‘I’m a cardiologist – here are the top five signs of heart failure’

In the UK, around a quarter of people will die from cardiovascular disease. This refers to any disease or condition that affects the heart or circulatory system.

Heart failure is one such condition, which occurs when the heart is unable to pump blood around the body properly. Usually this is because it has become too weak or stiff to do so.

It is a serious long-term condition that will typically get worse over time. Therefore, the sooner you spot any of the warning signs the sooner you can seek the appropriate medical treatment.

Making healthy lifestyle changes can slow the progression of heart failure but in many cases patients will require medication to manage symptoms. Devices such as pacemakers may also be needed and in some cases surgery will be required.

To help you get the treatment you need, London-based cardiologist Doctor Hafiz Naderi, shared the top five warning signs of heart failure to be aware of.

Speaking on YouTube, on his channel The Heart Doctor, he said: “In this video I want to focus on the top five signs and symptoms we commonly see when patients present with heart failure for the first time either in the emergency department or when they get referred to us by their family doctor.”

These signs are:

  • Breathlessness
  • Swelling
  • Weight gain
  • Palpitations
  • Tiredness.


According to Dr Naderi this is the “number one biggest symptom”.

“Remember in heart failure, your heart can’t keep up with your body’s requirements,” he said.

“So, when you exert yourself, your heart essentially tells your body, ‘I can’t keep up’, so you
feel this as being breathless.”

This sensation might be worse when you are lying flat.

He said: “This is because in heart failure you get fluid build-up in your lungs which worsens when
you lie flat.

“So, patients with heart failure often use a few pillows to help them breathe and be
more comfortable when sleeping.”


Swelling, or oedema, is most common in the extremities such as the ankles.

Dr Naderi said: “This again is due to the build-up of fluid due to the inadequate pumping action
of the failing heart.

“I often hear patients report that the swelling is worse as the day progresses and is better when they wake up in the morning.

“That’s just due to the effects of gravity pushing the fluid to your extremities throughout the day.”

Weight gain

This is again linked to fluid build-up in the body. “In heart failure management we often ask patients to tell us their dry weight, meaning their weight when there isn’t build-up of fluid in their body,” he continued.

“This helps us understand roughly how much to titrate their medication dosages and what
weight to aim for.”


Palpitations are the sensation that your heart is pounding or racing. You may also feel like your heart skipped or stopped beating.

“When we see patients in the emergency department with heart failure either as a first presentation or as a result of a decompensation, we often see that their heart rate is high,” Dr Naderi said.

“This is because the weak heart is overcompensating as it’s struggling to meet the body’s demands so it speeds up and this is why you may experience palpitations.

“The heart may also go into an abnormal rhythm, most commonly atrial fibrillation.”


Although this sign is a “little vaguer” it should still be cause for concern.

Dr Naderi added: “I often hear patients who have recently been diagnosed with heart failure say that they are really tired all the time.

“The weak heart is desperately trying to keep up and as a result you feel tired and fatigued.”

The NHS states that you should see your GP if you experience persistent or gradually worsening symptoms of heart failure.

But it says: “Call 999 for an ambulance or go to your nearest accident and emergency (A&E) department as soon as possible if you have sudden or very severe symptoms.”

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