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Heart Failure Symptoms - Topic Overview

If you have heart failure, symptoms start to happen when your heart cannot pump enough blood to the rest of your body.

Shortness of breath

While shortness of breath is the most common symptom of heart failure, it may be difficult or impossible to distinguish it from shortness of breath caused by other health problems such as emphysema or severe anemia. Your doctor can help you determine why you have been feeling short of breath.

People with heart failure experience shortness of breath in many different ways. You might feel that:

  • You can't catch your breath.
  • You feel tightness in your chest.
  • You feel tired when you walk.
  • You need to stop a lot when you walk.
  • It gets worse when you lie flat, and it may wake you up at night.

Shortness of breath from exertion or exercise. If your shortness of breath isn't severe, you may notice it only when you are exerting yourself, and sometimes only during more intense exertion. The medical term for this symptom is dyspnea (say "DISP-nee-uh").

When heart failure develops gradually, your shortness of breath also may develop gradually, which can make it hard to notice. But people with more severe heart failure may have shortness of breath with minimal exertion.

Shortness of breath while lying down. People with more severe heart failure may experience shortness of breath when they lie down. The medical term for this symptom is orthopnea (say "or-THAWP-nee-uh"). The severity of this symptom usually depends on how flat you are lying—the flatter you lie, the more you feel short of breath.

To gauge the severity of this symptom, doctors often ask people how many pillows they need to lie on to avoid feeling short of breath in bed. For example, "three-pillow" orthopnea is worse than "two-pillow" orthopnea, because you have less tolerance for lying flat.

The reason you may have orthopnea is that when you lie flat, the blood that ordinarily pools in the veins of your legs is reentering your bloodstream. If you have heart failure, your heart may not be able to keep up with the increased amount of blood returning to the heart, so fluid builds up inside the lungs and causes shortness of breath.

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