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Top 10 Signs of Heart Failure

By Rebecca S. Boxer, M.D., Caring.com senior medical editor, and Melanie Haiken, Caring.com senior editor
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Because the symptoms of heart failure (sometimes called congestive heart failure) can be difficult to identify and describe, it is often diagnosed quite late. If you or the person you're caring for has risk factors for heart disease, such as being a smoker or a former smoker and having high blood pressure or coronary artery disease (CAD), it's a good idea to be on the lookout for heart failure. Taken by themselves, any one of the symptoms listed here probably isn't cause for alarm, but two or more are good cause to call your doctor for an evaluation.

1. Shortness of breath, particularly when sleeping or lying down

One of the characteristic symptoms of heart failure is waking during the night or in the morning feeling as if you can't breathe deeply or can't catch your breath.

What it feels like: A feeling of compression in the chest and lungs, making it difficult to take a deep breath, particularly during exertion or when lying down. Other clues: difficulty sleeping because of breathing difficulties or choosing to sleep in a chair or recliner because it's more comfortable. This symptom is easily confused with other sleep problems and breathing problems, such as COPD and sleep apnea, but the difference is the feeling of being short of breath when lying down. Having to sit up to catch one's breath is particularly telling. Many heart failure patients compensate by propping themselves up on pillows to sleep; when making a diagnosis, doctors sometimes ask their patients how many pillows they sleep on.

Why it happens: Because the heart's ability to pump is weakened, blood backs up in the blood vessels that return blood from the lungs to the heart, causing fluid to leak into the lungs. When the head is elevated, gravity helps ease blood flow to and from the lungs, reducing the feeling of breathlessness.

2. A feeling of chest pressure or "drowning"

People diagnosed with heart failure often look back and recognize this early symptom but didn't know what was happening when they first experienced it, or had difficulty describing it.

What it feels like: It may feel like a pressure or heaviness in the chest, or a feeling akin to drowning or being compressed by a heavy weight. It may also feel as if the lungs are filled with fluid when trying to take a deep breath. Some people with heart failure experience chest pain, but not everyone does, so a lack of pain doesn't rule out heart failure.

Why it happens: Fluid overload throughout the body affects both the chest cavity and the lungs. Fluid in the lungs can feel like drowning when drawing a breath, and congestion in the chest and abdominal tissues can make the lungs feel pressure from outside, as they might deep under water.

3. Clothes and shoes that feel tight

Fluid retention with swelling is one of the primary symptoms of heart failure, but it can be difficult to recognize, since the swelling can occur in many areas of the body.

What it feels or looks like: Tightness in clothes and shoes, or puffiness of the skin. A relatively sudden increase in girth is a telltale sign of heart failure. Someone with heart failure often looks fatter or bigger around, or you might notice a protruding belly or a shirt with straining buttons that previously fit.

If the feet and ankles swell first, you may notice puffiness over the tops of the shoes or an inability to wear certain shoes that once fit. Roundness or puffiness in the face and neck is also a telltale sign. The increased weight will also show as an increase in pounds on the scale, but this may take longer to occur or to notice than the increase in size.

Why it happens: Reduced blood flow out of the heart causes blood returning to the heart to back up in the veins. The fluid then builds up within tissues, particularly in the abdomen, legs, and feet, a condition known as congestion (not to be confused with nasal congestion). Also, the weakened heart can't pump enough blood to the kidneys, which become less efficient at flushing sodium and fluids from the body.