How Do I Recognize Heart Failure Exacerbation?

Your loved one has heart failure and their symptoms have suddenly worsened. It may just be a bad day, but it could be an exacerbation.

Helpful Highlights

  • Understand how heart failure exacerbation happens and what to look for.

  • Learn how you can help your loved one during a heart failure exacerbation.

  • Know when to call the provider or call 9-1-1.

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What can you do for your loved one?

You can do a lot to help reduce the risk of exacerbations.

  • Help your loved one stay on the prescribed HF treatment plan

  • Assist your loved one to avoid items that contribute to fluid overload

    • Salty foods like anything canned, fast food, pizza, ham and deli slices, and processed foods, including cheese

    • Adding table salt to foods

    • Not taking diuretic medications ("water pills") appropriately

    • Drinking too much fluid (if your loved one is on a fluid restriction)

  • Observe for subtle changes in demeanor or physical well-being and ask your loved one questions about what they're experiencing

  • Encourage your loved one to speak openly with you, their primary care provider, and their cardiologist (if referred)

  • Ask providers about treatment options

  • Ensure your loved one has all the medications they need and knows how to take them as prescribed

  • Encourage the use of as-needed medications at the first sign of increased symptoms

  • Ensure everyone washes their hands frequently

  • Help your loved one to practice breathing exercises, relaxation, and body positioning techniques

  • Call the primary care provider if you notice signs and symptoms that are difficult to manage

  • Coordinate and assist with follow-up appointments with providers and therapists

Signs and Symptoms

What are the signs and symptoms of potential HF exacerbation?

Symptoms of possible HF exacerbation can include one or more of the following:

  • Severe weakness

  • Fainting

  • Increased shortness of breath when performing usual activities, lying down or sleeping

  • Persistent cough or wheezing

  • Cough with white or pink, frothy mucus 

  • Feeling full after only eating a few bites

  • Rapid weight gain due to fluid retention (2 lb. overnight or 5 lb. in a week) 

  • Bloating or swelling in the stomach

  • Swelling in the lower legs, ankles, or feet

  • Rapid or irregular heartbeat

  • Chest pain

If you experience any of the above symptoms, call the provider right away.

High Sodium (Salt)

What causes an HF exacerbation?

The most commonly identified cause of HF exacerbation is excessive sodium (salt) intake, which causes excess fluid retention. 

An HF exacerbation can be triggered by many factors, however, such as high salt intake, lung infections, certain medications, or not taking medications to control HF.


An HF exacerbation is diagnosed by a physical exam, imaging, and lab tests. A chest X-ray may be taken if pneumonia is suspected. An echocardiogram, with possible Doppler ultrasound, will evaluate how much blood the heart can pump throughout the body.

These diagnostics determine the strength of the heart muscle and what is called "ejection fraction", which is the percentage of blood that is pumped out of the left ventricle of the heart (blood that goes to the body). A normal ejection fraction is between 55-65%.


Persons who have HF exacerbation are usually admitted to the hospital for treatment. The main goal in treatment for HF exacerbation is to reduce the fluid volume in the body. Reducing fluid volume reduces the workload on the already weakened heart.


When discharged from the hospital, the healthcare provider may prescribe new medications and recommend lifestyle changes to prevent exacerbations in the future.

During the first follow-up, the provider may review the following:

  • You and your loved one's knowledge of the signs and symptoms of HF exacerbation

  • The medications your loved one is taking, when and how much, and if you have enough

  • A cardiac diet and regular exercise

  • The next follow-up appointment


American Heart Association (AHA) – Heart Failure

American Heart Association (AHA) – Classes & Stages of Heart Failure

2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure

Caraballo, C., Desai, N.R., Mulder, H., Alhanti, B., Wilson, F.P., Fiuzat, M., et al. (2019). Clinical implications of the New York Heart Association classification. Journal of the American Heart Association, 8(23), e014240. doi: 10.1161/JAHA.119.014240

CDC – Heart Failure

Cleveland Clinic – Heart Failure

No content in this app, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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