Recognizing the Symptoms of Congestive Heart Failure in the United States

When your heart begins to have trouble pumping blood to your body, it usually won't announce itself with any dramatic symptoms in the beginning. Rather, congestive heart failure creeps it way in, giving hints of symptoms that many Americans associate with getting older or simply out of shape. Knowing to identify these initial signs can be the difference in managing the illness and suffering from complications later.

Approximately six million Americans suffer from heart failure, and that number increases every year. One of the challenges with heart failure is how it starts. Maybe you notice that you get winded when walking up stairs that you could do without difficulty two at a time. Or, you start noticing that your ankles swell more than they usually do at the end of your day. These not-so-subtle changes are worth paying attention to because they could be related to what the heart needs.

While the term "heart failure" itself sounds terribly final, it can be misleading. Your heart has not stopped working or completely failed. Your heart is not working as well and is not able to perform its primary function of pumping blood to your body. You can think about this as an older car engine: it may run but may not have the power that it once did. When the heart is pumping less blood than what the body needs, a chain reaction happens throughout the body and develops the symptoms that act as your early warning signs of heart failure.

Breathing Changes That Shouldn't be Overlooked

Often one of the first signs that something is wrong with your heart relates to changes in your breathing. When your heart is not pumping and circulating blood effectively, fluid begins to back up into your lungs. This causes you to not be able to breathe as easily, but the changes happen so slowly that it can be very sneaky and you don't even realize what's happening.

Shortness of breath usually shows up first when you are physically active. You might notice that you have to pause halfway to the top of the stairs to catch your breath, or maybe you have to actually stop and rest half-way through your normal walk around the neighbourhood once it never bothered you at all. Then you notice you are huffing and puffing after doing activities that you never had a problem with before. Many people think it is simply from weight gain, not being active, or getting older; but this doesn't tell the whole story related to your heart.

As the disease progresses, breathing difficulties will start happening while you are at rest. For example, you might notice that you are breathing a little harder than normal while sitting on the couch watching TV. Others report it doesn't feel as if they can take a full breath, as if something is sitting on their chest.

Even at night you will notice changes with breathing if you are heading towards heart failure. When you start to wake up, you might feel like you are choking or drowning, and you gasp for air in a state of panic, which you will hear referred to by doctors as paroxysmal nocturnal dyspnea. It is caused by lying flat and the fluid redistributing into your lungs. Many people will end up instinctively sleeping with extra pillows to prop themselves up, and find it easier to breathe in a semi-reclined position.If you've made the switch from resting your head on one pillow to needing three or four, that's something to mention to your doctor.

Some people even choose to sleep in a recliner rather than a bed because it is the only comfortable way for them to breathe while sleeping. While this appears to be a reasonable, practical choice, your body is telling you that something serious needs to be medically addressed. 

When Your Body Retains Too Much Fluid

Fluid retention is yet another classic early sign of congestive heart failure, and it often presents itself in ways that many individuals initially consider insignificant. As your heart becomes unable to effectively pump blood, your kidneys respond by retaining more sodium and water. Following the extra fluid's retention there is only one place it can go based on the laws of gravity: down, to the lowest areas of your body. 

You will likely first notice swelling in your feet and ankles. By evening, your shoes will start to feel a little snug, even though they felt fine earlier in the day. If you press a finger into the swollen area, the indentation from your finger might take a while to return to its natural state. Sometimes your socks will leave a deep mark around your ankle that will take a while to fade, even after taking your socks off. Maybe your wedding ring suddenly feels tight, or when putting on your pants, you can tell they are tight around your waist, despite not adding pounds elsewhere. 

This is not the temporary type of puffiness that results from too much salt at dinner or after sitting with little movement during a long flight.Swelling related to heart failure is generally ongoing, and tends to get worse over time. You may also notice that the swelling increases higher up your legs over time; swelling that begins in your ankles may eventually reach your calves and above.

Weight gain frequently will accompany this fluid retention, and it occurs quickly, independent of any changes to your diet or your exercise routine. You should be concerned if you gain two or three pounds overnight or five pounds over one week. This is not normal and it is primarily due to fluid retention (not fat), and your body is now holding onto much more water than it should.

Some people will see swelling in their abdomen as fluid accumulates in that area. You may feel uncomfortable fullness or bloating after eating even if you haven't consumed much food. Your clothes that dressed your midsection correctly suddenly feel tight and discomforting. This bloating may compress the stomach so that you feel full even with small amounts of food.

The Fatigue That is More Than Just "Tired"

Fatigue is easily one of the most common but most undetected early signs of congestive heart failure. Everyone gets tired sometimes, but fatigue from heart failure is different than just tiredness. It is an overwhelming, profound fatigue that is not very improved with marginal rest, and it may make an average day feel like a lot of work.

It may take a sit down after tasks you used to do without hesitation in the past, like putting away your groceries or making your bed. Simply retrieving the mail from the mailbox can leave you feeling fatigued and needing to rest.Perhaps you start to refuse social invitations because you simply don't have the strength or even cancel an invitation because you feel like you could not follow through with it to the end. 

The fatigue occurs because your heart is unable to supply sufficiently oxygenated blood to actively pump it to your muscles and other parts of your body. When you are out of oxygen, your body is unable to produce energy efficiently, which has you feeling exhausted all of the time. Your muscles may feel weak and heavy, like you're walking through a thick mud pit all the time. 

Fatigue typically seems to worsens as the day goes on; for many people, the worst part of the day is in the late afternoon or evening. You may often find yourself taking naps, and going to bed early or even feeling fatigued when you wake up in the morning, even though you spent eight or nine hours in bed. 

Often when you feel physically fatigued, and your body feels tired or weighs heavy, you experience mental fatigue. Some people have difficulty concentrating, feel mentally foggy, or difficulty sustaining focus to perform task that require attention. Cognitive fogginess, sometimes referred to as "brain fog," chances when there is less of blood flow to the brain, and you develop forgetfulness or you become confused at times that you used to be sharp. 

Changes in Your Heart Rate and Rhythm

Your heart rate and rhythm can provide helpful insight that indicates something is wrong, many people who develop heart failure notice that their heart is working harder than it should for the activity that they are doing, even when they are resting. You may sense or feel your heart pounding and galloping while sitting still reading or watching television.Palpitations, or being conscious of your heartbeat in a way that is uncomfortable, can happen often. You may feel sensations that your heart is skipping a beat, has flipped in your chest, or is beating in a way that feels irregular. While sometimes people with good health may also observe palpitations, true persistent or frequent beats in an irregular rhythm should be evaluated. 

Some notice that after even mild physical exertion, the heart rate stays elevated longer. Climbing a single flight of stairs could put your heart rate up significantly, and it sometimes takes minutes for the heart to return to the pre-stair level. You may have a powerful pounding sensation that you feel in your neck or hear in your ears. 

A common and abnormal rhythm in atrial fibrillation often presents with heart failure. In atrial fibrillation, the upper chambers of your heart beat all over the place instead of beating normally. Usually, this presents with a sense of increased intricacy, or your heart may flutter, or perhaps you may have "butterflies in your chest." Alternately, some people feel absolutely nothing at all. The point is a rhythm never noticed until a routine exam by the doctor reveals an irregular heart rhythm. 

The Cough That Never Seems to Go Away 

A chronic cough unrelated to a cold or nasal allergies can be an early sign of heart failure. This occurs when fluid accumulates in the lungs, in turn irritating the airways, and a cough occurs. The cough may be a dry hacking cough, or you could produce white to pink mucus, which may be frothy. 

Many observe the cough is felt stronger with lying flat, and thus is often a disruption of sleep.You may notice that you cough more often at night or early in the morning. The cough may come in spasms accompanied by breathlessness and fatigue.

As this kind of cough develops slowly and may be confused with many other respiratory diseases, patients frequently ignore the cough or unsuccessfully treat it with over-the-counter cough medications. When a cough does not go away after more than a few weeks and there is no discernible source, like a cold, the cough needs to be evaluated by a healthcare provider. If a cough does not go away after 3 weeks, especially if there is any trouble breathing, then an evaluation is warranted. 

A frequent companion of cough can be wheezing. Wheezing can lead to mistaken diagnoses of asthma and chronic bronchitis, as the sound can be alarming, and patients may not recognize that the wheezing should alert them to see a healthcare provider. Wheezing occurs as the airways narrow (or swell) and fluid fills the lungs, and it will produce the familiar whistling sound when breathing. 

There are also symptoms related to the gastrointestinal tract, or body systems, that seem unrelated. 

Your gastrointestinal tract also may provide early signs that you are in heart failure. When your heart pumps ineffectively, blood backs up in the veins that return blood from your abdominal organs to the heart. Even though it causes some discomfort, many patients don't make the connection. 

In fact, lack of appetite is quite common in early heart failure. Some patients do not have any interest in food and others experience early satiety. Both of these symptoms contribute to loss of appetite. The loss of appetite happens for 2 related reasons: the first is abdominal fluid buildup, which puts pressure on the stomach and creates the sense of fullness; and second, since there is reduced blood flow to the gastrointestinal tract, the GI tract is functioning differently than normal. 

Nausea can also happen frequently, sometimes with no identifiable cause. A patient may wake up nauseous and be nauseous throughout the day, or they may experience waves of nausea that come and go.

Certain individuals may experience chronic indigestion or heartburn that does not seem to be affected by antacids. As fluid backs up into your liver, you may get abdominal discomfort or pain, especially in the upper right area where your liver sits. You may experience this discomfort as dull ache, fullness, or tenderness in that area. The fluid congestion may cause the liver to become enlarged, but you probably will not be able to tell on your own without a physician's evaluation. 

Digestive symptoms are often relegated to other causes such as stress, diet, or a stomach bug, but when they persist or occur with other possible symptoms of heart failure, they are worth paying attention to.

Changes in Urination Frequency

The frequency at which you urinate, especially at night, can give you insight into your heart's function. When you are lying down at night, fluid that has accumulated in your legs during the day is redistributed and filtered by your kidneys resulting in more urine. This is called nocturia, which is characterized by waking up two, three, or four times nightly to urinate when you would typically sleep through the night. 

If you have started to get up at night even though you did not used to wake up, that change warrants attention. Nocturia has a long list of potential causes including prostate issues for men and a myriad of other causes, but it can be an early sign of heart failure.Throughout the day, you also might experience some variations in your urine output. Some people may produce less total urine, even though they shy away from drinking normal amounts of fluid to avoid producing even more urine output at the expense of a poor circulation situation. One of the effects of poor circulation on the kidneys is that they tend to keep more of the water in your body. On the other hand, if you were taking diuretics for some other purpose prior to being diagnosed with heart failure- they you may not have noticed this effect on urine.

You also might notice that the urine itself looks darker or more concentrated than usual- just another indicator that your kidneys are not processing fluid normally. Some people might observe foamy or bubbly urine- an indication that there may be protein in the urine and that kidney function is affected.

Subtle Cognitive and Mental Changes

The brain also needs a steady supply of oxygen-rich blood to function well. When the heart is struggling to pump efficiently there is a possibility that your brain does not receive the oxygen it loves, which results in subtle cognitive changes that most people will explain away with things like being stressed, or that they are getting older, or that it is just one of those days. 

One of the early cognitive changes people notice is that they have trouble concentrating. You may find you are reading the same paragraph over and over again and the information just does not stick, or participating in a conversation and losing track of where to focus. Sustained attention when doing work is more of a challenge. 

Memory changes can come on subtly. You may forget a doctor's appointment, lose your train of thought while speaking, or walk into a room and forget why you went into that room. While we all forget things from time to time, difficulty calling things to mind consistently, or if things keep getting worse (with no identifiable reason) along with other symptoms, should lead you to get evaluated for heart failure.

Some people will tell you they occasionally feel confused or disoriented, and feel that way more during the times their symptoms are more pronounced. You may have an experience where you temporarily feel fuzzy mentally, or disconnected, almost as though thinking through a fog.

Mood changes can also occur. Anxiety and depression can be more prevalent in people with heart failure, even if it is in the earlier stages. You may feel that you are in a more irritable or anxious state for no true identifiable reason, but it just feels that way regarding your health, or you may feel a sense of abnormal uneasiness that you cannot explain. Some develop an impending sense of doom or worry excessively about their symptoms.

These cognitive as well as emotional changes are based upon a combination of factors in addition to other symptoms you may already be aware of: decreased blood flow to the brain, the stress of not feeling well, sleeping poorly due to other symptoms related to heart failure, along with neurochemical changes related to heart failure itself.

Gradually Worsening Activity Limitations

One of the most obvious trends in early heart failure is the progressive erosion of your ability to do the activities you like best. You might think of it as a slowdown in your ability to exercise, and it can happen so gradually that many people do not even recognize it as a reason to see the doctor.

You may find yourself avoiding stairs, parking as close as you can to store entrances, and asking others to help with activities that you use to do as a matter of course. Social activities that involve some walking or exertion are no longer appealing. You ask to skip the shopping trip with friends, or you have stopped doing the walking that you have done for recreation altogether.

Many people begin to unknowingly modify their lifestyle to cope with their declining energy without even realizing it is happening. Everything you do starts taking longer, you do some tasks in smaller portions, and you are resting more. The modifications to your lifestyle seem logical and appropriate, so you do them without giving the reasoning much thought.

These limitations are most noticeable with activities that require sustained energy, or a change in elevation. You may still be able to manage walking on flat surfaces. However, when it involves a hill, then it may be impossible to walk. Walking groceries or bags of laundry upstairs may have turned into a major undertaking. Gardening or housework or any other chores that you use to perform on a daily basis may have begun to feel like you are entering into a marathon process.

This inability to perform activities with ease is slowly having an impact on quality of life. Traveling may no longer be possible because it is too tiring. Hobbies may be neglected. Instead of playing on the ground with grandchildren, there may be little play. Instead the world is shrinking for you as your ability to sustain activity is declining.

Recognizing Patterns is Key

What makes early heart failure symptoms especially tricky is that any one symptom examined by itself may not seem alarming. After all, everyone occasionally gets short of breath, has some fatigue, and may have swollen ankles. The trick is to identify patterns and combinations of symptoms that would pertain to early heart failure.

If you feel like you have a number of these warning signs at once, that is much more of a concern than just one symptom by itself. Short of breath plus swelling plus fatigue has a much different implication than just shortness of breath alone. This combination adds up to a pattern that indicates your heart is having trouble keeping up with the body's needs for oxygen.

Think about whether your symptoms are getting progressively worse over time. Heart failure typically develops in a progressive manner, with symptoms quiely increasing over the course of weeks or even months. If your ankle swelling is worse, or the breathlessness limits you more each week, or the fatigue is increasing, those changes become more important than a single observation.

Think about whether your symptoms worsen with activity and get better with rest. In heart failure symptoms it is typically the case that exertion worsens symptoms and rest makes them feel better. When climbing stairs leaves you breathless, but ten minutes of sitting quietly at the top makes your symptoms feel better- that is very indicative of cardiac symptoms

Who is at Greatest Risk

Knowing your risk factors helps ensure that you can consider if your symptoms might be due to heart failure.There are specific conditions and traits that make heart failure more likely to occur. If you have one of these risk factors, you should be especially mindful of early warning signs. One of the most artificial risks for heart failure is high blood pressure. Having years of high blood pressure makes your heart work harder than it should working eventually causing the muscle to weaken. If you have high blood pressure, especially if it is poorly controlled, any new symptoms like those outlined here warrant early investigation. 

Coronary artery disease, which consists of having plaque build up in your arteries that feed the muscle of your heart, often results in heart failure. People who have had heart attacks are particularly at risk, as damaged muscle probably doesn't pump the blood as well. If you have known coronary disease or have survived a heart attack, pay special attention to any signs your heart may be struggling.

Diabetes is another condition that significantly increases the risk of heart failure via multiple mechanisms. Over time, high blood sugar harms both the blood vessels and the heart muscle itself. People with diabetes should be especially observant of signs of heart failure and keep their healthcare providers closely informed. 

Being overweight or obese adds extra strain to your heart and increases the risk of developing conditions that lead to heart failure. When you are carrying excess weight, your heart is working harder to provide blood to more tissue and all of obesity is typically associated with other problems such as high blood pressure, diabetes, and coronary artery disease.

Heart damage that may have occurred from infections, alcohol abuse, or certain medications may predispose you to heart failure.Chemotherapy drugs, for example, can injure heart muscle in some people. If you've received cancer treatment or have a history of heavy drinking, awareness of these symptoms should trigger a visit to your doctor.

Sleep apnea is a condition in which your breathing repeatedly stops and starts while you sleep, which creates stress on your heart and increases the risk of heart failure. If you snore loudly, ever wake up gasping for air or have someone tell you that you have stopped breathing while sleeping, then it is important to address this issue for the sake of your heart.

Family history is important too. If close family members have had heart failure, and especially if it was at a young age, then your risk of heart failure increases. Also, some genetic heart conditions do run in families, so to know your medical family history is important.

Age, in of itself, is a risk factor. Heart failure becomes more common as we get older. After a person reaches age sixty-five, the risk of heart failure increases substantially, however, younger people are certainly not immune to heart failure, especially if they have other risk factors.

Why Early Intervention is So Important

Recognizing heart failure in its earliest stages offers tremendous benefits with treatment and outcomes. If your heart has just started to fail, there are more options available for preserving your heart function and preventing further functional loss.

In some cases early treatment will actually allow your heart to recover some of its ability to pump. Medications that reduce the workload on the heart, maintain blood pressure, and help remove excess fluid allow your heart a chance to rest and heal. The sooner those medications get started the better they work at preserving heart function.Changes to your lifestyle will be most successful when started early. Dietary changes to decrease sodium, supervised exercise rehabilitation, and weight management will all help prevent progression when started early upon diagnosis of the problem. Intervening only once symptoms are severe will make it less effective and more difficult to change.

With early detection, identification, and treatment of the cause of your heart failure becomes more manageable. For example, if you are experiencing heart failure due to coronary artery disease, fixing blocked arteries no matter how through angioplasty or bypass, will stop ongoing damage to your heart. Similarly for uncontrolled high blood pressure, treatment to help aggressive management will be protective of your heart as part of your heart care plan.

Finally, early detection will help to prevent complications from heart failure that occurs as heart failure progresses. Complications that occur will damage to your kidneys, liver, and other organs. It also increases your risk for dangerous heart rhythms, and can lead to recurrent hospitalizations and decreased quality of life. When you diagnose heart failure early and treat it, you can avoid many of these terrible complications.

On a more practical level, treatment early means you can keep your independence and quality of life much longer. You can continue to work, travel, be active with family, and do many of the things you enjoy. Advanced heart failure is very limiting, but early detection and management allows you to function at a much higher level.

Moreover, the psychological aspect of early diagnosis should also be noted. For many, once they have heart failure, they feel relieved after years of searching for a diagnosis, even a serious diagnosis. Treatment provides hope for treatment and a plan to manage the diagnosis.Having vague, worsening symptoms without an understanding of what is wrong can be frightening and demoralizing. 

Taking Next Steps with Your Symptoms

If you notice a number of these early warning signs in yourself, your most important next step is to schedule an appointment with your healthcare provider, sooner rather than later. Under no circumstances should you wait until symptoms are severe or presume they will resolve on their own. Heart failure will not spontaneously resolve without treatment. 

When it is time to visit your healthcare provider, you will want to be able to describe your symptoms in detail. Tell your healthcare provider exactly what is happening, when it started, whether it is worsening, and anything that improves or worsens the symptom. Make sure to describe all the symptoms you are noticing, even if they do not sound like they would be related, because your healthcare provider needs to hear everything to understand the whole picture. 

If you are able, try to keep records of your symptoms before your appointment. For every symptom that occurs, write down when the symptom began, what you were doing when it started, and how long it occurred. Your healthcare provider will want to try to understand the pattern of your symptoms, as well as how bad the symptoms were. If there are certain activities that were once easy for you that you are struggling with now, share examples in detail. 

Be honest with your healthcare provider about your medical history and risk factors. This includes share any current conditions such as high blood pressure or diabetes, previous problems with your heart, family history of heart disease, and any medications you are currently taking. This history is a very important piece of information for your healthcare provider to be able to evaluate your symptoms appropriately. 

Your healthcare provider will probably want to perform a physical exam which includes listening to your heart and lungs, checking for swelling or other physical signs of heart problems, and will likely order one or more tests to evaluate how well your heart is functioning. An electrocardiogram assesses the electrical activity of your heart, and allows indications of rhythm disturbances and heart damage. An echocardiogram uses sound waves to take pictures of your heart that can indicate how well it is pumping and whether the valves are functioning appropriately. Bloodwork may also be utilized to determine if there are markers for heart failure, kidney function or other tests to indicate those factors.

A chest X-ray can also provide important data, such as whether there is an enlarged heart or fluid in the lungs. Other types of testing, like stress tests or cardiac catheterization, may also be needed to gain a full understanding of the condition of your heart.

Getting an evaluation does not mean you have heart failure. There are many other conditions, such as anxiety, lung or chest issues, or infections that can cause symptoms similar to heart failure and the only way to determine what is actually affecting your health is to obtain an evaluation. Regardless, it is best to get some clarification so you can move forward with your life and adherence to proper treatment, rather than continue to deal with uncertainty.

Living with Uncertainty of Early Symptoms

Experiencing potential early warning signs of heart failure before there is a diagnosis can be distressing and intimidating. Uncertainty occurring during the evaluation can also be difficult to handle, especially if you are feeling physically unwell or haven't seen a health care provider for an appointment.

Please remember, worrying does not help your heart. Its very good to have any associated symptoms evaluated, but try not to get too anxious before that is conducted. Stress comes with elevating hormones that will damage your heart if they are activated, and controlling your emotional response is just as important as managing the evaluation of your health condition.As you wait for the medical assessment to be completed, concentrate on the things under your control. If you are not doing so already, lower the amount of sodium in your diet, as excess sodium exacerbates fluid retention. You want to remain adequately hydrated, but don't force fluids. Continue taking your current dose of any prescription medications as directed. Strive for adequate rest, and if you are uncomfortable with your level of activity, avoid overdoing it.

Discuss your experiences with people you trust. Whether through family, friends, or support groups, the power of having someone to talk with is helpful in reducing feelings of emotional stress. Many people find that when they express their worries, they feel more capable of dealing with it, and often that they are less alone.

At the same time, don't overdo the research on the internet because that often adds more anxiety. While is it helpful to know the potential symptoms, when you go too far down the medical rabbit hole on the internet, you will most often create more fear than clarity. If you are going to look it up, stick with reputable sources; and remember, the only thing that can assess your symptoms is a proper medical examination.

Because heart failure (if that is what you are experiencing) is chronic and manageable can be somewhat comforting, no matter its serious nature or ongoing treatment. Individuals living with heart failure live full and meaningful lives when they receive proper care. Treatments are better than ever, and when you are diagnosed early, you have the maximum opportunity for a good prognosis.

Your body is flashing signals to you through these symptoms, and you are doing the right thing by paying attention to them, and seeking out medical advice. Recognizing the signals and being willing to seek out action is the first step toward preserving your heart health and receiving care. No matter what you are contending with, knowing is always better than not knowing because knowing causes you to have something to do about it.