Breathlessness and your heart

• By One Heart Clinic
• May 28, 2024

Dr Ricardo Petraco MD MRCP PhD

There are many reasons why people feel tired, fatigued and out of breath, with general lack of fitness and physical deconditioning contributing to this common symptom, particularly when we get older. However, the heart can also be a cause of breathlessness, and we should all be aware of a few clues which indicate this could be the case.

Sometimes the heart will become an inefficient blood pump and it will fail to send enough blood to the body, either because it is weak or too stiff. This is called heart failure, and it can cause breathlessness disproportionally to what one would expect for usual activities, such as walking on the flat or even at rest. Heart failure can also be associated with fluid retention and swollen ankles.

Leaky or narrowed heart valves can also lead to breathlessness, as they will prevent normal circulation of blood to the body. The most common valve problem in the elderly leading to breathlessness is called aortic stenosis, when the aortic valve becomes too stiff to open.

Lack of blood supply to the heat muscle itself, caused by cholesterol-rich blockages in the coronary arteries, can also cause breathlessness on exertion. This is often – but not always - associated with a sensation of chest tightness or pain on exertion, which we call angina.

Finally, sometimes the heart can beat too slowly or irregularly, and these heart rhythm disturbances can also cause a reduction in exercise tolerance, often felt by patients as breathlessness. Atrial fibrillation is the most common relevant heart rhythm abnormality, and it can increase the risk of strokes.

The only way anyone can tell whether your breathlessness is coming from your heart is by a clinical examination and by performing diagnostic tests such as ECGs and cardiac ultrasound (echocardiography).

That is why the medical professional with the ideal expertise to investigate your breathlessness is a heart specialist, and if you think your symptoms are disturbing your quality of life, you should ask your GP or your insurance to be referred to a cardiologist.