How to Recognize a Heart Failure Exacerbation -- and What to Do

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Heart failure symptoms can worsen suddenly or slowly over weeks. Either way, worsening of symptoms is known as an exacerbation or decompensation. It's important to know the signs of an exacerbation and what to do if you notice these changes. The more familiar you become with the symptoms of heart failure, the easier it will be to notice if they're getting worse or new symptoms are appearing.

Here are the most common signs of a heart failure exacerbation and what to do. All of these symptoms are important to take seriously; some are reasons to call the doctor, while others are reasons to call 911 or go to the emergency room. If you catch the worsening of symptoms early enough, sometimes changing a medication and/or making dietary changes can get things under control without a visit to the doctor.

Shortness of breath

Any noticeable change in breathing is important to pay attention to. Keep track of all changes, such as waking up in the middle of the night short of breath or difficulty breathing while lying down. Easiest to notice are changes in daily routine, such as more shortness of breath while resting or doing simple tasks such as getting dressed. Some people may report more severe symptoms -- feeling like they're drowning, for example. Alert the doctor to these changes.

Weight gain

Make weighing your loved one part of his or her daily routine, and write down the results. If there's a change of more than a few pounds over a week, call the doctor. Recording daily weights, and recognizing an increase in weight over a short period of time -- even if small (say 3 pounds in 3 days) -- can trigger you to make changes and avoid a full-blown exacerbation.

Swelling legs, feet, or abdomen

This may be accompanied by pain or discomfort. The veins in the neck may also bulge. You may notice that you can't get your loved one's shoes on or that pants are too tight around his or her abdomen. Sometimes fluid buildup in the abdomen leads to stomach symptoms, including nausea, loss of appetite, or constipation. A rapid increase in swelling is important to bring to your doctor's attention right away.

Coughing or coughing up sputum

More severe or more frequent coughing is a sign of worsening heart failure. The cough may be dry or may bring up frothy phlegm with a pinkish or reddish color. The cough may only come when the person is lying down. Wheezing may also be a symptom of worsening heart failure. Call the doctor if this is occurring.

Racing heart

An increase in heart rate or a "skipped" or irregular heartbeat, known as arrhythmia, is a sign of a heart failure exacerbation. It may feel like the heart is racing or pounding, and this can be accompanied by dizziness. Call the doctor about any changes in heart rhythm.


If you notice increasing tiredness or weakness, pay attention to the details such when it happens and which activities are being curtailed. Fatigue alone isn't reason to call the doctor, but if it worsens suddenly or accompanies other symptoms above, make the call.

Call 911 or go to the nearest emergency room for any of these signs:
  • Fainting or losing consciousness

  • Chest pain that lasts longer than 15 minutes despite rest

  • Dizziness or mental confusion

  • Severe, constant shortness of breath

It's important to recognize that symptoms of a heart failure exacerbation vary from person to person. One person's symptoms may be a swollen belly and no leg swelling, while another has severe shortness of breath and no other symptoms. Some people just get profoundly fatigued. Over time, pay attention to your loved one's typical symptoms during an exacerbation, so you're prepared to recognize them and act quickly.