Symptoms of the Four Stages of Heart Failure

Introduction

Heart failure (HF) is a progressive condition in which the heart becomes less efficient at pumping blood. The American College of Cardiology (ACC)/American Heart Association (AHA) classify heart failure into four stages (A, B, C, and D). Understanding the symptoms at each stage is important for early detection and management.

Stage A: At Risk for Heart Failure

This stage includes individuals who do not have structural heart disease or symptoms of HF but have risk factors such as hypertension, diabetes, obesity, or a family history of cardiomyopathy. - Symptoms: None, but patients should manage risk factors to prevent progression.

Stage B: Structural Heart Disease Without Symptoms

Patients have structural abnormalities (e.g., left ventricular hypertrophy or reduced ejection fraction) but no overt symptoms of heart failure. - Symptoms: Typically absent, but mild fatigue or occasional shortness of breath may occur during intense physical activity.

Stage C: Symptomatic Heart Failure

At this stage, structural heart disease causes significant symptoms even with daily activities. The severity of symptoms is typically categorized using the New York Heart Association (NYHA) classification. - Symptoms: - Shortness of breath (dyspnea), especially during physical activity or at rest - Fatigue and weakness - Swelling in the legs, ankles, and feet (edema) - Persistent cough, possibly with pink frothy sputum - Difficulty lying flat due to breathlessness (orthopnea) - Waking up breathless at night (paroxysmal nocturnal dyspnea)

Stage D: Advanced Heart Failure

Patients experience severe, refractory symptoms despite treatment and often require specialized cardiac interventions, such as heart transplantation or mechanical circulatory support. - Symptoms: - Severe shortness of breath, even at rest - Extreme fatigue, drowsiness, or mental confusion - Swelling in the abdomen and lower limbs due to fluid retention - Weak pulse and poor circulation - Significant weight loss due to cardiac cachexia

Conclusion

Heart failure progresses over time, making early diagnosis and intervention essential. Lifestyle modifications, medication, and advanced therapies can help slow down progression and improve the quality of life.

Source recommendations

1. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063
2. https://pubmed.ncbi.nlm.nih.gov/35378257/
3. https://www.sciencedirect.com/science/article/pii/S0735109721083959
4. https://professional.heart.org/en/science-news/2022-guideline-for-the-management-of-heart-failure
5. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2022/03/29/19/53/2022-AHA-ACC-HFSA-Heart-Failure-Guideline-gl-hf

2. 2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure

1. https://pubmed.ncbi.nlm.nih.gov/34447992/
2. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure
3. https://academic.oup.com/eurheartj/article/42/36/3599/6358045
4. https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.2333
5. https://academic.oup.com/eurheartj/article/44/37/3627/7246292