What are the symptoms of heart failure (HF)?

From the Guidelines

Heart failure symptoms include dyspnea, fatigue, and fluid retention, which may lead to pulmonary congestion and peripheral edema, as stated in the 2015 study 1. These symptoms occur because the heart cannot pump blood efficiently, causing fluid to back up in the lungs and other tissues. Some key symptoms of heart failure include:

• Dyspnea (dyspnea with exertion, dyspnea at rest, orthopnea, paroxysmal nocturnal dyspnea, nocturnal cough in supine position, tachypnea)
• Decreased exercise tolerance (reduced ability to perform activities that involve dynamic movement of large skeletal muscles because of symptoms of dyspnea or fatigue)
• Fatigue (usually described as feeling a lack of energy and motivation in both mental and physical activities, easily tiring and not being able to complete usual activities, and sometimes accompanied by dizziness, lightheadedness)
• Worsened end-organ perfusion (worsening cerebral, renal, liver, abdominal or gastrointestinal, peripheral circulatory function manifested by symptoms such as dizziness, lightheadedness, syncope, confusion, altered mental status, restlessness, decline in cognitive state, nausea, vomiting, abdominal pain, abdominal fullness, abdominal discomfort or abdominal tenderness, cold clammy extremities, discoloration of extremities or lips, jaundice, pain in extremities, reduced urine output, darkening of urine color, chest pain, and/or palpitations)
• Other symptoms of volume overload (swelling of lower extremities; swelling or indentation of pressure marks in areas of fluid accumulation such as the legs, ankles, or lower back; an increase in abdominal girth, right-sided abdominal fullness, discomfort, or tenderness; an increase in body weight; oozing and development of skin breakdown in lower extremities). The severity of symptoms doesn't always correlate with heart function—some people with significant heart damage may have minimal symptoms, while others with milder heart problems may experience severe symptoms, as noted in the 2009 study 2. Heart failure symptoms often worsen gradually, but can sometimes appear suddenly, especially during a heart attack or with acute heart valve problems, as mentioned in the 2005 study 3. If you experience these symptoms, particularly sudden shortness of breath, chest pain, or fainting, seek immediate medical attention as prompt treatment can improve outcomes and quality of life.

From the Research

Symptoms of Heart Failure

The symptoms of heart failure are not explicitly listed in the provided studies. However, the studies discuss the causes, treatment, and management of heart failure.

Causes of Heart Failure

• Coronary artery disease (CAD) and hypertension are the two main causes of heart failure, with CAD being a major cause of systolic heart failure and hypertension being a major cause of diastolic heart failure, especially in the elderly 4.
• The lifetime risk of developing heart failure is about 20%, increasing to 40% if hypertension is present 4.

Treatment and Management of Heart Failure

• Beta-blockers have become a cornerstone in the treatment of systolic heart failure, alongside ACE inhibitors, with bisoprolol, metoprolol, and carvedilol reducing all-cause death by 34-35% 4.
• The combination of beta-blockers and ACE inhibitors is effective in reducing mortality and hospital readmissions, and improving patient outcomes in chronic heart failure 5, 6.
• Beta-blockers, such as bisoprolol and carvedilol, are superior in reducing sudden cardiac death, particularly in patients with heart failure with reduced ejection fraction (HFrEF) 6.
• ACE inhibitors, including enalapril and lisinopril, effectively lower overall cardiovascular mortality by targeting the renin-angiotensin-aldosterone system (RAAS) and preventing further cardiac remodeling 6.
• Practical recommendations for the use of ACE inhibitors, beta-blockers, aldosterone antagonists, and angiotensin receptor blockers in heart failure have been developed to accelerate the safe uptake of these treatments and ensure that all eligible patients receive the most appropriate medications 7.