Heart failure can get worse gradually. When your symptoms change slowly, you might adjust your routine without realizing how much you’re limiting your activity.
But if your symptoms are getting worse, it could mean that your heart is having more trouble keeping up. Visiting your provider to talk about what’s going on, can help you get the care you need before a crisis happens.
Signs your heart failure may be getting worse
If heart failure is getting worse, you may notice:
- More shortness of breath during your normal activities
- Shortness of breath at rest
- Trouble lying flat or needing more pillows to sleep comfortably
- Waking up short of breath
- Swelling in your feet, ankles, legs or belly
- Sudden weight gain from fluid retention
- More fatigue or weakness
- Dizziness, lightheadedness or fainting
- Nausea or less appetite than usual
- Coughing or wheezing that does not get better
- Taking more breaks during routine activities
“Some of these are little symptoms that people ignore,” said Radha Gopalan, MD, a heart failure cardiologist with Banner - University Medicine.
What advanced heart failure can look like
With advanced heart failure, your quality of life may feel poor. Signs can include:
- Medications not controlling symptoms as well as they used to
- Symptoms that happen with less activity than before or at rest
- Severe shortness of breath, swelling, fatigue or weakness that limits your daily life
- Trouble with tasks like showering, dressing, walking across the room or climbing a few stairs
- Hospital visits more than once a year
- Low blood pressure that makes it hard to take the medication doses you need
- Abnormal heart rhythms (arrhythmias)
- Dysfunction in other organs, like the kidneys or liver
Why hospital visits are an important warning sign
Frequent hospitalizations for heart failure, such as needing overnight care more than once a year, can mean your current plan isn’t working well enough.
After any heart failure hospitalization, you should ask your care team about advanced support options. Advanced heart failure teams can review your medications, devices, rhythm issues, valve problems, fluid management and other care options.
What does low ejection fraction mean?
Your ejection fraction shows how much blood your heart is pumping out with each beat. If your ejection fraction is low, it can mean your heart is not pumping strongly.
The ejection fraction is measured as a percentage. Above 55% is normal, while less than 35% is severe.
It’s possible to have heart failure symptoms even with a normal or near-normal ejection fraction. Symptoms and quality of life matter too.
If your ejection fraction is low despite treatment or other symptoms are impacting your life, ask whether advanced support could help.
What does functional class mean?
Heart failure is classified at levels 1, 2, 3, 3B and 4. Higher levels mean heart failure is worse. If your functional class is 3, 3B or 4, talk to your cardiologist about care for advanced heart failure.
When to call your provider
Call your heart failure care team right away if you:
- Gain weight suddenly
- Have worsening swelling
- Are more short of breath than usual
- Need more pillows to sleep
- Feel dizzy, weak or faint
- Cannot take your medications as prescribed
- Have side effects that are new or getting worse
- Were recently in the hospital for heart failure
- Have symptoms that are limiting your daily life more than they used to
What advanced heart failure support may include
Your advanced heart failure team may:
- Review your symptoms, medications and test results
- Adjust or optimize your medications
- Check to see if side effects are limiting your treatment
- Review any heart rhythm, device or valve issues
- Order advanced imaging or testing
- Offer support for fluid management and lifestyle changes
- Recommend cardiac rehab or activity guidance
- Discuss advanced options, such as an artificial heart, LVAD, other types of mechanical circulatory support or transplant evaluation
- Suggest palliative care for symptom relief and quality of life, when appropriate.
“There’s no harm in having a consultation with an advanced heart failure specialist early,” Dr. Gopalan said. But if you wait too long, you might not qualify for certain life-saving treatment options.
When to get emergency care
Call 911 or go to an emergency department for:
- Severe trouble breathing
- Chest pain or pressure
- Fainting
- Confusion
- Blue lips or face
- A fast or irregular heartbeat with severe symptoms
- Sudden weakness, face drooping, speech trouble or stroke symptoms
Bottom line
Heart failure can change over time. Your care plan may need a closer look if shortness of breath or swelling are getting worse, you need care in the hospital or you are struggling with everyday activities.
Ask your cardiologist whether advanced heart failure support may help. If so, Banner Health providers can review what is happening, adjust your treatment and recommend options that can improve your symptoms and quality of life.
FAQs about advanced heart failure
How do I know if heart failure is getting worse?
Heart failure may be getting worse if you are short of breath, swelling more, gaining fluid weight, needing more pillows to sleep, feeling weaker or needing more hospital care.
What is advanced heart failure?
Advanced heart failure means regular treatments are not controlling symptoms well enough and daily life, hospital visits or quality of life are being affected.
Does advanced heart failure mean I need a transplant?
Not always. Advanced support may include medication changes, more testing, device evaluation, symptom management or other options. Transplant evaluation is only for some patients.
Why do hospital visits matter with heart failure?
Hospital visits can mean symptoms are not controlled well enough. If you have been hospitalized for heart failure, ask whether you need advanced heart failure support.
What does low ejection fraction mean?
Low ejection fraction means the heart is pumping out less blood than expected with each beat. It is one factor providers use to guide heart failure care.
When should I go to the ER for heart failure symptoms?
Seek emergency care for severe shortness of breath, chest pain, fainting, confusion, blue lips or face, severe irregular heartbeat symptoms or stroke symptoms.
