What Causes Heart Failure Symptoms? 

You are not alone if you’re living with heart failure. The CDC reports that there are 6.2 million people living with it and experience some common symptoms.2 Here is a list of some of the most common heart failure symptoms, followed by a pithy explanation of what causes them.

Why do I experience this symptom?

As a respiratory therapist and health blogger, I get asked a lot of questions. One question I often get asked is, “Why am I experiencing X symptom?” So, this post is more of an educational post to answer this question.

If you experience or have ever experienced these symptoms, this post will help you understand why they happen. For those who have never experienced these, we can just look at this as an informative post. That said, here are 6 potential heart failure symptoms and why they might occur.

Edema of lower extremities

This is swelling of your feet and ankles. It may be caused by other health conditions, but heart failure is one condition that may cause it.

Heart failure means your heart is a weaker muscle. It is unable to move blood through your blood vessels as it used to. So, mainly due to gravity, some fluid may accumulate in your feet and ankles. It may seep out of your veins and into nearby tissues. This causes swelling. Feet and ankle swelling is a common symptom of heart failure.2

Dyspnea on exertion

Common symptom

It’s a feeling of not being able to catch your breath when you exert yourself. This is the most common symptom of heart failure. Your heart is simply not strong enough to meet the metabolic needs of your body when you are exerting yourself.

Muscle needs

When you are exerting yourself, all the muscles of your body are working hard. To meet the metabolic needs of your muscles, your heart must pump harder and faster. This is necessary to give muscle tissue all the nutrients and oxygen it needs. With heart failure, your heart is simply not strong enough to do this job. So your tissues do not receive the extra oxygen they need, resulting in the feeling of not being able to catch your breath.

Catch your breath

The solution here is to stop and rest and catch your breath. Something that may help here is wearing supplemental oxygen when you are exerting yourself.4-5


It’s the feeling when you cannot catch your breath while lying flat. What causes this is a combination of a weaker heart and gravity. With heart failure, fluid may accumulate in your lower extremities, as described above. This is due to gravity. When you are lying flat, this fluid shifts to the lungs which makes you feel dyspnea when lying down. The solution here is to sit up straight. This may explain why some people with heart failure sleep with several pillows or in a recliner.4

Nocturnal cough

Here, you wake up in the middle of the night coughing. The cause here is the congestion of fluid in your lungs. It may irritate your cough reflex and trigger a cough that wakes you up. Similar to orthopnea, the solution here may be to sleep up on several pillows. Again, some will opt for sleeping in a recliner.4

Fatigue and/or weakness

It’s feeling tired during the day. This may be due to less oxygen getting to the muscles of your body. Of course, during the day, you are using your muscles to do your daily activities. Your heart must work harder to meet the metabolic needs of your muscles and may simply be incapable of meeting these demands. So, your muscles do not absorb enough nutrients. This can make you feel tired or weak.4-5

Less urine output

Some patients with heart failure may pee less often during the day. This may be due to less oxygen getting to your kidneys during the daytime. Interestingly, this is reversed when you are sleeping when you may experience increased urine output (you pee more frequently at night).

Gravity is the explanation given here as well. When you are sleeping and lying down, gravity causes blood to be distributed differently through your body. This causes your kidneys to become better perfused and the result here is more peeing at night. Of course, when you stand up during the day, you pee less often again.4

Researchers still learning

Listed above are symptoms that may be experienced by those who have heart failure. Researchers have postulated the above theories as to what may contribute to these symptoms. There are also other theories. The goal is that perhaps someday, this type of research will lead to better treatment for heart failure and perhaps even a cure.

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Heart-Failure.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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