Symptoms and Complications of Heart Failure

heart failure symptoms
 © Verywell, 2018

If you have heart failure, it is important for you to know what kinds of symptoms you can experience. By paying close attention to your symptoms, you can help your doctor optimize your therapy, both to keep your symptoms at bay and to reduce your chances of having some of the more serious complications of heart failure.

Most symptoms caused by heart failure can be divided into three general categories: 

  • Symptoms due to fluid overload and congestion
  • Symptoms due to reduced cardiac pumping
  • Symptoms due to cardiac arrhythmias

Fluid Overload and Lung Congestion

Fluid overload and lung congestion are unfortunately frequent in people with heart failure and are the most frequent reasons people with heart failure develop symptoms.

With heart failure, the pumping of the heart is less efficient than normal. To compensate for this reduced pumping ability the body attempts to hold on to salt and water. The accumulation of sodium and water can initially improve cardiac function, at least marginally—but eventually, fluid accumulation becomes excessive and leads to several kinds of symptoms. These include:

  • Weight gain. Salt and fluid retention can cause significant and rapid weight gain. This is why doctors ask people with heart failure to monitor their weight every day—a rapid accumulation of excess fluid weight can be an important sign that the heart failure is slipping out of control and that an adjustment needs to be made in medications or diet.
  • Edema. Edema, or swelling, is common with heart failure. Excess fluid tends to pool in the lower extremities and ankle or leg edema is often experienced. This edema can become quite pronounced and uncomfortable. In addition, ascites can occur in people who have right-sided heart failure. It is fluid accumulation in the abdominal cavity and can be extremely uncomfortable. In addition, it is frequently accompanied by other problems, including abnormal liver function and severe gastrointestinal disturbances.
  • Lung congestion. In heart failure, the body’s accumulation of salt and fluid produces increased pressures in the cardiac chambers. Elevated cardiac pressure causes some of that excess fluid to accumulate in the lungs. The result is lung congestion.

    Because lung congestion is so common, you will often hear the term "congestive heart failure” used as a virtual synonym for heart failure. This lung congestion typically causes breathing difficulties that can produce several distinct symptoms, including:
    • Dyspnea on exertion. Dyspnea, or shortness of breath, is very frequent in people who have heart failure. Most commonly, the dyspnea tends to occur with exertion. In a person with heart failure, both the cardiac function and the status of fluid accumulation tend to wax and wane over time. As these changes occur, the amount of exertion necessary to produce dyspnea will vary. So, people with heart failure should pay attention to the amount of activity they can perform before dyspnea occurs and report worsening of this symptom to their doctors.

      Notably, dyspnea on exertion is often accompanied by, or preceded by, a dry cough—and coughing with exertion may also be a sign that lung congestion is worsening.
    • Orthopnea. Orthopnea is dyspnea that occurs while lying flat. This symptom also tends to wax and wane, according to the severity of heart failure. Needing more pillows to be able to sleep is a classic sign that lung congestion may be worsening.
    • Paroxysmal nocturnal dyspnea (PND). PND is dyspnea is another classic symptom of worsening heart failure. People with PND wake up suddenly from deep sleep, feeling extremely short of breath. 
    • Bendopnea. Bendopnea is a symptom that occurs in people with heart failure that was described only in recent years. It refers to dyspnea that occurs when you bend over.
    • Acute pulmonary edema. Acute pulmonary edema is caused by sudden, rapid lung congestion which produces extreme dyspnea and cough. Pulmonary edema is a medical emergency. In people with chronic heart failure, this event is often caused by a sudden change in the condition of the heart, although it may also be produced in some people if they ingest excessive salt.

    The symptoms caused by fluid overload and lung congestion can be extremely disabling. Fortunately, doctors usually have several effective treatment options for managing these symptoms reasonably well.

    Reduced Cardiac Pumping

    The main job of the heart is to pump blood to all the body's organs. In people with heart failure,​ this pumping action is usually diminished to at least some degree.

    In most cases, the symptoms caused by poor cardiac pumping (also referred to as decreased cardiac output) are experienced only relatively late in the course of heart failure, when the heart muscle has become extremely weak.

    The most prominent symptoms caused by this reduced pumping capability are:

    • Extreme weakness and fatigue
    • Muscle weakness and muscle wasting
    • Lethargy and inanition
    • Extreme weight loss

    Obviously, symptoms like this are not compatible with a long life. Unless the cardiac function can be improved, or unless cardiac transplantation or a ventricular assist device can be used, once a person with heart failure develops these kinds of symptoms, death usually follows relatively soon.

    Cardiac Arrhythmias

    Heart failure is commonly associated with heart rhythm disturbances, especially atrial fibrillation, ​PACs, and PVCs. These arrhythmias commonly produce symptoms, including:

    In addition to causing symptoms, the arrhythmias associated with heart failure can lead to severe or dangerous complications.

    Complications

    If heart failure becomes severe, several dire complications can result. The most common of these include:

    • Pulmonary complications. People with heart failure who have prolonged or severe pulmonary congestion can develop lung complications, especially pneumonia and pulmonary embolus. Because their breathing is already compromised by the heart failure itself, these pulmonary complications can be particularly dangerous in a person with heart failure. In addition, people who have repeated episodes of acute pulmonary edema may simply reach the point where an acute episode causes death before they can get medical care.
    • Stroke. Stroke is common in people with heart failure, partly because blood flow can become relatively “sluggish,” and partly because blood clots that form in the heart can travel to the brain and cause the death of brain tissue. These intracardiac blood clots often develop because of atrial fibrillation, but they can also form simply because of blood pooling in massively dilated cardiac chambers.
    • Organ failure. Reduced cardiac pumping action can rob various organs of their needed blood supply, and organ malfunction can occur. In addition to the neurological deficits often seen in people with heart failure, kidney failure can occur, and severe gastrointestinal disorders are common. Such problems, obviously, contribute to the weight loss, lethargy, and weakness produced by having a low cardiac output.
    • Sudden death. Sudden death is disturbingly common in people with heart failure. Most often these sudden deaths are caused by cardiac arrhythmias (ventricular tachycardia or ventricular fibrillation) and are therefore potentially preventable (for instance, by using an implantable defibrillator).

      However, sudden death can also occur in people with severe heart failure simply because the worn-out heart muscle suddenly stops responding to the heart’s electrical signal—an event doctors often refer to as “electro-mechanical dissociation.”

    Any of these complications can lead to much worse long-term disability, or death, in a person living with heart failure. One of the main reasons to pay attention to changes in your symptoms, if you have heart failure, is to make sure you and your doctor are alerted to any potential changes in your cardiac condition. It is far easier, and more effective, to stabilize heart failure symptoms at an early stage before they progress to a severe, possibly irreversible condition.

    Sources:

    Allen LA, Gheorghiade M, Reid KJ, et al. Identifying Patients Hospitalized With Heart Failure At Risk For Unfavorable Future Quality Of Life. Circ Cardiovasc Qual Outcomes 2011; 4:389.

    Pocock SJ, Ariti CA, Mcmurray JJ, et al. Predicting Survival In Heart Failure: A Risk Score Based On 39 372 Patients From 30 Studies. Eur Heart J 2013; 34:1404.

    Yancy CW, Jessup M, Bozkurt B, et al. 2013 Accf/Aha Guideline For The Management Of Heart Failure: Executive Summary: A Report Of The American College Of Cardiology Foundation/American Heart Association Task Force On Practice Guidelines. Circulation 2013; 128:1810.