Heart disease, encompassing a variety of conditions affecting the heart’s structure and function, is one of the leading causes of death and comorbidity worldwide. For many people with heart disease, breathing difficulties represent a common and sometimes a first symptom, leading to initial diagnosis or decompensation. These issues may range from mild shortness of breath to severe episodes that affect daily activities. Managing breathing difficulties in heart disease is essential to improving quality of life and preventing further health complications.

The article below provides a comprehensive guide on how to manage breathing difficulties in heart disease. It covers the lifestyle changes for better breathing with heart issues and techniques to improve breathing in heart patients. In addition to this we have referenced several scientific articles` that provide evidence for the various strategies discussed, which help Dr Bart guide his patients towards optimal treatment. 

Breathing Difficulties in Heart Disease

Breathing difficulties often arise due to the heart’s inability to pump blood efficiently, which leads to fluid accumulation in the lungs, known as pulmonary congestion or pulmonary oedema. This insufficiency can also lead to reduction of oxygen delivery to tissues. Congestive heart failure (CHF) is a primary condition associated with breathlessness, though other forms of heart disease, such as coronary artery disease (CAD), valvular heart disease, or arrhythmias, can also lead to similar symptoms.

In a review article by Gheorghiade et al. from 2009 entitled `Acute Heart Failure Syndromes`, the authors explain that heart failure leads to abnormal cardiac output and fluid retention, which in turn cause shortness of breath, especially during physical exertion or while lying down. (https://www.sciencedirect.com/science/article/pii/S0735109708037960?via%3Dihub)

Additionally, an article published in 2000 by Remme describes the fact that ischemic heart disease also known as coronary artery disease (reduced blood flow due to blocked arteries) is a principal etiology of heart failure in the Western World. This reduction in blood flow limits the oxygen delivery to the heart, causing laboured breathing during exercise or in advanced form also at rest. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6654835/)

Techniques to Improve Breathing in Heart Patients

Improving breathing in heart patients involves a multifaceted approach that includes both medical interventions and self-care techniques. First, medical treatments aim to address the underlying causes of the breathing difficulties. For instance diuretics help with fluid retention, beta-blockers and ACE-inhibitors improve the function of the pumping chambers or vasodilators to enhance coronary blood flow.

An European Society of Cardiology Guideline published in 2021, describes in details all the medications and strategies that can be used in diagnosis and treatment of both chronic and acute heart failure patients. (https://onlinelibrary.wiley.com/doi/10.1002/ejhf.2333)

To diagnose or exclude heart failure a test called Echocardiogram is used, which is described in details in one of our videos. https://drbart.co.uk/videos/ 

Apart from medications, physical interventions such as breathing exercises and cardiac rehabilitation are helpful.

Breathing Exercises for Heart Disease Patients

Breathing exercises are non-invasive techniques that can help heart disease patients manage their symptoms. A study published in 2022 concluded that `addition of Breathing Exercises to Cardiac Rehabilitation programs in Chronic Heart Failure is effective and is a `patient-centred` approach`. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9690833/ 

This study described two additional breathing techniques: inspiratory muscle training and breathing calisthenics. 

Inspiratory muscle training was defined as using a special device used for respiratory muscle training to improve the function of the respiratory muscles through specific exercises. The patient who utilized this device was asked to inspire deeply through the mouthpiece of it against the selected load with all prescribed medications.

Breathing calisthenics were defined as exercises that strengthen the abdominal muscles. It consisted of three difference types of exercises described in details in the above article. 

Lifestyle Changes for Better Breathing with Heart Issues

Living with heart disease often requires lifestyle adjustments to improve breathing and overall cardiovascular health. Adopting a heart-healthy diet, engaging in regular physical activity, managing stress, and quitting smoking are key strategies that contribute to feeling less breathless. 

Heart-Healthy Diet to maintain a normal BMI, with a recommendation of Mediterranean type of diet.  

Regular Physical Activity: Although heart patients may fear physical exertion, moderate exercise has been shown to improve cardiovascular function and reduce breathlessness. Five tips recommended by British Heart Foundation include: 5 tips for exercising with heart failure `Don’t overexert yourself`, 

`Warm up and cool down before and after exercise`, `Try exercising little and often`, `Pace yourself day to day` and `Find a time of day that works best for you`. (https://www.bhf.org.uk/informationsupport/heart-matters-magazine/activity/exercise-for-heart-failure)

Stress Management: Yoga and meditation are two effective stress management techniques that have been shown to benefit heart patients. This review article published in 2021 concluded that ` Stress is a potentially modifiable factor, and addressing these gaps and advancing the science of stress in heart failure is likely to yield important insights about actionable pathways for improving patient quality of life and outcomes.` (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8026548/)

A meta-analysis published in 2022 showed `effectiveness of yogic interventions on lipid profile, blood pressure, and psychosocial outcomes in patients with diagnosed cardiac diseases.` (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9386118/) 

Smoking Cessation: Smoking damages lung function and reduces oxygen availability, leading to worsened breathlessness in heart patients. Smoking cessation has been associated with a reduction in cardiovascular mortality in multiple studies. This ranges from the reduction in the incidence of hypertension, type 2 diabetes, and incidence of heart failure. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10082935/) 

Trouble Breathing and Heart Attack Warning

Shortness of breath can also be a critical warning sign of an impending heart attack. Several symptoms of a heart attack are described on an official NHS website, https://www.nhs.uk/conditions/heart-attack/symptoms/. They include apart from shortness of breath also pain in the chest or other parts of the body (neck, jaw, back and tummy), felling dizzy or sweaty, feeling sick or anxious and coughing or wheezing. 

Recognizing the above signs early can be life-saving. If you experience sudden trouble breathing, especially with other heart attack symptoms such as nausea, dizziness, or sweating, seek immediate medical attention.

Dr Bart Olechowski is a Consultant Interventional Cardiologist, which means that he specialises in Heart Attacks. He performs coronary angiograms and coronary stenting procedures in Heart Centre in Basingstoke. (https://drbart.co.uk/videos/)  

Oxygen Therapy for Cardiac Patients

Oxygen therapy is used for patient`s who are hospitalised with symptoms of acute heart failure. This is a result of fluid congestion of the lungs It can be a result of a decompensated chronic heart failure or a new diagnosis in an acute setting. 

Home Remedies for Breathlessness in Heart Patients

British Heart Foundation website has several useful tips for patients who experience feeling of lack of breath. (https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/shortness-of-breath) They include:

– Finding a comfortable position, for instance in a chair leaning forward or sleeping on a side with extra pillows. 

– Using special breathing techniques, which allow to take more relaxed, slower breaths

– Using a cold towel on the face or a fan

– Open windows to allow fresh air

– Eating often and little rather than big meals

– Planning the day ahead with frequent breaks

– Rearranging home environment for your comfort and ease

– Being social and staying in touch with friends and family 

When to See a Doctor for Breathing Issues

It’s essential to recognize when breathing issues warrant medical attention. If you experience persistent shortness of breath that interferes with daily activities, or if it is accompanied by swelling in the legs, rapid heartbeat, or chest pain, it is crucial to see a doctor. These symptoms may indicate worsening heart failure or another serious cardiac event.

In addition to this if you already have a diagnosis of heart condition, but your symptoms have worsened and progressed, it`s important to reassess your clinical status. 

Cardiac Rehabilitation and Breathing Problems

Cardiac rehabilitation, also known as cardiac rehab programs play an important role in managing both heart disease and breathing difficulties. These programs combine medical care with physical training, counselling, and education to help heart patients regain strength and improve overall health.

Cardiac rehabilitation has been described in details on British Heart Foundation website, (https://www.bhf.org.uk/informationsupport/support/practical-support/cardiac-rehabilitation). Cardiac rehab can play a crucial role recovering fully after heart operation or heart attack, preventing further problems, building your confidence and return to work and daily duties. In addition to this cardiac rehab allows patients to understand their conditions and meet people who have similar health issues. 

Breathing Tips for Congestive Heart Failure

Congestive heart failure, so accumulation of additional fluid in the body, so called fluid overload is one of the most common causes of breathing difficulties in heart disease patients. Managing feeling of lack of breath in this population requires a combination of medical treatments and self-care techniques. Medications that are often prescribed to manage heart failure symptoms, reduce the workload on the heart, and prevent further damage. It is essential to take these medications as directed by a healthcare provider. Common medications for heart failure include ACE inhibitors (Ramipril or Perindopril), angiotensin receptor blocker (Candesartan or Valsartan)  beta-blockers (Bisoprolol or Nebivolol), diuretics (Furosemide or Bumetanide), aldosterone antagonists (Eplerenone or Spironolactone), angiotensin receptor neprilysin inhibitor (Sacubitril), sodium- glucose co-transporter 2 inhibitor (Dapaglifozin).

Conclusion

Breathing difficulties in heart disease are common but manageable with the right combination of medical treatments, lifestyle changes, and breathing exercises. Understanding the root causes of breathlessness and employing evidence-based strategies can significantly improve quality of life for heart disease patients. From prescription medication and cardiac rehabilitation to home strategies and specific breathing techniques, there are numerous ways to address this distressing symptom.

The key is to work closely with healthcare providers to create a personalised plan that addresses both heart health and respiratory function. By doing so, patients can lead more comfortable, active lives despite the challenges of heart disease.

Dr Bart Olechowski and his team review and consult private cardiology patients in Hampshire, UK. Dr Bart has clinics in Winchester at Sarum Road Hospital on Wednesday evening, in Basingstoke at Candover Clinic on Thursday morning, in Farnham at Spire Clare Park Hospital on Friday afternoons and in London on Saturday morning. During heart consultations a range of diagnoses can be reached, which include angina, heart failure, atrial fibrillation and heart valve disease. Via Dr Bart`s clinics several heart tests can be arranged, which include ECGs, Echocardiograms, Holter monitors, Cholesterol checks, Coronary angiograms and 24 hours Blood Pressure monitors. Dr Bart routinely sees patients with chest pains, breathlessness, palpitations, legs swelling, blackouts and dizzy spells. His personal assistant Amy Rossiter can be contacted on 07984 245 550 or via an email pa@drbart.co.uk. Additional blog posts can also be found on https://www.winchesterandbasingstokecardiology.co.uk/heart-health-advice , where Dr Bart writes weekly blog posts based on latest research evidence.