Feeling unusually breathless? It could be a sign of a heart problem

Written by: Dr Michael John Van der Watt
Published: | Updated: 19/12/2019
Edited by: Cameron Gibson-Watt

Breathing happens so automatically and easily that we don’t even realise we are doing it – until it’s suddenly difficult. Many of us don’t ever associate breathing difficulties with heart problems, but feeling short of breath is a common warning sign that there’s something wrong with your heart. Dr Michael John Van der Watt, a cardiologist based in Watford, gives us an overview of the various heart conditions that can leave a person gasping for air.

Why is breathlessness a symptom of heart problems?

Your heart and lungs both work together in transporting oxygen around your body, and if there are problems with either of these, it can affect your breathing. Struggling to catch your breath can be the result of the heart becoming less efficient at pumping blood (and oxygen) around the body. As the muscles in the heart weaken, they become less able to keep up with the supply of blood coming in and out of the heart.


What’s more, when the heart cannot handle the amount of blood coming into it, the lungs can become relatively engorged with blood. This can then result in fluid in the blood vessels leaking into the lungs. When there’s fluid in the lungs, they cannot function properly to remove carbon dioxide from the body, and to absorb oxygen, which leaves you feeling short of breath.


Which major heart problems cause breathlessness?

Feeling short of breath suddenly or gradually is a symptom of the following heart conditions:

  • Heart failure – a condition in which the heart can’t pump sufficient blood out to meet the body’s demand. A cause of heart failure can be due to a previous heart attack and weakened heart muscles. In the early stages, you may have trouble breathing after exercise and, as it gets worse, even after getting dressed.
  • Coronary artery disease – this is where there is narrowing or a blockage of the arteries due to a build-up of cholesterol and fatty deposits. The heart no longer receives enough oxygen and food, so it becomes weak. It can appear normal at rest, but at exertion, it deteriorates.
  • Atrial fibrillation – this is an irregular heartbeat that results in blood clots, heart failure and stroke. Breathlessness and weakness are some of the signs of this condition.
  • Heart valve disease – this occurs when one or more of the heart valves either starts leaking, or don’t open properly, resulting in increased blood pressure in the lungs, or reducing the amount of blood your heart can pump out to the body.
  • If the heart doesn’t speed up enough during exercise or any form of strenuous activity, this will also cause breathlessness


Rarer heart problems

Some rarer heart problems can cause shortness of breath. These include:

  • Pericardial effusion – when there is an abnormal amount of fluid accumulation around the heart, it causes increased pressure and damage to heart function.
  • Bradycardia or tachycardia – this is when your heartbeat is going too fast or too slow. If it’s too slow (bradycardia) then it is not pumping enough blood out and around the body. If it is too quick (tachycardia) the heart muscles can over time become weaker.
  • Pulmonary arterial hypertension – this is rare but quite progressive if not treated properly. It is characterised by high blood pressure in the arteries of the lungs. The signs are not usually obvious at the beginning but as the disease progresses, symptoms become worse.
  • Diastolic dysfunction - As you get older, your heart becomes stiffer. When this happens, the heart pumps blood out normally but doesn’t relax easily, making it difficult for blood to get into the heart. This can then cause the blood pressure in the lungs to rise and decrease the absorption of oxygen.


What other symptoms indicate heart problems?

Not all heart problems come with obvious warning signs. If you are over 60, overweight, have high blood pressure or cholesterol or you have diabetes, then you are at a higher risk of heart problems so you should be especially aware of the following symptoms if they become more frequent or severe.

  • Chest pain or discomfort on exertion (this is a serious sign of heart problems)
  • Weakness or dizziness
  • Fainting or near fainting
  • Swollen ankles
  • Palpitations (irregular heartbeats)


What exactly is cardiac asthma and how is it different from normal asthma?

Cardiac asthma is defined as wheezing, coughing or breathlessness induced by heart failure and is considered a medical emergency. It is not a form of asthma. Cardiac asthma is caused by fluid build-up in the lungs and airways that leads to breathing difficulties.


True asthma, however, is a chronic condition caused by spasm and associated inflammation of the airways and has nothing to do with fluid in the lungs or heart problems. For an asthmatic patient, it’s sometimes difficult to distinguish between this condition and true asthma, so seeking professional help is important to make the distinction, as both require very different types of treatment.


When should you take shortness of breath seriously?

Running out of breath is common when we’re exercising or playing sports. But, if you are experiencing shortness of breath from simply walking up a flight of stairs or walking out to the local shop, then it’s likely an indication that something is wrong. You should consider medical help if you are going through any of the following:

  • Your ability to exercise has suddenly changed meaning that you are out of breath much faster or you’re experiencing accompanied dizziness.
  • You are frequently surprised that you are more short of breath than usual.
  • You’re inappropriately breathless in relation to your physical activity.
  • You have the sensation of ‘air hunger’ (the feeling you aren’t getting enough air, no matter how deep you breathe).
  • You are experiencing shortness of breath accompanied by profuse sweating, pale skin, coughing up blood, passing out and/or chest pain.

It is important to note that these symptoms may not be sudden, instead, they can come on gradually, depending on the heart-related condition. Valve problems, such as aortic stenosis, usually progress gradually. Similarly, in angina (caused by narrowings in the blood vessels supplying the heart muscle) you may start to notice you are getting more and more out of breath over time, often with associated chest discomfort.


Sudden onset of chest pain and breathlessness must be assessed much more urgently, as this could be caused by dangerous conditions, such as a heart attack. This sudden onset of symptoms may be a sign that something in your heart has suddenly become unstable which can deteriorate quite rapidly. If you believe you are suffering a serious heart condition, such as a heart attack, do not hesitate and call 999 immediately.


If you are ever worried or in doubt about any of your symptoms, always seek medical help and let a doctor diagnose you. Dr Michael John Van der Watt is a renowned cardiologist based in Watford with over 20 years of experience. To make an appointment with him, visit his profile and book online.

By Dr Michael John Van der Watt

Dr Michael Van Der Watt is renowned and patient-oriented consultant cardiologist with over 20 years of experience, who specialises in palpitations, syncope and angina alongside heart murmur, heart failure and pacemaker treatments. He privately practices at Spire Bushey Hospital while his NHS base is West Hertfordshire Teaching Hospitals NHS Trust, where he is the medical director at Watford General Hospital. 

Dr Van Der Watt is highly qualified with varying experience in different areas of medicine. He specialised in internal medicine in South Africa and then moved to the UK in 1995 to move into in the cardiology specialty. Furthermore, he is a fellow of the Royal College of Physicians.

Alongside the specialities mentioned above, he expertly carries out treatments in acute coronary syndromes, valvular heart disease and arrhythmias alongside fainting, chest pain and breathlessness. His clinical interests are invasive cardiology, echocardiology and pacemaker implantation.  

Dr Van Der Watt's clinical research has been published in various peer-reviewed journals, while he is an active member of numerous professional organisations including the European Cardiac Society, (ECS) the British Cardiovascular Intervention Society (BCIS) and British Cardiac Society (BCS). He is also a member of the Royal College of Physicians.

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