Heart Health
5 warning signs and symptoms of early heart failure
The earliest symptoms of heart failure are often very subtle, but it's dangerous to ignore them.
- Reviewed by Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
It's an unfortunate truth that your body slows down in your sixth and seventh decades. Climbing a flight of stairs that you once took two at a time can now feel as daunting as scaling Mount Everest. While some degree of vitality loss can be attributed to natural aging, fatigue and breathlessness may also be signals that your heart is not functioning as well as it should.
Causes of heart failure
Heart failure occurs when something damages the heart muscle or reduces the heart's ability to pump effectively. Most often, the damage stems from coronary artery disease or heart attack. But faulty heart valves, longstanding high blood pressure, or genetic disease may also be to blame. No matter what the cause, the failing heart can no longer pump well enough to keep up with the body's demand for oxygen-rich blood.
Early heart failure symptoms
"There is a general tendency for people to ignore heart failure symptoms and attribute them to just getting older. Therefore, it was very important for us to create an easy way to identify those symptoms," says Dr. Mandeep R. Mehra, medical director of the Heart and Vascular Center at Harvard-affiliated Brigham and Women's Hospital.
FACES of heart failure
To help both doctors and patients quickly spot a possible combination of heart failure symptoms, the Heart Failure Society of America developed a handy tool that goes by the acronym FACES.
F = Fatigue. When the heart can't pump enough oxygen-rich blood to meet the body's energy needs, a general feeling of tiredness or fatigue sets in.
A = Activity limitation. People with heart failure are often unable to do their normal activities because they become easily tired and short of breath.
C = Congestion. Fluid buildup in the lungs can result in coughing, wheezing, and breathing difficulty.
E = Edema or ankle swelling. When the heart doesn't have enough pumping power to force used blood back up from the lower extremities, fluid can collect in the ankles, legs, thighs, and abdomen. Excess fluid can also cause rapid weight gain.
S = Shortness of breath. Fluid in the lungs makes it more difficult for carbon dioxide in used blood to be exchanged for fresh oxygen. It may also be harder to breathe when lying down, because gravity allows fluid from below the lungs to travel up the torso.
By themselves, these five warning signs do not confirm a diagnosis of heart failure, but they do convey a sense of urgency to seek medical advice, says Dr. Mehra.
Heart failure testing
In addition to the physical exam, doctors have two other important tools to spot the presence of heart failure. The first is an echocardiogram (often called an echo), which is a simple, noninvasive test that uses ultrasound to create images of your heart while it beats. If the echo shows a lower-than-normal percentage of blood leaving the heart when the left ventricle contracts, there is a strong possibility of heart muscle damage.
Other findings that point to heart failure include abnormal thickening and ballooning of the heart wall and malfunctioning heart valves.
The next step in identifying early-onset heart failure is to look for biomarkers in the blood, such as B-type natriuretic peptide, which is released when the heart is under stress. "I call these compounds 'tears from the heart' because they show that the heart is crying for help," says Dr. Mehra. Once the initial diagnosis is confirmed, further testing may be needed to figure out what's causing the heart's dysfunction and determine the best treatment approach.
Heart failure treatment options
Heart failure caused by damage to the heart that has developed over time can't be cured. But it can be treated, often with strategies to improve symptoms. Your doctor will work with you to develop a treatment plan which may include lifestyle changes, medications, devices and surgical procedures, as well as ongoing care.
Drugs to avoid when you have heart failurePeople with heart failure often take multiple medications. However, several commonly used prescription drugs, over-the-counter medicines, and supplements can interact dangerously to intensify heart failure symptoms. To be on the safe side, make sure all of your medical providers have a complete list of all the medicines you take. Particular compounds to watch out for include these:
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About the Reviewer
Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
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