Breathlessness often comes from the lungs, low fitness or anxiety, but it can also be the first sign of heart failure, a valve problem or an irregular rhythm. Severe difficulty breathing, a tight or heavy chest, or blue or grey lips need 999. Dr Navin Chandra, consultant cardiologist, checks whether the heart is involved at four hospitals across East Berkshire and South Buckinghamshire.
| Question | Answer |
|---|---|
| Common symptoms | Short of breath on stairs or walking, when lying flat or at night, often with swollen ankles |
| How it’s diagnosed | Examination, an ECG, an NT-proBNP blood test, a heart ultrasound scan and rhythm monitoring |
| Treatment options | Treating the cause: heart failure medicines, valve treatment or rhythm treatment |
| When to seek urgent help | 999 or A&E for severe breathing difficulty. NHS 111 if you are more short of breath than usual |
What Is Breathlessness, and When Does the Heart Play a Part?
Breathlessness is an uncomfortable awareness of your own breathing. It ranges from feeling puffed on a hill to struggling for air while sitting still. The NHS calls it shortness of breath.
Being out of breath after hard exercise is normal. It becomes a concern when it happens with less effort than before, or comes with other symptoms. A heart cause becomes more likely when the ankles swell or lying flat makes it worse.
The NHS page on shortness of breath explains common causes and when to get help.
Heart, Lung and Other Causes and Risk Factors
Dr Chandra looks for heart causes first, while keeping the other possibilities in view.
- Heart failure: the heart cannot pump blood as well as the body needs. The name sounds alarming, but the heart has not stopped.
- Valve disease: a narrowed or leaking aortic or mitral valve makes the heart work harder.
- Atrial fibrillation and other rhythm problems: an irregular or fast beat pumps blood less well.
- Coronary artery disease: narrowed heart arteries can leave you breathless on effort.
- Pulmonary hypertension: high pressure in the blood vessels of the lungs.
- Pericardial effusion: fluid collecting in the sac around the heart.
- Lung and general causes: asthma, a chest infection, COPD, being overweight, smoking or a panic attack.
Heart failure is more likely if you are 65 or older, smoke, drink a lot of alcohol or live with obesity. Years of raised blood pressure, or coronary heart disease, also put strain on the heart.
Symptoms That Suggest a Heart Cause
A heart cause is more likely when shortness of breath follows a pattern.
- Out of breath during everyday tasks, such as stairs or a short walk
- Breathless when lying flat, sometimes called orthopnoea
- Waking at night gasping for air, known as PND
- Tiring sooner than usual on exercise
- Swollen ankles or feet, or sudden weight gain
- A wheeze or a tight feeling in the chest
Some breathing problems need help today. Use this table.
| Red-flag symptom | Go to |
|---|---|
| Severe difficulty breathing: gasping, choking or unable to get words out | Call 999 or go to A&E |
| A tight or heavy chest, or pain reaching your arms, back, neck and jaw | Call 999 or go to A&E |
| Lips or skin turning very pale, blue or grey, or sudden confusion | Call 999 or go to A&E |
| More short of breath than usual, coughing up blood, or pain or swelling in one leg | Contact NHS 111 |
| Breathless lying down or with everyday activity, frothy pink phlegm or sudden weight gain | Urgent GP appointment or NHS 111 |
| Getting worse with normal activities, swollen ankles, or a cough for 3 weeks or more | See a GP |
Never drive yourself to A&E when you are this breathless. Get a lift or an ambulance, and take your medicines along.
Short of Breath Lying Flat or Waking at Night: What It Can Mean
Needing extra pillows to breathe comfortably is a clue worth noting. The NHS lists breathlessness when lying down as a heart failure symptom. Medicines that clear fluid from the body and lungs can ease it.
Some people wake at night gasping and need to sit up to recover. Others notice swollen feet or ankles, or a cough at night. Together, these signs point towards fluid build-up and possible heart failure.
Note how many pillows you use, how far you can walk, and any weight change. That record helps your GP and Dr Chandra judge how things are changing.
When to See a Specialist About Shortness of Breath
A cardiology opinion is sensible in these situations.
- Shortness of breath that is worsening during ordinary activity or on lying down
- Feeling short of breath with swollen ankles
- Known valve disease or atrial fibrillation with new or worse symptoms
- A raised NT-proBNP blood test from your GP, which NICE links to a specialist assessment and heart scan
- A heart murmur or an abnormal ECG found at a routine check
GP referral is welcome, and insured or self-funding patients can also book.
How a Heart Cause Is Diagnosed: Blood Tests, Echo and Rhythm Monitoring
At a first visit of up to 30 minutes, Dr Chandra hears your story, examines your heart, lungs and ankles, and plans the tests.
- ECG: a quick recording of your heart’s rhythm and electrical activity.
- Blood tests: a blood count, kidney and thyroid tests, and NT-proBNP. NICE uses NT-proBNP to decide how soon a heart scan is needed.
- Echocardiogram: an ultrasound scan that shows the heart’s pumping and its valves. More detail is on the cardiac imaging page.
- Rhythm monitoring: a recorder worn from 24 hours up to 7 days, to catch atrial fibrillation or other rhythm problems.
- Further tests: chosen by cause, such as valve follow-up or tests for pulmonary hypertension.
NICE advises an urgent specialist assessment and heart scan within 2 weeks when NT-proBNP is above 2,000 ng/L. A level between 400 and 2,000 ng/L calls for one within 6 weeks. Below 400, heart failure is less likely.
Dr Chandra arranges and reviews these tests, and goes through every result with you.
Treatment Options for Heart-Related Shortness of Breath
Treatment depends on the cause found.
Heart Failure Medicines and Lifestyle
Medicines can clear extra fluid, ease the heart’s workload and slow the heart rate. Weighing yourself, staying active and cutting down on alcohol help too.
Valve Treatment
Mild valve disease is watched with regular scans. A severely narrowed aortic valve may need surgery or transcatheter aortic valve implantation.
Rhythm Treatment
Atrial fibrillation and other rhythm problems are treated with medicines or a procedure. See heart rhythm management.
Heart Devices
Some people need a device, such as a pacemaker, to support the heart’s rhythm. Dr Chandra fits pacemakers and can discuss whether one may help.
Lung or Other Causes
If the heart is not the cause, the next step is usually back with your GP, who can arrange lung or other tests.
Living With a Heart Condition That Leaves You Short of Breath
Heart failure is a long-term condition. Treatment aims to ease symptoms and stop it getting worse. Lifestyle changes help too.
- Take your medicines exactly as prescribed.
- Weigh yourself regularly, as sudden weight gain can mean fluid is building up.
- Stay active, and ask about a cardiac rehabilitation assessment.
- Have the vaccines you are offered, such as the flu jab.
- Stop smoking and cut down on alcohol.
Report any change in your breathing early, rather than waiting for your next appointment.
Why See Dr Chandra About Breathlessness?
Dr Navin Chandra holds an NHS consultant post at Frimley Health NHS Foundation Trust. He also has an honorary post at Royal Brompton and Harefield. His work covers coronary disease, heart valve conditions and rhythm problems.
Because he also treats valves and narrowed arteries, one consultant can follow your care from the first test to any procedure. Complex cases are discussed with the Heart Team. Read more about Dr Navin Chandra.
Where Dr Chandra Assesses Shortness of Breath
| Hospital | Address |
|---|---|
| The Parkside Suite, Heatherwood Hospital | Brook Ave, Ascot SL5 7GB |
| The Parkside Suite, Wexham Park Hospital | Wexham, Slough, Berkshire SL2 4HL |
| BMI Princess Margaret Hospital | Osborne Road, Windsor, Berkshire SL4 3SJ |
| Spire Thames Valley Hospital | Wexham Street, Wexham, Buckinghamshire SL3 6NH |
These are the four hospitals where he holds clinics. For clinic days, phone 020 7099 9685 or write to enquiries@navinchandra.co.uk with your question. If your breathing worsens at night or at the weekend, contact NHS 111. Severe breathing difficulty needs 999.
Paying for a Breathlessness Consultation: Fees and Insurance
2026 fees are confirmed when you book. Blood tests, scans and monitors are priced separately and explained first.
- Insured: confirm your cover and any pre-authorisation before your visit. Insurers include Aviva, WPA, Bupa, Vitality, AXA Health, Cigna and Healix.
- Self-pay: available, with test costs set out before anything is arranged.
FAQs About Breathlessness
Is breathlessness a sign of heart problems?
It can be, but most cases have other causes, such as asthma, a chest infection or low fitness. A heart cause is more likely with swollen ankles, breathlessness lying flat or symptoms on little effort.
Why am I short of breath when I lie down at night?
Lying flat can let fluid spread through the lungs when the heart is pumping less well. Needing more pillows, or waking up gasping, should be checked by your GP or a cardiologist.
Can anxiety cause shortness of breath?
Yes. The NHS lists a panic attack as a common cause. Even so, if breathing problems keep returning, it is worth ruling out a heart or lung cause first.
What makes me breathless when walking or climbing stairs?
Low fitness and extra weight are common reasons. Heart failure, a narrowed valve or narrowed heart arteries can also limit how far you can walk. New or worsening symptoms deserve a check.
Is breathlessness a sign of heart failure?
It is one of the main symptoms, especially during everyday tasks or when lying down. Swollen ankles, tiredness and sudden weight gain often go with it. An NT-proBNP test and a heart scan help confirm or rule it out.
Can high blood pressure make you short of breath?
High blood pressure itself does not usually cause symptoms. Over many years, though, it strains the heart and can lead to heart failure, which does cause shortness of breath.
How much shortness of breath is normal?
Getting out of breath during hard exercise is normal and settles quickly with rest. See a GP if it happens with normal activities, when lying down, or with swollen ankles.
Book a Breathlessness Consultation with Dr Navin Chandra
- Phone: 020 7099 9685
- Email: enquiries@navinchandra.co.uk
- Online: use the booking form to request a face-to-face or virtual consultation
Struggling to breathe or turning grey needs 999 or A&E straight away. NHS 111 can advise on anything urgent that is not an emergency.
Related pages cover chest pain and palpitations, and the symptoms overview lists every symptom Dr Chandra sees. You can also use the contact form.