Symptoms of Heart Failure

Symptoms of heart failure can sometimes be hard to identify. If left untreated, you may experience a variety of symptoms, including:

  • Shortness of breath, even when lying down
  • Dry, hacking cough (most often when lying flat)
  • Fatigue and lack of energy
  • Loss of appetite
  • Rapid weight gain
  • Trouble sleeping
  • Abdominal bloating

In more severe cases of heart failure, you will have congestion in your lungs, and swelling in your legs and feet. This is why heart failure is sometimes called congestive heart failure.

Meet the Heart Failure Team

Northwestern Medicine Bluhm Cardiovascular Institute is a nationally recognized destination for those who require highly specialized cardiovascular care.

Stages of heart disease

The American College of Cardiology and the American Heart Association have developed a system to help you better understand the stages of heart failure. The staging system includes specific treatments targeted to each stage. Understanding the staging system can help you have a meaningful conversation with your health care provider as you plan your care.

Stage A

You may have heart failure risk factors, including high blood pressure, coronary disease, diabetes, drug or alcohol abuse or a family history of cardiomyopathy (diseases of the heart muscle). Since you have some risk, now is an ideal time to take preventive action to ward off more serious heart disease or failure, even if you do not have active heart disease or symptoms.

Stage B

In spite of not showing symptoms, you may already have heart disease of some kind, including a structural heart disorder, and you may be able to take steps to reduce your risk of developing symptoms.

Stage C

You have heart disease, with some prior or current heart failure symptoms. At this stage, you can work with your physician to control your symptoms.

Stage D

You have advanced heart disease (also known as end-stage heart failure), with symptoms that are still active, despite medical treatment. You may be eligible for advanced treatment procedures, such as ventricular assist devices or heart transplantation.

For patients who have Stage C or Stage D heart failure (presence of symptoms), doctors often classify patients’ heart failure according to how severe their symptoms are. Below is the most common classification system, the New York Heart Association (NYHA) Functional Classification. The NYHA Functional Classification system places patients in one of four categories based on how much they are limited by their heart failure symptoms during physical activity.

Class I
No symptoms and no limitation in ordinary physical activity.

Class II
Mild symptoms and slight limitation during ordinary activity. Comfortable at rest.

Class III
Marked limitation in activity due to symptoms, even during less-than-ordinary activity. Comfortable only at rest.

Class IV
Severe limitations. Experiences symptoms even while at rest.