What are the symptoms of heart failure?

Symptoms may develop gradually or become noticeable over a short time. Breathlessness can occur during activity, when lying flat, or wake someone from sleep. Some people also notice needing to urinate more at night, a reduced appetite, nausea, difficulty concentrating, or feeling unusually cold in the hands and feet.

Heart failure means the heart is not pumping blood around the body as effectively as it should. Blood and fluid can back up into the lungs, causing breathlessness or cough, while fluid can collect in the feet, ankles, legs or abdomen. Reduced blood flow to muscles can make everyday tasks feel harder and cause fatigue.

These symptoms are not specific to heart failure. A cough, fatigue, palpitations or shortness of breath can have several causes, and swollen ankles may also follow standing, medication effects or other health problems. A clinician considers the pattern, medical history and examination rather than using one symptom alone.

Arrange a medical assessment if breathlessness, ankle swelling, tiredness or reduced exercise tolerance is new, worsening or interfering with routine activities. Record when symptoms occur, whether they change when lying down, and any recent change in weight or swelling. Bring a list of medicines and relevant conditions such as high blood pressure.

Assessment may include listening to the heart and lungs, checking blood pressure and oxygen levels, and arranging tests. An electrocardiogram records the heart's electrical activity and may help identify an abnormal rhythm or signs of strain. Ongoing symptoms may be followed through a chronic disease review.

Seek emergency help immediately for severe or rapidly worsening breathlessness, breathlessness at rest, blue or grey lips, fainting, new confusion, or chest pain or pressure. A very fast or irregular heartbeat with dizziness, weakness or breathlessness also needs urgent assessment.

Sit upright while waiting for help and avoid driving yourself if you feel faint or severely short of breath. Do not wait for ankle swelling or a cough to settle if breathing is becoming difficult.

Useful questions include: Could these symptoms have a heart-related cause? Which changes should prompt same-day help? Do I need an electrocardiogram or other tests? How should I monitor swelling, breathing and weight at home? Could any of my medicines be contributing?