Heart failure: Cardiologist highlights 5 subtle signs like swollen ankles that indicate your heart is weakening

Dr Pradeep highlights warning signs of heart failure, including increased urination at night, swollen ankles, and breathlessness.

Heart failure is one of the most common cardiac conditions, and its risk increases steadily with age, affecting more than 64 million people worldwide, as per data provided by the World Heart Federation.

To gain a deeper understanding of this deadly condition and its subtle signs, such as swollen ankles, which could indicate weakening of the heart, HT Lifestyle spoke with Dr Pradeep Haranahalli, consultant interventional cardiologist, Manipal Hospital, Whitefield, Bengaluru.

Early symptoms that are easy to miss

According to Dr Pradeep, this cardiac condition is broadly classified into two categories: heart failure with preserved ejection fraction and heart failure with reduced ejection fraction. “While these categories guide treatment, the symptoms patients experience are often similar. Recognising these signs early is key to effective management,” he emphasised.

Watch out for these early signs of heart failure  (Twitter/PsychiatristCNS)

One of the earliest and most common symptoms of heart failure, according to Dr Pradeep, is “reduced effort tolerance, a gradual decline in the ability to perform physical activity.” Many people dismiss this as a normal part of ageing.

However, Dr Pradeep noted that in reality, it can be a subtle warning sign of underlying heart failure. “This is particularly relevant in older individuals with back or knee problems, who reduce activity because of pain and may never truly test their stamina. In such cases, heart failure can remain hidden until it becomes advanced,” he added.

Fluid buildup and breathing problems

Next, Dr Pradeep noted that as physical activity decreases, weight gain may occur, often due to fluid accumulation rather than fat. He emphasised, “This fluid congestion can affect the intestines, leading to poor appetite and early fullness after meals.”

Swelling of the legs, noted the cardiologist, is another important sign. “Initially, it appears in the evening and disappears by morning. As heart failure progresses, the swelling persists throughout the day and should never be ignored,” he explained.

Moreover, fluid can also accumulate in the lungs, causing breathlessness, coughing, and difficulty lying flat. “Many patients need extra pillows at night or feel more comfortable sitting up. Some wake suddenly from sleep with severe breathlessness and coughing, known as paroxysmal nocturnal dyspnea. These symptoms clearly indicate fluid in the lungs,” Dr Pradeep elaborated.

As heart failure progresses, the swelling persists throughout the day and should never be ignored. (Unsplash)

Risk factors, test clues, and advanced signs

Other warning signs, as per Dr Pradeep, include:

• Shoes feeling tighter
• Abdominal bloating
• Facial puffiness on waking

The cardiologist added, “Heart failure also triggers the release of natriuretic peptides, which can cause increased urination at night. Routine health checks may provide clues, such as an enlarged heart on chest X-ray or raised creatinine and NT-proBNP levels in blood tests.”

Lastly, the doctor noted that heart failure is more common in people with obesity, diabetes, hypertension, previous heart attacks, or known heart disease.

Moreover, in advanced stages, patients may experience breathlessness even at rest, with simple activities like bathing or walking across a room becoming exhausting. “These symptoms should never be attributed to ageing alone. Heart failure is highly manageable when identified early, and timely medical care can significantly improve quality of life and outcomes,” he cautioned.

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.