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Shortness of breath: People with heart failure often feel breathless during activity or while lying flat. This happens because fluid builds up into the lungs, making breathing more difficult. This is called pulmonary oedema. It is the cardinal symptom of heart failure.
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Fatigue and weakness: The heart’s reduced ability to pump blood means muscles and organs receive less oxygen. As a result, everyday activities can feel exhausting.
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Swelling (oedema) in legs, ankles, or feet: Fluid can accumulate in the lower body. This swelling may worsen by the end of the day or after standing for long periods. It can also occur around the eyes (peri-orbital oedema), genitals and in the tummy.
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Rapid or irregular heartbeat: The heart may beat faster to compensate for its weakened pumping ability (tachycardia). People may notice palpitations (a fluttering sensation) in the chest. If this is irregular the heart may have gone into an abnormal rhythm called atrial fibrillation (AF).
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Persistent cough or wheezing: Fluid buildup in the lungs can cause a chronic cough or wheezing, sometimes producing white or pink-tinged sputum. This symptom often becomes more noticeable when lying down.
When to worry
Contact your doctor if you notice new or worsening symptoms such as:
- Shortness of breath, especially with activity or when lying flat
- Swelling in the feet, ankles, legs, abdomen, rapid weight gain
- Fatigue or weakness that limits daily activities
- Persistent cough or wheezing (especially at night)
- Dizziness or lightheadedness (can be a sign of low blood pressure, BP)
Note. Many of these symptoms are non-specific and seen in other diseases, e.g. lung or liver failure, or CKD.
When to see a doctor right away
Seek urgent or emergency care if you have:
- Severe or sudden shortness of breath
- Chest pain or pressure
- Rapid or irregular heartbeat with weakness or dizziness (atrial fibrillation (AF) can precipitation acute heart failure)
- Fainting or confusion
- Pink, frothy sputum (a sign of fluid in the lungs (pulmonary oedema))
- Rapid weight gain (e.g. 3-4 pounds or 0.5kg in a week)
People who should seek care earlier
- Those with a history of heart attack, high blood pressure, or heart valve disease
- People with diabetes, chronic kidney disease (CKD), or obesity
- Adults age 65 and older
- Anyone already diagnosed with heart failure who notices any change in symptoms.
