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Cardinal Signs of Heart Failure

By Chris Collora ; Updated August 14, 2017

Congestive heart failure is characterized by complications involving the bottom left and bottom right heart chambers. Often, it is a sign of severe heart disease and considered a terminal illness. Patients in advanced stages of heart failure have a 40 to 50 percent chance of surviving the disease, explains Dr. David D. Shocken, author of a 1992 article called Prevalence and Mortality Rate in Congestive Heart Failure in the United States published in the "Journal of the American College of Cardiology." Knowing the cardinal signs and symptoms of congestive heart failure is important in discovering the disease early on to prevent death.

Shortness of Breath

The medical terminology for shortness of breath is dyspnea. According to Dr. Michael H. Crawford, author of the 2007 textbook "Current Diagnosis and Treatment in Cardiology," it is the first and most frequent sign of congestive heart failure. Physical activity usually triggers dyspnea in persons suffering from this condition. As heart failure worsens, the intensity of physical activity that initiates dyspnea decreases. Left untreated, congestive heart failure will start to cause dyspnea at rest.


Fatigue and weakness, especially in the arms and legs, are other common symptoms of heart failure. This is due to reduced output of blood from the heart and subsequent poor circulation in the limbs. Fatigue and weakness can occur at rest or during physical activity and may become worse after eating due to the increased demand of blood flow to the stomach to aid digestion.

Nocturia and Oliguria

Nocturia, a frequent and early sign of heart failure, occurs when the kidneys do not receive adequate blood flow. The result is waking up frequently during sleep to urinate. Oliguria is marked by a significant decrease in production of urine associated with reduced output of blood from the heart. This condition may be an indication of severe heart failure, according to Crawford.

Abdominal Symptoms

Heart failure patients may experience gastrointestinal discomfort as a result of fluid retention in the abdomen and abdominal organs such as the liver. This abdominal discomfort is normally described as a general achiness or heavy feeling and is caused by stretching of the abdomen and organs from water retention. As Crawford points out, a recent increase in waist size or clothes feeling tighter around the waist may possibly be related to heart failure.

Cerebral Symptoms

Cerebral symptoms such as confusion, memory loss, headaches, anxiety, insomnia and hallucinations may be present in older patients with advanced heart failure, explains Crawford. These symptoms are associated with reduced blood flow from the heart and subsequent poor circulation of blood to the brain.

Dry Cough

A dry cough that does not produce any mucus may be present in patients with congestive heart failure. This is caused by lung congestion that occurs with heart failure. In addition, some of the medication used to treat heart failure can also lead to coughing, notes Crawford.

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