Heart Failure Signs and Symptoms

Primary Clinical Signs and Symptoms

The European Society of Cardiology recommends that breathlessness (dyspnea) is a key symptom of heart failure, which may occur at rest or during exercise, and can present as nocturnal dyspnea or orthopnea 1, 2
Peripheral edema is a characteristic sign of heart failure, typically manifesting as ankle swelling, as noted by the European Heart Journal 2, 3
Fatigue is a complex symptom related to low cardiac output and peripheral hypoperfusion in heart failure patients, according to the European Heart Journal 1, 4

Increased pulmonary capillary pressure contributes to pulmonary edema and breathlessness in heart failure, as reported by the European Heart Journal 1
Low cardiac output leads to fatigue, peripheral hypoperfusion, and other symptoms of heart failure, as described by the European Heart Journal 1

The New York Heart Association (NYHA) functional classification is commonly used to classify heart failure severity, with Class I indicating no limitation of physical activity, and Class IV indicating inability to perform any physical activity without discomfort, as defined by the European Heart Journal 2, 7

Clinical signs alone are insufficient for diagnosis of heart failure, and objective evidence of cardiac dysfunction, such as echocardiography, is required, as stated by the European Heart Journal 1, 2
Natriuretic peptides (BNP, NT-proBNP) are useful in supporting the diagnosis of heart failure, with elevated levels indicating heart failure, and normal levels making heart failure unlikely, as reported by the European Heart Journal 3, 7
Chest X-ray may show cardiomegaly and pulmonary congestion in heart failure patients, as noted by the European Journal of Heart Failure 5, 8

There is a poor relationship between symptoms and the severity of cardiac dysfunction in heart failure, as reported by the European Heart Journal 1, 7
Right and left heart failure present with different predominant signs, with systemic venous congestion characteristic of right heart failure, and pulmonary venous congestion characteristic of left heart failure, as described by the European Heart Journal 4, 6