Lifestyle

Swollen Ankles and Needing Extra Pillows to Breathe at Night Are Easy-to-Miss Signs of Heart Failure

By Erica Coleman · October 29, 2026

Getting winded on a flight of stairs, shoes that feel tight by evening and a tiredness that never quite lifts are easy to put down to getting older. Together, they can also be early signs that the heart is not pumping as well as it should.

Heart failure happens when the heart cannot pump enough blood and oxygen to support other organs in your body, according to the Centers for Disease Control and Prevention. The CDC stresses that the name does not mean the heart has stopped beating, and it says nearly 6.7 million U.S. adults have the condition. When the heart falls behind, Mayo Clinic explains, blood often backs up and fluid can build up in the lungs and other parts of the body.

Age matters. The National Heart, Lung, and Blood Institute says people 65 years or older have a higher risk of heart failure and are more likely to have other health conditions that cause it.

These are the signs listed by the NHLBI, Mayo Clinic, the American Heart Association and the CDC.

Shortness of breath. The NHLBI says one of the first symptoms you may notice is feeling short of breath after routine activities like climbing stairs. As the heart weakens, it can happen while getting dressed or walking across a room. The institute adds that older adults who are not very active may not notice breathlessness at all, but may feel tired and confused instead.

Trouble breathing when lying down. The American Heart Association says breathlessness can come on suddenly at night, and that some people need several pillows to raise the upper body to breathe more easily.

Swelling and quick weight gain. Fluid can collect in the feet, ankles, legs and belly. Mayo Clinic lists very fast weight gain from fluid buildup, and the heart association notes that weight gain is common as a result of the swelling.

Constant tiredness. The heart association describes a tired feeling all the time and difficulty with everyday activities such as shopping, climbing stairs or carrying groceries. Mayo Clinic also lists weakness and a reduced ability to exercise.

A cough that won’t go away. Mayo Clinic and the heart association both describe persistent coughing or wheezing, sometimes with white or pink mucus tinged with blood.

Poor appetite, nausea or a racing heart. The heart association lists feeling full or sick to the stomach and heart palpitations. Mayo Clinic lists a fast or irregular heartbeat.

Confusion or trouble concentrating. The heart association says memory loss and disorientation can occur, and that a caregiver or relative may notice this first.

Mayo Clinic says coronary artery disease is the most common cause of heart failure. High blood pressure, heart valve disease, irregular heartbeats, diabetes, sleep apnea and obesity also raise the risk, along with smoking and heavy drinking. Mayo Clinic adds that some medicines, including nonsteroidal anti-inflammatory drugs (NSAIDs), may lead to or worsen heart failure.

Many of these symptoms have other causes, and Mayo Clinic says a complete checkup is needed to make a diagnosis. The heart association urges anyone with one or more symptoms, even without a known heart problem, to tell a health care professional and ask for an evaluation of the heart. Mayo Clinic says to call 911 for chest pain, fainting or severe weakness, or sudden severe shortness of breath with coughing up white or pink foamy mucus. The CDC says early diagnosis and treatment can improve quality and length of life.

This article is for general information and is not medical advice. Talk with your doctor about any symptoms, and call 911 for chest pain, fainting or sudden severe shortness of breath. This article was produced with the assistance of AI and fact-checked against the sources cited by LightWave Reports.