Symptoms of Congestive Heart Failure

CHF Symptoms and Associated Physical Activity

  • Class 1: Physical activity is not limited. Symptoms are nonexistent or mild.
  • Class 2: Physical activity is limited slightly. Symptoms are mild to moderate with activity but at a comfortable level while at rest.
  • Class 3: Physical activity is markedly limited. Symptoms are moderate to severe.
  • Class 4: Any physical activity causes discomfort. Symptoms are severe and may be present at rest.

Source: New York Heart Association

  • Shortness of breath or difficulty breathing (dyspnea) This is the most common symptom of CHF and is caused by pulmonary edema. Many different types of dyspnea may be encountered:
    • Shortness of breath only with exertion (dyspnea on exertion) -- As the disease progresses, the amount of exertion needed to produce dyspnea becomes less.
    • Shortness of breath while at rest
    • Shortness of breath when lying down (orthopnea) -- When lying down, blood from the elevated legs returns to the heart and causes pulmonary edema. Sitting up usually relieves this symptom. Many people sleep on several pillows to avoid this effect. As the disease progresses, some people even need to sleep sitting in a chair.
    • Intermittent shortness of breath at night (paroxysmal nocturnal dyspnea) -- This is caused by pulmonary edema and by depression of breathing during the sleep state.
  • Cough
  • Edema This occurs most often in the legs. Edema in the legs usually increases during the day because gravity increases the amount and pressure of blood in the veins of the leg, which pushes more fluid out. It improves at night when the legs are elevated. Edema is usually treated with diuretics (fluid pills) to eliminate the excess fluid. Edema can occur in many other areas, including the abdominal cavity, the space between the lungs and the chest cavity, the pericardium, and the stomach and intestines (causing nausea and loss of appetite).
  • Weight gain Fluid retention often increases a CHF sufferer's weight.
  • Fatigue This is a common symptom and may be related to reduced blood flow to many of the organs and muscles. Occasionally, CHF may reduce blood flow to the brain and cause confusion, especially in the elderly.
  • Chest pain This is a symptom of angina and heart attacks, both leading causes of CHF.
  • Acute pulmonary edema This is a severe and abrupt onset or worsening of CHF. This condition leads to a dangerously low level of oxygen in the blood, which can be life threatening. Symptoms of acute pulmonary edema include severe shortness of breath, a cough that is sometimes blood tinged (hemoptysis), profuse sweating, and anxiety. Acute pulmonary edema must be treated immediately.

When a physician examines someone with CHF, he or she may find the following:

  • Enlargement of the heart (cardiomegaly)
  • A third heart sound (S3) -- Normally, the heart makes two sounds (S1 and S2) often described as "lub dub, lub dub." In CHF there is a third sound, which is also called an S3 gallop because the three sounds are reminiscent of a horse galloping.
  • Sound of fluid in the lungs during inspiration (Rales)
  • Enlargement of the jugular vein in the neck (jugular venous distention) -- This occurs because CHF causes an increase in the amount of blood and pressure in veins.
  • Enlargement of the liver (hepatomegaly) -- This is caused by a back-up of blood from the heart.
  • Hepatojugular reflex -- When the liver is depressed, more blood travels into the jugular veins, causing them to become even more enlarged.
  • Edema -- This is usually located in the legs, ankles, feet. The term "pitting edema" is often used because applying slight fingertip pressure produces a temporary pit which resolves quickly.
  • Fast heart rate (tachycardia)
  • Increased rate of breathing (tachypnea)
  • High blood pressure (hypertension)
  • Low blood pressure (hypotension) -- When the cardiac output is severely decreased, then low blood pressure occurs. This is obviously an ominous sign and may mean death is imminent. This is also called cardiogenic shock.
  • Fluid in the abdominal cavity (ascites)
  • Fluid in the space between the lungs and the ribs (pleural effusion)

The following are useful diagnostic tests for CHF:

  • A chest X-ray (CXR) is a very useful test in CHF. It can detect pulmonary edema, an enlarged heart and pleural effusion.

  • An electrocardiogram (EKG) is helpful because it can detect the presence of a heart attack, cardiac ischemia, abnormal heart rhythms or an enlarged heart.

  • An echocardiogram can determine the amount of blood ejected from the heart with each heartbeat (ejection fraction). An ejection fraction is a way to quantify how well or efficient the heart is beating and to determine the severity of CHF. Normally, the ejection fraction is 55 to 75 percent. In addition, an echocardiogram can help determine the cause of CHF by detecting heart valve abnormalities, pericardial abnormalities, congenital heart disease or an enlarged heart. An echocardiogram can show if the heart is contracting abnormally (wall motion abnormalities), which is a sign of coronary artery disease.