Cardiology congestive heart failure heart failure Physiotherapy

Symptoms of Heart Failure

In this article we will discuss the Symptoms of Heart Failure

In this article, we will discuss the Symptoms of Heart Failure. So, let’s get started.


  • Dyspnea and orthopnea: Dyspnea is the early symptom of congestive heart failure, occurs as a result of increased effort in breathing first observed during sternuous exercise and then with progression of heart failure, it appears first with less exertion and then at rest. This is due to reduced compliance of the lung and increased cost of breathing. Orthopnea (dyspnea in recumbent position) occurs later than exertional dyspnea. Patients with orthopnea may elevate their heads on several pillows at night to get relief. Frequently, they feel short of breath and cough at night when their head slips of their pillow and disturb their sleep. The breathlessness is usually relieved by sitting upright since this position reduces venous return and pulmonary venous congestion. In advanced heart failure patients with orthopnea cannot lie down at all and may spend the whole night in sitting position. On the other hand, long-standing left heart failure nay lead to right heart failure which relieves the pulmonary congestion and breathlessness (dyspnea).
  • Paroxysmal nocturnal dyspnea (PND): Attacks of breathlessness and coughing occur at night usually awaken the patient from sleep and is not relieved by sitting position. The term cardiac asthma relates to PND is categorised by wheezes secondary to bronchospasm, hence, resembles bronchial asthma from which it has to be differentiated.
  • Cough with or without expectoration and wheezing: This is due to pulmonary congestion and edema. The cough and wheezing accompanied the dyspnea, hence the term cardiac asthma is used.
  • Cheyne-Stoke respiration: It is periodic (cyclic) breathing in which periods of apnea alternate with periods of hyperventilation. It is a sign of congestive heart failure, can also be seen in raised intracranial tension, respiratory failure and uremia.
  • Fatigue, weakness, poor effort tolerance: These are non specific but common symptoms of heart failure, are related to low cardiac output with hypoperfusion of skeletal muscles.
  • Oligouria and nocturia: Oliguria is a sign of heart failure, occurs due to hypoperfusion of kidneys leading to acute renal failure. Nocturia is due to increased renal perfusion in recumbent position, results in excretion of fluid retained during the day. It is an early symptom.
  • Cerebral symptoms: Disturb consciousness, confusion, impairment of memory headache, insomnia, difficulty in concentration are due to low cerebral perfusion.
  • Gastrointestinal symptoms, e.g. nausea, vomiting ,early satiety, abdominal pain and fullness. This is due to congestion of liver and intestine.
  • Cardiac cachexia: Severe chronic heart failure produces weight loss and cachexia.

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