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There are two major underlying causes of the symptoms in heart failure: excess fluid accumulation that may occur in the lungs or elsewhere, and symptoms associated with reduced cardiac output that worsens with exertion. These symptoms may develop over a lengthy span of time, even over a period of years. Because they may not seem important on their own, people may not seek treatment until heart failure has caused significant damage. Specific symptoms include:
- Shortness of breath (dyspnea). This is one of the earliest symptoms of heart failure. The patient gets winded and fatigued more quickly than before, just by doing regular daily activities or even lying in bed. There is also decreased tolerance to exercise, and the muscles may feel weaker than before.
- Swelling (edema) of the feet or legs is another common symptom in heart failure, though it could also be caused by unrelated conditions.
- Swollen neck veins.
- Abdominal discomfort such as swelling, pain or nausea.
- Mental confusion.
- Racing or pounding heartbeat (palpitations).
- Kidney malfunction or failure (in the later stages of heart failure).
In addition to the symptoms listed above, which the patient may notice, the physician may also be able to detect signs of congestive heart failure, which may include:
- An abnormal heart murmur (a telltale sign of a valve-related disorder).
- A crackling sound of fluid in the lungs (rales), which is a sign of pulmonary congestion.
- A rapid heartbeat (tachycardia) or abnormal heart rhythm (arrhythmias).
- Swelling and fluid retention (edema) in the liver or gastrointestinal tract (in advanced stages of heart failure).
- Hypertrophy or enlargement of the heart.
- Liver malfunction.
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