Brushing Off Heart Failure Symptoms

Overview

Heart failure is a long-term condition where the heart muscle cannot pump blood as well as it should. It does not mean the heart has stopped or is about to stop. It means the heart needs support to keep up with the body’s needs.

Yes. Heart failure affects a large number of people around the world, and the risk increases with age. It is one of the most common reasons older adults are admitted to hospital, but with good care many people stay stable for a long time.

Heart failure can affect anyone, but it is most often seen in older adults. People who have had a heart attack, high blood pressure, coronary artery disease, diabetes, or a condition that weakens the heart muscle are at higher risk.

Symptoms

Common symptoms

• Breathlessness during light activity or even at rest
• Feeling unusually tired or weak
• Swelling in the ankles, legs, or tummy due to fluid buildup
• Waking up at night short of breath
• Needing extra pillows to prop yourself up in bed to breathe comfortably
• A fast or irregular heartbeat
• A persistent cough or wheeze, sometimes with frothy phlegm

Symptoms in children

• Heart failure in children is rare and often linked to heart defects present at birth.
• Warning signs can include poor feeding, breathlessness while feeding, slow weight gain, unusual tiredness, and swelling around the eyes or legs.
• A child may breathe faster than usual or seem pale and clammy.
• If you are worried about your child’s breathing or energy, seek medical advice the same day.

Symptoms in older adults

• In older adults, heart failure symptoms can be mistaken for normal aging.
• Common signs are feeling short of breath while walking to the shop, being too tired for daily tasks, confusion or a drop in activity, swollen ankles, or needing to sleep sitting up.
• Sometimes the only sign is increasing confusion or less interest in eating and moving.
• Do not assume these changes are just ‘old age’ — they deserve a proper check.

Causes

Main causes

• A previous heart attack that damaged the heart muscle
• Long-term high blood pressure that makes the heart work too hard
• Coronary artery disease, where the heart’s blood supply is narrowed
• Cardiomyopathy, which is disease of the heart muscle itself
• Heart valve problems
• Drinking too much alcohol over many years
• Some medical treatments that can weaken the heart

Risk factors

• Older age
• A history of heart attack
• High blood pressure
• Diabetes
• Obesity or excess weight
• Smoking
• An unhealthy diet high in salt and processed foods
• A family history of heart disease or heart failure

When to see a doctor

See a doctor urgently if:

• If you have any new or worsening symptom, such as increased breathlessness or swelling, contact a doctor the same day.
• If your symptoms come on suddenly or feel severe, do not wait — call your local emergency number or go to urgent care.

Book a routine appointment if:

• If you have persistent tiredness, mild ankle swelling, or get breathless more easily than usual, make an appointment with your doctor. “I did not want to bother anyone” is one reason many people wait too long. Your doctor wants to know.

Diagnosis

To diagnose heart failure, a doctor will ask about your symptoms, take your medical history, examine you, and listen to your heart and lungs. They may also check your blood pressure, pulse, and fluid levels.

Tests that may be done

• Blood tests, including a heart function test called BNP or NT-proBNP
• An electrocardiogram (ECG) to check the heart’s rhythm and electrical activity
• An echocardiogram, which is an ultrasound scan of the heart to see how well it is pumping
• A chest X-ray to look at the size of the heart and check for fluid in the lungs
• Sometimes a stress test or magnetic resonance imaging (MRI) scan

What to expect at your appointment

The doctor should explain what each test is for and what the results mean. If heart failure is suspected, you may be referred to a heart specialist or a heart failure clinic. You will be involved in decisions about your care, and you can ask questions at any time.

Treatment

Heart failure treatment is not about curing the condition, but about improving symptoms, slowing down the damage, and helping you live well. Most people need a combination of medicines, healthy habits, and regular follow-up with their care team.

Self-care at home

• Weigh yourself regularly and report a sudden weight gain of more than 2 kilograms in a few days, as it may mean fluid is building up.
• Limit salt in your diet to help control fluid retention.
• Follow any fluid restriction advice your care team gives you.
• Take all medicines exactly as prescribed, and never stop suddenly without talking to your doctor.
• Stop smoking and limit alcohol.
• Stay as active as your condition allows, but avoid pushing yourself to breathlessness.

Medical treatments

Treatment usually involves medicines that help the heart pump more efficiently, reduce fluid buildup, and protect the heart from further stress. Some people may have a device implanted, such as a pacemaker or defibrillator, to keep the heartbeat steady or respond to dangerous rhythms. Cardiac rehabilitation programmes can also help you regain strength and confidence. Your care team will explain the options that fit your personal situation.

When is surgery considered?

Some people with heart failure benefit from surgery, for example to replace or repair a heart valve, to bypass a blocked coronary artery, or to implant a device that supports the heart. A specialist surgeon will only recommend surgery if the expected benefit outweighs the risks, and they will discuss everything with you first.

Living with this condition

Living with heart failure means learning a new rhythm. Plan your activities, build in rest breaks, and keep a simple diary of symptoms such as breathlessness, swelling, and weight. This can help you notice warning signs early and feel more in control.

Lifestyle tips

• Keep salt intake low and avoid processed ready meals.
• Try to maintain a healthy weight.
• Stop smoking and avoid alcohol or keep it to a minimum.
• Move regularly within limits that feel manageable.
• Make time for sleep, stress relief, and enjoyable activities.

Diet and exercise

A heart-friendly diet is rich in vegetables, fruits, whole grains, and healthy proteins, with very little added salt. Before starting exercise, ask your care team what is safe for you. Often, gentle walking or an approved cardiac rehabilitation class is recommended, because regular movement can improve stamina and mood.

Mental health and emotional wellbeing

Heart failure can bring anxiety, low mood, and fear. It is completely normal to feel this way after a diagnosis. Talk to your care team about how you are feeling, and if you ever feel unable to cope, reach out to your local crisis helpline or emergency service. You do not have to face it alone.

Prevention

Heart failure cannot always be prevented, because some causes such as congenital heart defects are not avoidable. However, many cases can be delayed or prevented by keeping your heart healthy, treating high blood pressure and diabetes early, staying physically active, eating well, not smoking, and avoiding heavy drinking.

Vaccines

Infections like flu, pneumonia, and COVID-19 can make heart failure worse, so keeping your vaccinations up to date is very important. Ask your pharmacist, GP surgery, or local health service which vaccines are recommended for you.

Screening programmes

If you have risk factors such as high blood pressure, diabetes, or a family history of heart disease, regular health checks can help detect problems early. Ask your doctor how often you should have your blood pressure, cholesterol, and blood sugar checked.

Complications

If left untreated

• Worsening shortness of breath and fluid buildup in the lungs
• Frequent hospital admissions
• Kidney damage due to low blood flow
• Dangerous irregular heart rhythms
• Sudden cardiac arrest, though this is less common

Long-term outlook

Heart failure is a serious condition, but receiving care early can change its course. Many people feel much better after treatment starts and stay stable for years. There is real hope: improvements in treatment mean more people are living longer, fuller lives. A diagnosis is not the end — it is the beginning of a new way of caring for your health.

Find support

International organisations

• Heart Failure Matters ↗
• British Heart Foundation ↗

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