heart and blood vessel disorders
Heart Failure (HF)
Symptoms of Heart Failure
Symptoms of heart failure may begin suddenly, especially if the cause is a heart attack. However, most people have no symptoms when the heart first begins to develop problems. Symptoms then develop gradually over days to months or years. Heart failure may stabilize for periods of time but often progresses slowly and insidiously. However, people may become aware of symptoms suddenly, as when symptoms restrict an activity for the first time or when symptoms occur while at rest. Some common symptoms are Shortness of Breath None Fatigue Fluid accumulation ( Swelling ) in the legs Inability to exercise or do other activities that require exertion In older people, heart failure sometimes causes vague symptoms such as sleepiness, confusion, and disorientation. Theseverity of heart failureis usually classified based on how well the person is able to carry out activities of daily life. The New York Heart Association (NYHA) classification remains an important tool for people and their caregivers to understand the severity of the illness and its impact on their life. Class Symptoms I No limitation Ordinary physical activity does not cause undue tiredness, shortness of breath, or awareness of heartbeats (palpitations). II Mild Ordinary physical activity causes tiredness, shortness of breath, palpitations, or chest discomfort (angina). III Moderate The person is comfortable at rest, but ordinary physical activity causes tiredness, shortness of breath, and palpitations or chest discomfort (angina). IV Severe Symptoms occur at rest, and any physical activity increases symptoms. * New York Heart Association classification. Right-sided heart failure and left-sided heart failure cause different symptoms. Although both types of heart failure may be present, the symptoms of failure of one side often predominate. Eventually, left-sided heart failure causes right-sided failure. The main symptom of right-sided heart failure is fluid accumulation, leading to swelling ( Swelling ) in the feet, ankles, legs, lower back, liver, and abdomen. Where the fluid accumulates depends on the amount of excess fluid and the effects of gravity. If a person is standing, fluid accumulates in the legs and feet. If a person is lying down, fluid usually accumulates in the lower back. If the amount of fluid is large, fluid also accumulates in the abdomen. Fluid accumulation in the liver or stomach can cause nausea, bloating, and loss of appetite. Severe right-sided heart failure can result in loss of weight and muscle. This condition is called cardiac cachexia. Left-sided heart failure leads to fluid accumulation in the lungs, which causes Shortness of Breath . At first, shortness of breath occurs only during exertion, but as heart failure progresses, it occurs with less and less exertion and eventually occurs even at rest. People with severe left-sided heart failure may be short of breath when lying down (a condition called orthopnea) because gravity causes more fluid to move into the lungs. Such people often wake up, gasping for breath or wheezing (a condition called paroxysmal nocturnal dyspnea). Sitting up causes some of the fluid to drain to the bottom of the lungs and makes breathing easier. People with left-sided heart failure also feel tired and weak when doing physical activities, because their muscles are not receiving enough blood. When heart failure is advanced, Cheyne-Stokes respiration (periodic breathing) may develop. In this unusual pattern of breathing, a person has a period of not breathing for a few seconds, and then begins to breathe progressively faster and deeper, then slower and shallower until they again briefly stop breathing and repeat the cycle over and over. Cheyne-Stokes respiration develops because blood flow to the brain is reduced and the areas of the brain that control breathing therefore do not receive enough oxygen. Cheyne-Stokes respiration is considered a form of Central sleep apnea . Sleep Apnea (in which airway blockage interrupts sleep, resulting in daytime sleepiness) is a different and more common breathing disorder that can occur in people with or without heart failure. Severe obstructive sleep apnea can make heart failure worse. Acute pulmonary edemais a sudden accumulation of a large amount of fluid in the lungs. It causes extreme difficulty breathing, rapid breathing, bluish skin, and feelings of restlessness, anxiety, and suffocation. Some people have severe spasms of the airways (bronchospasms) and wheezing. Acute pulmonary edema is a life-threatening emergency that can occur when people with heart failure develop very high blood pressure, have a heart attack, or sometimes just stop taking their heart failure drugs or eat salty food. can form in the heart chambers when the heart is severely damaged. The blood clots can form because blood flow within the chambers is sluggish. Clots may break loose (becoming emboli), travel through the bloodstream, and partially or completely block an artery elsewhere in the body. If a clot blocks an artery to the brain, a Overview of Stroke may result. Depression and decline in mental function are common in people with severe heart failure, particularly in older people, and require careful evaluation and treatment. 