Shortness of breath and chest pain are among the earliest and most obvious symptoms of heart failure. However, there are others that are less common and still indicate problems with heart function.

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Congestive heart failure (CHF) affects your heart’s ability to pump enough blood to effectively meet your body’s needs. When this happens, the symptoms can range from mild to severe. CHF symptoms can affect the health and function of all your organs, including your brain. They can also affect your energy level and mood.

You may be able to manage many of these symptoms and ease complications of heart failure with the help of medications, lifestyle adjustments, and, in some cases, medical procedures.

Learn more about congestive heart failure.

There are distinct stages of CHF, and several systems may help represent these stages. The American Heart Association describes the stages of heart failure: A, B, C, and D. These stages help the doctor guide the management and treatment of CHF.

Here are the symptoms of CHF by stage.

In the early stage of heart failure, you may experience no noticeable symptoms.

You may know you have heart failure only because tests such as echocardiography indicate that your heart isn’t pumping enough blood with each contraction. A blood test measuring B-type natriuretic peptide is also helpful in diagnosing heart failure.

Stage B is considered pre-heart failure. In this stage, you may experience a slight change in your ability to carry out usual activities. With some exertion, you may notice:

By stage C, symptomatic heart failure, you will probably have significant limitations on the amount and intensity of any physical activity, according to the American Heart Association.

In addition to the symptoms common to stage B, individuals at stage C may also experience:

  • coughing
  • nausea
  • swelling in the lower extremities due to fluid buildup (this can also cause weight gain)

Stage C is often the point at which symptoms become too serious to ignore and at which point individuals often seek out medical attention if they haven’t already received a diagnosis.

Stage D, active heart failure, is associated with severe illness and hospitalizations. Symptoms such as shortness of breath occur even when you’re at rest.

Lying down flat is difficult to do without coughing. This is typically the stage at which you may talk with your doctor about surgery or other procedures.

When there is considerable congestion — the buildup of fluid and blood in the lungs — you may experience a dry cough. If fluid builds up in the abdominal cavity, liver, stomach, and intestines, you may experience bloating.

Congestive heart failure may cause problems in blood circulation and may also cause these less common symptoms:

  • feeling cold in your arms, hands
  • insufficient blood flow to the kidneys causes less frequent urination
  • reduced blood flow to the brain causes lightheadedness and/or confusion.

Managing congestive heart failure symptoms usually starts with making several key lifestyle changes to support better heart function. Among the tips suggested by the National Heart, Lung, and Blood Institute are:

  • maintaining a moderate weight
  • exercising regularly (your condition may require cardiac rehabilitation to learn how to exercise safely and effectively)
  • getting 7–9 hours of sleep each night
  • limiting or avoiding alcohol (if you drink)
  • managing stress through meditation or other relaxation strategies
  • quiting smoking (if you smoke)
  • reducing your sodium intake by buying low sodium products and limiting or avoiding added salt

When to talk with a doctor

When it’s an emergency, you may notice obvious symptoms, such as:

  • arrhythmia (change in your heart’s rhythm)
  • fainting
  • nagging cough
  • shortness of breath at rest
  • sudden and severe chest pain
  • swelling and weight gain of at least 2 or 3 pounds within 24 hours
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Your doctor may prescribe certain medications to lower your blood pressure and ease the workload of the heart. Doctors may prescribe some initial medications for congestive heart failure, which may include:

  • angiotensin converting enzyme inhibitors
  • angiotensin II receptor blockers
  • angiotensin receptor plus neprilysin inhibitors
  • beta-blockers
  • digoxin
  • diuretics
  • sodium glucose cotransporter-2 inhibitors

Sometimes, procedures are necessary to address structural problems in the heart or other conditions. For example, you may need an implantable cardioverter defibrillator to help maintain a steady heart rhythm if your heart failure has triggered an arrhythmia or if your heart function remains low even with optimal treatment.

What is usually the first noticeable symptom of congestive heart failure?

Often, the first sign of heart failure is shortness of breath that occurs from an activity you were able to do earlier with no problem, such as walking upstairs.

Do heart failure symptoms ever improve on their own?

You may notice some symptom relief in the early stages once you start exercising regularly, quit smoking, and lose weight. However, heart failure is a long-term (chronic) condition that requires a lifetime of treatment and symptom management. There is no “cure” for heart failure.

Do heart failure symptoms always worsen over time?

With proper treatment and a commitment to a healthy lifestyle, you may be able to preserve your heart health and avoid worsening symptoms for many years. The key is to work with your healthcare team and accept that congestive heart failure is a lifelong condition.

Congestive heart failure symptoms depend on the stage of the disease and your overall health. The sooner a doctor evaluates your symptoms, the sooner you can receive guidance about how to manage your heart failure through medications and lifestyle changes.

At some point, you may need surgery or devices to help preserve healthy heart function. But if you can get an early diagnosis and start down the road toward better heart health, you may be able to put off more invasive procedures necessary to address your congestive heart failure symptoms.