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Heart failure is often portrayed in films as sudden and dramatic, with people collapsing or clutching their chest. In reality, the condition usually develops slowly, with subtle symptoms that are easy to overlook. Early signs may include persistent fatigue, unexplained weight gain, fluid retention, coughing when lying down, shortness of breath, or sleep disturbances. Dr Dmitry Yaranov, a cardiologist and heart transplant surgeon, emphasises that recognising these warning signs early is essential. By identifying the subtle indicators of a struggling heart, individuals can seek medical care promptly, manage the condition effectively, and reduce the risk of serious complications. Awareness and timely intervention can significantly improve long-term heart health and quality of life.


Understanding heart failure and how it develops

Heart failure occurs when the heart is unable to pump blood effectively to meet the body’s needs. This inefficiency can lead to fluid buildup in the lungs, abdomen, and other tissues, causing a range of symptoms that may not initially seem heart-related. Unlike acute heart attacks, heart failure often progresses quietly, and early signs can be mistaken for fatigue, stress, or ageing.

Dr Yaranov highlights that recognising these early, subtle symptoms allows patients to receive care before the condition worsens, improving outcomes and quality of life.

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Heart failure: Early warning signs that are overlooked

• Sudden weight gain: An early warning sign of heart failure

One of the most overlooked signs of heart failure is sudden weight gain. This usually occurs over a few days and results from fluid retention. When the heart struggles to pump efficiently, fluid accumulates in the body, causing swelling and rapid weight increase. Dr Yaranov explains, “Your scale can detect these changes before your body feels them. A sudden gain, especially accompanied by swelling in the legs or abdomen, can be one of the first signals that your heart is under stress.”

Recognising this early can prompt timely evaluation and treatment, potentially preventing further fluid buildup and complications.

• Chronic cough and wheezing related to heart health

A persistent cough or wheezing, particularly when lying down, can be a subtle but significant sign of heart failure. This differs from a cough caused by a common cold because it is linked to fluid accumulation in the lungs. When lying flat, fluid can shift and irritate the airways, triggering coughing.

Dr Yaranov advises, “If your cough worsens when you lie down or feels unusual compared to typical colds, it may indicate your heart is struggling to maintain circulation. This warrants further medical assessment.”

• Digestive symptoms: Nausea and loss of appetite

Heart failure can also affect the digestive system. Reduced blood flow to the gut may slow digestion and lead to symptoms such as nausea, loss of appetite, or feeling full after small meals. These signs are often subtle but can indicate that the heart is not supplying enough oxygen-rich blood to the digestive organs.

According to Dr Yaranov, “When the heart slows, the gut responds. Feeling nauseous or unusually full can be an early, quiet signal that something is wrong with your heart.”

• Cognitive changes: Confusion and memory loss

The brain is highly sensitive to changes in blood flow, and reduced circulation from heart inefficiency can cause cognitive issues. Patients may experience memory lapses, confusion, difficulty concentrating, or a sense of mental fog.

Dr Yaranov notes, “Your brain may notice reduced blood supply before you feel physically unwell. Trouble focusing or forgetting simple tasks can be subtle early warnings that the heart is not pumping efficiently.”

• Sleep problems as a heart warning sign

Sleep disturbances are another symptom that can indicate early heart failure. Difficulty falling asleep, frequent waking during the night, or needing extra pillows to breathe comfortably can be linked to fluid buildup in the lungs and reduced cardiac efficiency.

Dr Yaranov explains, “Restless nights are often dismissed as insomnia or stress. However, when the heart is struggling, these sleep issues can be a signal that your body needs help.”


Preventing heart failure: Tips to act on early warning signs

While recognising early symptoms is crucial, taking proactive measures can help reduce the risk of heart failure or slow its progression. Lifestyle modifications, regular monitoring, and timely medical interventions play a key role in protecting heart health.

• Maintain a heart-healthy diet

A balanced diet low in salt, saturated fats, and added sugars helps prevent fluid retention and high blood pressure, both of which can strain the heart. Focus on whole grains, fruits, vegetables, lean proteins, and healthy fats. Monitoring portion sizes and reducing processed foods can support weight control and improve cardiovascular health.

• Monitor weight and fluid changes

Regularly tracking your weight can help identify sudden fluid retention early. Even a small, unexplained increase in a few days should prompt attention. Keeping an eye on swelling in the ankles, legs, or abdomen can also help detect early signs of heart stress.

• Stay physically active

Moderate, consistent exercise strengthens the heart, improves circulation, and supports overall cardiovascular health. Activities such as walking, swimming, or cycling are effective, but individuals should consult a doctor before starting any new exercise routine, especially if early symptoms are present.

• Prioritise quality sleep

Good sleep supports heart health by regulating blood pressure and reducing stress on the cardiovascular system. Establishing a regular sleep schedule, creating a comfortable sleeping environment, and addressing sleep disturbances early can help prevent worsening heart strain.

• Manage stress and monitor symptoms

Chronic stress can increase heart rate and blood pressure, worsening heart function over time. Techniques such as meditation, deep breathing, or yoga can help. Additionally, keeping a record of unusual symptoms such as fatigue, nausea, or cognitive changes can provide valuable information for your healthcare provider.

• Seek timely medical care

Early evaluation by a cardiologist is essential if multiple warning signs appear. Routine check-ups, blood pressure monitoring, and heart function tests can detect problems before they become serious, allowing for timely treatment and better long-term outcomes.


When to seek medical advice

While a single symptom does not automatically mean heart failure, a combination of sudden weight gain, coughing when lying down, digestive disturbances, memory issues, and sleep problems should prompt medical evaluation. Early detection allows doctors to manage the condition effectively and prevent serious complications.

By paying attention to these subtle signs, individuals can take proactive steps to protect their heart health, seek timely medical care, and improve long-term outcomes.



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