When it comes to our health, it’s easy to brush off certain bodily quirks — especially when they seem minor. But sometimes, subtle signs are doing more than just hinting. They’re warning.
While many people associate heart failure with shortness of breath or chest pain, the British Heart Foundation (BHF) has highlighted a less obvious but “one of the most common” warning signs - swelling in the ankles and legs.
Heart failure occurs when the heart becomes too weak or stiff to pump blood efficiently around the body.
It's a chronic condition that typically worsens over time, but with proper care, symptoms can be managed for years.
The BHF recently explained that doctors may refer to “stages of heart failure” or “classes of heart failure” to describe how severe symptoms are and how they impact daily life. “It can help your healthcare team plan the best treatment and support for you,” they said.
“The most commonly used classification system is based on the New York Heart Association (NYHA) classification. It divides heart failure into four classes.”
These classes are determined by how much physical activity a person can handle and the severity of symptoms such as fatigue, breathlessness, and palpitations.
However, the NHS adds that one symptom often overlooked is swelling in the lower body - especially the ankles and legs. This condition, known as edema, is caused by fluid retention and can make walking difficult.
While edema may be less noticeable in the morning, the NHS warns it can “get worse later in the day.”
Medical News Today offers more detail about how this happens, noting that poor heart function causes blood pressure to rise inside the vessels.
“This elevation in pressure forces fluid out of the blood vessels and into the surrounding tissues, resulting in swelling, or edema,” the site explains.
This swelling can show up as puffy or enlarged ankles, feet, or legs, shiny or tight-looking skin, changes in color, discomfort or stiffness, and even indentations that remain after pressing on the skin.
Although edema can be tied to heart failure, it’s also linked to a number of other conditions or lifestyle factors.
These include:
- Standing or sitting for extended periods
- A high-salt diet
- Pregnancy
- Obesity
- Certain medications (like blood pressure drugs, contraceptives, antidepressants, steroids, and hormone therapy)
- Injuries such as strains or sprains
- Insect bites or stings
- Kidney or liver issues
- Blood clots
- Infections
Heart failure comes with a long list of potential symptoms, and some are more recognizable than others.
According to the NHS, breathlessness is common and may worsen when lying down or wake you up at night. Fatigue is also a major red flag, as is feeling lightheaded or fainting.
Less frequently, people may experience a persistent nighttime cough, wheezing, a bloated abdomen, appetite changes, rapid weight gain or loss, confusion, and irregular or fast heartbeats known as palpitations.
Some also struggle with depression or anxiety related to their condition.
The NHS advises that anyone noticing “persistent or gradually worsening symptoms of heart failure” should book an appointment with their doctor. If symptoms are “sudden or very severe,” it’s important to seek emergency help by calling 911.