What does it feel like when your heart fails

9 Heart Failure Symptoms [An Illustrated Guide]

Cardiology, Heart Failure, Medicine

Heart failure is a common medical condition that requires attention and close follow up with your doctor. We will discuss how congestive heart failure (C.H.F. for short) causes symptoms and what are the signs and symptoms of heart failure everybody should recognize. 

What Causes Symptoms Of Heart Failure?

The heart is the engine of our bodies; it keeps us alive by pushing blood where it is needed. If our heart is damaged, it can lose its ability to pump blood forward. When this happens, other parts of the body like the kidneys and the brain will notice a drop in blood pressure. Because the body does not work well with low blood pressure, these other organs try to raise the blood pressure by increasing the amount of water inside the body. This makes sense in a situation where the low blood pressure is temporary. To understand this better, think back to the time of the caveman


Imagine a caveman hunting for food. If an accident happens and he becomes injured and loses a lot of blood, this would cause the blood pressure to drop. The kidneys and brain would kick into action and increase the amount of water inside his body. This increase in water would help to raise the blood pressure and keep the caveman alive until he recovered from his injuries. When the heart engine fails, low blood pressure is more than just temporary. This leads to an abnormal accumulation of water that continues over time. Eventually, this excess water becomes a problem.

Heart Failure Symptoms: Things We Can Measure

High blood pressure caused by congestive heart failure
High Blood Pressure:

Congestive heart failure (CHF) is not often the cause of the medical condition called hypertension but patients with heart failure can develop high blood pressure. This happens because the mechanisms the body has to help the failing heart also involve water retention and a “ramping up” of the same system the body has that regulates normal blood pressure.

Fast heart rate caused by congestive heart failure
Fast Heart Rate:

The work the heart does, known as the “cardiac output”, can be estimated by multiplying amount of blood that is squeezed out by how fast the heart is beating. If the heart muscle is weak and cannot push a lot of blood out, one of the ways it compensates for it is by raising  how fast it beats. 

Weight gain caused by congestive heart failure
Weight Gain:

Sensing little blood flow coming from a failing heart, the kidneys trigger the release of hormones like aldosterone and vassopresin into the body. These hormones act on the kidneys themselves to make them retain water to raise blood pressure. Patients with heart failure can gain impressive amounts of weight in short periods of time. 

CHF Symptoms: Physical Changes

Leg swelling caused by congestive heart failure
Swelling Legs:

As the heart looses strenght it fails to move blood out of the venous circulation and into arterial circulation.  The veins in the thighs and calves expand to accommodate all the blood. The fluid component of the blood then moves into the space outside of the veins and the surrounding skin and makes the skin swell. This makes the legs large and heavy. 

A growing belly caused by congestive heart failure
A Growing Belly:

The same way fluid accumulates under the skin of the legs it can also accumulate under our belly. Different from the legs, it can be much harder to notice a growing belly. This is something that can sometimes be confused with weight gain related to over-eating. 

Bulging neck veins in congestive heart failure
Bulging Neck Veins: 

Bulging neck veins are in fact one of the most important markers of heart failure doctors use to determine the status of a patient suffering from it. As the heart fails, the veins that bring blood to the heart swell up. The neck sits right next to the heart and offers a window into the heart’s function. 

Congestive Heart Failure Symptoms

Heart failure causes fatigue

Fatigue, or feeling tired all the time,  is one of the most common things patients with heart failure complain about. This happens for both types of congestive heart failure, systolic and diastolic. An easy way of understanding why this happens is simple: the heart cannot keep up with the body’s demands.

Shortness of breath caused by heart failure.
Shortness of Breath with Exercise: 

Exercise requires a heart that is able to increase its work to meet increased demands. The failing heart cannot do this either because it cannot fill with blood (diastolic heart failure) or because it cannot squeeze blood out (systolic heart failure). As the working muscles demand oxygen the heart cannot deliver, the person can feel out of breath with minimal exercise. 

Signs of end stage heart failure.
Shortness of Breath at Rest:

This is an ominous sign that may indicate end stage heart failure. What is happening is the heart is so weak it cannot even meet the demands of a resting body.  This is a situation that needs to be taken seriously. A person struggling with shortness of breath at rest should be brought to the emergency room.

Difficulty Laying Flat

In addition to these a person may notice that laying flat in bed will become very difficult as it will cause shortness of breath, a symptoms doctors call “orthopnea”; the person may need 3 or 4 pillows to be able to sleep. Also they may find themselves waking up in the middle of the night feeling like they can’t breathe. The combination of these symptoms should alert a person that has never had them before that he or she might have heart failure. For patients who already know they have a weak heart, these symptoms should alert them to seek medical attention.

About the Author

Jose Taveras M.D. F.A.C.C.


Dr Taveras works as a cardiologist caring for spanish speaking communities in the Bronx. He completed a dual residency in Internal Medicine and Pediatrics and then served as chief resident of internal medicine at the St. Vincent’s Catholic Medical Center of New York. He went on to specialize in cardiovascular disease at NYU Winthrop Hospital , under the mentorship of Dr. Kevin Marzo, chief of Cardiology at Winthrop. He is board certified in both internal medicine and cardiovascular diseases, and sub specializes in echocardiography, nuclear cardiology and computed tomography of the heart. Apart from his work in community outreach, Dr. Taveras' career focuses on innovation and technology. Dr. Taveras is a fellow of the American College of Cardiology. 

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Last Modified: May 27, 2018 @ 2:38 pm

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