Everyone knows that crushing chest pain is often a sign of a heart attack. But there are some types of cardiovascular disease whose symptoms are far more subtle.
Take this patient who went to the doctor about shoulder aches and pain. Her doctor told her to lighten her load, and carry her purse on the other side. A few days later, the pain had not subsided. The woman went to see Martha Gulati, MD, division chief of cardiology at the University of Arizona College of Medicine in Phoenix. Sure enough, Dr. Gulati found blockages in her arteries.
It’s important to keep an eye out for more than just the “classic” problems.
Most common types of heart disease
Cardiovascular disease is an umbrella term that encompasses several types of heart issues:
- Coronary artery disease: Coronary artery disease is the most common heart disease. It results when there’s a buildup of LDL (bad cholesterol) in your arteries. If unmanaged, this can lead to cardiac arrest and death.
- Congestive heart failure: This happens when your heart muscle is too weak and either pumps too little or at too high a pressure. About 5 million people struggle with congestive heart failure in the U.S., and more than half die within five years of being diagnosed.
- Valvular heart disease: When one of the four heart valves doesn’t work properly, either because of an illness, a birth defect, or damage to the heart over time, you will experience valvular heart disease. It is most common in older people, and less common than other heart diseases. Some people may go their entire lives without knowing they have a valve problem.
- Atherosclerosis: This is when plaque builds up on the walls of your arteries. Atherosclerosis affects about 3 million people annually. It often has no symptoms and may never cause an issue, but can lead to a heart attack if untreated.
- Arrhythmia: This is when your heart beats too fast, too slow, irregularly, or skips beats. It’s one of the most common heart conditions and often isn’t a cause for concern. However, seniors with other risk factors may want to take a blood thinner to ward off strokes. If it’s untreated, it can result in cardiac arrest.
- High or low blood pressure: Though technically not a disease in itself, high blood pressure is one of the most common conditions in the world. It can be controlled with medications, and should be—unchecked blood pressure problems can cause heart attacks, stroke, and coronary artery disease.
What are the warning signs of heart disease?
Different symptoms can indicate different types of heart disease. Watch for these signs that might seem innocuous, but could signal that your heart health is at risk.
1. Extreme fatigue
Could indicate: Coronary artery disease; congestive heart failure; valvular heart disease
There are many conditions that can cause fatigue. Yet, persistent, unexplained tiredness could be a sign that your heart is not pumping well, or is encountering some other problem—like a blockage or a valve issue.
2. Shortness of breath
Could indicate: Atherosclerosis; coronary artery disease; congestive heart failure; valvular heart disease
Sure, you get winded easily if you’re a little out of shape, but don’t write it off too quickly. If you find yourself gasping for air after a small amount of exertion, like walking out to the car or up the front steps, it could be heart-related.
3. Change in exercise tolerance
Could indicate: Coronary artery disease; congestive heart failure; valvular heart disease
John Osborne, MD, the director of cardiology at LowT Center/HerKare and volunteer for the American Heart Association (AHA), regularly sees patients who could mow the lawn easily a few months ago, but now struggle—and they end up having heart disease. If tasks that used to be painless are now difficult, consider seeing a doctor.
4. Digestive concerns
Could indicate: Coronary artery disease
Lightheadedness, nausea, vomiting, or stomach pain can be common signs of a heart attack—especially for women, who often have different symptoms than men. It can start with a vague sense of not feeling well in the digestive area or heartburn, but these, along with breaking into a cold sweat, can indicate coronary artery disease.
5. Sleep apnea, snoring, or waking up during the night
Could Indicate: Arrhythmia; coronary artery disease; congestive heart failure
Heart disease could be behind your poor night’s sleep. Your blood flow and heart rate change when you go to sleep when everything is functioning normally. If there’s something wrong, it could be waking you up at 1 a.m. Heart failure can cause sleep apnea or make fluid build up in the lungs, and arrhythmia can make you feel like your heart is racing—both of which can interrupt your dreams.
Could indicate: Congestive heart failure; valvular heart disease
Especially in the legs, ankles, or feet, swelling can be a sign of heart failure. If you have puffed up so much that your finger leaves an indent when you touch your body, it might be time to check with a medical professional.
7. Chest discomfort or angina
Could indicate: Atherosclerosis; coronary artery disease; valvular heart disease
Feelings of squeezing, tightness, pressure, or heaviness can be signals that something is wrong with your heart. People commonly describe cardiac distress as feeling like an elephant is sitting on their chest.
8. Leg cramps
Could indicate: Atherosclerosis
Leg pain, or difficulty walking, can be a sign that your circulation is impaired. The main organ behind blood flow? Your heart.
9. Heart rhythm and rate changes
Could indicate: High or low blood pressure, congestive heart failure; valvular heart disease; arrhythmia
When your heartbeat feels unusual—too fast or uneven—that is called palpitations. It’s a feeling similar to when you’ve had too much caffeine or feel panicked. But if you’re just sitting and reading a book, and your heart starts to race, it could mean you’re at risk for heart disease.
10. Shoulder, arm, neck, back, abdomen, or jaw pain
Could indicate: Atherosclerosis, coronary artery disease
When your heart is struggling, it can make other parts of your body call out in pain. Arm pain is a classic heart attack symptom, but it can also occur in the shoulders, back, stomach, or jaw.
11. Dizziness or lightheadedness
Could indicate: Arrhythmia; high or low blood pressure; congestive heart failure; valvular heart disease
Feeling faint usually means there’s not enough blood flow to the brain. While there are lots of causes, abnormal heart function could be one of them—especially when you feel dizzy upon standing up.
12. Persistent cough
Could indicate: Coronary artery disease; congestive heart failure
Heart failure can make fluid build up in your lungs, which can trigger coughing or wheezing.
13. Weakness in extremities
Could indicate: Atherosclerosis
Weakness in the legs goes hand-in-hand with change in exercise tolerance and shortness of breath. It could be a type of fatigue associated with heart trouble.
If you experience any of the above symptoms of heart disease—either acutely or worsening over time—first stop what you’re doing and wait for it to resolve. Then, call your primary care physician and make an appointment to get it checked out. If it doesn’t resolve and you begin to experience other urgent symptoms, like more intense pain or difficulty walking, go to the emergency room.
What are the warning signs of a heart attack?
Heart attacks are an emergency. Keep watch for these common symptoms so you can help yourself or others.
- Chest pain. This could manifest as chest pressure, squeezing, discomfort, or the feeling of “an elephant on your chest,” Dr. Gulati says.
- Arm pain. This includes your jaw, shoulder, and arm, and is usually on the left side; it could be localized to one spot.
- Stomach problems. This includes indigestion, heartburn, acid, nausea, stomach pain, or reflux that doesn’t correlate with a meal, especially in the case of silent heart attacks, Dr. Osborne says.
- Lightheadedness. If you’re dizzy, light-headed, or passing out, that’s a sign of an emergency.
- Sweating. This typically manifests as a cold sweat, but any sudden excess sweating without warning is a symptom.
- Shortness of breath. This includes difficulty taking a deep breath or asthma-like symptoms.
- Fatigue. Your heart struggling to keep you alive can make you very tired very fast.
What should I do if I or a loved one is having a heart attack?
If you suspect you or someone around you is having a heart attack, you need to act quickly. First (and most importantly), call 911. Do not attempt to drive yourself or anyone you know to the hospital. While the ambulance is on the way, take these steps if you’re having a heart attack:
- Chew an aspirin. This will help thin the blood and start to break up the blood clot causing issues.
- Unlock the door. If you’re alone and you pass out, the paramedics will still be able to enter easily.
- Stop what you’re doing and try to relax. You need to immediately remove any extra strain on your heart, so sit or lie down. If coughing hard or banging on your chest helps you feel better, do it, but Dr. Osborne notes that it doesn’t really make any difference in the course of a heart attack.
If you’re not the one having the heart attack, administer CPR if necessary.
Frequently asked questions about heart symptoms
What is a dangerous heart rate?
Generally, a healthy heart rate is between 60 (or 50 if you’re really healthy) and 100 beats per minute—so anything above or below those numbers could be a problem. On either end of the spectrum, you might be feeling dizzy, faint, or lightheaded, or pass out, Dr. Osborne says. If it’s above 100 beats per minute, that’s when you might have chest pain and shortness of breath.
Either way, though, high or low, head to the doctor. An irregular heartbeat at these levels could mean thyroid problems, heart failure, atrial fibrillation, or any number of other conditions.
Can symptoms of a heart attack last for days?
When we hear about heart attacks, it’s typically something that’s come on out of nowhere and was unexpected. But some heart symptoms—depending on the situation—can last for several days.
“Everybody’s different,” Dr. Gulati says. “[For] some people, symptoms will come on suddenly, and that usually means that maybe a clot broke off or something initiated the cascade of a thrombus or blood clot formation. But other people may have ongoing symptoms of angina [reduced blood flow to the heart] that just get worse over time. It might be a response to stressful situations or both physical and emotional stress may bring it on.”
For example, you could get chest heaviness while walking, but it goes away once you begin to rest. Or you could have chest heaviness and shortness of breath, and feel excessively hot and sweaty when exercising—so you stop.
“Those are usually warning signs that there’s something going on,” Dr. Gulati says. “Angina presents in many different ways to different people. Some people, it will be sudden in onset and they’ve never experienced a symptom before, and for other people, they may have been experiencing small but subtle things that have been gradually getting worse.”
Other symptoms that could last for several days or even months, Dr. Osborne says, include swelling, waking up short of breath at night, not being able to sleep flat, breathlessness, and the inability to take a deep breath.
When should I be worried about heart palpitations?
Though they may be scary at the time, heart palpitations are rarely something to be concerned about. Dr. Gulati says that some people are just more aware of their heartbeats than others and are more likely to notice skipped beats or other palpitations. But she and Dr. Osborne both agree that it’s time to seek medical attention when those palpitations come along with fainting, dizziness, pain, or shortness of breath.
What are common heart medications?
If you need heart medication, there are hundreds of options for your cardiologist to choose from. These are the most common medication categories (and how they work).
- Blood thinners: Stop blood from clotting
- Antiplatelet agents (including aspirin): Stop blood platelets from sticking together and forming clots
- Angiotensin-converting enzyme (ACE) inhibitors: Expand blood vessels and help blood flow more easily and reduce blood pressure
- Angiotensin II receptor blockers (ARBs): Stop blood pressure from rising
- Angiotensin-receptor neprilysin inhibitors (ARNIs): Break down natural substances that can block arteries
- Beta blockers: Make the heart beat slower and stronger
- Calcium channel blockers: Stop calcium from entering the heart and blood vessels and reduce blood pressure
- Cholesterol medications: Lowers high cholesterol levels
- Digitalis: Make heart contractions stronger
- Diuretics: Remove excess fluid from the body
- Vasodilators: Relax blood vessels and brings more blood and oxygen to the heart and can reduce blood pressure as well
Incorporate healthy lifestyle changes to enhance the efficacy of heart medications. A poor diet and lack of physical activity can put you at a higher risk of heart disease.
While many heart problems don’t have clear warning signs, there is often treatment available. If you notice one of these unusual signs there might be a problem with your ticker, don’t delay. See your doctor, and find out what you can do to treat it.