Congestive heart failure can be due to right heart failure or left heart failure. The clinical signs are related to the organs affected and to whether left or right heart failure is the origin of the abnormal function. There are several symptoms of congestive heart failure: dyspnea and cough, fatigue, paroxysmal nocturnal dyspnea, orthopnea, peripheral edema, right upper quadrant pain and cool skin.
Difficulty Breathing or Dyspnea and Cough
In left heart failure, when the heart fails to pump, the blood coming from the lungs gets back up in the lungs. Fluid accumulates in the lungs making it difficult for the lungs to exchange CO2 for O2. It becomes difficult to breathe. Difficulty breathing upon exertion that is with exercise or activity is common in congestive heart failure. It is also seen in people with lung disease. Worsening of dyspnea on exertion or dyspnea at rest is a major symptom of congestive heart failure. A persistant, dry cough may be present.
Fatigue/Lethargy
Fatigue is an early symptom of congestive heart failure. Since the lungs cannot function, little O2 is taken in and blood flow to the muscles is compromised, lactic acid builds up and one becomes easily fatigued. Difficulty walking the usual distance or difficulty climbing the usual amount of stairs or difficulty engaging in the usual amount of activity is common in congestive heart failure. In severe congestive heart failure, blood flow and perfusion of the brain is compromised and confusion and lethargy are seen.
Paroxysmal Nocturnal Dyspnea
Waking after about one to two hours of sleep short of breath is called paroxysmal nocturnal dyspnea, or PND. It is usually related to being horizontal at night and is associated with pulmonary edema and congestive heart failure. It occurs suddenly at night and is related to fluid redistribution.
Orthopnea
When the patient breathes better sitting up or standing this is called orthopnea. Orthopnea is caused by the increase venous return. The patient often sleeps with several pillows or in a chair. Orthopnea is even more specific finding in congestive heart failure than is dyspnea.
Peripheral Edema: Ankle Swelling and Weight Gain
When the heart cannot pump the blood, blood gets backed up and fluid seeps out into the tissues of the dependent areas, that is, the legs and the feet. This swelling called peripheral edema is a common sign of congestive heart failure. Right heart failure can present as ascites (abdominal fluid accumulation) liver distention and right upper quadrant pain and loss of appetite. Accumulation of fluid can result in an increase in weight. This symptom may or may not be present.
Right Upper Quadrant Pain
When the blood from the lower extremities flow toward the liver and the blood from the inferior vena cava cannot flow through the heart properly because the heart is not pumping well, the liver becomes engorged with blood that is backed up from the heart. This engorgement can sometimes cause the liver to swell and stretch the capsule surrounding the liver and causes pain.
Cool Skin
The skin becomes cold and clammy when the body, trying to keep the blood pressure up, which is often low because the heart cannot pump the blood around well, vasoconstricts the non- core or peripheral blood vessels. Warm blood no longer flows as easily through the vessels of the skin. The skin becomes cool.
