Signs and Symptoms of Congestive Heart Failure

By MaryAnn DePietro, CRT. Medically reviewed by Tom Iarocci, MD. May 7th 2016

With some exceptions, congestive heart failure is a condition that responds to treatment, but never goes away. It’s also a hard disease to fully understand for the millions of Americans who are affected.

“Congestive heart failure develops when the heart becomes weak and does not beat strong enough to meet the body’s needs,” says Dr. Michael Zimring, internal medicine specialist at Mercy Medical Center in Baltimore, Maryland.  

Heart failure affects millions in the U.S. and can develop after a heart attack or due to other causes, such as persistent untreated high blood pressure. Certain congenital heart defects or problems with heart valves can also lead to congestive heart failure, but most cases of heart failure relate to coronary artery disease.

There are different stages of heart failure, and many different symptoms may result, so patients and caregivers should have a good understanding of these symptoms, and a good dialog with their doctor’s office, so that they know to seek medical attention when something arises.

Symptoms of Congestive Heart Failure

According to the National Heart, Lung and Blood Institute, typical symptoms of congestive heart failure include:

  • Swelling in the feet, legs and ankles,
  • Shortness of breath
  • Fatigue

People with congestive heart failure also often have additional medical conditions, called comorbidities, which might have caused the heart failure to develop or may have occurred as a result of heart failure.

“In some instances, other conditions often go hand in hand with heart failure, such as coronary artery disease, kidney failure and pulmonary hypertension,” says Zimring. “Those other conditions may also contribute to symptoms of congestive heart failure.”

How is Congestive Heart Failure Diagnosed?

There is no single test for heart failure, so signs and symptoms and a detailed history are important in making the diagnosis. After a physical exam and medical history, there are several tests a doctor may order to make a diagnosis of congestive heart failure. A chest x-ray will often be ordered to determine the size and shape of the heart as well as fluid in the lungs, which can indicate congestive heart failure. In some cases, blood tests may indicate changes that are consistent with heart failure.

An EKG will also be performed. An EKG records the heart’s rhythm or how the heart is beating while at rest. Your doctor will be able to determine abnormal heart rhythms, which may indicate past damage to the heart or an enlarged heart muscle, a sign of heart failure.

An echocardiogram, which uses sound waves to create a picture of the heart, may also be recommended to check the size and movement of the heart. Additional tests to help confirm a diagnosis may include an exercise stress test to determine abnormalities during exertion and an angiography, which detects blocked blood vessels.

Symptom Flare-up Prevention

Symptoms of congestive heart failure may vary in severity and frequency. “While the natural course of congestive heart failure is progressive, variations in daily life, such as diet, exercise, stress and environment can clearly change the symptoms and intensity of congestive heart failure from day to day,” said internist Dr. Marc Leavey, Mercy Medical Center, Baltimore Maryland.

“The important lesson to prevent congestive heart failure symptoms would be control what can be controlled,” says Leavey. “This may be one of the few times it’s a good idea to sweat the small stuff. Pay attention to all the little things involved in daily living, which can affect congestive heart failure symptoms.”

There are several things people with congestive heart failure can do in order to reduce symptom flare-ups. The American Heart Association recommends the following ways to prevent symptoms of congestive heart failure:

Next Steps

For Patients

People with congestive heart failure should take an active role in preventing symptoms and slowing the progression of the disease.

  • “Be aware that congestive heart failure is a real disease, with real issues and symptoms, not just a side condition of heart disease,” says Leavey.
  • See your doctor on a regular schedule and follow his recommendations regarding medication and lifestyle changes.

“Don’t be afraid to talk with your doctor about anything that is bothering you. No symptom, no question, no concern is too small to discuss,” says Leavey.

For Family Caregivers

  • Watch and be aware of any changes in your loved one’s condition, changes that they may not see.
  • Remind the person you’re caring for to take prescribed medication and weigh in daily to track weight gain, which may be due to fluid buildup.
  • Don’t make every day be all about their condition. Living with congestive heart failure does require careful monitoring and following their doctor’s recommendations. But congestive heart failure does not have to run your life. Encourage your loved one to live their life to the fullest. 

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