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Avatar photoKathy Marinias RN

Kathy Marinias is a Registered Nurse with more than 25 years of experience across cardiovascular health, nursing, and healthcare administration. Her career has been defined by a deep commitment to person-centred care — meeting patients where they are and walking alongside them through what can often be an overwhelming experience. Kathy brings a compassionate and practical perspective to heart health, with a particular gift for translating complex medical information into guidance that is meaningful, accessible, and genuinely empowering for patients and their families. As Associate Editor at Heart Matters, Kathy plays a central role in shaping the voice and direction of the platform — ensuring every article meets the standard our readers deserve. Her clinical experience and patient advocacy lens mean that nothing leaves Heart Matters without the patient perspective firmly at its heart.

Greek Spinach Rice (Spanakorizo)

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A traditional Greek spinach and rice dish that’s simple, nourishing
and ready in 30 minutes. Wholesome Mediterranean comfort food that’s
as good for your heart as it is delicious.

Heart Health During Pregnancy: What You Need to Know

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Key Points

  • Pregnancy places extra demands on the heart, blood volume rises by up to 50%, the heart beats faster, and the body works harder. These changes are normal and expected.
  • Many symptoms in pregnancy, palpitations, breathlessness, fatigue, and mild ankle swelling, are a normal part of these adaptations, not a sign that something is wrong.
  • Some conditions, including high blood pressure, heart rhythm changes, and rarely peripartum cardiomyopathy or SCAD, can occur during or after pregnancy and are important to be aware of.
  • Most of these conditions are manageable when recognised early, and your maternity and cardiology teams are experienced in supporting women through them.
  • If you have a pre-existing heart condition, planning your pregnancy with your specialist team makes a significant difference to outcomes.
  • Complications in pregnancy can also be a window into your future heart health, making follow-up after delivery an important part of long-term wellbeing.

Pregnancy is one of the most remarkable things the human body does. To support a growing baby, your heart and circulation adapt in ways that are genuinely extraordinary, and for the vast majority of women, pregnancy is a safe and healthy experience.

That said, the heart is working harder than usual, and it helps to understand what is normal, what is worth mentioning, and, in the rare cases where something does need attention, what good care looks like. This article is designed to give you that picture clearly and honestly, without causing unnecessary alarm.

What happens to your heart during pregnancy?

From the earliest weeks of pregnancy, your cardiovascular system begins to adapt. Blood volume increases by up to 50% to support the placenta and baby. Your heart beats faster, typically 10 to 20 beats per minute more than usual. And the total output of blood your heart pumps each minute increases significantly, often by 30 to 50%.

Blood pressure tends to fall slightly in the first and second trimester as blood vessels relax and widen, before gradually returning toward your normal level in the third trimester. These are not signs of anything going wrong, they are the body doing exactly what it is supposed to do.

What this means practically is that your heart is doing more work. And like any system under increased load, it can produce symptoms that, understandably, feel concerning, even when they are entirely expected.

Symptoms that are usually a normal part of pregnancy

Many of the cardiovascular symptoms women notice during pregnancy are simply the body adjusting to its new demands. They are worth knowing about so they do not come as a surprise.

Symptom Why it happens
Palpitations The faster heart rate and increased blood volume can make you more aware of your heartbeat, particularly at rest or at night
Breathlessness The diaphragm is pushed upward by the growing uterus, and the body’s oxygen demands increase, mild breathlessness on exertion is very common
Fatigue The cardiovascular system is working significantly harder, tiredness, especially in the first and third trimester, is expected
Ankle swelling Fluid retention is common, particularly later in pregnancy, due to hormonal changes and pressure on the pelvic veins
Light-headedness Blood pressure naturally falls in early pregnancy, standing up quickly can occasionally cause a brief dizzy sensation

In my experience, the women who feel most at ease during pregnancy are those who know what to expect from their body, and who feel confident enough to speak up when something doesn’t feel right.

These symptoms are common and usually reassuring when they occur in isolation and do not dramatically worsen. If any of them feel sudden, severe, or out of proportion, they are always worth mentioning to your midwife or doctor, not because they are likely to be serious, but because it is always better to be certain.

Blood pressure in pregnancy

Blood pressure monitoring is one of the most important aspects of antenatal care, and for good reason. While mild falls in blood pressure early in pregnancy are normal, a significant rise, particularly in the second half of pregnancy, needs attention.

Gestational hypertension

Some women develop high blood pressure after 20 weeks of pregnancy without any other features. This is called gestational hypertension. It often resolves after delivery, but it does require monitoring and sometimes medication to keep blood pressure within a safe range for both mother and baby.

Pre-eclampsia

Pre-eclampsia is a more significant condition that combines high blood pressure with signs that other organs, typically the kidneys or liver, are under stress. It affects around 2–8% of pregnancies. Symptoms can include persistent headache, visual changes, upper abdominal pain, and sudden worsening of swelling.

Pre-eclampsia is taken seriously because of its potential to progress, but it is also one of the most closely monitored conditions in obstetric care. Women who develop it are supported carefully, and the condition resolves after delivery. If you have risk factors such as a first pregnancy, multiple pregnancy, obesity, diabetes, or a family history of pre-eclampsia, your team will be watching closely from the outset.

2–8%
of pregnancies are affected by pre-eclampsia, a closely monitored and manageable condition that resolves after delivery

Heart rhythm changes in pregnancy

Palpitations are among the most common cardiac symptoms reported during pregnancy, and in the vast majority of cases they are entirely benign. The combination of a faster heart rate, higher blood volume, and the hormonal environment of pregnancy can make extra heartbeats, known as ectopic beats, more noticeable than usual.

Most of the time, these are harmless. They do not require treatment and typically settle after delivery. However, if palpitations are frequent, prolonged, associated with dizziness or fainting, or feel like a sustained rapid or irregular rhythm, they are worth reporting. An ECG is quick, painless, and safe in pregnancy, and can provide important reassurance or identify whether any further assessment is needed.

Some women with pre-existing heart rhythm conditions, such as supraventricular tachycardia (SVT), find that episodes become more frequent during pregnancy. This is manageable with appropriate monitoring and, where needed, treatment that is safe for the baby.

Peripartum cardiomyopathy

Peripartum cardiomyopathy is a rare condition in which the heart muscle becomes weakened in the final month of pregnancy or in the months following delivery. It is uncommon, affecting approximately 1 in 1,000 to 1 in 4,000 pregnancies, but it is important to be aware of.

The symptoms can overlap with normal pregnancy experiences, breathlessness, fatigue, and swelling, which is why any significant or rapidly worsening symptoms in late pregnancy or after delivery deserve prompt attention. When recognised early, the outlook is genuinely encouraging. Most women with peripartum cardiomyopathy recover well with appropriate treatment, and many regain normal heart function within months.

Risk factors include older maternal age, multiple pregnancy, pre-eclampsia, and African heritage. If you develop new and significant breathlessness, difficulty lying flat, or swelling that seems out of proportion in the weeks around delivery, mention it to your doctor promptly, not because it is likely to be serious, but because early assessment makes a real difference.

SCAD, Spontaneous Coronary Artery Dissection

Spontaneous coronary artery dissection, or SCAD, is a rare but important cause of heart attack in young women, and it has a particular association with pregnancy and the postpartum period. It occurs when a small tear develops in the wall of a coronary artery, disrupting blood flow to part of the heart muscle.

SCAD can feel like a classic heart attack, chest pain, breathlessness, and sometimes pain radiating to the arm or jaw. In the context of a recently pregnant or postpartum woman, these symptoms should always be taken seriously and assessed urgently. The good news is that the majority of women with SCAD recover well, and with the right specialist support, outcomes are positive.

We have a dedicated article on SCAD on this site if you would like to understand more about this condition.

Pre-existing heart conditions and pregnancy

Women with known heart conditions, including congenital heart disease, valve disease, or cardiomyopathy, can and do have successful pregnancies. The key is planning ahead with a specialist team who can assess how pregnancy is likely to affect your individual situation and put appropriate monitoring in place from early on.

This kind of joint care, between your cardiologist and your obstetrician, makes an enormous difference. It allows potential issues to be anticipated rather than reacted to, and ensures that any medications you are on are reviewed for safety in pregnancy well in advance.

If you have a heart condition and are thinking about starting a family, a preconception appointment with your cardiologist is one of the most valuable investments you can make.

Investigations that are safe in pregnancy

If your doctor or midwife wants to investigate a cardiac symptom during pregnancy, there are several tests that are completely safe and commonly used.

An ECG is painless and safe at any stage of pregnancy. An echocardiogram uses ultrasound, the same technology used to image your baby, and carries no radiation risk whatsoever. Blood tests, including markers of heart stress, can also be checked safely if there is clinical concern. Your team will only request investigations when they are genuinely needed, and they are experienced in interpreting results in the context of pregnancy’s normal physiological changes.

Medications in pregnancy

Some cardiac medications are safe to continue during pregnancy, others need to be adjusted, and a small number should be avoided. This is an area where the guidance is specific to each person and each condition, a medication that is appropriate for one woman may not be right for another.

If you are on cardiac medication and become pregnant, or are planning a pregnancy, speak with your cardiologist as early as possible. Do not stop any medication without guidance, as this can sometimes carry its own risks. The goal is always to find the approach that best protects both you and your baby.

After pregnancy, looking after your heart long-term

The period after delivery is an important one for heart health monitoring. Peripartum cardiomyopathy, SCAD, and postpartum pre-eclampsia can all emerge or continue in the weeks after birth, so paying attention to new symptoms after delivery matters just as much as during pregnancy.

Beyond the immediate postpartum period, there is growing evidence that complications in pregnancy, particularly pre-eclampsia, gestational diabetes, and preterm delivery, are associated with a modestly increased risk of cardiovascular disease later in life. This does not mean that heart disease is inevitable; it means that your pregnancy history is a useful part of your overall health picture.

When you see your GP or cardiologist in future years, mention any significant pregnancy complications. It allows your longer-term cardiovascular risk to be assessed appropriately and helps ensure that any preventive measures, lifestyle, blood pressure monitoring, cholesterol checks, are put in place at the right time.

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Women’s Heart Health

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Questions to Ask Your Midwife or Cardiologist

Going into appointments prepared helps you get the most from the time you have. Here are some questions worth raising:

Questions worth asking

  • The palpitations I am experiencing, are these something you would expect at this stage of pregnancy, or do they warrant further investigation?
  • My blood pressure has been a little high, what level would prompt you to consider medication, and what are the safest options in pregnancy?
  • I had pre-eclampsia in a previous pregnancy, does this change how you will monitor me this time?
  • I have a pre-existing heart condition, who should I be seeing through this pregnancy, and how often?
  • After delivery, what follow-up should I have for my heart health, and over what timeframe?

Conclusion

Pregnancy is a time of extraordinary change for the heart and circulation, and for the vast majority of women, those changes unfold safely, supported by a body that is remarkably well designed for the task. Most cardiac symptoms during pregnancy are a normal part of that adaptation, not a warning sign.

Where conditions do arise, whether blood pressure changes, rhythm disturbances, or the rarer but important conditions like peripartum cardiomyopathy or SCAD, the outcomes with good care are genuinely encouraging. Awareness is not the same as anxiety; knowing what to look for means that if something does need attention, it gets it promptly.

Your maternity and cardiac teams are there to support you at every stage. Trust your instincts, speak up when something feels different, and know that asking questions is always the right thing to do.

Free Resources

Our Heart Glossary explains terms like pre-eclampsia, cardiomyopathy, arrhythmia, and echocardiogram in plain language, helpful to have alongside your antenatal appointments.

Resistance Training: Why Lifting Matters More Than You Think

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Key Points

  • Resistance training, any exercise that works muscles against a load, has well-established cardiovascular benefits including lower blood pressure, improved cholesterol, better insulin sensitivity, and reduced cardiovascular mortality.
  • It also supports muscle mass, bone density, balance, and metabolic health, benefits that become increasingly important with age and are not delivered by cardio exercise alone.
  • More muscle means a higher resting metabolic rate, the body burns more calories at rest, which supports weight management over the long term.
  • Resistance training does not need to be strenuous or gym-based, resistance bands, bodyweight exercises, and light weights at home are all effective and appropriate for older adults.
  • Most guidelines recommend resistance training at least two days per week alongside regular aerobic activity for cardiovascular benefit.
  • Anyone with existing heart disease or significant cardiovascular risk factors should discuss an exercise plan with their doctor before starting a new resistance training program.

When people think about exercise for heart health, they typically think about walking, cycling, or swimming, aerobic activities that raise the heart rate and get the blood flowing. These are genuinely important, and the evidence supporting them is strong. But there is a parallel and equally compelling body of evidence for resistance training, and it tends to get far less attention in cardiac health conversations than it deserves.

Resistance training is not just about building muscle or aesthetics. For older adults in particular, it is one of the most powerful tools available for cardiovascular health, metabolic function, bone strength, and physical independence. If you are not doing some form of it already, this article explains why it is worth starting, and how straightforward it can be.

What Is Resistance Training?

Resistance training, also called strength training or weight training, is any form of exercise that works your muscles against a resistance load. This includes:

Forms of Resistance Training

  • Free weights dumbbells, barbells, kettlebells
  • Resistance bands lightweight, portable, and excellent for older adults and beginners
  • Bodyweight exercises squats, lunges, push-ups, wall sits, no equipment needed
  • Weight machines gym-based, useful for controlled movement with guided resistance
  • Everyday functional activities carrying shopping, gardening, climbing stairs, all count as resistance work

The common thread is that the muscles are working against a force, and adapting over time to become stronger, more efficient, and more metabolically active. It does not need to be heavy, intense, or gym-based to be effective.

The Cardiovascular Benefits

The cardiovascular evidence for resistance training is robust and increasingly well recognised in clinical guidelines. Regular resistance training has been shown to:

Lower blood pressure both systolic and diastolic blood pressure respond favourably to resistance training, with effects comparable to some medications in people with mild to moderate hypertension. The mechanism involves improved blood vessel elasticity and reduced peripheral vascular resistance.

Improve cholesterol and triglycerides resistance training raises HDL cholesterol and reduces triglycerides, contributing to a more favourable lipid profile over time.

Improve insulin sensitivity and blood sugar control muscle tissue is one of the primary sites of glucose uptake in the body. More muscle mass and better-conditioned muscle means more effective blood sugar regulation, directly relevant to cardiovascular risk given the strong link between insulin resistance and heart disease.

Reduce cardiovascular mortality population studies have consistently found that people who engage in regular resistance training have lower rates of cardiovascular death, even after accounting for aerobic exercise levels. A landmark study found that even one to two sessions per week was associated with significantly reduced cardiovascular mortality compared to no resistance training.

Resistance training and aerobic exercise are genuinely complementary, they deliver overlapping but distinct cardiovascular benefits. The evidence increasingly supports doing both rather than choosing between them. For older adults especially, resistance training addresses risks that walking alone simply cannot.

Beyond the Heart, Why Muscle Mass Matters as We Age

This is where the case for resistance training becomes particularly compelling for older adults, and for anyone thinking about their long-term health and independence.

Sarcopenia, The Silent Loss of Muscle

From around the age of 30, adults begin to lose muscle mass at a rate of approximately 3–5% per decade, a process called sarcopenia. Without deliberate resistance training, this loss accelerates significantly after 60. The consequences extend well beyond strength, sarcopenia is associated with falls, fractures, loss of independence, metabolic decline, and increased cardiovascular risk.

Resistance training is the most effective intervention available for preserving and rebuilding muscle mass at any age. The body retains a remarkable capacity to respond to resistance training even well into the 70s and 80s, it is never too late to start and see meaningful benefit.

Bone Density

Resistance training places load on bones as well as muscles, stimulating bone remodelling and helping maintain bone density. This is particularly important for post-menopausal women, who face accelerated bone loss and higher fracture risk. Weight-bearing resistance exercises are among the most evidence-supported strategies for reducing osteoporosis risk and maintaining skeletal health into older age.

Metabolism and Weight Management

Muscle is metabolically active tissue, it burns calories at rest. More muscle mass means a higher resting metabolic rate, meaning the body consumes more energy even when not exercising. This is one of the reasons resistance training supports long-term weight management more effectively than cardio exercise alone, cardio burns calories during exercise, but resistance training raises the baseline metabolic rate that persists around the clock.

For anyone managing weight alongside cardiovascular risk factors, the combination of resistance training and a heart-healthy diet is considerably more effective than diet or cardio alone.

Balance, Coordination, and Fall Prevention

Falls are one of the leading causes of injury and loss of independence in older adults, and many falls are preventable. Resistance training improves leg strength, stability, and coordination, all of which contribute to better balance and reduced fall risk. This is a quality-of-life benefit that is difficult to achieve through any other single intervention.

2x
Per week, the minimum resistance training frequency recommended by most major cardiovascular and exercise guidelines for health benefit in adults
American Heart Association / World Health Organization Physical Activity Guidelines

How to Get Started, It Doesn’t Need to Be Complicated

One of the barriers to resistance training for older adults and cardiac patients is the perception that it involves heavy weights, gyms, and strenuous effort. None of that is necessary. Effective resistance training for cardiovascular and general health can be done at home, with minimal or no equipment, at a gentle pace, and still deliver meaningful benefit.

Simple Ways to Start Resistance Training

  • Resistance bands inexpensive, lightweight, and available in varying resistance levels. Seated band exercises are appropriate even for people with limited mobility. Excellent starting point for anyone new to resistance training.
  • Bodyweight exercises chair squats (sitting and standing from a chair), wall push-ups, calf raises, and step-ups require no equipment and can be done in any room. These are genuinely effective and appropriate for older adults.
  • Light dumbbells a pair of 1–3kg dumbbells is sufficient for many upper body exercises. Bicep curls, shoulder presses, and lateral raises done with light weight and controlled movement are low-risk and beneficial.
  • Start with two sessions per week two 20–30 minute sessions covering the major muscle groups (legs, back, chest, arms) is the evidence-based minimum. This is a very achievable starting point.
  • Focus on controlled movement slow, deliberate movement through the full range of motion is more effective and safer than rushing through repetitions with heavier weight.
  • Progress gradually the principle of progressive overload, gradually increasing resistance or repetitions over time, is what drives continued adaptation. Start easy and build over weeks and months.

Is Resistance Training Safe for People with Heart Disease?

For most people, including many with well-managed heart disease, resistance training is safe and beneficial. The key is appropriate intensity and good technique, and for anyone with existing cardiovascular conditions, starting with guidance from a doctor or cardiac rehabilitation professional is sensible.

Cardiac rehabilitation programs increasingly include resistance training as a standard component, the evidence for its safety and benefit in post-heart attack and post-procedure patients is well established. If you have had a heart attack, stent, bypass surgery, or significant heart failure, ask your cardiologist about whether a supervised cardiac rehabilitation program including resistance training is appropriate for you.

ⓘ  Before You Start, A Note for People with Heart Conditions

If you have existing heart disease, uncontrolled high blood pressure, significant heart failure, or have recently had a cardiac procedure, speak with your cardiologist or GP before beginning a new resistance training program. They can advise on appropriate intensity, exercises to modify or avoid, and whether a supervised program would be beneficial.

For most people with well-managed cardiovascular conditions, appropriately paced resistance training is not only safe but actively recommended. The goal is to find the right starting point for your individual circumstances.

Conclusion

Resistance training is one of the most evidence-supported and underutilised tools in cardiovascular prevention. Its benefits extend well beyond the heart, supporting muscle mass, bone density, metabolism, balance, and physical independence in ways that aerobic exercise alone cannot replicate. For older adults particularly, it is not an optional extra, it is a core component of healthy aging.

It does not need to be strenuous, expensive, or gym-based. Two sessions per week of gentle, progressive resistance work, with bands, bodyweight, or light weights, is enough to deliver meaningful benefit at any age. The body’s capacity to respond to resistance training never fully disappears, and starting at any point delivers real returns.

If you have been focusing on walking or cardio and have not yet incorporated any resistance work into your routine, this is worth raising with your doctor or physiotherapist. It may be one of the most valuable additions you can make to your heart health program.

Related Reading

Why You Need More Pillows to Sleep: Breathlessness Lying Flat

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Key Points

  • Breathlessness when lying flat, which doctors call orthopnoea, is a specific cardiac symptom rather than a comfort preference or a normal part of getting older.
  • The usual mechanism is fluid. Lying down moves fluid from the legs back into the central circulation, raising pressure in the lungs. Sitting up relieves it, which is why people reach for extra pillows.
  • The number of pillows someone needs is a genuinely useful clinical measure, and a rise from one to two to three over months tells a story about what is happening inside the heart.
  • Waking suddenly from sleep gasping for air, known as paroxysmal nocturnal dyspnoea, is a more severe form of the same problem and warrants prompt assessment rather than waiting.
  • Heart failure is the most common cause, but valve problems, lung conditions and sleep apnoea can produce similar patterns, and telling them apart is straightforward with the right tests.

Most people do not notice it happening. One pillow becomes two. Two becomes three. At some point lying completely flat starts to feel uncomfortable, then slightly breathless, then not worth attempting. It gets filed away as a sleeping preference, or a bad back, or simply getting older.

In cardiology it is none of those things. How many pillows a person sleeps on is one of the first questions I ask when assessing someone for heart failure, and the answer often tells me more than the examination that follows.

The medical term is orthopnoea. What it describes is breathlessness that comes on, or gets worse, when lying flat, and that eases on sitting up.

Why You Might Need More Pillows Than You Used To

When you are upright, gravity holds a certain amount of fluid in your legs and lower body. Less blood returns to the heart at any given moment, and the pressure inside the heart and lungs stays manageable.

Lying down removes that effect. Fluid that was pooled in the legs shifts back into the central circulation within minutes. More blood arrives at the heart, pressure rises, and if the heart is already struggling to keep up, that pressure pushes fluid into the lung tissue.

The lungs become stiffer and less efficient at moving oxygen, and the result is breathlessness. Sitting up reverses it, which is why the relief is often immediate and why people work out the pillow solution long before anyone puts a name to the problem.

A healthy heart handles this shift without difficulty. It is only when the heart is under strain that lying flat tips things from manageable into symptomatic.

What the Number of Pillows Tells a Cardiologist

One pillow is normal. Two may mean nothing at all, or may be the beginning of something. Three or more, or being unable to lie flat, generally means pressures inside the heart are meaningfully raised.

Cardiologists write “three-pillow orthopnoea” in notes precisely because it is a useful shorthand. It sounds unglamorous, but the trajectory is what matters. Someone who used one pillow last year and needs three now has a story that a single measurement cannot capture.

3 pillows
Needing three or more pillows to sleep, or being unable to lie flat at all, is a recognised clinical finding that generally prompts cardiac assessment.
A change over time matters more than any single number

It is worth asking yourself the question directly, because the change happens slowly enough to be invisible. How many pillows did you sleep on a year ago? Have you stopped lying flat entirely? Do you sleep in a chair some nights?

Waking Up Suddenly Short of Breath

There is a more dramatic version of the same problem, and it has a distinct pattern worth recognising.

A person falls asleep normally, then wakes an hour or two later acutely breathless, often with a sense of suffocation or panic. They sit bolt upright, sometimes get out of bed, sometimes go to an open window. Over fifteen to thirty minutes of sitting up, the breathlessness settles.

Doctors call this paroxysmal nocturnal dyspnoea, usually shortened to PND. It happens because fluid has been redistributing gradually during sleep, and at a certain point the pressure crosses a threshold.

It is a more significant finding than gradual orthopnoea and generally means treatment needs reviewing. Anyone experiencing it would reasonably seek assessment promptly rather than waiting to mention it at a routine appointment.

When the pillow count has quietly climbed from one to three, things have usually been worsening for a while, even when the person felt they were managing.

Prof. Peter Barlis, Interventional Cardiologist

What Causes It

Heart failure is the most common explanation, and it applies to both main types: the kind where the heart pumps weakly, and the kind where it pumps normally but has become stiff and fills poorly. Both raise the filling pressures that lying flat then worsens.

Valve problems can do the same. A narrowed or leaking mitral valve raises pressure in the left side of the heart and back into the lungs by exactly the same mechanism. Orthopnoea appearing in someone with known valve disease often signals that the valve has become significant enough to need attention.

Fluid around the lungs, either from heart failure itself or another cause, produces positional breathlessness for mechanical reasons.

Lung conditions and sleep apnoea can produce overlapping symptoms. Obstructive sleep apnoea in particular causes night-time breathing disturbance that can be mistaken for a cardiac cause, and the two frequently coexist.

Carrying significant excess weight restricts the chest mechanically when lying down. This is a real cause, though cardiac explanations are usually looked for first because they are more consequential if missed.

What Usually Accompanies It

Orthopnoea rarely arrives alone, and the other symptoms help make sense of it.

Swollen ankles that are worse by evening and better by morning follow the same fluid physiology in reverse. Weight that climbs by a kilo or two over a few days is fluid rather than fat, and is one of the earliest warning signs. Tiredness out of proportion to activity is common, and so is breathlessness on ordinary exertion such as stairs.

Any of these alongside the pillow problem strengthens the case for a cardiac cause considerably.

How It Is Investigated

A BNP or NT-proBNP blood test is usually the starting point. It measures a substance the heart releases when its walls are stretched by raised pressure, and it is reliably elevated when the cause is cardiac. A normal result in someone with these symptoms points fairly strongly elsewhere.

An echocardiogram is the key imaging test. It shows how well the heart is pumping, how stiff it is, whether the valves are working, and gives an estimate of the pressures inside.

A chest X-ray can show fluid in or around the lungs. Where sleep apnoea is suspected, a sleep study may be arranged alongside rather than instead of the cardiac tests.

How It Is Treated

Orthopnoea is a symptom, so treatment means addressing whatever is causing it.

Where fluid overload is the problem, diuretics relieve congestion relatively quickly, and many people notice they can lie flatter within days of a dose being adjusted. It is one of the more satisfying responses in cardiology, because the improvement is obvious to the person experiencing it.

Longer term, the combination of medicines used in heart failure works on the underlying problem rather than the fluid alone, and improves both symptoms and outcomes over months and years.

Where a valve is responsible, the presence of symptoms such as orthopnoea is one of the factors that shifts the balance towards repair or replacement, since valve intervention is often timed by symptoms rather than by measurements alone.

What Is Worth Raising

The most useful thing to bring to an appointment is the trajectory rather than today’s state. How many pillows a year ago, how many now, and whether the change has been gradual or recent.

Whether you have woken from sleep breathless, and how often, is worth stating plainly because it changes the urgency. So is any ankle swelling, any recent weight gain over days rather than weeks, and whether ordinary activity has become harder.

Where a diagnosis is already established, whether the current diuretic dose still matches the symptoms is a reasonable question, as is what change should prompt a call to the heart failure team rather than waiting for the next review.

Conclusion

Needing extra pillows is one of those changes that arrives so gradually it never gets questioned. It is not a preference, not a normal feature of ageing, and not something to work around with more cushions.

What it usually reflects is fluid that the heart is no longer clearing as easily as it once did, and that is a problem with a name, a set of tests, and treatment that works. The gap between noticing the pillows and mentioning them to a doctor is often months, and it does not need to be.

Related Reading

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