Pulmonary congestion in heart failure: what to know

It may make breathing harder when lying flat or cause repeated waking at night needing to sit upright. Reduced oxygen exchange can leave a person tired and less able to exercise. Congestion can develop or worsen when the heart cannot keep up with the body's circulation needs.

The left side of the heart normally receives oxygenated blood from the lungs and pumps it around the body. If it cannot empty efficiently, pressure backs up into the blood vessels in the lungs. Fluid then leaks into surrounding tissue and interferes with normal breathing.

You may also notice wheezing, a fast heartbeat, swollen ankles or a quick change in how much activity you can manage. Atrial fibrillation, hypertension, infection and missed or changed medicines can contribute to worsening symptoms, but the cause needs clinical assessment.

Contact your heart-failure care team or clinician promptly if breathlessness is increasing, you need more pillows to sleep, your cough is new, or ankle swelling is worse. Keep a record of symptoms, sleep position, activity tolerance and medicines. Follow the fluid, salt and medicine plan provided for you; do not take extra doses or change diuretics unless your clinician has given you a clear plan.

A review may include checking your breathing, pulse, blood pressure, weight trend, heart rhythm and kidney function. A chronic disease review can help update medicines and agree on warning signs to monitor.

Call emergency services for severe breathlessness, breathing that rapidly worsens, pink or blood-stained frothy sputum, chest pain, fainting, confusion, blue or grey lips, or inability to speak in full sentences. Sit upright, stop exertion and use prescribed emergency instructions while waiting for help.

Ask how to recognise your earliest signs of congestion, when to call the care team, whether you have a personalised diuretic plan, and how your heart rhythm, blood pressure or kidney function affect treatment decisions.