More than 6 million Americans are living with heart failure. Unfortunately, the first symptom of heart failure can be a serious event like a heart attack or stroke.

But there may be more subtle signs that you can watch out for. Keeping alert for the early symptoms of heart failure can help you get the treatment you need sooner in order to prevent serious complications.

It’s important to speak with your doctor if you notice the early symptoms of heart failure. In this article, we’ll go over what they are, and cover the risk factors for developing this condition.

Most of the common symptoms of heart failure are also associated with other conditions.

But if you have any symptoms that are recurrent or persistent, or if you have two or more common early signs of heart failure, it’s a good idea to seek medical care. A medical professional can assess your symptoms and determine if heart failure is the cause.

Common early symptoms of heart failure include:

  • shortness of breath
  • difficulty exercising
  • fatigue and weakness
  • swelling and weight gain
  • dry cough
  • unexplained weight gain
  • trouble sleeping, or sleeping on extra pillows
  • waking up at night short of breath
  • loss of appetite or nausea
  • heart palpitations

Next, we’ll explain a bit more about why each of these symptoms can be caused by heart failure.

Shortness of breath

There are many reasons you could be experiencing shortness of breath. While it’s common to be short of breath after intense activity, it’s more of a concern when there’s no apparent cause, occurs with minimal exertion, or happens when you’re at rest.

Heart failure leads to shortness of breath because your heart can’t keep up with the blood supply coming in from the lungs. This causes it to back up in the pulmonary veins into the lungs, which can lead to breathing trouble.

Heart failure can also cause shortness of breath due to increased pressure inside the heart. This happens more when the heart is beating fast and has less time to relax.

Fatigue and weakness

Feeling tired and run down over an extended period is called fatigue. Sometimes, it can be caused by things like allergies or colds, which can resolve quickly. But fatigue can also be caused by chronic conditions like heart failure.

Fatigue happens in heart failure because there’s less oxygen-rich blood getting to your organs to keep up with demand. This means that the heart is working harder to circulate your blood.

Swelling and weight gain

Your feet, ankles, and abdomen are all areas of the body that can swell. It’s possible to have some swelling after a workout or on a very hot day. When swelling occurs, it’s called edema.

Edema happens in heart failure because your kidneys aren’t able to properly filter sodium. Your heart then releases chemicals that cause the body to hold onto fluid. You might notice that your clothes or shoes no longer fit right, or that you’ve gained weight unexpectedly or quickly.

Frequent dry cough

Many things can lead to a cough, but the cough you experience with heart failure will be noticeably different from those from allergies, colds, or the flu.

When a cough is caused by heart failure, you might have a lasting dry, hacking cough. You may even begin to cough up pink, frothy mucus.

Heart failure can cause chronic coughing because fluid has backed up in your lungs.

Trouble sleeping

It’s normal to have trouble sleeping from time to time. Acute insomnia can be caused by many common factors. If you have trouble sleeping for least 3 days per week for at least 1 month, there may be a bigger reason.

When you’re having trouble sleeping due to heart failure, you also might be uncomfortable lying flat. A 2015 study found that lying on your back (face up) was associated with poorer blood oxygenation, respiratory mechanics, and blood movement when compared to sitting.

Loss of appetite or nausea

You might not feel very hungry when you’re experiencing heart failure. You might also feel nauseous more often than normal.

Heart failure can cause these symptoms for the same reason it can cause fatigue. This can be due to “poor forward flow” or congestion of the organs with extra fluid.

Heart palpitations

With heart palpitations, you might feel like your heart is racing, pounding, fluttering, or skipping. When you feel your own pulse in your neck or wrist, it’ll feel much faster than normal.

This happens with heart failure because your heart isn’t getting as much blood as it needs. Your heart weakens without enough blood, causing it to beat faster.

There are several risk factors for heart failure. Any one of these risk factors can lead to heart disease. Your risk goes up when you have a combination of factors.

The risk factors for heart failure include:

  • High blood pressure. High blood pressure causes your heart to work harder, eventually making it weaker and not able to work effectively.
  • Obesity. Obesity carries many health risks, including an increased risk for heart failure.
  • Arrhythmias. Irregular heartbeats, called arrhythmias, can weaken your heart and lead to heart failure.
  • Excessive alcohol. Long-term alcohol misuse can weaken your heart and cause heart failure.
  • Smoking. Like obesity, smoking can lead to many health issues, including heart failure.
  • Sleep apnea. Sleep apnea prevents you from getting enough oxygen during the night, which can increase your heart rate and lead to heart failure.
  • Diabetes. Diabetes can raise your blood pressure and cause microscopic damage to the heart, which can lead to heart failure.
  • Coronary artery disease. In coronary artery disease, your arteries narrow and don’t bring enough blood to the heart. Over time, this can weaken your heart and cause heart failure.
  • Congenital heart disease. Heart conditions you’re born with are called congenital heart disease and can lead to heart failure.
  • Certain medications. Some medications, including those for diabetes, blood pressure, psychiatric, and cancer, as well as certain over-the-counter medications, can cause damage to your heart. Talk with your doctor about any medications you take to make sure you know about any possible increased risk of heart disease.
  • Previous heart attack. A heart attack can damage your heart and lead to heart failure.
  • Viral infection. Viral infections can damage your heart muscle and cause heart failure.

The first sign of heart failure can often be an emergency event, like a heart attack. But there are some signs and symptoms that can appear earlier that you can watch for.

It’s a good idea to tell a medical professional right away if you notice any signs of heart failure, especially if you have increased risk factors for heart disease. Early treatment can prevent serious complications and improve your outlook.