Symptoms of heart failure: oedema, palpitations and wakefulness

The other main symptoms of heart failure include feeling congested or full of fluid (oedema), having an irregular heartbeat, finding it difficult to sleep at night, having a small appetite and poor circulation. As with symptoms of breathlessness and tiredness, these symptoms are not specific to heart failure and can also occur in other medical conditions (see ‘Feeling breathless and tired’). Medication will usually help to relieve the symptoms described here.

Oedema or swelling of the ankles and feet is a common symptom of heart failure. Other parts of the body such as the abdomen may also get a build-up of fluid, though most people said that medication helped to alleviate the problem. Some people with more serious heart failure described how fluid could build up in the lungs. One woman said that at one stage before starting medication she had felt as though she was almost drowning in her own body but that she had responded to drugs and treatment.

She describes how it felt when she had oedema that led to a cardiac arrest.

Age at interview 69

Gender Female

Age at diagnosis 67

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July 2001 it was quite a warm summer and I was suffering from breathlessness and I thought it was because of the heat of the day and my husband had been ill for several years, about 8 years and I was looking after him and I just felt that my feeling of unwell was due to the distress there. But on the Sunday morning I woke up and I felt quite ill, I felt a sort of crackly sound like (laughing) crunching of crystal (crunchy noises being made) sounds and I thought that was silly because I had been in bed and had a good night’s sleep and I woke up, and said to my son I’d like to be taken into a hospital to the Accident and Emergency department because I didn’t feel well, which he thought was amusing because I… you don’t just go for that reason. And we did, we went in, and whilst I was there I took ill, and the cardiac arrest you know, happened. At the time I thought the pain was just like an angina pain, but there was obviously more involved because I felt this fluidness… in my lungs, and I had a spell of vomiting, which was a frothy fluid, and blood which was the lining of the lungs. And at the time I didn’t quite understand it, now I do know and can appreciate, it was the oedema which was the lungs filling up with water and that is a feeling of drowning in your own… within your own body which is rather frightening.

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Any prolonged irregular heart rhythm (‘arrhythmia’) may indicate the presence of heart disease; one man who had experienced palpitations as a child said that since starting treatment his palpitations didn’t worry him as much and that he now knew what kinds of things caused them. Someone else said she had noticed that her palpitations happened at the same time as chest and stomach pains.

He describes the kind of things that make him have palpitations.

Age at interview 62

Gender Male

Age at diagnosis 56

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I am told, by the great specialist, that I have an extensively irregular heart beat and when I say extensively, as in time. In other words, it’s very irregular most of the time, even with the Sotalol. And a few years ago, when I first saw him, I suppose 6 years or whatever it was ago when I first saw him, he told me that… having palpitations meant that the chambers of the heart didn’t flush themselves out of blood properly and there was a danger that clots could form and you know, this was an extremely dangerous sort of situation and blah, blah, blah. But hes now told me that the latest research has shown that in fact it doesn’t really happen like that and it doesn’t really matter, and that having a disorganised heartbeat is not necessarily as bad is it was once thought to be. And frankly, I don’t notice it.

And so, it does occasionally, if I get stressed up or somebody irritates me I can feel it going, I can feel wonky behaviour coming on with the heart. And I would also say that, you know if one is discomforted, you know, if it’s a very hot day and you’re having to stand in the tube train or something (which God forbid one doesn’t have to do anymore now) but you would notice it then. The rest of the time I just ignore it. Sometimes you feel it and think wow, and I sort of quickly go like that and say ‘Yes, it’s still beating, yes!’ But it is actually quite irregular.

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She experienced palpitations at the same time as pain in her arms and chest. (Video and audio clips in Punjabi, text in English.)

Age at interview 84

Gender Female

Age at diagnosis 82

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(This interview was conducted in Punjabi and the transcript translated into English.)

Lots of palpitations and pain, pain here in my chest and stomach, pain in my arms and palpitations. They then got me into a bed. I don’t know exactly what tests they did but after staying in hospital I did improve. After staying in hospital I did feel better;

They didn’t give you an operation though?

No, no operation;

Just tests?

Yes, they checked me over completely and gave me medications, and with them I’m fine;

Did that all take place two years ago?

Yes, two years ago. About one-and-a-half years ago. Well the problem was going on and really looked into about two years ago. Before that the doctors kept telling me it was acid indigestion but they didn’t really know what it was. Then there was that main problem, when I went into hospital and they did all the tests. But I hadn’t had any major problem in terms of my heart. I was okay;;

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Difficulty sleeping through the night from time to time was a common experience, though others said they had always slept very well. Sometimes people had woken themselves up coughing but said that this had been put right when their medication was changed. Others described how they slept for 3 or 4 hours at a time during the night. Waking up during the night was acceptable to some, but one man said he missed getting a full night’s sleep. Nurses had often advised people to go to sleep propped up with pillows; some had found this helpful and others said that they slipped down the bed during the night.

If he lies flat he wakes up early and coughs.

Age at interview 59

Gender Male

Age at diagnosis 58

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Well if I get flat, and of course I have got a bed with lift now, but you tend to slide down, and if I’m lying flat then often I’ll wake up probably breathless but maybe with a coughing attack. Coughing is a real problem for me when I’m flat. And I wake up also early in the morning, when I wake up 4 o’clock, 5 o’clock, 6 o’clock but I’ll often to off to sleep again for a bit, but I’m always up by 7. Just to go to bed and have an interrupted nights sleep and wake up at 8 o’clock would be delicious, but it isn’t happening, and we nearly two years in now, so I don’t think it’s going to come back.

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Several people talked about their poor circulation; one man mentioned having very cold feet and shins and another said his feet were too hot at night. Someone else said that his skin had become flaky because his circulation was so poor.

Feeling uncomfortably full after eating small amounts of food was also something people noticed though not everyone associated it with heart failure. Some said they had smaller appetites than before and had put it down to their medication (see ‘Common side effects of heart failure medication’).

He felt bloated after eating small amounts of food.

Age at interview 46

Gender Male

Age at diagnosis 45

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Basically it was about end of November that I started. Developed like well, I couldn’t eat my food, my food wouldn’t settle. Any time I ate, no matter the littlest thing I ate, I felt like I was bloated. So I went to my own GP who, in turn, turned round and told me that I had a… suffered with asthma, so he gave me an inhaler and this was like in November. And I was using the inhaler up until the 28 or whenever it was of December when me and my sister went out, just normal, going out with her husband and so forth, just over the Christmas, because I hadn’t been with them all over the Christmas. Went out with them and ended up collapsing after coming out of a club. Got to my local hospital, they turned round and says, ‘Well, you’ve had a mild heart attack.

It felt as if the slightest, anything you ate, it could be half a bar of chocolate, an apple, it just felt that your stomach was full, and that was the fluid developing on the stomach because of the heart’s apparently working too hard, and the fluid couldn’t get out. Right so the heart was creating too much fluid on the lungs, that’s it, water on the lungs, that’s what they call it.

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