Main symptoms

The most common symptoms of heart failure are:

• Shortness of breath this may occur after activity or at rest; it may be worse when you're lying down, and you may wake up at night needing to catch your breath
• Fatigue, you may feel tired most of the time and find exercise exhausting
• Swollen ankles and legs this is caused by a build-up of fluid (edema); it may be better in the morning and get worse later in the day

In order to simplify and clarify the clinical signs of heart failure, the treatment of the symptoms is also done according to the classification of the disease. Listed and explained below are the symptoms of left ventricle heart failure and right ventricle heart failure.

Symptoms of left ventricle heart failure

Acute left ventricle failure- is characterized by dyspnea which occurs mostly at night, resembling cardiac asthma or acute pulmonary edema. The symptomatology of these conditions has been covered in the article for atherosclerotic cardiosclerosis and pulmonary edema. 

Chronic left ventricle failure - the earliest symptom to emerge in chronic failure of the left ventricle is dyspnea.

a. Dyspnea.  Dyspnea is a very early and important symptom which in the beginning only appears during physical exertion. Later on, it also occurs while the patient is at rest. The patient feels the need to sleep with taller pillows and a greater number of pillows. In more advanced stages, the patient cannot lie down at all, they have to remain in a half-upright sitting position which is called an orthopneic position. In other cases, the dyspnea takes on the character of a paroxysmal condition which occurs at night, waking the patient from sleeping. If further measures are not taken, this can lead to the development of acute pulmonary edema.

b. Coughing. Dyspnea is accompanied by coughing with a small amount of sputum. In cases of pulmonary edema, the expectorant (sputum) amount increases, becoming foam-like and at times, hemoptoic (containing blood).

c. Bloody expectorant (blood in the sputum when coughing).

d. Angina pain (Chest pain). This mostly occurs during crises commonly experienced by patients suffering from acute pulmonary edema.

e. Cyanosis.  This symptom is usually not present, except for the cases which become complicated by the onset of acute pulmonary edema or a pulmonary embolism. 

For patients suffering from hypertension and elderly patients suffering from cerebral atherosclerosis, Cheyne-Stokes periodic respiration may be evident (the breathing stops and restarts at irregular intervals).

Symptoms of right ventricle heart failure

Symptoms of right ventricle heart failure are illustrated below separated by class, in terms of whether the disease has a chronic or acute nature

1. Acute right ventricle heart failure

Acute right ventricle heart failure is much less common than that of the left. This failure usually emerges as a consequence of pulmonary embolisms, or as a result of great physical exertion in patients suffering from compensated mitral stenosis, etc. 

Symptoms include:

• Cyanosis
• Swelling of the jugular veins
• Enlargement of the liver (this is also accompanied by pain in this region)
• Patients may fall into a collapsed state with prominent tachycardia
• Anuria (lack of urination)

2.   Chronic right ventricle heart failure

•  Pain in the right hypochondrium. In this type of failure, patients complain of a feeling of heaviness or pain in the right hypochondrium     (In order to appropriately understand this, visually picture the abdomen to be divided into 4 parts from top to bottom, from the left to the right. In this case, the pain would be localized to the upper right quadrant) This is due to the enlargement of the liver from the stasis and strain on the Glisson’s capsule. 
• The liver is enlarged, the surface turned flat while the corners are rounded, its consistency denser and painful upon palpation. While palpating (pressing on the liver) one can observe a swelling of the jugular veins, this is termed the hepatojugular reflux. 
• Heaviness in the right hypochondrium
• Cyanosis of the lips and cheekbones
• Cyanosis of the nail beds
• Oliguria during the day and nicturia during the night
• Gastrointestinal issues
• Tachycardia
• Edema, which occurs in the lower extremities. The lower extremities become soft and when pressed, the finger leaves a mark, without causing any pain. In more advanced stages, there is transudate in the serous cavities such as ascites (accumulation of water in the belly), hydrothorax (accumulation of water in the thoracic region), in more rare cases, hydro pericarditis.  When the entire body swells, hence when the edema becomes generalized, this is called anasarca.

Less common symptoms

Other symptoms of heart failure can include:

• a persistent cough, which may be worse at night
• wheezing
• a bloated tummy
• loss of appetite
• weight gain or weight loss
• confusion
• dizziness and fainting
• a fast heart rate
• a pounding, fluttering or irregular heartbeat (palpitations)

Some people with heart failure may also experience feelings of depression and anxiety.