Clinical features
Right - sided and left - sided heart failure produce different symptoms and although both types of heart failure may co - exist, the features of one type of failure often predominates.
The main symptoms are as below:
- Breathlessness on exertion, breathlessness at rest and on lying down, wheeze, cough (known as “cardiac asthma”), coughing up blood and fatigue (all a symptom of left heart failure),
- Swelling (oedema) of legs, feet and ankles, discomfort in the abdominal area, nausea, loss of appetite, loss of weight and muscle (“cardiac cachexia”) and fatigue.
The breathlessness, or shortness of breath, is due to fluid building up in the lungs. In the early stages it occurs only on exertion but as the disease progresses it occurs with less and less exertion.
A person with severe disease may suffer from breathlessness on lying flat due to the shift in fluid to the lungs. Sudden flooding of the lungs may cause a condition called acute pulmonary oedema.
The swelling in the feet, ankles and legs is also known as oedema and is caused by the effects of fluid retention and gravity. The fluid accumulates, for example, in the lower limbs, especially the ankles because of the effects of gravity. However, if the person spends a lot of time lying down the fluid accumulation may be in the lower back area (known as the sacral area).
Patients with congestive heart failure may deteriorate progressively or suddenly and require hospital admission. Acute failure, which is a life threatening condition, may occur, for instance, after a myocardial infarction or heart attack).
A person suffering from chronic heart failure will usually walk slowly with evidence of breathlessness and fatigue.
Clinical signs
Clinical signs of heart failure include:
- Oedema or swelling of feet and ankles,
- Congestion noticeable in the veins,
- Blue extremities (peripheral cyanosis),
- Enlarged liver,
- Crackles, on listening to the chest,
- Fast heart beat (tachycardia),
- Fast respirations (tachypnoea),
- Outwardly displaced apex beat (of the heart), indicating an enlarged heart,
- Pleural effusion (water leaking from the lungs),
- Reduced peak flow reading.
