You’ve started pausing halfway up the stairs. Or perhaps the daily walk with the dog suddenly feels much longer than it used to.
You tell yourself: I’m just exhausted. I’m stressed. I’m getting older. I really need to get back to the gym.
But Australian health experts are warning that changes in breathing or energy could also be an early sign of heart failure.
“Shortness of breath on walking upstairs or being more tired than usual are not normal parts of ageing and this should be a signal to go and have a check-up with your doctor,” cardiologist Professor Andrew Sindone, Director of the Heart Failure Unit at Concord Hospital, tells The Weekly.
What is heart failure?
Heart failure is a serious condition that affects around 500,000 Australians, with around 67,000 new diagnoses each year, according to cardiovascular charity Hearts4hearts.
Despite its name, it does not mean the heart has stopped working. “Heart failure is a condition where the heart is not able to pump enough blood around the body to meet the demands of the body,” Professor Sindone explains. “This leads to tiredness, shortness of breath, dizziness, swelling of the legs, loss of appetite and inability to do things that a person could do previously.”
It’s different from a heart attack, which happens when an artery supplying the heart becomes blocked. A heart attack can damage the heart muscle and lead to heart failure, but it isn’t the only cause.
Long-term high blood pressure, heart valve problems, irregular heart rhythms, viral infections, excessive alcohol consumption and some chemotherapy medicines can also damage or place strain on the heart.
What are the early signs of heart failure?
Heart failure often develops gradually, so symptoms can be mistaken for ageing, poor fitness or another health condition.
“If someone is only able to walk short distances or there has been a new deterioration in breathlessness or tiredness then these are clues that someone may have something more serious than lack of fitness,” Professor Sindone says. “Look for swelling in the legs, an irregular pulse, pain in the chest, lightheadedness, loss of appetite or not being able to keep up with your family and friends with normal activities.”
Other possible signs include:
- swelling in the ankles or abdomen
- heart palpitations
- waking during the night feeling breathless
- difficulty breathing while lying flat
- sudden weight gain caused by fluid retention.
These symptoms don’t necessarily mean you have heart failure. Anaemia, iron deficiency, sleep apnoea and lung conditions can cause similar changes, but your GP can help work out what is behind them.
“Any of these should prompt someone to come to the doctor for a checkup,” Professor Sindone says.
Why heart failure can be missed in women
Heart disease is still often seen as an older man’s health issue, but heart failure affects women too.
Professor Sindone says narrowing of the coronary arteries is more common in men, while heart failure caused by a stiff heart muscle is more common in women and becomes increasingly likely with age.
“Women often ignore the symptoms because they are caring for others and if they cannot do the usual activities due to tiredness or shortness of breath then they should consult the doctor,” he says.
Who is most risk of heart failure?
Heart failure becomes more common with age, but it isn’t an inevitable part of getting older.
The risk is higher for people who have previously had a heart attack or live with type 2 diabetes, high blood pressure, chronic kidney disease, an irregular heart rhythm or lung disease.
“High blood pressure puts increased strain on the heart and, with time, the heart may become tired and unable to perform its usual activity efficiently,” Professor Sindone explains.
Diabetes can affect the heart in several ways. “It can narrow the arteries around the heart leading to heart attack and damage to the heart muscle as well as increasing the risk of spasm of the coronary arteries, but diabetes can also increase blood pressure, make the heart muscle more stiff or affect the kidneys.”
Nearly half of people with heart failure are also living with chronic kidney disease.
“Kidney disease can be silent for a long time, and many people may not know they are living with it until it has progressed,” says Chris Forbes, CEO of Kidney Health Australia.
“For people with heart failure, or those at risk of heart failure, understanding kidney health is an important part of the overall picture. Simple checks can help identify kidney disease earlier, and earlier detection gives people a better chance to take action.”
When should you talk to your GP?
Tell your doctor what has changed, when you first noticed it and which everyday activities have become harder.
Professor Sindone suggests explaining that you can no longer do what you could previously and want to rule out heart failure.
A heart check may include checking your blood pressure and pulse and listening to your heart and lungs. Your GP may also arrange an ECG, blood tests or a chest X-ray, or refer you to a cardiologist.
“Early detection is key because we have excellent treatment options which can make people feel better, live longer and stay out of hospital,” Professor Sindone says.
