If your patient has breathlessness, fatigue or swollen ankles, it could be heart failure1

Order an NT-proBNP test — a simple blood test could change it all

 Explore the other signs and symptoms of heart failure
Explore the other signs and symptoms of heart failure
 Review heart failure 
risk factors
Review heart failure 
risk factors
 Test your understanding 
in an interactive exercise
Test your understanding 
in an interactive exercise

Heart failure

signs and symptoms1,2


Typical symptoms

  • Breathlessness in general or when lying down (orthopnea)
  • Shortness of breath that awakens the patient (paroxysmal nocturnal dyspnea) ​
  • Reduced exercise tolerance​
  • Fatigue, tiredness, increased time to recover after exercise​
  • Swollen ankles
Less typical symptoms
  • Nocturnal cough
  • Wheezing
  • Bloated feeling
  • Loss of appetite
  • Confusion (especially in the elderly)
  • Depression
  • Heart palpitations
  • Dizziness
  • Fainting
  • Shortness of breath when leaning forward


More specific signs

  • Elevated jugular venous pressure​
  • Hepatojugular reflux​
  • Third heart sound​
  • Laterally displaced apical impulse
Less typical signs include
  • Weight gain (>2 kg/week)
  • Weight loss (in advanced heart failure)
  • Tissue wasting
  • Cardiac murmur
  • Peripheral swelling (e.g. sacral, scrotal)
  • Pulmonary crackles
  • Rapid beating of the heart (tachycardia)
  • Irregular pulse
  • Abnormally rapid breathing
  • Cold extremities
  • Narrow pulse pressure

If it could be heart failure, order an NT-proBNP test to investigate — a simple blood test could change it all.

Explore how to test and refer

Risk factors

A diagnosis of heart failure is more likely in patients with:1,2,4 ​
 Hypertension Hypertension
 Diabetes Diabetes
 A history of cigarette smoking A history of cigarette smoking
 Coronary artery disease Coronary artery disease
 ​Previous myocardial infarction ​Previous myocardial infarction
 Obesity Obesity
Additional risk factors include:1,4
Chronic kidney disease
Treatment with cardiotoxic chemotherapy
Chest radiation
A family history of cardiomyopathy pain or sudden death at a young age (<50)
Alcohol misuse
Sedentary lifestyle
Common co-morbidities for heart failure include:5,6
Ischaemic aetiology
Chronic kidney disease

The patient profiles displayed in this material are hypothetical.

COPD, chronic obstructive pulmonary disease; NT-proBNP, N-terminal pro-B-type natriuretic peptide.


1. McDonagh TA, et al. Eur Heart J. 2021;42:3599–3726. 2. Heindenreich PA, et al. JACC. 2022;79:e263–e421. 3. Wong CW, et al. J Card Fail. 2021;27:925–933. 4. Groenewegen A, et al. Eur J Heart Failure. 2020;22:1342–1356. 5. Rabe KF, et al. Eur Respir Rev. 2018;27:180057. 6. Drozd M et al. Heart. 2021;107:1417–1421.

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