What are the signs of heart failure?

Signs of heart failure are often missed because they come on gradually or get dismissed as a natural sign of aging. Unfortunately, if these symptoms are ignored too long, treatment may get more challenging and hospital admission may become necessary, said cardiology experts at M Health Fairview.

Heart failure occurs when the heart cannot pump enough blood to meet the body’s needs. Ultimately, this leads to a variety of symptoms that may worsen over time.

Any chest pain, especially when accompanied by fainting or progressive weakness, coughing up pink foamy mucus, are signs that you need emergency care. Call 911.

Mitch Timmons, DO, a cardiologist with M Health Fairview, and Tamas Alexy, MD, a heart failure and transplantation cardiologist with M Health Fairview and an associate professor at the University of Minnesota Medical School, share some early signs of heart failure worth paying attention to.

“Early recognition of these symptoms can significantly improve quality of life and help prevent complications,” Timmons said. “People experiencing any of these signs should consult their healthcare provider for evaluation and personalized treatment options.”

Alexy recommended monitoring your body and knowing what is normal for you. That will help you catch any changes early, even if those happen gradually. For example, if you can usually walk around your neighborhood easily, then one day find yourself out of breath after a block or two, that's your sign that something else is going on.

“Many heart problems are easier to manage early, when they are less severe,” Alexy said. “There might be more options available. People – myself included – often have the tendency to put things off, thinking it’s normal or no big issue, but it actually might be. When caught early, heart problems can sometimes be managed at home with lifestyle changes or medication, which most people prefer. But if caught later, there is a higher chance that a procedure or surgeries will be needed to address the issue.”

What causes heart failure?

When the heart muscle becomes weakened or stiffer, symptoms of heart failure can develop. Some factors that can harm the heart include:

Timmons and Alexy said it’s especially important to get care if any of the signs start suddenly or if two or more occur together.

Early signs of heart failure.

Fatigue. 

If you find yourself taking naps when you didn’t previously or lacking the energy for your usual activities, you might be experiencing reduced blood circulation due to heart failure. Reduced circulation leads to low energy levels, or fatigue.

Shortness of breath.

Shortness of breath, called dyspnea, can be a sign of heart problems. People often feel breathless with physical activity, but you might feel breathless with less exertion than you did previously. If your breathlessness tends to happen more abruptly than you might expect from deconditioning, which occurs when you stop engaging in a particular activity, then it may be a warning sign. For example, you might suddenly get winded after climbing one flight of stairs when, a couple weeks ago, you could climb two or three flights easily. 

Difficulty breathing when lying flat.

If you start sleeping with extra pillows or wake up gasping for air at night, you might be experiencing a condition called paroxysmal nocturnal dyspnea, which is fluid buildup in the lungs. This is a sign of heart failure.

Swelling in the legs, ankles and abdomen. 

When heart failure develops, extra fluid starts backing up in the body’s tissues. This fluid buildup often starts by swelling in the lower limbs or belly, mostly owing to the effect of gravity. It might be a sign of heart failure, particularly if it occurs with rapid weight gain.

Loss of appetite or nausea.

You might notice that you feel full on less food than you previously ate. This could be due to fluid retention in vessels around your stomach. Fluid buildup and reduced heart function can also affect the digestion process.

What to do if you’re having heart problems.

If you notice these signs, tell your primary care provider. They might start the testing process or refer you to a cardiologist. You can make an appointment with our heart care team if you have concerns.

“It’s OK to share any concerns,” Alexy said. “Even if you don’t think it’s a major concern, the information might point us in a certain direction or be an area we should explore more.”

At your cardiology appointment, your doctor might run some tests, like an echocardiogram (heart ultrasound) that shows the function and structure of your heart in great detail. The tests also help doctors determine if a heart valve issue might be contributing to your symptoms.

They might also have you walk for a cardiopulmonary stress test, which shows how your heart and lung work together in response to exercise.