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.

about 1 year, said...

my dad has just been given 6 months to live and this was his diagnosis he has other issues as well. He can't use his left hand or arm and one leg is huge and leaks fluid sometimes. He can't seem to keep weight on him and he throws up a lot. because he takes hydrocodone several times a day for pay and wears a pain patch he is always constipated and has to give himself enema's. I am moving so I can help take care of him. It's heart breaking because his brain is sharp as it's always been. He will not let Hospice help so that is why i am going to move to take care of him. I just want to tackle one problem at a time. how do you handle the constipation? I am not sure what to do for him. He can hardly walk much less perform that on himself. thank you

over 1 year, said...

when i lay down, or fall asleep, it feels like an elephant is sitting on my chest...I wake up strangling and gasping for air- my bp has been up and down erratically-and i am SO exhausted! My lungs sound all crackly as well..and my complexion is, well-, icky to say the least- just all pale and a bit broken out- ( I am 57 years old!) I hate this restless tossing and turning.. and being so dang hot!! -- Well- lol there is a bunch wah/ whining!! -So sorry, Y'all- I got a bit carried away....Thanks for the ear..!

almost 2 years, said...

Ok I'm 53 about 2 or 3 weeks ago I noticed my chest hurting shortness of breath and feel like water in my chest but I'm not sick.? Have to keep taking deep breaths today and did get tired at Walmart. And as far as eating I fill full right away but can eat a lot if I want but then fill so full like nothing is digesting for a while. And then I belch everything up that I eat and vetch a lot period which I've never done before. Oh I do have a irregular heart beat have had it for a few years if not all my life and I have high blood pressure . I'm on pills for that and a half of water pill thanks for ur help SHOULD I WORRY

almost 3 years, said...

I was told by my Cardiologist that I have mild CHF. I was very worried at first until I began reading and discovered that there are 4 stages of CHF.

about 3 years, said...

I'm only 23 and have been told my resting pulse is around 120. I have many of these symptoms and my grandma had a total of seven heart attacks and heart failure. Until a month ago my heart was fine just slightly elevated blood pressure. With my age is heart problems even possible.

over 6 years, said...

I have noticed more chest pain, heart racing, fatigue trying to get ready along with tachycardia and blacked out yesterday and found myself lying on floor. I don't have swollen legs or weight gain and in fact only weigh105lb. I am however nauseous and lack appetite. I have been diagnosed and treated briefly for lyme disease.

over 6 years, said...

The sign's to look for.

over 6 years, said...

Hello lucinda deut­sch, Thank you for your question. Unfortunately, we are unable to diagnose medical problems for our site members, or provide medical guidance online. While members of our community may respond to your question, we recommend that you contact a doctor offline regarding this medical issue. Thank again for participating in our community! Take care -- Emily | Community Manager

over 6 years, said...

The artcle even though brief in its contents is quite informative. It is a news to me that coughing and weight-gain over a short period also constitute symptoms of a possible heart ailment. This information will help not only me, but others with whom I correspond frequently on such health issues. Dr.Parameswaran, Engineering Consultant

over 6 years, said...

Are swollen testicles another sign?

over 6 years, said...

Knowing what to watch out for and how to help my mom live a little longer

over 6 years, said...

Good information!