Heart Failure & Breathlessness

Hearing that your heart is “weak” or that you have “heart failure” can be frightening. You may wonder whether your heart is about to stop, whether medicines can help, or whether you will need a procedure.

Heart failure may first feel like getting unusually breathless or tired during activities you previously managed comfortably. You may notice swollen ankles, need extra pillows to breathe comfortably in bed, or wake at night feeling short of breath. These symptoms can have other causes too, so they need assessment rather than an assumption that your heart is weak.

Heart failure means that a problem with the heart’s pumping or filling function is causing symptoms and signs such as breathlessness, tiredness or fluid build-up. It does not mean that your heart has stopped. Some people have reduced pumping strength; others have a preserved pumping percentage but abnormal filling and pressure within the heart.

Treatment can ease symptoms, reduce the risk of hospital admission and, in some patients, substantially improve heart function. The starting point is to understand what is causing the problem and what your heart needs.

Dr. Kulin Sheth, interventional cardiologist, assesses and treats patients with heart failure at Sheth Heart Clinic in Bopal, Ahmedabad, with hospital care and specialist input arranged according to the patient’s needs.

Severe breathlessness at rest, chest pain, collapse or new confusion needs emergency assessment. Do not wait for a clinic appointment or a WhatsApp reply.

• No. These terms describe different problems, although they can be connected.

  Question	Heart attack	Heart failure or a “weak heart”
  What is happening?	The heart muscle is being injured because it is not receiving enough blood and oxygen, commonly because a coronary artery is blocked.	The heart is not pumping or filling adequately, leading to symptoms and sometimes fluid accumulation.
  How may it present?	Chest pressure, sweating, breathlessness, nausea or other symptoms, sometimes without typical chest pain.	Breathlessness, tiredness, swelling and reduced ability to manage usual activity. It may develop gradually or worsen suddenly.
  How are they connected?	A heart attack can damage the heart muscle and lead to heart failure.	Heart failure can also arise without a previous heart attack, for example from high blood pressure, valve disease or cardiomyopathy.

  Having heart failure does not mean that you will definitely have a heart attack. Your risk depends on whether coronary artery disease and other risk factors are present. These need their own assessment and treatment.

  Heart failure also differs from cardiac arrest, when the heart suddenly stops pumping blood effectively and the person becomes unresponsive. Sudden collapse with absent or abnormal breathing is an emergency requiring immediate help and CPR.

  The chest pain and heart attack page explains the warning symptoms in more detail.

When pressure builds up behind the left side of the heart, fluid can collect in the lungs. Breathing may become harder during walking, climbing stairs or doing household work. Some people need more pillows to sleep comfortably or wake at night feeling short of breath.

Patients may describe this as “Thodu chalu to pan saans chadhe chhe” or “Thoda chalne par bhi saans phoolti hai.” A change from what you could comfortably do before deserves attention.

Other symptoms may include:

• Unusual tiredness or a gradual reduction in walking distance.
• Swelling in the feet, ankles or legs.
• Increasing weight over a short period because of fluid retention.
• Abdominal fullness, bloating or reduced appetite.
• Persistent cough, particularly when lying down.
• Palpitations, dizziness or light-headedness.

You do not need to have every symptom. Equally, breathlessness alone does not establish heart failure. Lung disease, anaemia, excess weight, reduced fitness and other conditions can cause similar symptoms, and more than one problem may be present.

My Legs Are Swollen. Does That Mean My Heart Is Weak?

Not necessarily. Heart failure can cause leg swelling, but vein problems, kidney or liver disease, some medicines and prolonged sitting or standing can also contribute.

The pattern matters: whether one or both legs are affected, how quickly swelling developed, and whether it is accompanied by breathlessness, weight gain or difficulty lying flat. Examination and appropriate tests help establish the cause.

New, unexplained swelling in one leg, particularly with pain, redness or warmth, needs urgent assessment. If it occurs with chest pain or sudden breathlessness, seek emergency care. Do not assume it is simply fluid from a weak heart.

Can I Have Heart Failure With a Normal Pumping Percentage?

Yes. The ejection fraction, or EF, describes the proportion of blood the left ventricle pumps out with each beat. It is one measurement of heart function. It does not tell us what proportion of the heart is alive or working.

Some reports use the term “mildly reduced EF”. Terminology has evolved, and Dr. Kulin will explain how your report relates to your symptoms and treatment. Neither a normal EF nor a low EF should be interpreted in isolation.

Finding the cause helps guide treatment. Possible causes and contributing conditions include:

• Coronary artery disease, including damage from a previous heart attack.
• Long-standing or inadequately controlled high blood pressure.
• Heart valve disease.
• Cardiomyopathy, a condition affecting the heart muscle, which may be inherited or acquired.
• Sustained fast or irregular heart rhythms.
• Certain cancer treatments or other substances that affect the heart muscle.

Diabetes, obesity and kidney disease can also contribute and influence treatment. Sometimes several factors act together. Less common causes are investigated when the history, examination or imaging suggests them.

How Is Heart Failure Diagnosed?

Assessment begins with your symptoms, their timing, previous illnesses, medicines and a physical examination. Dr. Kulin considers whether the findings fit heart failure, what else could explain them and whether urgent treatment is needed.

Tests may include:

• ECG: assesses the heart’s electrical activity and may identify rhythm or conduction problems. It does not measure pumping strength directly.
• 2D echocardiography: evaluates pumping function, chamber size, valves, filling patterns and other findings that help explain symptoms.
• BNP or NT-proBNP: blood markers of stress on the heart that can support the assessment. Obesity and treatment can lower levels; kidney disease and other illnesses can raise them. A result needs clinical interpretation.
• Other blood tests: assess kidney function, sodium, potassium, blood count, iron status and other possible contributors, depending on the situation.
• Chest imaging or further tests: selected when needed to evaluate congestion, lung disease or the underlying cause.

A low EF is an important finding, but a diagnosis and treatment plan need the full picture. Similarly, a report mentioning “diastolic dysfunction” does not automatically establish symptomatic HFpEF. When resting tests do not explain persistent breathlessness, additional assessment may be needed.

Cardiac MRI or coronary testing may be appropriate for selected patients. Heart failure does not automatically mean that everyone needs angiography or a stent. The question is whether coronary disease is likely and whether finding or treating it would change care.

Sheth Heart Clinic uses the GE HealthCare Vivid T8 Ultra Edition system with global longitudinal strain, or GLS. Dr. Kulin Sheth routinely incorporates GLS into heart-failure assessment when suitable images can be obtained, including assessment of patients with reduced or preserved EF.

GLS measures how the heart muscle shortens along its length during contraction. It adds information beyond the pumping percentage and can reveal impaired muscle function even when EF remains preserved. Comparing suitable studies over time can also help assess changes in heart-muscle function.

For you, this means the assessment looks beyond a single EF number. GLS is interpreted alongside the complete echo, symptoms, examination and other results. It cannot independently confirm or exclude heart failure, and reliable interpretation depends on image quality and the clinical circumstances.

The cardiac tests page explains 2D echo and GLS in more detail.

I Am Starting Cancer Treatment. Will It Make My Heart Weak?

Some cancer treatments can affect heart function, but this does not happen to everyone. Risk depends on the treatment, dose, previous treatment and your cardiovascular health. The oncology and cardiology teams decide what assessment and monitoring are appropriate; not every cancer medicine requires the same testing schedule.

At Sheth Heart Clinic, Dr. Kulin Sheth uses 2D echo with GLS before and, where indicated, during cancer treatment to assess heart-muscle function. GLS can identify changes before EF falls in some patients. These findings help the treating teams decide whether closer monitoring or heart treatment is needed. A normal scan cannot guarantee that no complication will develop. Do not stop or delay cancer treatment without discussion with your oncology team.

Yes, in some patients, medicines can substantially improve pumping function without a heart procedure. Improvement may develop over weeks to months as treatment is adjusted and the underlying problem is addressed.

The degree of recovery varies. It depends on the cause, the amount of established damage, how long the problem has been present and the response to treatment. Some patients regain near-normal pumping function; others have more modest improvement or continue to need treatment for persistent disease.

Medicines remain important even when a procedure is needed. Conversely, an improved EF does not automatically mean the condition has been permanently cured. Treatment withdrawal can allow heart dysfunction to return, so do not stop tablets because you feel better or because the latest echo has improved.

How Do Heart Failure Medicines Help?

Treatment aims to relieve congestion, protect heart function, reduce hospital admissions and help you live better. Different medicines perform different jobs, which is why several tablets may be prescribed together.

When Pumping Function Is Reduced

For many patients with substantially reduced EF, treatment includes several complementary groups:

The choice, timing and doses depend on EF, blood pressure, pulse, kidney function, potassium and tolerance. Treatment is introduced and adjusted with monitoring; not every patient can take every medicine or the same dose. Other medicines may help in selected circumstances.

When Pumping Function Is Preserved

HFpEF also has treatment options. These include SGLT2 inhibitors in suitable patients, diuretics for congestion and consideration of finerenone, a nonsteroidal MRA, according to clinical suitability and local prescribing requirements.

Treatment also addresses blood pressure, atrial fibrillation, diabetes, kidney disease and obesity. Selected patients with obesity and HFpEF may benefit from medicines such as semaglutide or tirzepatide as part of an individualised plan. These are not suitable for everyone and do not replace the rest of heart-failure care.

Medicines may affect blood pressure, kidney function and electrolytes such as potassium. Tests are therefore arranged after relevant treatment starts or dose changes, often within one to two weeks for medicines requiring early kidney and potassium monitoring, with timing adjusted to your risk.

Tell the treating team about dizziness, faintness, marked weakness, vomiting, diarrhoea, poor intake or difficulty taking medicines. Ask for an individual plan for illness, fasting or surgery. Do not stop several medicines or change water tablets on your own unless you have an agreed written plan.

Salt, Fluids and Monitoring at Home

How Much Water Can I Drink?

There is no single daily fluid allowance for everyone with heart failure. Advice depends on congestion, sodium levels, kidney function, medicines and your circumstances, including hot weather or an illness causing fluid loss.

If a restriction is needed, ask for a clear daily amount and what to count. Tea, milk, chaas, soup and other drinks contribute to fluid intake. Avoid both excessive drinking and overly strict restriction without advice.

Do I Need to Stop Salt Completely?

Avoid excessive salt, particularly from pickles, papad, namkeen, packaged snacks, instant foods and salty restaurant meals. The aim is a workable eating plan that supports fluid control and adequate nutrition. Severe restriction is not a universal prescription.

Do not automatically switch to a potassium-based “low-sodium” salt substitute. It may be unsuitable with kidney disease or medicines that raise potassium.

What Should My Family and I Watch For?

Your home plan may include:

• Weight recorded regularly, often daily, using the same scale under similar conditions.
• Changes in breathing, pillow requirements, swelling and usual activity.
• Blood pressure and pulse readings when advised.
• A current medicine list and a record of relevant symptoms or missed doses.

Ask what weight change should trigger a call and whom to contact. A rapid rise over a few days may represent fluid retention, but your action plan should reflect your usual weight and clinical condition.

Check before taking over-the-counter painkillers, herbal products or supplements. Some, including NSAID painkillers such as ibuprofen or diclofenac, can worsen fluid retention or kidney function.

Many people return to meaningful daily activity with treatment. Once your condition is stable, gradual exercise and an appropriate cardiac rehabilitation programme can improve stamina and confidence. Prolonged bed rest is not the routine long-term plan.

Walking targets, work duties and travel advice depend on your symptoms, recent admissions and overall health. Build activity gradually and pause for review if breathlessness, dizziness or fatigue is worsening. Discuss strenuous exercise and travel after a recent admission before resuming them.

Recovery is assessed through how you feel and function, examination, blood tests and repeat imaging when appropriate. One EF reading cannot reliably predict an individual’s future.

When Is Hospital Treatment Needed?

Heart failure may become decompensated, meaning the body can no longer compensate adequately and symptoms worsen. Hospital treatment may be needed for significant congestion, low oxygen levels, poor circulation, a dangerous rhythm or another serious trigger.

The hospital team may use intravenous diuretics, provide breathing support when needed and look for triggers such as infection, a heart attack, rhythm disturbance or changes in kidney function. Oxygen is used when indicated, rather than automatically for every patient.

Before discharge, the plan should explain medicines, monitoring, pending tests and follow-up. Early review after discharge allows reassessment of congestion, kidney function and treatment tolerance. Repeated admissions or persistent severe symptoms warrant a fresh review of the diagnosis, causes and treatment, including specialist heart-failure referral where appropriate.

When Do Devices or Procedures Help in Heart Failure?

Most treatment decisions begin with the cause of heart failure and an appropriate medicine plan. Devices and procedures help selected patients:

• ICD: implantable cardioverter-defibrillator. Detects and treats certain dangerous ventricular rhythms. Its main purpose is protection from selected rhythm-related risks; it does not directly strengthen the heart muscle.
• CRT: cardiac resynchronisation therapy. Coordinates contraction in selected patients with an electrical delay and impaired function. It can improve symptoms and heart function when the eligibility criteria are met.
• Treatment of an underlying problem. Coronary revascularisation, valve treatment or rhythm procedures may help when a specific indication is present.

A low EF alone does not decide whether you need a device. The assessment considers symptoms, ECG findings, treatment response, timing, other illnesses and expected benefit. The ICD and CRT page explains these decisions in greater detail.

For advanced disease despite treatment, a specialist team may consider further options, including mechanical support or transplantation in suitable patients. Symptom relief, emotional support and discussion of personal goals are important throughout care.

Seek emergency care immediately for:

• Severe or rapidly worsening breathlessness at rest, especially if you cannot speak comfortably.
• Chest pressure or pain, particularly with sweating, nausea or breathlessness.
• Collapse, new confusion, or blue or grey lips.
• Coughing pink, frothy sputum or sudden severe breathing difficulty.
• A painful swollen leg accompanied by sudden breathlessness or chest pain.

Contact your treating team promptly, usually the same day, for:

• Increasing breathlessness, new difficulty lying flat or waking breathless.
• Increasing swelling or a rapid weight rise beyond your agreed action threshold.
• Markedly reduced urine, persistent dizziness or difficulty tolerating medicines.

If symptoms are severe, progressing quickly or you cannot obtain timely advice, seek urgent in-person assessment. Do not wait for a WhatsApp response.

References

• European Society of Cardiology: 2026 guidelines for the management of heart failure.
• American College of Cardiology: 2026 expert consensus pathway for heart failure with preserved ejection fraction.
• American College of Cardiology: 2024 expert consensus pathway for heart failure with reduced ejection fraction.
• NICE: chronic heart failure in adults, diagnosis and management.
• American Society of Echocardiography and European Association of Cardiovascular Imaging: clinical applications of strain echocardiography.
• American Society of Echocardiography: evaluating diastolic function and diagnosing heart failure with preserved ejection fraction.
• European Society of Cardiology: 2022 cardio-oncology guidelines.
• Cardiological Society of India: position statement on management of heart failure in India.
• American Heart Association: improving a low ejection fraction.
• GE HealthCare: Vivid T8 Ultra Edition ultrasound system and imaging capabilities.