Heart Failure: Complications

Piemont Augusta's Advanced Heart Failure Center

1350 Walton Way
Augusta, GA 30901-2629
Phone: 706.774.7855 
Fax. 706.364.0516 
Hours: 8 a.m.-4:30 p.m.

The complications caused by heart failure influence a patient's chance for survival. Although heart failure produces very high mortality rates, treatment advances are improving survival rates.

Cardiac Cachexia

If patients with heart failure are overweight to begin with, their condition tends to be more severe. Once heart failure develops, an important indicator of a worsening condition is the occurrence of cardiac cachexia, which is unintentional rapid weight loss (a loss of at least 7.5 percent of normal weight within six months).

Impaired Kidney Function

Heart failure weakens the heart's ability to pump blood. This can affect other parts of the body including the kidneys (which in turn can lead to fluid buildup). Decreased kidney function is common in patients with heart failure, both as a complication of heart failure and other diseases associated with heart failure (such as diabetes). Studies suggest that, in patients with heart failure, impaired kidney function increases the risks for heart complications, including hospitalization and death.

Congestion (Fluid Buildup)

In left-sided heart failure, fluid builds up first in the lungs, a condition called pulmonary edema. Later, as right-sided heart failure develops, fluid builds up in the legs, feet, and abdomen. Fluid buildup is treated with lifestyle measures, such as reducing salt in the diet, as well as drugs, such as diuretics.

Arrhythmias (Irregular Beatings of the Heart)

There are several types of arrhythmias:

  • Atrial fibrillation. A rapid quivering beat in the upper chambers of the heart. It is a major cause of stroke, especially for people with heart failure. Atrial fibrillation can also make other aspects of a patient's heart failure more difficult to manage.
  • Left bundle branch block. An abnormality in electrical conduction in the heart. It develops in about 30 percent of patients with heart failure.
  • Ventricular tachycardia and ventricular fibrillation. Life-threatening arrhythmias that can occur in patients when heart function is significantly impaired. Some patients with heart failure may be offered an implanted defibrillator to protect them from these arrhythmias.

Angina and Heart Attacks

While coronary artery disease is a major cause of heart failure, patients with heart failure are at continued risk for angina and heart attacks. Special care should be taken with sudden and strenuous exertion, particularly snow shoveling, during colder months.


Many symptoms of heart failure result from the congestion that develops as fluid backs up into the lungs and leaks into the tissues. Other symptoms result from inadequate delivery of oxygen-rich blood to the body's tissues. Since heart failure can progress rapidly, it is essential to consult a doctor immediately if any of the following symptoms are detected:


Patients may feel unusually tired.

Shortness of Breath (Dyspnea)

Symptoms and types of dyspnea include:

  • Feeling out of breath after exertion. While this may begin only when climbing stairs or taking longer walks, it can eventually be present even when walking around the home. (Patients who have chest pain or feel like a heavy weight is pressing on the chest should also be evaluated for possible angina.)
  • Orthopnea refers to the shortness of breath felt when lying flat at night. Patients may report that they need to use one or two pillows underneath their head and shoulders in order to be able to sleep. Sitting up with legs hanging over the side of the bed often relieves symptoms.
  • Paroxysmal nocturnal dyspnea (PND) refers to sudden episodes that cause awakening at night. Symptoms include severe shortness of breath and coughing or wheezing, which generally occur 1 to 3 hours after going to sleep. Unlike orthopnea, symptoms are not immediately relieved by sitting up. It usually takes more time to recover from an episode.

Fluid Retention (Edema) and Weight Gain

Heart failure can cause foot, ankle, leg, or abdominal swelling. In rare cases, swelling can occur in the veins of the neck. Fluid retention can cause sudden weight gain and frequent urination.

Wheezing or Cough

Heart failure can cause asthma-like wheezing, or a dry hacking cough that occurs a few hours after lying down and stops after sitting up.

Loss of Muscle Mass

Over time, patients may lose muscle weight due to low cardiac output and a significant reduction in physical activity.

Gastrointestinal Symptoms

Problems include loss of appetite or a sense of feeling full after eating small amounts. Patients may also have abdominal pain.

Pulmonary Edema

When fluid in the lungs builds up, it is called pulmonary edema, which produces severe symptoms. These symptoms may develop suddenly or gradually build up over a matter of days:

  • In addition to shortness of breath, patients sometimes have a cough that produces a pinkish froth.
  • Patients may experience a bubbling sensation in the lungs and feel as if they are drowning.
  • Typically, the skin is clammy and pale, sometimes nearly blue. This is a life-threatening situation, and the patient must go immediately to an emergency room.

Abnormal Heart Rhythms

Heart failure can cause episodes of abnormally fast or slow heart rate. Patients may need to have a pacemaker or defibrillator implanted.

Central Sleep Apnea

This sleep disorder results when the brain fails to signal the muscles to breathe during sleep. It occurs in up to half of people with heart failure. Sleep apnea causes disordered breathing at night. If heart failure progresses, the apnea may be so acute that a person, unable to breathe, may awaken from sleep in panic. Treatment with continuous positive airway pressure (CPAP) can be beneficial for people with heart failure and sleep apnea.