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Heart Failure Symptoms and Diagnosis

Benjamin McDonald, MD, edited by Ann Witt, MD Updated: Jun 24th 2016

list with boxes checkedThere are multiple symptoms that can indicate heart failure. Most of these symptoms are related to the fluid back-up that occurs as a result of heart failure.

Edema/Fluid Retention. If you gain three to five pounds in the span of a day, this weight gain can most likely be attributed to fluid retention. Your kidneys may retain fluids when they perceive less than normal blood flow. This extra fluid will build up in various tissues, often causing visible swelling of the limbs, most often in the legs, ankles, and feet. In fact, weight loss from treating heart failure (and removing the extra water) is often used to confirm the initial diagnosis.


Congested Lungs. In addition to your legs and ankles, fluid can buildup in your lungs during heart failure. This causes symptoms including shortness of breath, a cough that is often worse at night, and suddenly awakening in the middle of the night short of breath.

Dizziness and Fatigue. All of your muscles and body organs require regular blood flow to supply them with the oxygen and nutrients they need to function. When your organs and muscle cells become deprived of these nutrients, you may feel weak, dizzy or tired for no apparent reason.

Heart Failure Diagnosis

Only a medical doctor can properly diagnose heart failure. It is extremely important that you consult your doctor immediately if you notice any of the above described symptoms. The earlier heart failure is diagnosed and properly treated, the faster you can start down the path to recovery and with less long-term damage. When discussing your symptoms with your doctors, be prepared to honestly answer questions concerning your medical history, your drug and alcohol use, and smoking habits. Doctors need this sort of personal information to make effective treatment recommendations. Your doctor may also order one or more of the following medical tests to further diagnose your condition:

Blood Tests. The doctor will most likely request a blood sample so that he or she can check levels of thyroid hormone, your blood count, B-type natiuretic peptide (BNP), and maybe cardiac enzymes (to rule-out a myocardial infarction as the cause of heart failure). BNP is a protein that increases with heart failure as the body starts to retain fluid and can help with diagnosis as well as tracking worsening of symptoms.

X-ray. Your doctor may order an x-ray photograph of your chest area. This x-ray will give the doctor an indication of the size of your heart and whether there is any fluid buildup in or around the lungs.

Echocardiogram. Echocardiography is used to show the structures of the heart. This test can be particularly useful as it can show how well the heart is pumping and which areas are not functioning properly. During an Echo, they will be able to determine your heart's ejection fraction. The ejection fraction test is a measure of how much blood your heart pumps out during each beat. If the test determines that your heart is pumping out less than 40% of its volume on each pump, then your heart failure is usually attributed to a systolic (pumping) disorder.

Referral to a cardiologist for other heart testing including an angiogram (to look for blood vessel blockage), a holter monitor (to look for irregular heart beats), and a stress test (to look for signs of coronary artery disease and sometimes ejection fraction).


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