessels, and make it easier for your heart to pump. These include medications such as captopril (Capoten®), enalapril (Vasotec®), lisinopril (Zestril®), quinapril (Accupril®) and ramipril (Altace®).
Angiotensin II receptor blockers. They lower your blood pressure and make it easier for your heart to pump blood. These include medications such as losartan (Cozaar®) and valsartan (Diovan®).
Angiotensin-receptor neprilysin inhibitors (ARNIs). They ease pressure on your heart by widening your blood vessels. This medication is a combination of sacubitril and valsartan (Entresto®).
Beta-blockers. They block hormones such as adrenaline to slow down your heart rate. These include medications such as metoprolol ER (Toprol XL®) and carvedilol (Coreg®).
If-channel blockers. They help slow down your heartbeat. That helps it pump more blood with each contraction. You may be given ivabradine (Corlanor®).
Your doctor might also prescribe other medications, including:
Diuretics (water pills). These help your body rid itself of extra fluids and sodium through peeing. This helps take some of the work off your heart and lungs.
Anticoagulants (blood thinners). You take these only if you have heart failure with an irregular heartbeat or have another heart problem.
Cholesterol-lowering drugs (statins). Your doctor may prescribe this class of medication if you have high cholesterol or have had a heart attack.
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A heart failure diagnosis can feel scary, but there are specialists ready to help you every step of the way. Cardiac rehab is a program tailored to your needs. These doctors and mental health professionals provide physical, mental and emotional support. With their help, you can stabilize, lessen or even reverse heart failure symptoms.11
Changes in your habits
You can also work with your care team to improve certain parts of your life. Some areas you might focus on include:
- Quitting smoking
- Maintaining a healthy weight
- Drinking the right amount of liquids for your body
- Limiting caffeine, salt and alcohol consumption3,9
- Eating heart-healthy meals
- Being physically active
- Getting flu and pneumonia vaccines (pneumonia is a lung infection that causes severe coughing, shortness of breath and a fever)
- Managing stress
- Tracking your heart failure symptoms
- Keeping an eye on your blood pressure
- Getting enough sleep9
Don’t worry. You won’t have to tackle these all at once. Your team will help you set goals that work with your life.
Devices and surgeries
Some devices can be implanted to help your heart work properly. Whether you get one will depend on the severity and cause of your heart failure. These devices include defibrillators, pacemakers and mechanical pump-like devices. For more severe cases, there are surgeries available, including:
- Heart transplants
- Coronary artery bypass surgery (to redirect the blood around the blocked part of an artery)12
Knowing the signs and symptoms of heart failure is important. It can help you identify this health problem before it causes a dangerous complication. With the help of medication and habit changes, you can go on to lead a long, healthy life.
- American Heart Association. What is heart failure? Last reviewed May 31, 2017. Accessed September 8, 2022.
- American Heart Association. Causes and risks for heart failure. Last reviewed May 31, 2017. Accessed September 8, 2022.
- American Heart Association. How can I live with heart failure? Published March 2022. Accessed September 8, 2022.
- National Heart, Lung, and Blood Institute. Heart failure: What is heart failure? Last updated March 24, 2022. Accessed September 8, 2022.
- American Heart Association. Understand your risk for heart failure. Last reviewed May 31, 2017. Accessed September 8, 2022.
- American Heart Association. Heart failure signs and symptoms. Last reviewed May 31, 2017. Accessed September 8, 2022.
- National Heart, Lung, and Blood Institute. Heart failure: Symptoms. Last updated March 24, 2022. Accessed September 8, 2022.
- American Heart Association. How can I live with heart failure? Accessed September 8, 2022.
- American Heart Association. Lifestyle changes for heart failure. Last reviewed May 31, 2017. Accessed September 8, 2022.
- American Heart Association. Medications to treat heart failure. Last reviewed May 31, 2017. Accessed September 8, 2022.
- American Heart Association. Cardiac rehab for heart failure. Last reviewed May 31, 2017. Accessed September 8, 2022.
- American Heart Association. Devices and surgical procedures to treat heart failure. Last reviewed May 31, 2017. Accessed September 8, 2022.
- American Heart Association. Types of heart failure. Last reviewed May 31, 2017. Accessed September 22, 2022.
- Health Equity. Cardiologists' Perspectives on Race-Based Drug Labels and Prescribing Within the Context of Treating Heart Failure. Published May 22, 2019. Accessed September 23, 2019.
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