A normal, healthy heart is a very strong muscle that pumps blood throughout the body. The blood delivers necessary oxygen and important nutrients to tissues and organs.

With heart failure, the organ becomes progressively weaker. Over time, it loses its ability to pump enough blood to meet the body’s needs. In early heart failure, the heart tries to keep up with the body’s demands by:

• Getting larger
• Pumping faster
• Narrowing the blood vessels to increase blood pressure to try to get blood where it needs to go
• Diverting blood away from other organs so other parts of the body can have it

There are several kinds of heart failure. Some types have overlapping symptoms, some types can happen at the same time, and some types can lead to other types. This article covers the different kinds of heart failure:

• Left-sided heart failure
• Right-sided heart failure
• Congestive heart failure
• Congenital heart failure

As heart failure progresses, you may have more — and more severe — symptoms. The exact signs and symptoms of heart failure depend on the type of heart failure and how advanced it is.

Early Symptoms of Heart Failure

A person with early heart failure might not have any noticeable signs. When early symptoms occur, they can be subtle and easy to miss or ignore. Early signs of heart failure include:

• Shortness of breath, at first when you’re active and later even when you’re sitting or lying down
• Lowered ability to exercise or be active
• Confusion or forgetfulness
• Frequent fatigue, sleepiness or weakness
• Palpitations, or a fluttering feeling in your chest, as the heart pumps harder and faster

Without treatment, heart failure can worsen over time. Symptoms that were once mild can become increasingly more severe, and may prevent you from doing everyday tasks.

Left-Sided Heart Failure Symptoms

Most heart failure occurs in the left ventricle (the bottom left chamber of the heart). Left-sided heart failure can be systolic heart failure, when the ventricle can’t contract (squeeze) normally. Or it can be diastolic (heart failure with preserved ejection fraction), when the chamber is stiffer and can’t relax normally.

If the chamber can’t pump well, blood backs up in the blood vessels that carry oxygenated blood from the lungs to the heart. This backup leads to fluid accumulation in the lungs, which causes shortness of breath. Most people with left-sided heart failure first notice mild breathing difficulty only during exercise. Over time, people may experience shortness of breath when they are being less active and even when resting.

Other symptoms of left-sided heart failure include:

• Bluish color in the fingertips and lips
• Cough, which may bring up phlegm or mucus tinged with blood 
• Fatigue and weakness, even after resting 
• Rapid or irregular heartbeat (arrhythmia)
• Sudden, unexpected weight gain
• Swelling in the ankles, legs, feet and/or abdomen
• Trouble concentrating 

People with severe left-sided heart failure may experience orthopnea, shortness of breath when lying down. This troubled breathing is caused by fluid accumulating in the lungs when you lie down. You may wake up wheezing or gasping for air, called paroxysmal nocturnal dyspnea. Sitting up causes some of the fluid to drain to the bottom of the lungs, and makes breathing easier.

Right-Sided Heart Failure Symptoms

Right-sided heart failure happens when the right ventricle is too weak to pump enough blood to the lungs. Blood backs up in vessels that carry it from the body to the heart. This backup can push fluid out of the veins and into other tissues, causing swelling in these areas of the body:

• Ankles
• Belly
• Feet
• Genital area (groin)
• Internal organs
• Legs
• Lower back

This fluid buildup and swelling can cause additional symptoms, such as:

• Discomfort in the chest
• Frequent urges to urinate
• Loss of appetite
• Nausea
• Palpitations
• Shortness of breath
• Unexpected weight gain

Congenital Heart Failure Symptoms

Heart failure mostly affects older adults. But babies, children and young adults can develop heart failure due to a congenital heart condition (a heart condition present since birth).

Symptoms of heart failure in children and young adults may include:

• Coughing, wheezing or difficulty breathing
• Dizziness or fainting
• Excessive sleepiness
• Excessive sweating
• Failure to thrive (gain weight)
• Irritability due to pain or fatigue
• Rapid or irregular heartbeat or breathing rate
• Swelling in the belly, legs, ankles or feet
• Trouble keeping up with peers during physical activities
• Unexplained weight gain

What to Do If You Notice Worsening Heart Failure Symptoms

Heart failure can lead to serious complications, such as kidney or liver damage, other heart conditions, pulmonary hypertension and stroke. If you’re experiencing worsening symptoms of heart failure, keep track of them and talk to your doctor.

Seek immediate medical attention or call 911 if you experience:

• Cough that brings up a white or pink foamy substance
• Fainting, dizziness or confusion
• Nausea or loss of appetite
• New, sudden chest pain
• Rapid weight gain (2 pounds or more in a day, or 5 pounds or more in a week)
• Sudden, severe shortness of breath
• Sudden, severe weakness
• Swelling that has gotten significantly worse
• Very fast or irregular heartbeat