Tired young woman catching her breath after a long run

Ask a cardiologist: Shortness of breath

Q: I feel winded after a few minutes of stair climbing or brisk walking. Could I have a heart condition?

A: Probably not. Feeling short or out of breath is a common symptom that overlaps with many conditions. In most cases it has nothing to do with your heart. 

Dr. Jay Udell stands before a white screen

Dr. Jay Udell

What it might be

Typically, only one in 100 people who experience shortness of breath after physical exertion have a heart condition. And the other 99? Some of it is a natural change that comes with aging or being too sedentary. Shortness of breath is also linked to anemia, lung conditions (bronchitis, emphysema, asthma), smoking history, lack of sleep, stress, and a number of other potential conditions. Expect your doctor to ask you about your lifestyle or even run a blood test to narrow down the underlying cause.  

The good news is a symptom like this isn’t as worrisome as it was 60 or even 30 years ago. We’ve done a great job at improving early screening, diagnostic testing and treatments.

When it is your heart

Shortness of breath can be an early sign of heart failure. Traditionally, we think of heart failure as a heart that’s too weak to pump blood. But there’s another type, known as diastolic dysfunction, where the heart muscle can’t relax. When we’re talking about shortness of breath, it’s more likely that we’re dealing with a relaxation problem. A heart muscle that is constantly flexed changes shape and can thicken over time (like any muscle), making it paradoxically harder rather than easier for your heart to pump blood and move oxygen through your body.

What happens next

If we detect an underlying heart condition, we’ll check for risk factors that may predispose you to stiffening of the heart muscle, like high blood pressure or diabetes.  Changes to diet and an increase in physical activity can significantly help lower these risk factors. If after a good effort your risk is still high, your doctor may recommend medication or when necessary a cardiac test/procedure. Occasionally we find that there was an injury to the heart muscle that weakened or stiffened it, like a heart attack that the patient may or may not have realized occurred in the past. Sometimes shortness of breath may indicate an active condition where there’s an inadequate supply of oxygen to the heart muscle from a severely blocked coronary artery. Other times a disturbance in the heart’s beat-to-beat rhythm may be the culprit for shortness of breath. There are other heart-related injuries that cardiac testing can also detect and treat. When a weakened or stiff heart muscle is caused by a genetic condition, we recommend screening for the patient’s closest relatives (children, parents and siblings). The earlier we can detect a potentially serious condition, the sooner we can get it under control.

Emerging research coming out of our collaborative BREATH program based at Mount Sinai Hospital with support from Toronto General Hospital and Women’s College Hospital all in Toronto, could reshape how we screen (and ultimately treat) heart failure. Led by Dr. Susanna Mak, a previous Foundation-funded researcher, this promising research uses sophisticated technology to detect subtle changes within the heart muscle at the earliest stages. Early detection is especially important for patients dealing with a heart relaxation problem, because this requires different treatments from those that help patients with a weakened heart muscle.

One thing that we almost always prescribe is moderate exercise. It’s one of the best therapies we can offer. No matter what the underlying condition is, when patients introduce exercise into their lives they increase their endurance. Gradually, they can do more activity with less shortness of breath.

I’d recommend exercise even if the tests come back all clear. If it’s a symptom that had you worried, it’s important to be honest with yourself – not hard on yourself. Most Canadians don’t get the recommended amount of physical activity. If you’re one of them, it’s never too late to increase your physical activity, a little bit at a time.


4 Responses

    1. Sharon Hollingsworth

      Hi Cayla,

      Thank you for your comment on the Heart and Stroke blog post regarding shortness of breath. Since you state that you come close to fainting while walking, we strongly recommend that you check in with your healthcare provider before participating in further physical activity to rule out any serious health issues. There could be any number of reasons for the problems you are experiencing, but your doctor is best equipped to get to the bottom of it. Best of luck with this and thanks again for checking in. Yours sincerely, Sharon at the Heart and Stroke Foundation

  1. Kelli

    I was recently diagnosed with Microvascular Heart Disease after a bout of chest pain and shortness of breath. Angiogram was normal. My question is how is this diagnosed without any test?

    1. Sharon Hollingsworth

      Hi Kelli and thanks for your interest in the Heart & Stroke blog. Microvascular disease is often ascribed as a diagnosis of exclusion when the coronary angiogram is normal, which is to say that there was no obstructive coronary disease seen. It is sometimes diagnosed based on clinical presentation and absence of obstructive coronary disease, sometimes reinforced with a stress test showing objective signs of ischemia (lack of sufficient oxygen supply to the heart during the stress).

      Hope this answers your question. Best wishes for a good weekend! Sincerely, Sharon at Heart & Stroke

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