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How do you feel with heart failure?

Heart failure is a chronic, progressive condition that affects millions of people worldwide. It occurs when the heart is unable to pump enough blood to meet the body’s needs. This can lead to a variety of distressing symptoms that can significantly impact quality of life.

What is heart failure?

Heart failure, sometimes referred to as congestive heart failure (CHF), occurs when the heart muscle is damaged or weakened and can’t pump enough blood to meet the body’s needs. This can happen for a variety of reasons:

  • Coronary artery disease – narrowing of the arteries that supply blood to the heart
  • High blood pressure – forces the heart to work harder
  • Heart attack – damages the heart muscle
  • Congenital heart defects – problems with heart’s structure from birth
  • Viral infections – can damage heart muscle
  • Excess alcohol use – weakens heart muscle over time
  • Arrhythmias – abnormal heart rhythms

When the damaged heart can’t pump strongly enough, blood can back up into the lungs, abdomen, and lower body, causing congestion. The body’s tissues don’t get enough oxygen and nutrients from the blood, which can cause fatigue and shortness of breath. Sometimes heart failure develops quickly, but more often it progresses gradually over time.

What are the symptoms of heart failure?

The most common symptoms of heart failure include:

  • Shortness of breath – occurs from fluid buildup in the lungs
  • Fatigue and weakness – results from inadequate blood flow
  • Swelling in the legs, ankles, feet, and abdomen – from fluid buildup caused by inadequate pumping
  • Rapid or irregular heartbeat – the heart tries to compensate for inadequate pumping
  • Reduced ability to exercise – tired and short of breath with exertion
  • Persistent cough or wheezing – from fluid buildup in the lungs
  • Difficulty concentrating or decreased alertness – from reduced blood flow to the brain
  • Appetite loss, nausea, and abdominal pain – from congestion in the digestive tract
  • Feeling dizzy or lightheaded – from inadequate blood supply to the brain
  • Chest pain – may feel like tightness or pressure in the chest

Symptoms are often mild at first but get worse as the condition progresses. Lying down flat can relieve shortness of breath and other symptoms.

How does heart failure feel day to day?

Living with heart failure can negatively impact your energy levels and ability to perform daily activities. You may experience:

  • Feeling extremely exhausted with minimal activity
  • Being short of breath from simple tasks like getting dressed or walking across a room
  • Waking up frequently throughout the night gasping for air
  • Trouble thinking clearly, poor concentration, and memory problems
  • Dizziness, weakness, and frequent falls
  • Needing to urinate frequently, especially at night
  • Loss of appetite, nausea, difficulty swallowing food
  • Depression, sadness, isolation from inability to do activities you enjoy
  • Anxiety about your condition getting worse or having a heart attack

As heart failure worsens, quality of life diminishes significantly. Even small amounts of activity can leave you exhausted. You may need assistance with daily self-care activities like bathing, dressing, and housework. Being unable to lay flat makes sleep very difficult.

What is a heart failure exacerbation?

Many people with heart failure experience periodic worsening of their symptoms known as an acute exacerbation or decompensation. Exacerbations can occur when:

  • You don’t follow your treatment plan
  • You eat foods high in sodium
  • You forget to take your medications
  • You don’t limit your fluid intake
  • You don’t weigh yourself daily to check for fluid retention
  • You develop a respiratory infection or the flu
  • Your heart failure worsens over time

Exacerbations cause more severe shortness of breath, coughing, edema, weight gain, and overwhelming fatigue. Hospitalization may be required for intravenous diuretics, oxygen, and additional medical treatment.

How does heart failure progress over time?

Heart failure is a chronic, progressive disease, which means it typically gets worse over time. There are four stages of heart failure:

Stage A

You have risk factors for heart failure but no structural damage to the heart.

Stage B

You have structural heart damage but no symptoms.

Stage C

You have structural heart damage and are experiencing symptoms of heart failure.

Stage D

You have advanced heart failure that does not respond adequately to standard treatments. You will likely experience severe, hard to control symptoms at rest or with any exertion.

Progression through these stages may be gradual or rapid. But over time, heart failure symptoms typically become more frequent and severe. More intense medical management is required at each successive stage to help delay further progression.

How does advanced heart failure feel?

In the end stages of heart failure, also known as advanced or end-stage heart failure, symptoms are severe even at rest. You may experience:

  • Overwhelming fatigue and exhaustion
  • Severe shortness of breath requiring oxygen
  • Frequent coughing spells
  • Little to no ability to exercise without distress
  • Fluid retention with weight gain, edema, and ascites
  • Nausea, loss of appetite, abdominal bloating
  • Impaired thinking and concentration
  • Increased urination at night
  • Irregular heartbeat, palpitations, and dizziness
  • Chest pain even at rest
  • Anxiety, depression, and hopelessness about the future

Performing basic daily living activities or self-care may be extremely difficult. You likely require assistance from caregivers. Hospitalizations may be frequent as your heart failure worsens.

How does heart failure affect quality of life?

Living with heart failure can profoundly impact quality of life. As the condition progresses you may experience:

  • Physical limitations – decreased exercise capacity, activity intolerance, exhaustion with minor exertion
  • Shortness of breath – difficulty breathing or catching breath even at rest
  • Disrupted sleep – inability to lay flat, frequent urination, breathing difficulty
  • Depression – from isolation, dependence on others, inability to work
  • Anxiety – about the unpredictable course of heart failure
  • Relationship strain – partners often become caregivers
  • Financial stress – from medical expenses and inability to work
  • Frequent doctor visits and hospital stays – disrupt normal routines
  • Dietary restrictions – difficulty adjusting to low salt, low fluid diet
  • Medication side effects – can contribute to fatigue and sexual dysfunction

Coping with worsening symptoms and loss of independence often takes a toll both physically and emotionally. Support from friends, family, and health care providers can help improve quality of life.

What is the life expectancy with heart failure?

The prognosis for someone with heart failure can vary greatly depending on the underlying cause and severity. But in general:

  • Mild heart failure: Life expectancy of 5-10 years if treated appropriately
  • Moderate heart failure: Life expectancy of 3-7 years with treatment
  • Severe heart failure: Life expectancy of 1-3 years even with treatment

Other factors that influence prognosis include:

  • Age – older adults have higher mortality rates
  • Ejection fraction – measurement of heart’s pumping ability
  • NYHA functional classification – ranks severity of symptoms
  • Kidney function – worse function increases mortality risk
  • Treatment compliance – following medication/diet instructions
  • Access to specialized heart failure care – improves outcomes

But with today’s medicines and devices, many people live for 10 years or longer after being diagnosed with heart failure. Your doctor can provide a more accurate estimate based on your individual condition.

What can you expect as heart failure progresses?

As heart failure worsens over time, you can expect:

  • Increasing shortness of breath, fatigue, and exercise intolerance
  • More frequent emergency care or hospitalizations
  • Higher doses or additional medications needed to control symptoms
  • Potential heart pump or transplant evaluation for end-stage heart failure
  • Increasing challenges performing normal daily activities
  • More dietary and fluid restrictions
  • Declining overall health and quality of life

Progression varies – heart failure may stabilize for periods of time with treatment and self-care. But it’s important to discuss your changing condition regularly with your doctor. Palliative care and hospice services can also help relieve suffering and improve quality of life as heart failure advances.


Living with heart failure can be extremely challenging, both physically and emotionally. As the condition progresses, worsening symptoms like fatigue, breathing problems, swelling, and exercise intolerance take a toll on your health and quality of life. Advanced heart failure may eventually lead to complete dependence on others. But following your treatment plan, maintaining a positive outlook, and utilizing available support services can help you manage symptoms and live well for as long as possible.