Heart failure (also known as congestive heart failure) can reduce your life expectancy and increase your chances of suffering a sudden cardiac arrest, which is why it’s important to be able to recognize symptoms of heart failure getting worse.
If you have been diagnosed with pre-heart failure (stage A or B) or heart failure (stage C or D), you should familiarize yourself with signs that your condition is worsening. If you do notice any of the signs, the time to take action is now.
Heart Failure Can Worsen Before You Even Know You Have It
Heart failure, or the inability of the heart to pump blood effectively around the body, affects around 6.2 million adults in the United States[mfn]cdc.gov[/mfn].
As this condition typically begins without symptoms, many adults may have heart failure without even realizing it. Over time, the condition can worsen until symptoms appear or you suffer a heart attack. Once the condition becomes acute or chronic, heart failure can lead to death within a matter of years[mfn]ncbi.nlm.nih.gov[/mfn].
Pre-Heart Failure (Stages A and B)
In the earliest stages of congestive heart failure (stages A and B), patients are in what’s known as “pre-heart failure” and continue to feel normal. However, it’s possible to progress to chronic heart failure and then advanced heart failure if steps aren’t taken to treat the condition.
Stage A
Stage A (pre-heart failure) describes people who have not been diagnosed with systolic left ventricular dysfunction and don’t have any symptoms of heart failure but are at high risk for developing the condition. The most common risk factors include:
- Coronary artery disease
- Congenital heart disease
- High blood pressure
- Heart attack
- Diabetes
- Obesity
- Metabolic syndrome
- History of alcohol abuse
- History of smoking tobacco
- History of rheumatic fever
- History of taking cancer drugs, including chemotherapy and radiation
- A family history of heart failure or cardiomyopathy
If you have any of these risk factors, it’s essential to follow all of the dietary and lifestyle advice given to you by your healthcare provider and have an echocardiogram to rule out progression to stage B. You may be prescribed medications to treat high blood pressure or high cholesterol, directed to start (or increase) your exercise routine, and advised to follow a healthy, low-sodium diet to prevent you from developing high blood pressure and heart failure.
Stage B
In stage B, patients still don’t have any of the symptoms of heart failure. An echocardiogram shows that they have an ejection fraction of 40% or less, and they are subsequently diagnosed with systolic left ventricular dysfunction. While this is still not a heart failure diagnosis, people with stage B heart failure will typically need to take medications, make lifestyle changes, and monitor changes in their fluid and weight.
Heart Failure: Stages C and D
In stages C and D, sufferers have a reduced ejection fraction that’s typically at 40% or less. As the heart fails to pump blood effectively around the body, the person can experience fluid buildup in the lungs along with several other symptoms, including:
- Shortness of breath
- Fatigue
- Leg weakness during exercise
- Swelling in the legs, ankles, and belly
- Weight gain
- Needing to get out of bed to urinate
- Heart palpitations or an irregular heartbeat/abnormal heart rhythms
- A persistent cough
- Bloating or hard stomach
- Nausea, loss of appetite, and/or losing weight
Stage C
In stage C, symptoms will typically come and go. The patient may need a biventricular pacemaker to maintain the correct cardiac synchronization or have an implantable cardiac defibrillator placed to reset their heart if they go into sudden cardiac arrest.
Stage D
Stage D is the last stage of heart failure. The person will typically experience heart failure symptoms much more frequently, more severely, or experience more symptoms from the list.
Patients with stage D heart failure may be offered advanced therapies to treat heart failure, including:
- Heart surgery
- A ventricular assist device
- A heart transplant
- Continuous intravenous infusions
- Hospice care
- Experimental therapies
Stage C and D with Preserved Ejection Fraction
It’s possible to have chronic heart failure with a preserved ejection fraction, meaning that the ejection fraction is normal (at or above 50%) but there is high left ventricular filling pressure. People with HF-pEF still need to have heart failure treated but may not need all of the treatments and medications. The most important thing is to treat any underlying conditions to prevent the condition from getting worse.
Common Symptoms of Heart Failure Getting Worse
If you are in pre-heart failure or have a heart failure diagnosis, diagnostic tests and symptomatic changes may indicate that the condition is getting worse.
Diagnostic Testing
Diagnostic tests are used to determine whether you have heart failure, how it’s progressing, and what possible causes might be aggravating it. If you start to experience symptoms of heart failure or your current symptoms are worsening, your healthcare provider may suggest any of the following tests:
- Echocardiogram
- Electrocardiogram (ECG or EKG)
- Magnetic resonance imaging (MRI)
- Multigated Acquisition Scan (MUGA scan)
- Chest X-ray
- Blood test
- NT-pro B-type Natriuretic Peptide (BNP) blood test
- Cardiac catheterization
- Stress test
New or Worsened Symptoms
The presence of any of the symptoms of heart failure typically indicates that pre-heart failure (stage A or B) has developed into a heart failure diagnosis (stage C or D). If you have any of the risk factors, left ventricle dysfunction or left-sided heart failure, you should get tested for heart failure as soon as possible.
For those who already have a heart failure diagnosis, your condition may be worsening if:
- You develop symptoms of heart failure that you didn’t previously have.
- Your existing symptoms of heart failure are getting worse or occur more frequently.
- You experience a rapid weight gain of 5 pounds or 2.3 kilograms over a few days.
What to Do if You Think Your Heart Failure is Getting Worse
If you develop a new symptom or an existing symptom worsens, it’s important to contact your doctor right away so you can be treated medically. The doctor may order more tests, find out possible contributions to the decline, and recommend medications or lifestyle changes as necessary.
Many of the symptoms of heart failure could be symptoms of something else, which is why it’s so important to have tests performed if you present with any of the symptoms of heart failure.
Severe Symptoms You Should Never Ignore
Call 9-1-1 in the United States or go to the emergency room immediately if you experience any of the following symptoms:
- Chest pain
- Severe weakness
- Fainting
- Sudden shortness of breath
- Irregular or rapid heartbeat together with chest pain, fainting, or shortness of breath
- Coughing up foamy mucus, either white or pink
Any or all of these symptoms could indicate the need for urgent treatment. Some treatments may include intravenous medications, surgery, or defibrillation with an automated external defibrillator if you go into sudden cardiac arrest. In the hospital, your condition can be stabilized, diagnostic tests performed, and a specialized regime developed for your optimal treatment.
Recognizing Symptoms of Heart Failure Getting Worse in Someone Else
If you don’t personally have heart failure but want to help your family, friends, or people in your community, it may be possible to recognize heart failure symptoms in someone else and guide them to seek medical assistance.
The telltale signs of a medical emergency due to heart failure are the emergency symptoms listed above (chest pain, shortness of breath, fainting, coughing up foamy mucus). If you notice any of these symptoms and the person is still conscious, remain with them, keep them calm, and call 9-1-1. Because a cardiac arrest can occur at any time, it’s also wise to invest in a high-quality AED, like the Philips HeartStart FRx or ZOLL AED Plus. Hopefully, you’ll never have to use it, but if you do, you’ll be forever grateful to have it close at hand.
If you see someone collapse suddenly and/or stop breathing normally, call 9-1-1, send someone to get an automated external defibrillator, and commence chest compressions immediately. It’s possible that this person has gone into sudden cardiac arrest and needs compressions to keep oxygen-rich blood circulating through the body until emergency medical services arrive.
Prevention Is Better than Cure
While you can’t reverse pre-heart failure, you can prevent (or delay) progression to the next stage. Getting an early diagnosis, following a healthy lifestyle and diet, maintaining a healthy weight, and taking all medications as directed can help prevent or slow the progression of the disease.
If you know someone with pre-heart failure or heart failure, you can help by encouraging them to follow the diet, exercise, and medications prescribed by their doctor.
Finally, you can help reduce mortality from heart failure and cardiac arrest by taking a CPR and AED training course. You never know when someone around you might go into sudden cardiac arrest, and your timely action could save their life.
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