From the Guidelines
Heart failure is characterized by symptoms that reflect the heart's inability to pump blood effectively, including shortness of breath, fatigue, swelling, and rapid or irregular heartbeat, as noted in the most recent guidelines 1.
Characteristic Symptoms of Heart Failure
The symptoms of heart failure can vary but commonly include:
- Shortness of breath (dyspnea), especially during physical activity or when lying down (orthopnea)
- Fatigue and weakness
- Persistent coughing or wheezing
- Rapid or irregular heartbeat
- Reduced ability to exercise
- Swelling (edema) in the legs, ankles, and feet
- Sudden weight gain from fluid retention These symptoms occur because when the heart cannot pump efficiently, blood backs up in the veins, causing fluid to accumulate in the lungs and other tissues. The body also activates compensatory mechanisms like increased heart rate and fluid retention to maintain blood pressure, which can worsen symptoms over time.
Importance of Early Recognition
Early recognition of these symptoms is crucial for timely medical intervention, which typically includes medications like ACE inhibitors, beta-blockers, diuretics, and lifestyle modifications to reduce the heart's workload and improve quality of life, as recommended by recent guidelines 1. Heart failure symptoms may develop suddenly (acute) or gradually (chronic), and their severity often correlates with the extent of cardiac dysfunction.
Clinical Diagnosis
It's worth noting that there is no single diagnostic test for heart failure because it is largely a clinical diagnosis based on a careful history and physical examination, as emphasized in 1. Imaging plays a supportive role in confirming heart failure and detecting left ventricular dysfunction. The classification of heart failure into reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF) is important for guiding treatment and prognosis, as discussed in 1 and 1.
From the Research
Characteristic Symptoms of Heart Failure
The characteristic symptoms of heart failure (HF) include:
- Shortness of breath 2, 3, 4
- Fatigue 2, 3, 4
- Peripheral oedema 3
- Pain 4
- Decreased well-being 4
- Tiredness 4
Causes of Symptoms
The causes of these symptoms may be different in various entities encompassed by the general term heart failure, such as:
- Acute pulmonary edema
- Circulatory collapse
- Chronic heart failure 2 Impaired vasodilation and altered metabolism in skeletal muscle, circulating metabolites and pulmonary ventilation-perfusion mismatch with consequent increased physiologic dead space may all contribute to the genesis of symptoms 2.
Assessment of Symptoms
History taking and physical examination have particular utility in assessing patients who have heart failure 5. The Edmonton Symptom Assessment System (ESAS) can be used to identify the prevalence and severity of pain and other symptoms experienced by patients with acute decompensated heart failure 4. Daily weights can also be useful in the assessment and management of patients who have heart failure 5.