Signs that Heart Failure is Progressing (Getting Worse)

There are several signs and symptoms to know that indicate heart failure symptoms are getting worse, or that the condition itself is progressing.

Helpful Highlights

  • The easiest way to know that heart failure is getting worse is your loved one's ability to do less and less.

  • Frequent or persistent swelling/edema is another common indicator, especially in the lower legs, ankles, and feet.

  • Exacerbations also occur more often as heart failure progresses.

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If you notice that heart failure is causing changes in your loved one's behaviors and activities, or there are subtle yet noticeable changes in things like sleeping, toileting, eating, or thinking - it’s time to visit a provider. They can help.

When should my loved one see a provider?

They start pacing themselves during tasks or activities - doing a little, then stopping to rest before they do a little more, and so on in this pattern. 

They stop doing hobbies that involve physical activity, whether it's gardening or fishing, woodworking, or restoring an old car.

They used to play 18 holes and now they are down to nine. (Even changing a well-established tee time can be a sign.)

They avoid stairs whenever they can, including no longer using the bedroom upstairs but instead electing to sleep on the sofa downstairs. Then they need to sleep in the recliner rather than on the sofa. Then they can't sleep at all.

They choose to only walk short distances, and they do it very slowly.

They have increased shortness of breath with moderate activity, then light activity. then with daily activity, then at rest. Any of these change points indicate it's time to see the provider.  

After eating just a little, your loved one suddenly feels full. Or, even though they are barely eating, they are somehow gaining weight. 

They have a cough that is worsening - especially when lying down versus sitting up

They have a cough accompanied by frothy or pink-tinged sputum.

They complain of waking up at night, unable to breathe, or with a feeling of drowning or suffocation.

They have audible wheezing or their breathing sounds wet or crackly.

Pitting Edema

Edema/Swelling becomes a consistent feature and worsens

  • Feet, ankles, lower legs

  • Swelling may move into the upper legs and pelvis

  • Distended abdomen*

  • "Pitting" edema (typically in lower extremities) - when you push your fingertip into a swollen area and the pit created by your fingertip remains for a prolonged period (could be several seconds to a couple of minutes) before going away

  • Eventually, blisters may form, the skin may break, and the clear fluid inside can start to seep out; this places them at high risk for an infection called cellulitis

*Your loved one's belly area appears swollen and they may have upper right abdominal pain. When the liver becomes congested with fluid due to heart failure, it swells and causes the abdomen to protrude or enlarge, and oftentimes causes pain in that area.


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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