Shortness of breath: the heart problems that can affect your breathing

Shortness of breath happens to be the most common reason for visiting a hospital A&E department. The COVID-19 pandemic has shed light on this issue, we know the health of our lungs can impact our breath but of course, so can the heart.

To ensure that the importance of our heart isn’t overlooked during this time, we got in contact with the renowned consultant interventional cardiologist, Dr Niket Patel, to discuss how different types of heart problems can affect your breathing.

How can heart problems affect your breathing?

Simply put, your heart’s primary function is as a pump for the circulatory system. Anything that makes your heart less efficient in performing this vital role can make you breathless. There are two sides of the heart and failure of either side to work properly can cause significant problems.

The left side of the heart receives blood from the lung and pumps it to the body. Problems of this side of the heart can cause pressure and fluid build-up in the lungs. This makes the lungs less efficient at absorbing oxygen from the air causing breathlessness. This can affect your ability to tolerate activities that need a higher blood supply to your muscles. This can even happen on daily activities, such as climbing stairs, going up inclines, vacuuming, carrying the shopping or walking. If you are generally a fit person day to day life may not be affected initially, but maybe cause you to have a reduced aerobic capacity limiting duration or intensity of exercise. The pressure and fluid build-up caused by the left side of heart can also cause the right of the heart to fail.

The right side of the heart receives blood returning from the body and pumps it to the lungs. Failure in function of this side of the heart principally causes pressure build-up in the veins of the body. This can cause fluid to build up in the tissues of the body which starts in the most dependent area (lowest points in the body) such as the feet, ankles, and lower legs. Fluid can also build up in other areas including the abdomen.

What heart problems can cause breathing problems?

There are many cardiac conditions that can cause difficulty in breathing. Some can cause breathlessness in episodes and others cause persistent problems. The following are the most common cardiac conditions causing of breathlessness. They can occur in isolation or in combination.

• Heart failure: Blood is pumped out of the heart by squeezing action of the main pumping chambers called ventricles. This is achieved by contraction of the cardiac muscle that makes up the walls of the heart. If the muscle is weakened and or the chamber is enlarged then less blood is expelled with each heartbeat. Various conditions can impair the contraction of the ventricle(s) called cardiomyopathies. Furthermore, breathlessness can also occur if the ventricle(s) have an impairment in filling of blood due to poor relaxation of the muscle after contraction.
   
• Valvular heart disease: There are four valves of the heart designed to allow one way travel of blood from one chamber to another. If the valves do not open properly (stenosis) or are leaky (regurgitation) then the function of the heart can become inefficient particularly if the valve problem is severe causing symptoms of breathlessness.
   
• Arrhythmias: The heartbeat is generated by an electrical impulse that activate the muscular walls of the four chambers of the hear in a timed fashion for each heartbeat cycle. Abnormalist of the electical activity either continuously or episodically can cause breathlessness. The most common arrhythmia is atrial fibrillation which is where there is disorganised electrical activity in the top chambers of the heart causing a fast and irregular rhythm of the pulse. Sometimes atrial fibrillation can cause significant breathlessness as well increasing the risk of other serious complications.
   
• Coronary heart disease: Narrowing(s) (stenosis) of the coronary blood vessels can cause mismatch in the supply and demand of blood by the energy and oxygen hungry heart muscle. If this occurs the chest pain is the most common symptom (angina), however, this can also manifest as breathless.
   

When should someone see a cardiologist for these symptoms?

If you develop breathlessness or a reduction in your usual exercise capacity, then you should see a doctor to help understand the significance of your symptoms with a clinical review. If you have a history of heart disease then this requires monitoring and long-term care. You should seek medical assistance to optimise your therapy particularly if you have not been reviewed for some time or if your symptoms/clinical status changes.
 

Other associated symptoms pointing to a heart condition as a cause for your breathlessness include breathlessness lying flat, lower leg swelling, awaking at night gasping for breath, chest pains, palpitations and black out. Investigations maybe warranted to find the cause of the symptoms so that treatments for the underlying cause(s) can be tailored for you as an individual.
 

What should patients expect when they visit you?

I treat my patients as individuals and tailor therapies to their specific needs. This starts with an initial consultation to outline the course of the symptoms and any other medical conditions followed by clinical examination. Investigations maybe required to guide therapies with follow-up care and monitoring as needed. I provide timely bespoke care centred around my patients needs.
 

What type of diagnostic procedures can you offer?

I provide a full range of cardiac investigations to treat heart conditions. You can find a full list of these in my next article on diagnostic procedures.
 

If you would like to receive medical guidance from one of the UK’s leading consultant interventional cardiologists, we recommend booking an appointment with Dr Niket Patel. Click here to visit his Top Doctors profile today.