The classic symptoms of heart failure don't always seem clearly linked to the heart. Swollen ankles, for example, might seem an unlikely sign of heart problems. But, the heart's impact - for better or worse - is on the whole body. The network of arteries and veins link the farthest corners of the body to this life-giving organ. No single symptom is the key to recognizing it - a cough may be just be a cough - but a tell-tale grouping could signal heart failure.

A list of heart failure symptoms
Here are the most common symptoms of heart failure:

• Shortness of breath, especially during activity or when lying down
• Fatigue or tiring easily
• Swelling of feet, ankles, legs and, occasionally, the abdomen
• Weight gain
• Cough, raspy breathing or wheezing
• Poor appetite, unexplained weight loss
• Problems concentrating, staying alert

Because heart failure usually develops slowly, the symptoms may not appear until the condition has progressed.

What do the symptoms mean?

Shortness of breath.The left atrium of the heart receives blood from the lungs. Then, the left ventricle pumps it out to the body. If the left side of the heart can't pump well, blood coming in from the lungs may back up. This can make it hard to breath. Fluid buildup in the lungs is called pulmonary congestion or pulmonary edema. When it occurs because of heart failure it's called congestive heart failure.

Fatigue. Lots of illnesses can cause fatigue. But in heart failure, the weak heart pump can't supply your vital organs with enough blood and oxygen. The body diverts blood to the most important organs - the heart and brain - and less gets to your muscles. Oxygen is needed for all organs and all of your body's tissues to work well.

Swelling.The right side of the heart receives used blood from the body and sends it to the lungs for oxygen.When the right side can't pump well, blood backs up in the body's veins. This causes swelling in the legs, feet and ankles and abdomen.

Weight gain. When the heart doesn't pump well, fluid builds up in the tissues throughout the body. This can lead to weight gain.

Cough. In left-sided heart failure, fluid builds up in the lungs. Along with shortness of breath, this can cause a persistent cough. As heart failure gets worse, you may cough up pink or blood-tinged mucus. Coughing may be worse during activity or when lying down.

Weight loss. The weak heart pump results in not enough blood being pumped to the body's organs, including the digestive system. This can cause problems with appetite and digestion and may lead to weight loss. Also, fluid buildup in the abdomen can make you feel full or bloated. In severe or late stage heart failure, poor oxygen and blood flow cause a cascade of hormonal and metabolic problems that lead to wasting away of body tissues, especially muscle tissue. This serious complication is called cardiac cachexia.

Problems concentrating. Poor blood flow to major body organs, including the brain and kidneys, can cause trouble concentrating and staying alert. When the kidneys don't get enough blood flow they don't work properly. This can lead to a change in the amount of different substances in the blood, which can impair thinking.

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External Sources American Heart Association. Signs and symptoms of heart failure. . Accessed November 06, 2008 Heart Rhythm Society. Heart failure.. Accessed November 07, 2008 Heart Failure Online. Symptoms and signs. . Accessed November 07, 2008 Givertz MM, Colucci WS. Heart failure. In: Noble J, Green HL, Levinson W, et al, eds. Textbook of Primary Care Medicine. 3rd ed. St. Louis, MO.: Mosby, Inc.; 2002.

This article was reviewed and updated 08-01-2009.