This can be due to causes which are not of concern, such as a lack of appreciation that we are a little older than we were or that we have put on a pound or two! It can, however, be a sign of a more important problem, and making the distinction between the two can be difficult. The most common problems which can present as breathlessness are Heart Failure and Coronary Artery Disease. The heart is a muscle and if it has become weakened then it cannot keep up with the body’s needs, which may result in Heart Failure. This is not the heart simply stopping, as it might sound, but a failure to pump the blood round the body as well as the body needs. This leads to breathlessness, which may also be accompanied by fluid retention such as swelling of the lower legs.
Like any muscle, the heart needs a blood supply and this comes from the coronary arteries. There are three main coronary arteries which run on the surface of the heart and give branches which supply the heart with it’s blood. If these become narrowed or even blocked (this is called ‘Coronary Artery Disease’), then the heart cannot get enough blood, especially when it has to work a little harder such as when we exert ourselves, and this may result in breathlessness.
The strength of the heart muscle can usually be easily determined by a simple ultrasound scan of the heart called an echocardiogram. This simply involves some jelly on the skin of the chest and moving a probe around to get pictures of the heart- much like the ultrasound to look at a baby in the womb. It shouldn’t be painful, though can occasionally be a little uncomfortable as the probe needs to be pressed quite hard against the skin to get good pictures. The coronary arteries can be checked using a range of tests ranging from a simple exercise test- monitoring the heart whilst the patient walks on a treadmill- to a coronary angiogram.
Weakness of the heart muscle is treated in a variety of ways. If there is fluid retention, this will be treated with one or more type of diuretic (‘water tablets’). Sometimes the cause can be identified and the heart’s strength improved by some form of operation, such as improving the blood supply to the muscle by either opening up the narrowings with coronary angioplasty– ballooning and positioning metal cages in the arteries called ‘stents’. If the heart muscle is generally weak, in some situations this can be improved by a special type of pacemaker called a biventricular pacemaker.