Tiredness and Fatigue

What Is Cardiac-Related Fatigue?

Cardiac-related fatigue is persistent tiredness caused by the heart working less efficiently, so your muscles and organs receive less oxygen-rich blood. What sets it apart from ordinary tiredness is the company it keeps: it is often accompanied by breathlessness, ankle swelling or palpitations, and it typically worsens with activity rather than easing with rest. Around 200,000 people in the UK are newly diagnosed with heart failure each year [1] - a condition in which fatigue and reduced exercise tolerance are core symptoms.

When Should You Seek Assessment for Tiredness?

Everyday tiredness usually settles with rest, better sleep or less stress. It is worth arranging an assessment when fatigue does not resolve or is joined by other signs. You should consider booking a cardiology assessment if your tiredness:

• Is associated with breathlessness, on exertion or at rest
• Comes with palpitations, chest discomfort or ankle swelling
• Has developed gradually over weeks or months and is worsening
• Limits your ability to carry out everyday activities
• Occurs alongside an irregular or fast heartbeat

LivingCare is a specialist outpatient service and is not an emergency care facility. If your symptoms are sudden or severe, call 999.

How Cardiac-Related Fatigue Is Assessed

At our cardiology service, a consultant cardiologist begins with a careful history before tailoring an investigation plan - outpatient, with no GP referral needed. Depending on your symptoms, this may include:

• An ECG to record your heart's rhythm and electrical activity.
• An echocardiogram, an ultrasound scan that checks the heart muscle and valves for heart failure, valve disease or cardiomyopathy.
• Cardiac blood tests, including BNP (a marker of heart strain), thyroid function and a full blood count to look for non-cardiac causes such as an underactive thyroid or anaemia.

Not everyone needs every test; your cardiologist will advise which are most useful.

What Might Be Causing My Tiredness?

When fatigue is cardiac in origin, the conditions a cardiologist looks to identify or exclude include:

• Heart failure
• Cardiomyopathy (disease of the heart muscle)
• Valve disease
• Arrhythmias (abnormal heart rhythms)
• Coronary artery disease

Most tiredness, however, is not caused by the heart. Common non-cardiac causes that a cardiologist may help identify, or refer you on for, include an underactive thyroid, anaemia, sleep apnoea, low mood or depression, and chronic fatigue syndrome. [2] A cardiology assessment helps clarify whether your fatigue has a cardiac cause and guides the right next steps.

References

1. British Heart Foundation - Incidence and prevalence of heart failure
2. NHS - Tiredness and fatigue