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Heart Failure Symptoms - Topic Overview

Being very tired (fatigue)

You might feel that:

  • You have less energy and feel more tired than usual.
  • You can't exert yourself like you could before.

You might also have low exercise capacity. This can be harder to describe. It is a symptom that people with heart failure often don't even notice because they have gradually reduced the level at which they exert themselves.

For example, they may stop walking up the stairs, or they may drive to the store instead of walking. Some people at first deny that they have been experiencing this symptom. It is only after doctors ask them about changes in their activities that they realize they have been avoiding physical exertion. This decrease in your ability to exert yourself physically is what doctors call low exercise capacity.

Swelling in ankles or feet

People with heart failure often experience swelling in their ankles or feet. You might notice that:

  • It gets worse at the end of the day or after you stand for long periods.
  • It hurts.
  • Pressure leaves impressions in your skin.
  • Shoes no longer fit.

The degree of swelling you experience depends on how well your body is compensating for heart failure and how much sodium and water your body retains. In some cases the swelling is mild and merely bothersome, while in other cases it can be severe and painful if the skin becomes taut and sensitive.

The medical term for this swelling in the legs is pedal edema—"pedal" refers to the feet and "edema" refers to the buildup of excess fluid. Heart failure often causes what doctors call "pitting edema," meaning that applying pressure to the swollen skin leaves an indentation in the skin. Doctors often test for edema by pressing their thumb to the skin and seeing whether it leaves an impression. You may see this yourself if you take off your shoes and socks and find that your socks have left an impression in the skin of your ankles and feet.

You may notice more severe swelling if you have been eating too much salt, which causes your body to retain fluid. Elevating your feet or wearing supportive stockings can help relieve the swelling.

Urinating more often

In the earlier stages of heart failure, some people need to urinate more frequently during the night than during the day. This happens because during the day, fluid and blood can pool in your legs while you are standing, resulting in less blood in the circulation and, as a result, less blood flow to the kidneys.

At night when you lie down, blood and fluid in your legs reenter the circulation and therefore increase the blood flow to your kidneys and the amount of urine produced.

If your heart failure gets worse, your kidneys receive less and less blood, both during the day and at night. As a result, the kidneys produce less urine. If you are urinating infrequently or not at all, tell your doctor right away because it may mean that the amount of blood your heart is pumping is critically low.

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