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
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
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
- 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
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
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
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