Fatigue : poor perfusion 

Anorexia. The loss of weight reflects the anorexia, possible problem with GI absorption and overall poor nutrition.

Exertional dyspnea : By the time heart fails it has used up all its reserve capacity. Ability to increase cardiac output is limited.  Exertion demands the heart to increase cardiac output which it is unable to do, resulting in shortness of breath. (Specificity 60%)

Paroxysmal nocturnal dyspnea 

• Dreams

• Slipping off of pillow

• Sympathetic activity and phase of sleep

Orthopnea. (Sensitivity 20-30%)

• Increased venous return in supine position

• Larger lung volume in upright position

• Boggy congested liver pushing diaphragm up in supine position

• Better use of accessory muscles in upright position

Cough: productive of pink, frothy sputum  Encountered in pulmonary edema.