Yes. Heart disease can cause shortness of breath when the heart cannot pump blood effectively, when blood flow to the heart is reduced, or when the heartbeat is irregular. Breathlessness may happen during activity, while lying flat, or even at rest. It can also come on suddenly during a heart attack. Because lung and other conditions can cause similar symptoms, new or worsening breathlessness needs medical assessment.
How Can Heart Disease Make You Short of Breath?
Your heart pumps blood to your lungs and the rest of your body. When a heart condition interferes with this process, you may feel unable to take a satisfying breath or may struggle to get enough air during everyday activities.
One common cause is heart failure. Despite its name, heart failure does not mean the heart has stopped working. It means the heart cannot pump blood as effectively as the body needs. Blood may then back up in the blood vessels returning from the lungs, allowing fluid to collect in lung tissue and making breathing more difficult.
MedlinePlus explains that heart disease can cause breathlessness when the heart cannot pump enough blood to meet the body's needs. Other heart conditions can also cause this symptom, even when fluid buildup in the lungs is not the main problem.
Which Heart Conditions Can Cause Shortness of Breath?
1. Heart failure
Heart failure is an important heart-related cause of shortness of breath. It can develop when the heart muscle becomes weak or stiff and cannot fill with or pump out blood effectively. Breathlessness may begin during exercise or activities such as climbing stairs. As the condition progresses, some people also experience difficulty breathing while resting or lying flat.
According to the American Heart Association, people with heart failure may also experience persistent coughing, wheezing, tiredness, swelling in the feet or ankles, and difficulty breathing at night. These symptoms can occur in different combinations and require assessment in context.
2. Coronary artery disease and heart attack
Coronary artery disease occurs when the blood vessels supplying the heart become narrowed, reducing blood flow to the heart muscle. This can cause chest discomfort and may be associated with shortness of breath, particularly during physical activity. If blood flow becomes severely restricted or blocked, a heart attack can occur.
A heart attack does not always cause obvious chest pain. Some people experience breathlessness, unusual tiredness, nausea, sweating, dizziness, or discomfort in the back, jaw, neck, or arms. The American Heart Association notes that shortness of breath can occur with or without chest discomfort during a heart attack.
3. Heart valve disease
The heart has valves that control the direction of blood flow through its chambers. If a valve becomes narrowed or does not close properly, the heart may have to work harder to move blood. Depending on the valve problem and its effects, a person may develop breathlessness during normal activities, fatigue, dizziness, palpitations, or swelling in the ankles and feet.
The NHS identifies shortness of breath as a possible symptom of heart valve disease. Some people have no noticeable symptoms, while others need further examination and heart tests to determine whether a valve problem is present.
4. Irregular heart rhythms
An abnormal heart rhythm, also called an arrhythmia, occurs when the heart beats too quickly, too slowly, or irregularly. Depending on the type of rhythm problem, the heart may not pump blood as effectively as it needs to. This can be associated with shortness of breath, a racing or fluttering heartbeat, weakness, dizziness, or fainting.
MedlinePlus lists shortness of breath among the possible symptoms of an arrhythmia. These symptoms may come and go, and some people with an abnormal rhythm have no noticeable symptoms.
What Does Heart-Related Shortness of Breath Feel Like?
Breathlessness can feel different from one person to another. Its timing and the activities that bring it on can help a healthcare professional understand what may be causing it. Some patterns that can occur with heart disease include:
- Breathlessness during physical activity: Walking, climbing stairs, or doing routine tasks becomes more difficult than usual.
- Difficulty breathing while lying flat: You may find it easier to breathe when sitting upright or using extra pillows.
- Waking up short of breath: You may wake during the night feeling unable to breathe comfortably and need to sit up.
- Breathlessness at rest: You may feel short of breath even when sitting quietly or doing very little.
- Breathlessness with other symptoms: You may also notice ankle swelling, unusual fatigue, coughing, palpitations, dizziness, or chest discomfort.
These are examples of symptoms that can occur with heart disease, not a checklist for identifying a particular condition. The same experiences can have other causes, and some heart conditions may produce few obvious symptoms.
Can Shortness of Breath Be Caused by Something Other Than Heart Disease?
Yes. Breathlessness is not specific to heart problems. Lung conditions such as asthma, chronic obstructive pulmonary disease (COPD), and pneumonia can make breathing difficult. Other possible causes include anemia, anxiety, allergic reactions, and blood clots in the lungs.
The cause may not be obvious from the sensation alone. For example, breathlessness during activity can occur with heart or lung disease, as well as in people who are less physically conditioned. The timing of symptoms, other changes in health, medical history, and examination findings help guide the evaluation.
When Is Shortness of Breath a Medical Emergency?
Seek emergency medical help immediately if shortness of breath starts suddenly, is severe, or makes it difficult to speak or breathe normally. Do not wait for chest pain to appear before seeking help. A sudden heart or lung problem may cause breathlessness even without the symptoms people commonly associate with a heart attack.
Emergency warning signs include:
- Sudden or severe difficulty breathing.
- Chest pressure, tightness, or pain, particularly if it spreads to the arm, back, neck, or jaw.
- Shortness of breath accompanied by cold sweats, nausea, fainting, or marked dizziness.
- Breathlessness with a rapid or irregular heartbeat, especially when accompanied by chest discomfort or fainting.
- Blue or grey lips, confusion, or a sudden loss of consciousness.
The American Heart Association advises seeking emergency help for possible heart attack symptoms, including shortness of breath with or without chest discomfort. Call your local emergency number if these warning signs occur rather than driving yourself to hospital.
Breathlessness that is new, persistent, gradually worsening, or interfering with usual activities also deserves prompt medical evaluation, even when it is not an emergency. If you have an existing heart condition, contact your healthcare team promptly about new symptoms or a noticeable worsening of your usual breathing.
How Do Doctors Find Out Whether Heart Disease Is Causing Breathlessness?
A healthcare professional will usually begin by asking when the breathlessness started, whether it occurs during activity or at rest, whether it changes when you lie down, and whether you have other symptoms. Your medical history, existing conditions, medications, and any recent changes in your health also help guide the assessment.
The examination may include checking your heart rate, blood pressure, breathing, oxygen level, and signs of fluid buildup. Depending on the findings, further tests may be needed, such as:
- Electrocardiogram (ECG): Records the heart's electrical activity and can help identify abnormal rhythms or signs of a heart problem.
- Echocardiogram: Uses ultrasound to show the heart's structure, pumping function, and valves.
- Blood tests: May check for signs of heart strain, heart muscle injury, anemia, or other possible causes.
- Chest X-ray: Can help identify fluid in the lungs or other chest problems.
- Exercise or other specialized heart tests: May be recommended when symptoms suggest a problem that requires further investigation.
The National Heart, Lung, and Blood Institute explains that diagnosing heart failure involves medical history, a physical examination, and test results. Not everyone needs every test; the choice depends on the symptoms and the findings from the initial assessment.
What Happens If Heart Disease Is Causing Shortness of Breath?
Treatment depends on the underlying heart condition rather than breathlessness alone. For example, treatment for heart failure may involve medicines and changes to daily care, while coronary artery disease, valve disease, and abnormal heart rhythms may require different medicines or procedures.
When breathlessness is related to a heart condition, treating that condition may help improve breathing and daily activity. The appropriate approach depends on the specific diagnosis, its effects on heart function, and the person's overall health.
If your breathing has changed recently, note when it occurs, what you were doing, how long it lasts, and whether other symptoms appear at the same time. These details can help your healthcare professional assess the problem and decide which investigations or treatments may be appropriate.