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Heart failure breathing problems: Heart Failure Symptoms | Johns Hopkins Medicine

Heart Failure Symptoms | Johns Hopkins Medicine

A normal, healthy heart is a very strong muscle that pumps blood throughout the body. The blood delivers necessary oxygen and important nutrients to tissues and organs.

With heart failure, the organ becomes progressively weaker. Over time, it loses its ability to pump enough blood to meet the body’s needs. In early heart failure, the heart tries to keep up with the body’s demands by:

  • Getting larger
  • Pumping faster
  • Narrowing the blood vessels to increase blood pressure to try to get blood where it needs to go
  • Diverting blood away from other organs so other parts of the body can have it

There are several kinds of heart failure. Some types have overlapping symptoms, some types can happen at the same time, and some types can lead to other types. This article covers the different kinds of heart failure:

  • Left-sided heart failure
  • Right-sided heart failure
  • Congestive heart failure
  • Congenital heart failure

As heart failure progresses, you may have more — and more severe — symptoms. The exact signs and symptoms of heart failure depend on the type of heart failure and how advanced it is.

Early Symptoms of Heart Failure

A person with early heart failure might not have any noticeable signs. When early symptoms occur, they can be subtle and easy to miss or ignore. Early signs of heart failure include:

  • Shortness of breath, at first when you’re active and later even when you’re sitting or lying down
  • Lowered ability to exercise or be active
  • Confusion or forgetfulness
  • Frequent fatigue, sleepiness or weakness
  • Palpitations, or a fluttering feeling in your chest, as the heart pumps harder and faster

Without treatment, heart failure can worsen over time. Symptoms that were once mild can become increasingly more severe, and may prevent you from doing everyday tasks.

Left-Sided Heart Failure Symptoms

Most heart failure occurs in the left ventricle (the bottom left chamber of the heart). Left-sided heart failure can be systolic heart failure, when the ventricle can’t contract (squeeze) normally. Or it can be diastolic (heart failure with preserved ejection fraction), when the chamber is stiffer and can’t relax normally.

If the chamber can’t pump well, blood backs up in the blood vessels that carry oxygenated blood from the lungs to the heart. This backup leads to fluid accumulation in the lungs, which causes shortness of breath. Most people with left-sided heart failure first notice mild breathing difficulty only during exercise. Over time, people may experience shortness of breath when they are being less active and even when resting.

Other symptoms of left-sided heart failure include:

  • Bluish color in the fingertips and lips
  • Cough, which may bring up phlegm or mucus tinged with blood 
  • Fatigue and weakness, even after resting 
  • Rapid or irregular heartbeat (arrhythmia)
  • Sudden, unexpected weight gain
  • Swelling in the ankles, legs, feet and/or abdomen
  • Trouble concentrating 

People with severe left-sided heart failure may experience orthopnea, shortness of breath when lying down. This troubled breathing is caused by fluid accumulating in the lungs when you lie down. You may wake up wheezing or gasping for air, called paroxysmal nocturnal dyspnea. Sitting up causes some of the fluid to drain to the bottom of the lungs, and makes breathing easier.

Right-Sided Heart Failure Symptoms

Right-sided heart failure happens when the right ventricle is too weak to pump enough blood to the lungs. Blood backs up in vessels that carry it from the body to the heart. This backup can push fluid out of the veins and into other tissues, causing swelling in these areas of the body:

  • Ankles
  • Belly
  • Feet
  • Genital area (groin)
  • Internal organs
  • Legs
  • Lower back

This fluid buildup and swelling can cause additional symptoms, such as:

  • Discomfort in the chest
  • Frequent urges to urinate
  • Loss of appetite
  • Nausea
  • Palpitations
  • Shortness of breath
  • Unexpected weight gain

Congenital Heart Failure Symptoms

Heart failure mostly affects older adults. But babies, children and young adults can develop heart failure due to a congenital heart condition (a heart condition present since birth).

Symptoms of heart failure in children and young adults may include:

  • Coughing, wheezing or difficulty breathing
  • Dizziness or fainting
  • Excessive sleepiness
  • Excessive sweating
  • Failure to thrive (gain weight)
  • Irritability due to pain or fatigue
  • Rapid or irregular heartbeat or breathing rate
  • Swelling in the belly, legs, ankles or feet
  • Trouble keeping up with peers during physical activities
  • Unexplained weight gain

What to Do If You Notice Worsening Heart Failure Symptoms

Heart failure can lead to serious complications, such as kidney or liver damage, other heart conditions, pulmonary hypertension and stroke. If you’re experiencing worsening symptoms of heart failure, keep track of them and talk to your doctor.

Seek immediate medical attention or call 911 if you experience:

  • Cough that brings up a white or pink foamy substance
  • Fainting, dizziness or confusion
  • Nausea or loss of appetite
  • New, sudden chest pain
  • Rapid weight gain (2 pounds or more in a day, or 5 pounds or more in a week)
  • Sudden, severe shortness of breath
  • Sudden, severe weakness
  • Swelling that has gotten significantly worse
  • Very fast or irregular heartbeat

Heart Failure, Tachycardia, and More

Written by WebMD Editorial Contributors

  • Heart Problems That Affect Your Breathing
  • Check With Your Doctor

You breathe in and out thousands of times a day and rarely give it a thought — until it starts to feel hard. Breathing problems can happen for many reasons, like being out of shape, congestion, fever, or asthma. But in some cases, they’re a sign that something is wrong with your heart.

Whatever the reason, always take breathing issues seriously. Tell your doctor so they can help you figure out the cause. And if your problem is sudden and severe, you should get medical help right away.

Heart failure (sometimes called congestive heart failure). Even though “failure” is in the name, it doesn’t mean that your heart stops beating. It means that it’s not serving the needs of your body. Shortness of breath and feeling tired can be signs of the condition. Often people also have swelling in their ankles, feet, legs, and mid-section because the heart is not strong enough to pump blood properly.

In the early stages of heart failure, you may have trouble breathing after exercise, getting dressed, or walking across a room. But as the heart gets weaker, you may feel breathless even when you lie down. See your doctor if that’s happening to you. They can recommend medicines and treatments that can help.

Tachycardia is a fast heart rate — usually more than 100 beats per minute in an adult. There are several kinds, but one that may cause shortness of breath is SVT, or atrial tachycardia. In SVT, the heart rate speeds up because the heart’s electrical signals don’t fire properly. People who have SVT and are short of breath should get medical help right away. Your doctor may recommend other things that can help, too, like quitting smoking and drinking less coffee and alcohol.

Pulmonary edema. This condition means there’s extra fluid in your lungs, which makes it hard to breathe. It’s usually caused by heart problems. If the heart is ill or damaged, it cannot pump out enough of the blood it gets from the lungs. When that happens, pressure in the heart builds up and pushes fluid into the lungs’ air sacs, where it doesn’t belong. Breathing problems may happen over time, or they may come all of a sudden.

Get medical help right away if you have trouble breathing that’s worse when you lie down, if you have to gasp for breath, feel like you are drowning, have blue or gray skin color, cough up spit that may have blood in it, or feel your heartbeat is fast or irregular.

Cardiomyopathy is a serious problem with the heart muscle that makes it hard for it to pump and send blood to the body. There are different types of cardiomyopathy and many reasons it happens, such as a heart attack, diabetes, or cancer treatment. Or the reason could be linked to excess weight, too much alcohol, or high blood pressure. In some cases, doctors don’t know why it happens.

You may not notice any symptoms of cardiomyopathy at first. But as it gets worse you may feel breathless when you’re active or even at rest. You may get swollen legs, ankles, and feet. You could feel tired or dizzy, have a cough while lying down, a fast, fluttering heartbeat, or chest pain. If you have trouble breathing, or chest pain that lasts more than a few minutes, get emergency help.

If you have a breathing problem, you need to see a doctor. They will examine you and may want to check your blood or do other tests to find out what’s going on.

You might want to make notes about how you feel and bring them to your appointment. That way, you won’t forget the important details. You may also want to write down some questions you’d like to ask the doctor. The more your doctor knows, the better.

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Heart failure: symptoms, diagnosis, treatment of heart failure

The main function of the heart is pumping – the heart muscle pumps blood through the body. The task of blood is to carry oxygen to all organs and tissues.

Heart failure is the inability of the heart to deliver the required amount of blood and oxygen to organs and tissues.
A lot of heart diseases (hypertension, myocardial infarction, heart defects, myocarditis, etc.) can lead to heart failure. Sometimes heart failure is a complication of diseases of other organs.

Symptoms of heart failure are varied, from very mild shortness of breath, which a person hardly notices, to the most severe degrees of the disease, when a person is practically unable to move (severe shortness of breath, massive swelling, etc.) Shortness of breath and swelling are the most specific symptoms of heart failure . Also, symptoms of the disease can be weakness and fatigue, hypotension, palpitations, blue lips and earlobes during physical exertion.
The most common symptom.

Shortness of breath is rapid breathing caused by oxygen starvation of the tissues. Normally, a person makes 14-16 respiratory movements per minute. With heart failure, this figure can double. With shortness of breath caused by heart failure, it is difficult to breathe.
Initially, physical activity becomes a “provocateur” of shortness of breath. There is a classification of heart failure into 4 functional classes, depending on exercise tolerance.

  • functional class – shortness of breath occurs during very large physical exertion.
  • functional class – shortness of breath appears with moderate physical exertion.
  • functional class – small household loads already cause shortness of breath.
  • functional class – shortness of breath occurs at rest – the person does not move, but breathes very quickly.

The extreme manifestation of shortness of breath is the inability to sleep lying down (in the supine position, shortness of breath increases). As soon as a person tries to lie down, he begins to suffocate. This is due to the fact that when a person lies down, the flow of blood from the veins to the heart increases, and it is unable to pump it. Blood stagnates in the vessels of the lungs, so shortness of breath occurs. Sometimes patients with heart failure sleep half-sitting or even sitting, lowering their legs down – in this position, part of the blood goes into the veins and it is easier for the heart to work. The maximum relief from such symptoms is achieved in the sitting position on a chair – this is the easiest way for a person to breathe.
Shortness of breath in heart failure may lead to pulmonary edema. This is an acute condition, accompanied by weakness and panic attacks, cold sweat, blue lips. Shortness of breath is getting stronger, not stopped by the usual methods. If you experience these symptoms, you should immediately call an ambulance. Before the arrival of the brigade, take a semi-sitting position with legs down, remove all items of clothing that tighten the throat and chest, and provide fresh air.

Edema usually occurs on the legs. Most often, swelling begins to appear on the ankles and legs. In the first stages, swelling occurs after a long walk, in the evening – and disappears after rest, in the morning. Each person can check his body for the presence of edema. To do this, just press on the shin in front, hold for a few seconds and release. If a trace (fossa) remains, there is edema.
The location of the edema depends on how mobile the person is. If a person is mainly in bed rest, lying, swelling can be localized on the face, on the sacrum, on the legs. The degree of edema depends on the degree of heart failure – only the ankles or lower legs can swell, the ankles, lower legs and thighs can swell at the same time. There may be swelling throughout the body (including an edematous abdomen – accumulation of fluid in the abdominal cavity) – the highest degree of heart failure. In advanced cases of the disease, the kidneys suffer, which cannot cope with the excretion of fluid and it lingers in the body; liver and other internal organs.

Systolic and diastolic, left ventricular and right ventricular, heart failure
Heart failure is primarily subdivided into systolic and diastolic. Systole is a period of contraction of the heart muscle (the heart pushes blood out), diastole is a period of relaxation (the heart draws blood). In systolic heart failure, the heart is unable to contract strongly enough. The heart muscle is weak and does not push all the blood into the body. As a result, a certain amount of blood constantly remains in the heart, it begins to stretch, and all organs and tissues suffer from a lack of oxygen. Systolic heart failure occurs when diseases of the heart muscle itself, such as myocarditis, coronary heart disease (CHD), scarring of the heart, myocardial infarction.
In diastolic heart failure the heart muscle can contract and eject all the blood, but it is unable to relax sufficiently. The heart takes in less blood than the body needs. Diastolic heart failure can occur with arterial hypertension, amyloidosis (deposition of a certain protein on the inner wall of the heart, due to which it loses elasticity), valvular heart disease, diabetes mellitus and other diseases.
To understand the mechanism of right ventricular and left ventricular failure, you need to understand how blood moves through the body.
The heart consists of two sections – right and left. The right heart is venous. Blood in the heart flows from the veins into the right atrium, then into the right ventricle, and from there into the lungs. This is a small circle of blood circulation. The blood in it is venous, “dirty”, blue. In the lungs, the blood is enriched with oxygen, it becomes not venous, but arterial. From the lungs, it flows into the left atrium, from there into the left ventricle, and the left ventricle sends blood to the aorta, from where the blood will disperse through all the vessels to nourish the organs and tissues. In the smallest vessels (capillaries) gas exchange occurs – the blood gives off oxygen, takes carbon dioxide. From the capillaries, blood enters small veins, and then the “dirty” blood moves through the veins back to the heart.

Right ventricular heart failure – reduced ability of the right side of the heart to draw blood from the veins. Because of this, the veins begin to expand, there is a leakage of part of the blood fluid into the intervascular bed of the subcutaneous fatty tissue. Edema occurs. Therefore, the main manifestation of right ventricular failure is edema. Right ventricular heart failure may develop in diseases of the lungs. For example, the primary disease is bronchial asthma. Due to the fact that the vessels of the lungs are very much changed, the right parts of the heart, in order to push the blood into these changed vessels, are forced to work with a very large overload. The right parts of the heart are weak, not adapted to heavy loads. They do not have time to take blood from the veins.
Left ventricular failure is reduced function of the left side of the heart. The left side of the heart must take blood from the lungs and pump it into the body. If the left ones do not work well, blood from the lungs flows through the arteries, and the heart cannot pump it. Then part of the blood stagnates in the lungs. There is shortness of breath. From the left ventricle, blood is also ejected weakly – an insufficient amount of blood – a person has low pressure, a person may faint. Edema in left ventricular failure can also occur, but the right side of the heart is involved.

Diagnosis of heart failure
It is very important to diagnose the disease in time, to establish its causes. Sometimes when the causes of heart failure are eliminated, the heart returns to normal . Only a doctor can determine the scope of diagnosis in case of suspected heart failure based on the patient’s story – what exactly worries you, how the first signs of discomfort appeared, etc.
As a rule, an ECG, ECHO KG (ultrasound examination of the heart) is performed. ECHO KG allows you to see how much the heart contracts and relaxes (systole and diastole), to clarify the ejection of blood (amount of blood), to evaluate the functioning of the heart valves. A biochemical blood test is mandatory, and sometimes the function of the thyroid gland is examined. In each case, the scope of the necessary diagnostics is specified depending on the symptoms.

Treatment of heart failure
In the treatment of heart failure , drug treatment is primarily used. But in some situations, surgical methods have better results. For example, for many heart defects, the most effective surgical treatment is valve replacement.
It is very important that in case of heart failure the patient is observed by one doctor, because the treatment regimen, the selection of drugs is strictly individual. The doctor selects the dosage of the drug for each specific case, and carefully monitors the dynamics of the patient’s condition.

How to distinguish between cardiac and pulmonary dyspnea, symptoms and treatment

Bronchial asthma Wet cough Wet cough in children For the heart and blood vessels Stroke Heart failure Dry cough Dry cough in children Tablets Tablets Tablets

Article author

Grishina Alexandra Nikolaevna,


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Contents of the article

  • Shortness of breath in heart failure, symptoms and treatment
  • Causes, types and classification of dyspnea
  • How to distinguish between cardiac and pulmonary dyspnea
  • Shortness of breath after coronavirus
  • Ask an expert on the topic of the article

Shortness of breath due to heart failure, symptoms and treatment

provoked by shortness of breath . Doctors call shortness of breath dyspnea, in which the frequency of respiratory movements (RR) is disturbed. In this case, two conditions are distinguished: tachypnea and bradypnea.

With tachypnea, a person breathes shallowly, but very quickly, making more than 20 breaths per minute. Such “breath of a hunted beast” is observed in diseases of the blood, anemia, fever, hysteria. Bradypnea, on the contrary, is characterized by deep, but rare inhalations-exhalations (less than 12 respiratory movements (DR) per minute) and occurs against the background of acidosis, prolonged hypoxia, and brain damage.

In addition to impaired breathing, dyspnea is manifested by characteristic symptoms: suffocation, squeezing and tightness in the chest, sounds of noise when trying to breathe in, difficulty exhaling.

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Causes, types and classification of dyspnea

This condition occurs when the level of oxygen in the body (hypoxia) or in the blood (hypoxemia) decreases. This leads to irritation of the respiratory center in the brain, resulting in an involuntary increase in breathing, and there is a feeling of lack of air.

The main causes of hypoxia:

  • Intoxication of the body and pathologies of the heart, lungs, nervous system
  • Extrapulmonary diseases or conditions in which chest mobility is limited, for example, obesity, pregnancy, physical activity and pathological. The first is a short-term phenomenon associated with hard work or sports loads. The second is systemic or chronic in nature, appears in a calm state or with minimal physical exertion. The pathological form indicates a painful lesion of certain systems.

    Depending on the causes, there are 4 types of dyspnea.

    • Pulmonary – disease of the bronchi and lungs, respiratory failure.
    • Cardiac – with heart failure associated with heart disease, cardiomyopathies, myocarditis, myocardial infarction;
    • Central – pathologies of the central nervous system, neurosis and exposure to neurotropic poisons.
    • Hematogenous – liver failure, poisoning, decompensated diabetes mellitus, anemia.

    More often than others, cardiac and pulmonary dyspnea are diagnosed, which are important to distinguish from each other in order to prescribe adequate treatment and provide effective assistance.

    How to distinguish cardiac from pulmonary dyspnea

    The real cause is accompanied by symptoms of the disease that provoke dyspnea, which can be:

    • Acute – develops within minutes
    • Subacute – develops within hours or days – stored in for several weeks or months

    When there is an acute form, an ambulance must be called urgently.

    The tables show the triggering diseases and their signs, as well as recommendations for medical care. This will help determine the type of shortness of breath and take appropriate measures.

    Pulmonary dyspnea – causes and signs

    9017 9

    9 0259

    Disease Symptoms Medical assistance
    Asthma Wheezing that starts spontaneously, accompanied by and caused by exposure to provoking factors (upper respiratory tract infections, allergens, cold air, exercise) Examination by a doctor to determine respiratory rate and airway function
    Pneumothorax Suddenly disturbed respiratory rate and there is acute pain in the chest. Often occurs spontaneously and also after trauma and in people with COPD Chest x-ray
    Pulmonary embolism Spontaneous chest pain that worsens with inspiration, palpitations and breathing CT and angiography examination
    Pulmonary hypertension 901 83

    Gradually increasing intensity of dyspnea, cough, weakness, swelling of the legs Echocardiography, cardiac catheterization
    Restrictive diseases Difficulty in breathing occurs due to occupational activities associated with prolonged inhalation of irritants Chest x-ray,

    lung function test
    Exacerbation of COPD (chronic obstructive pulmonary disease) Productive or non-productive cough (with or without sputum), inhalation-exhalation through pursed lips, wheezing Examination by a doctor, x-ray chest
    Pneumonia Severe chest pain on inspiration, fever, cough, weakness, unusual lung sounds Examination by a doctor, chest x-ray
    Obstructive pulmonary disease Violation of respiratory rate provokes heavy smoking, history of emphysematous chest Chest x-ray, studies of respiratory functions

    Cardiac dyspnea – causes and symptoms

    disease symptoms medical care
    Heart failure, ischemic heart disease
    • In the acute form – shortness of breath increases when lying on the back or begins at night 1-2 hours after falling asleep. The condition is accompanied by swelling of the legs, the appearance of foamy pink sputum, noises in the lungs.
    • In subacute or chronic, a feeling of constriction in the chest, with pain that may radiate to the arm or jaw.
    • Listening with a stethoscope, blood test for brain natriuretic peptide (BNP), echocardiography, chest x-ray.
    • Electrocardiography, stress test, cardiac catheterization.
    Heart attack or acute myocardial ischemia Feeling of deep pressure in the chest, which may be accompanied by pain radiating to the jaw or arm

    Electrocardiography, cardiac catheterization, blood tests

    All three the form of shortness of breath requires consultation with a cardiologist, pulmonologist, endocrinologist or other specialists who will prescribe an appropriate examination and select the correct methods of treatment.


    • “Diseases of the lungs and respiratory tract. Symptoms of lung diseases. Shortness of breath, MSD Handbook
    • ​“How to understand the “language” of shortness of breath?”, Journal of Atmosphere. Pulmonology and Allergology, No. 4, 2012
    • “Evidence Based Treatment of Dyspnea in Patients with End-stage Cardiovascular and Pulmonary Diseases”, Journal of Palliative Medicine and Rehabilitation, No. 2, 2005
    • “Dyspnea: pathophysiological and clinical aspects”, Journal “Therapeutic archive”, № 3, 2005

    Shortness of breath after coronavirus

    After the coronavirus epidemic, doctors faced shortness of breath as a post-COVID symptom. It occurs at the slightest load and even at rest. It manifests itself in the form of rapid breathing, pressing pain in the chest, dry cough, inability to take a deep breath. Also, like the loss of smell, it can persist for a long time.

    Causes of shortness of breath after coronavirus:

    • Fibrosis. With inflammation, the lung spongy tissue is replaced by connective tissue, which does not absorb oxygen.
    • Frosted glass. The situation when the alveoli are filled with fluid and do not participate in the process of gas exchange. Ground glass can develop into fibrosis.
    • Psychogenic factor. Doctors use the terms “post-covid depression” or “respiratory neurosis.” Shortness of breath is often accompanied or provoked by panic attacks.
    • Heart problems. In most cases, this is due to the fact that coronavirus complicates chronic diseases of the cardiovascular system.

    Due to the fact that shortness of breath occurs for various reasons, it is important to see a doctor for diagnosis.

    The specialist will select the right therapy, which consists of methods such as:

    • oxygenation – oxygen therapy
    • inhalation
    • physiotherapy
    • medical treatment
    • breathing exercises
    • therapeutic massage
    • psychological or psychotherapeutic assistance

    At home, the patient can help to restore normal breathing in the following ways:

    • humidification
    • breathing exercises, pool swimming
    • physiotherapy exercises for all muscle groups
    • daily outdoor walks
    • taking vitamin D, over-the-counter sedatives

    Ask an expert on the topic of the article

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