Tiredness and Heart Failure
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Fatigue is a commonly experienced and expressed complaint by several individuals. It is typically characterised by a lowered level of will and motivation to undertake activities and a feeling of lethargy, tiredness and drowsiness. Fatigue can be associated with several health ailments, including sleep apnoea, thyroid or influenza. However, it may also be a trait in people suffering from heart failure (HF).1

The nature and presence of fatigue varies in patients with HF, and it has a differential effect on mortality in such patients. Understanding fatigue and its role in HF can help identify high-risk patients and appropriate management of the condition.2

Determinants of heart failure

Given that fatigue is such an undifferentiated symptom that can arise from almost any cause, pinning down its exact determinants may prove difficult.

However, two significant causes have been found, which can be linked to HF:2

  • It was suggested that low-grade, chronic haemodynamic stress can lead to skeletal myopathy (a disorder characterised by progressive muscle weakness), giving rise to a sensation of fatigue
  • Other studies identified personality factors, depression or difficulty breathing as determinants of fatigue.

Fatigue in heart failure

It has been seen that fatigue is a prevalent symptom among those with HF. It is also known that the progression of HF causes the symptoms of fatigue to increase. However, not all patients experience the same kinds and levels of fatigue or its progression.2

Symptoms of fatigue

Several symptoms in patients with HF are relatable to fatigue. Some of these include:1

  • Disturbed immunity
  • Altered autonomic patterns
  • Changes in heart rate with shifting positions, e.g., from sitting to standing
  • Lowered blood pressure when tilted
  • Changes in the activity of the autonomic nervous system

Factors affecting fatigue in heart failure

It has been found that there are several predictors that can determine fatigue and its severity in HF. Some of these include medication prescribed, general health and capacity for exercise, co-morbidities, age and sex.2

Fatigue and heart failure  – The connection

Fatigue remains one of the hidden, unresolved issues related to HF.2 Heart failure is associated with poor quality of life and fatigue is an important contributing factor to it.3 Because the heart is unable to pump enough blood to all body tissues, blood is diverted away from some organs, especially the muscles in the limbs and supplied to the heart and brain. This leads to a tired feeling, making it difficult for the person to carry out their day-to-day activities such as climbing stairs or walking.4

In general, it has been observed that when fatigue levels are relatively low, patients are in better health with few or no health complications. 2

Fatigue is one of the symptoms integrally connected to HF, such that if you have not been diagnosed with heart problems but experience fatigue along with difficulty breathing or swelling in the feet or ankles, you should get your heart evaluated as these are the typical symptoms of heart failure.4

Given the connection between the two, the catch lies in understanding how we can manage these two coexisting conditions. Is it the HF alone causing the fatigue, or can it be the result of another condition as well? Your medical practitioner can help you understand and guide you in managing your fatigue well.


  1. Nelesen R, Dar Y, Thomas K, Dimsdale J. The relationship between fatigue and cardiac functioning. Arch Intern Med. 2008 May 12;168(9):943-949. doi: 10.1001/archinte.168.9.943.
  2. Smith O, Kupper N, de Jonge P, Denollet J. Distinct trajectories of fatigue in chronic heart failure and their association with prognosis. Eur J Heart Fail. 2010 Aug;12(8):841-848.  doi: 10.1093/eurjhf/hfq075.
  3. Drexler H, Coats AJ. Explaining fatigue in congestive heart failure. Annu Rev Med. 1996;47:241-56.
  4. American Heart Association. Warning signs of heart failure [Internet]. [updated 2018 Feb 13; cited 2020 Jan 16]. Available from: https://www.heart.org/HEARTORG/Conditions/HeartFailure/WarningSignsforHeartFailure/-Warning-Signs-for-Heart-Failure_UCM_002045_Article.jsp.

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