Everyone gets short of breath once in a while. But if it happens when you’re not exercising or dashing around during busy days, it could be an early signal your heart isn’t pumping as well as it should—also known as heart failure.

“Heart failure doesn’t mean the heart just stops, but that it’s not working right and you’re not breathing right,” says cardiologist Robert Berkowitz, M.D., who specializes in heart failure and transplant cardiology at Hackensack University Medical Centre.

Top 4 Signs
Shortness of breath when you aren’t exercising or doing strenuous activity
Difficulty breathing when lying down (heart failure causes fluid below the chest to press on the lungs)
Unexplained swelling, especially in the legs and feet (because the heart doesn’t have enough power to efficiently move blood through the body)
Tiredness or fatigue
“In some cases, there might also be chest pain and palpitations with early heart failure,” adds Dr. Berkowitz, who founded Hackensack’s Heart Failure Program in 2000, noting that symptoms depend on whether your heart is too weak or too stiff. Either problem can cause heart failure.

Confirming the Diagnosis
Though older age—as well as chronic high blood pressure, prior heart attack or family history of heart disease—places you at greater risk of developing heart failure, many are surprised to learn that young people are not immune to the condition.

“Younger people find they can’t run anymore or can’t go up the stairs quickly—that something has changed dramatically,” Dr. Berkowitz explains. “Breathing is almost always affected. Some patients can’t talk in full sentences.”

Confirming the diagnosis typically involves several tests. First is a BNP blood test, which Dr. Berkowitz and others developed about 20 years ago. It looks for a biomarker in blood called B-type natriuretic peptide, which is released when the heart is under stress. A BNP test can tell the difference between heart failure and pneumonia, despite looking similar on X-rays and producing similar symptoms.

Other heart failure testing can include echocardiogram (often dubbed an “echo”), which uses ultrasound to produce images of your heart as it beats. Additionally, an electrocardiogram, or EKG, may be done to track the electrical impulses of your heart, measuring rhythm, strength and timing.

If you experience one or more early signs of heart failure, Dr. Berkowitz urges you to see your primary care doctor or a cardiologist. “Early identification is the most important thing,” he says. “Heart failure is a very common disease, but we have great treatments for it and you shouldn’t be afraid.”

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