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6 surprising signs of heart failure

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When it comes to matters of the heart, knowledge is power. Here’s what everyone needs to know about heart failure.

Rosemary Black

By Rosemary Black

When your car is experiencing engine failure, it doesn’t mean it’s going to just stop working out of the blue. It’s something that typically happens gradually. There may be drops in performance that get worse over time.

Turns out, heart failure occurs in much the same way. It may sound like a medical emergency, as if someone’s heart is about to just stop beating. But heart failure actually means the heart isn’t pumping as well as it should be.

This lack of pumping power can be brought on by other heart conditions that leave the heart too weak or stiff to work properly. These include high blood pressure and coronary artery disease, which is the narrowing of arteries that supply blood flow to the heart.

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The American Heart Association (AHA) estimates that 1 in 5 people will develop heart failure. But more than half of Americans don’t know what symptoms to look for.

Your job: Know the signs. There are more treatment options than ever to help people with heart failure live better for longer. And the sooner you and your health care team catch it, the sooner you can prevent it from getting worse.

The warning signs of heart failure

Here is a list of some of the most common — and surprising — symptoms of heart failure. If you do have any of them, however, it’s important not to jump to conclusions.

The best thing to do is call your health care provider, says Mariell Jessup, MD. Based in Boston, Dr. Jessup is the chief science and medical officer of the American Heart Association. “It may be appropriate to begin testing for heart failure,” she says. This way, your doctor can rule out other causes and help you get the treatment you need.

When should you raise the alarm? It’s time to call 911 if you feel light-headed or as though you may pass out, if you have a fluttering or racing heart, or if you feel sudden chest pain or sudden chest heaviness, Dr. Jessup says.

Related reading: How to manage the side effects of statins.

Heart failure sign #1: Swelling in the legs, ankles and feet

“If you have heart failure, your heart doesn’t pump with enough force,” says Dr. Jessup. “Not enough blood is pumped out of the heart with each heartbeat, and blood returning from the body can’t enter the heart, backing up the veins.” Fluid from the blood vessels is forced into other body tissues. This can cause swelling.

Your kidneys normally help dispose of extra fluid, Dr. Jessup says. But when they’re not getting the blood they need, they’re not able to do their job as well. And gravity can naturally pull the fluid down into your legs, ankles and feet. (Learn more about leg swelling here.)

Heart failure sign #2: Shortness of breath when you’re lying down

Having shortness of breath during activities that normally wouldn’t faze you is a common sign of heart failure. Examples include walking to your car or climbing the steps to your front door.

But you can also feel breathless while resting or even sleeping.

It has to do with that fluid buildup. “A person lies down, fluid fills the lungs, and it gets hard to breathe fully,” says Maya Guglin, MD. Dr. Guglin is the chair of the American College of Cardiology’s Heart Failure and Transplant Section and Leadership Council in Indianapolis. “Then they sit up and gravity pulls the fluid down and the breathing gets better,” she says.

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Heart failure sign #3: Lack of appetite

When you have heart failure, your digestive system receives less blood. This can lead to pain, nausea or issues with taking in food. “You may eat just a little bit and feel like you’re full,” Dr. Guglin says.

Even though you’re not able to eat food as you normally would, you may find that you gain weight. But as Dr. Jessup explains, “The weight gain may be from the fluid buildup.”

Heart failure sign #4: Persistent coughing

The heart and the lungs are closely connected. Your lungs fill blood up with oxygen and then deliver it to the heart via the pulmonary veins. The heart then shuttles that oxygenated blood to the rest of the body.

Remember, though, with heart failure, the heart has trouble pumping blood. And fluid can back up into the lungs.

According to the Cleveland Clinic, the body then responds by coughing to try to get rid of that excess fluid. You may also find that the cough produces white or pink mucus.

Heart failure sign #5: Excessive tiredness

Blood and its circulation are the fuel-delivery service for the rest of the body. Blood carries oxygen, nutrients such as sugar for energy, and other hormones and proteins the body needs to function at its best.

When the body’s needs aren’t being met due to heart failure, you can feel tired and fatigued.

According to the AHA, the body may also divert blood away from less vital organs (such as muscles in your arms and legs) and send it to the heart and brain instead. And this can make everyday activities such as carrying groceries seem extra tough or even impossible.

Heart failure sign #6: Feeling confused

We’re not talking about everyday memory hiccups such as forgetting the birthday of your estranged second cousin once removed. “If you have heart failure, you may experience confusion and you can’t think clearly,” Dr. Jessup says.

When your circulation is off, it can mess with the levels of substances such as sodium that impact how well your brain cells communicate with one another. And that can lead to memory loss and feelings of disorientation, according to the AHA.

Heart failure is a serious condition. But knowing the signs can go a long way toward protecting yourself and your loved ones.

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Additional sources
Background on heart failure and its consequences:
American Heart Association
Statistics on heart failure: American Heart Association
A persistent cough may be a sign of heart failure: Cleveland Clinic

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