Swollen ankles can be a sign of heart failure - here’s what to look out for

Friday, 2nd October 2020, 1:20 pm
Updated Friday, 2nd October 2020, 1:20 pm
These are the signs to look out for (Photo: Shutterstock)
These are the signs to look out for (Photo: Shutterstock)

The symptoms of heart failure can vary from person to person, and can develop suddenly or over a longer period of time, making it difficult to accurately identify.

A common but not widely known symptom of heart failure can actually be spotted in someone’s ankles.

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What is heart failure?

The NHS explains that heart failure means that “the heart is unable to pump blood around the body properly” and this usually occurs because the heart has become too weak or stiff.

“Heart failure does not mean your heart has stopped working, it just needs some support to help it work better,” the NHS says.

It can occur at any age, but is most common in older people. It’s also a long term condition that tends to get gradually worse over time.

There is no cure for heart failure, but the symptoms can often be controlled.

The symptoms of heart failure

One of the most common symptoms of heart failure is swollen ankles or legs. This is caused by a buildup of fluid and can be better in the morning and get worse during the day. This buildup of fluid is called oedema.

The other main symptoms of heart failure are:

  • Breathlessness, which may occur whether you’re active or resting, and it can be worse when you’re lying down which can cause you to wake up at night needing to catch your breath
  • Fatigue, which leaves you feeling tired most of the time

Less common symptoms of heart failure, according to the NHS, include:

  • A persistent cough, which can be worse at night
  • Wheezing
  • A bloated stomach
  • Loss of appetite
  • Weight gain or weight loss
  • Confusion
  • Dizziness and fainting
  • A fast heart rate
  • A pounding, fluttering or irregular heartbeat

While all of these symptoms can be caused by other, less serious, conditions, you should get them checked out by your GP.

How is heart failure diagnosed?

Tests to diagnose heart failure include:

  • Blood tests, which check whether there’s anything in your blood that could indicate heart failure or another illness
  • An electrocardiogram (ECG), which records the electrical activity of your heart to check for problems
  • An echocardiogram, which is a type of ultrasound scan where sound waves are used to examine your heart
  • Breathing tests, where you may be asked to blow into a tube to check whether a lung problem is the culprit for your breathlessness
  • A chest x-ray, which will check whether your heart is bigger than it should be, whether there’s fluid in your lungs (a sign of heart failure), or whether a lung condition is the reason for your symptoms

If you’re diagnosed with heart failure, your doctor will usually be able to tell you what stage of heart failure you’re experiencing.

There are four stages:

  • Class one: you don’t have any symptoms during normal physical activity
  • Class two: you’re comfortable at rest, but normal physical activity triggers symptoms
  • Class three: you’re comfortable at rest, but minor physical activity triggers symptoms
  • Class four, you’re unable to carry out any physical activity without discomfort and may have symptoms when resting

Your treatment will depend on what stage of heart failure you have.

Treatment for heart failure

While heart failure cannot be cured, there are ways to keep the symptoms under control.

The main treatments are:

  • Healthy lifestyle changes, such as eating a balanced diet, doing exercise and not smoking
  • Medication
  • Devices implanted in your chest to control your heart rhythm
  • Surgery

“In many cases, a combination of treatments will be required,” the NHS says.

Some of the main medicines for heart failure include:

  • ACE inhibitors
  • Angiotensin-2 receptor blockers (ARBs)
  • Beta blockers
  • Mineralocorticoid receptor antagonists
  • Diuretics
  • Ivabradine
  • Sacubitril valsartan
  • Hydralazine with nitrate
  • Digoxin

The most common devices to combat heart failure include:

  • Pacemakers
  • Cardiac resynchronisation therapy (CRT) devices
  • Implantable cardioverter defibrillators (ICDs)
  • CRT-Ds

The most common surgeries for heart failure include:

  • Heart valve surgery
  • A coronary angioplasty or bypass
  • Left ventricular assist devices
  • Heart transplant