If you’re getting winded doing things that used to be easy, like climbing stairs, carrying groceries or taking a short walk, it’s easy to brush it off. Many people blame aging, stress or being out of shape. But new or worsening shortness of breath can be a sign of a heart problem.
"The heart and lungs work closely together," said Emily Rapstine, MD, a cardiothoracic surgeon with Banner Health. “For many people, feeling short of breath and tired after activity are the first signs of heart disease or valve problems."
While shortness of breath isn’t always caused by a heart issue, it’s important to notice if it feels different or worse. Here’s what you should know when breathlessness could mean something more.
What shortness of breath really means
Your heart and lungs work as a team. Your lungs take in oxygen and your heart pumps that oxygen-rich blood to your body. If this teamwork isn't working right, you might notice it first when you move.
When your heart doesn't pump blood well, less oxygen reaches your muscles and organs. That’s why simple tasks like climbing stairs can make you feel short of breath.
Shortness of breath, or dyspnea, is the feeling that you can't get enough air. Sometimes, mild issues like a cold or anxiety cause it. But if it keeps getting worse or doesn't go away, it could be a sign of heart or lung problems or other health issues.
Heart-related causes of shortness of breath
Several heart problems can make it hard to breathe. Some happen suddenly, while others develop gradually over time. Here are some of the most common ones.
Coronary artery disease
Blocked or narrow arteries often cause heart disease. In coronary artery disease, plaque (made up of cholesterol and fat) builds up in the arteries that carry blood to your heart.
Less blood flow means less oxygen for your heart muscle. This can lead to:
- Fatigue (extreme tiredness)
- Lower energy levels
- Shortness of breath with activity
- Feeling weaker than usual
Women, older adults and people with diabetes often have less obvious symptoms. Learn more about coronary artery disease and how it can affect your heart.
Valvular heart disease
Your heart has four chambers that keep blood flowing in the right direction. When a valve becomes too narrow or leaky, your heart must work harder to pump blood.
This can lead to:
- Shortness of breath during activity
- Trouble breathing when lying flat
- Fatigue (tiredness)
- Swelling in the legs or feet
Some valve problems develop slowly. Many people think their symptoms are just a part of getting older. Learn more about heart valve disease and the signs to look for.
Heart failure
Despite its name, heart failure doesn’t mean the heart has stopped. It means the heart isn't pumping blood as well as it should. When this happens, fluid can build up in the lungs and body, making it hard to breathe.
Causes of heart failure include clogged arteries, long-term high blood pressure (hypertension) and heart muscle diseases. Infections that hurt the heart can also cause it.
Common signs of heart failure include:
- Swelling of feet, ankles or stomach
- Waking up at night feeling short of breath
- Needing extra pillows to sleep comfortably
- Rapid weight gain from fluid retention
Heart failure symptoms can get worse gradually, making them easy to miss. Learn more about the signs of heart failure and its treatment.
When is shortness of breath normal and when should I worry?
Not every moment of breathlessness is a red flag. It helps to know the difference.
Usually normal:
- After a tough workout
- During a short-term illness like a cold or the flu
- During moments of stress or anxiety
- At high elevations
Warning signs to bring to your health care provider:
- New or worsening shortness of breath
- Getting winded during mild activity, like walking to the mailbox
- Needing extra pillows to breathe at night
- Swelling in your legs or feet
- Dizziness
- Racing or irregular heartbeat
When to call 911 or seek emergency care:
- Sudden or severe shortness of breath that doesn’t get better with rest
- Breathlessness with chest pain, jaw pain, arm pain or fainting (syncopal episode)
- Develop sudden confusion
- Have blue lips or fingertips
What happens during a heart evaluation?
Heart testing might sound scary but most early tests are simple, quick and painless. Here’s what to expect:
- A physical exam and review of symptoms
- Checking vital signs like heart rate, blood pressure and breathing rate
- An electrocardiogram (EKG) to monitor your heart’s electrical activity
- An echocardiogram, which is an ultrasound showing how your heart pumps and how your valves work
- Stress testing to see how your heart handles activity
- Imaging tests like X-ray, CT scan and sometimes MRI to look inside your chest
“These tests help your provider determine whether the problem is related to your heart, lungs or another condition,” Dr. Rapstine said. “Shortness of breath can sometimes be caused by conditions such as COPD, pneumonia, Valley fever, viral infections or pulmonary fibrosis.”
If results point to a heart cause, more detailed tests like a coronary angiogram, transesophageal echocardiogram or cardiac MRI may follow.
If treatment or surgery is needed
If your tests show a heart problem, today's treatments are better and more effective than ever. Many people can go back to the activities they enjoy.
Treatments may include:
- Medications to lower blood pressure, manage cholesterol or reduce fluid buildup
- Procedures like stents to open blocked arteries
- Surgeries such as bypass or valve repair or replacement
Finding a problem early can make a big difference. The sooner a problem is found, the more options you may have.
“When breathlessness is caused by coronary artery disease, timely treatment to restore blood flow can lead to better long-term results, using stents or bypass surgery,” Dr. Rapstine said. “For valve problems like aortic stenosis, tricuspid regurgitation or mitral regurgitation, medicines can help ease symptoms while a cardiologist or surgeon plans for valve repair or replacement.”
Takeaway
Shortness of breath isn't always just a sign of getting older. If you find yourself getting winded more easily, avoiding activities or struggling to breathe during normal tasks, pay attention to how you feel. You know your body best. Even mild symptoms can be a sign of heart disease.
If your symptoms are new or getting worse, a heart specialist can help find out what’s causing them and what to do next. Find a Banner Health specialist near you. If your symptoms are severe or come on suddenly, call 911 right away.
Frequently asked questions
Is shortness of breath always a heart problem?
Shortness of breath can happen due to lung conditions, infections, anxiety, allergies or other health issues. If your breathlessness is new, lasts longer than a few minutes or keeps coming back, it’s a good idea to see your provider.
When should I worry about being short of breath?
Seek medical care if you have new or worsening shortness of breath, especially if it happens during mild activity or comes with chest pain, swelling or dizziness.
Can heart problems cause symptoms without chest pain?
Yes. Some heart conditions cause fatigue, breathlessness, swelling or palpitations before you feel chest pain. Feeling short of breath is often the first sign.
What should I do if I suddenly can’t catch my breath?
Seek emergency care immediately or call 911, especially if symptoms are severe or include chest pain, jaw pain, fainting or a racing heartbeat.
