Symptom Management

Heart failure is a progressive condition. Its effects are highly variable, and the condition is often not diagnosed until symptoms occur and people seek medical attention. 

As the condition progresses, there may be changes to the structure and function of your heart. These changes may be easy to notice or happen in small steps over time. You may not recognize the presence or severity of symptoms as they develop.

That’s why it’s critical to be aware of the symptoms of heart failure and its effects on your day-to-day life. 

Your family or friends may notice changes in your health before you do. It’s important to make sure they are also aware of the symptoms of heart failure – especially if they are involved in your care.

What Symptoms Should I Track?

Your healthcare team will advise you on which heart failure symptoms to monitor. The most common things to monitor:

  • Any shortness of breath. 
  • Your energy level and ability to perform your regular activities.
  • Your pulse rate and if you experience heart palpitations and/or racing or throbbing heartbeats.
  • Your daily weight and whether you gain more than two pounds in a 24-hour period or more than five pounds in a week. Make sure you understand how much weight gain your doctor considers to be a problem for you.
  • Any swelling (or worsening swelling) in your ankles, lower legs, feet, or stomach.
  • Feeling confused, dizzy, or lightheaded.
  • Having problems with your memory or with thinking clearly.

Your care team may also ask you to keep track of other factors, such as your appetite, diuretic use, or sleeping ability. If you’ve been prescribed oxygen, your doctor may ask you to keep track of how much you’re using


How can I help manage my symptoms?


Breathlessness is the feeling of not being able to catch your breath. It is also called “shortness of breath”. It is a common feeling, and can occur during activity, while resting, or even while sitting or lying down. Sometimes it gets worse when a person lies down flat.

Why it happens: The heart needs to pump blood from the lungs to the body. Fluid backs up into the lungs, making it difficult to breathe. Breathlessness can be a frightening sensation. Feelings of panic can make the breathlessness worse, leading to a vicious cycle.

What Can Help
  • Increasing “water pills” (diuretics) that help eliminate extra fluid through urine
  • Oxygen
  • Breathing exercises can help decrease the feeling of breathlessness and panic
  • Managing fluid intake
  • Other medications, such as opioids*, that help reduce the feeling of breathlessness.

*Speak with your doctor before adjusting your medications.


Fatigue is weakness or feeling tired more easily.

Why it happens: In heart failure, the heart cannot pump enough blood to the organs and muscles of the body. When the muscles and organs of the body don’t get enough blood, a person tires more easily and feels fatigued (tired and weaker).

What Can Help

Learn how to conserve your energy to build up your strength for daily activities and other things you enjoy. Practice the 4 Ps to conserve your energy: Prioritize, Plan, Pace, and Position.

  • Prioritize: Decide what’s most important and focus on that first
  • Plan: Plan ahead to avoid extra trips and alternate between heavy and light tasks
  • Pace: Maintain a slow and steady pace, resting before you feel tired. Listen to your body and know your limits
  • Position: Sit when you can. Avoid bending and reaching too much as they can cause fatigue and shortness of breath

Click here to learn how to conserve energy


Swelling means that a person’s feet, ankles, legs or abdomen will have more water in them and become swollen. They may feel heavy and painful. This may be at its worst at end of day or after sitting a long time.

Why it happens: Swelling means that a person’s feet, ankles, legs or abdomen will have more water in them and become swollen. They may feel heavy and painful. This may be at its worst at end of day or after sitting a long time. The heart is weakened and cannot pump blood effectively around the body. Since the blood can’t go forward from the heart, fluid backs up behind the heart into both the lungs and the body. Without enough blood going to the body, organs such as the kidneys can suffer. When the kidneys aren’t working well, a person is less able to make urine and get rid of extra fluid. Fluid pools in lower areas due to gravity. This can cause weight gain, mobility problems, and fatigue.

What Can Help
  • Managing (decreasing) fluid Elevating the legs and salt intake. Follow any instructions from your healthcare team
  • Increasing “water pills” (diuretics) to try and help your kidneys get rid of extra fluid
  • Elevating the legs


Click here to learn more about managing your fluids



Pain can happen in the chest or be experienced as general body aches and weakness. Chest pain can feel like tightness, cramping, or aching. There can also be general body ache and weakness.

Why it happens: There are many reasons why people have pain. They may have chest pain from heart disease or pain from other common symptoms such as arthritis. There can also be general body aches and weakness.

What Can Help
  • Acetaminophen*
  • Coping strategies like distraction, attention focusing, and imagery
  • If pain is more severe, low dose opioids**

**DO NOT TAKE anti-inflammatory medications, such as ibuprofen (Advil), naproxen (Aleve), or acetylsalicylic acid (Aspirin) for pain or fever. Low-dose aspirin for cardiovascular protection is okay if prescribed.

**Please speak with your doctor before adjusting your medications

Nausea and changes in appetite

You, your family member, or care recipient may experience feelings of nausea or a decrease in appetite. They may not feel hungry, eat less than they used to or feel full after eating just a small amount of food.

Why it happens: The heart is not pumping as well as it used to, causing fluid to build up in and around the stomach and intestines. This will make a person feel bloated and less hungry. There is less blood flow to the digestive system as well, making it harder to digest food. Lastly, some medications can cause nausea.

What Can Help

  • Focus on eating things they enjoy. Eat small amounts more frequently
  • Do not force yourself or your care recipient to eat
  • Sometimes a prescription medication called metroclopramide can relieve this symptom


Confusion means that it becomes harder to think clearly or remember things.

Why it happens: Heart failure means less blood is being pumped to the brain. Toxins can stay in the body longer because the kidneys can no longer get rid of them. Both these things can lead to confusion.

What Can Help
  • Provide a calm, quiet environment that is well-lit during the day
  • Ensure any hearing or visual aids are easily accessible
  • Talk to your family member to keep their mind active (for example, remembering the past)
  • Keep visitors to a minimum to prevent overstimulation
  • Install a night light in bathrooms or hallways. Try to have regular sleeping
  • Encourage activity if you or your care recipient is physically able

Managing Advanced Heart Failure Symptoms

Illustration of a house in the shape of heart, with people inside rooms completing daily tasks
Advanced heart failure can cause many symptoms. Our new guide Living with Advanced Heart Failure: Coping with Symptoms and Uncertainty will help you identify and manage symptoms such as:

• Breathlessness
• Fatigue
• Swelling
• Pain
• Nausea and changes in appetite, and
• Anxiety and depression