Let’s Talk About the Signs and Symptoms of Heart Disease
Knowing the red flags that signal heart disease can help you get diagnosed and treated as soon as possible. by Matt McMillen Health Writer
Maybe you’ve been feeling unusually fatigued or a bit out of breath lately. Or, maybe there’s an occasional pain in your chest that goes away when you lie down. Perhaps you’ve noticed swelling in your legs and feet, or your heart sometimes races or beats erratically. These symptoms (and more) can indicate some form of heart disease. We’ll help you learn what to look out for—and which symptoms to never ignore. Your job: Talk to your doctor, stat, about your concerns so you can be screened for heart disease—which just might save your life.
Our Pro Panel
We went to some of the nation's top experts in heart disease to bring you the most up-to-date information possible.
Guy Mintz, M.D.
Director of Cardiovascular Health & Lipidology
Sandra Atlas Bass Heart Hospital
Michael Goyfman M.D., MPH
Director of Clinical Cardiology
Long Island Jewish Forest Hills
Andrew Freeman, M.D.
Director of Cardiovascular Prevention and Wellness
National Jewish Health
Generally speaking, no. However, it often can be managed with the right lifestyle adjustments. That means exercising at least 150 minutes a week and eating a nutritious diet. Limit or avoid salty, sugary, and fatty foods. If you smoke, quit. There’s a great deal you can do, but it’s not always easy. Fortunately, help’s available. Depending on your diagnosis, you may qualify for cardiac rehab, which will help you make necessary lifestyle changes. Medications and procedures likely also will be necessary to help your heart.
While it’s true that chest pain is the most common symptom, many heart attacks occur without it. Your goal should be to understand whether you’re at risk of a heart attack. If you are, then knowing that even vague symptoms like nausea and fatigue can signal a heart attack will make you take those symptoms seriously. When in doubt, err on the side of caution—call 911.
While it’s true that most types of heart disease begin to occur around retirement age, the numbers of younger people with heart disease has risen in recent decades. Even if that were not the case, you’d still want to keep your heart health in mind when you’re young. Heart disease often develops slowly over many years, as a result of unhealthy lifestyle choices, like poor diet, lack of exercise, or binge drinking. So develop lifelong habits like eating well and exercising regularly to protect your ticker as you age.
First, if you are stressed about your heart disease risk, talk to your doctor and learn where you stand rather than letting worry gnaw at you. Stress, especially when it’s chronic, or ongoing, can affect your heart both directly and indirectly. Stress hormones like adrenaline and cortisol boost your heart rate, blood pressure, and blood sugar. Stress also makes it harder to resist giving in to temptation. You’re more likely to overeat, overindulge in alcohol, and smoke when you are stressed. And stress can make it tougher to get a good night’s sleep, something that your heart needs to stay healthy.
First, What Exactly Is Heart Disease?
Heart disease is not a single disease. Instead, it’s a catchall term for a wide range of ailments that affect the body’s most important muscle. (We’ll provide an overview of the main types—and the signs and symptoms they trigger—in just a moment.)
It’s also the number-one killer of both men and women, according to the Centers for Disease Control and Prevention (CDC), responsible for one American death every 37 seconds. Those are alarming stats, no doubt about it.
But if you heed your body’s warning signs and act in time, you have a solid chance of either stopping heart disease in its tracks or beating its worst effects altogether. That might mean upping your exercise quotient, chucking cigarettes, or making other lifestyle adjustments.
Why? Because the American Heart Association estimates that 8 out of 10 cases of heart disease can be prevented. That means your heart’s long-term health is often in your own hands.
Not everyone can avoid heart disease by making healthier choices—sometimes things like age, biology, and genetics play a role in its development. Still, no matter how or why your ticker needs attention, early diagnosis is the goal: The sooner you get treatment, the better your chances are of living well going forward. That’s what makes recognizing the signs and symptoms of heart disease so very important.
What’s the Difference Between Heart Disease Signs and Heart Disease Symptoms?
It’s actually pretty straightforward:
A symptom is something you feel or experience but one that can’t be objectively measured. Fatigue is a good example of this. You may feel fatigue due to some types of heart disease, but your doctor can’t observe or officially quantify it.
Signs, on the other hand, can be measured. Your doctor can do a blood pressure reading, take images of your heart, and test your blood to reveal indications of heart disease.
In some cases, you may have signs of heart disease but no symptoms. High blood pressure (HBP) is a good example of this; it often gets dubbed “the silent killer” because it may be present and causing harm to your heart without any obvious physical clues. In fact, many people aren’t aware they have HBP until a doctor tells them so.
What Are Some Common Signs and Symptoms of Heart Disease?
One thing to make clear from the start: Numerous heart disease symptoms are actually pretty vague, meaning they could be caused by any number of things other than heart disease. Which can make things tricky, or even lull you into thinking nothing serious is going on.
Take fatigue: In our go-go, 24-7 world, everyone’s feeling a little tired, right? And while some types of heart disease, such as heart failure, can make you feel extremely fatigued, being exhausted or rundown doesn’t automatically mean you have a heart disorder.
So how do you know when it’s nothing and when it’s something? Never write off persistent or unusual fatigue as nothing to worry about. We’re talking about feeling worn out after climbing a single flight of stairs, or trouble sleeping despite your exhaustion. Listen to your body, and if something does not feel normal or right, pay attention.
Ok, let’s get started. We’ll break down signs and symptoms by types of heart disease. As you’ll see, some types of heart disease share similar symptoms.
The pumping of your heart creates pressure with each beat. That pressure forces blood through your blood vessels to the rest of your body and back again to your heart. This pressure can become higher than normal for a variety of reasons, and over time an elevated pressure puts you at risk of coronary artery disease CAD, heart attack, stroke, and heart failure.
Half of all American adults have HBP, according to the CDC, which is nearly 110 million men and women. It becomes more common as you grow older, but fortunately treatments exist to keep it in the normal range.
Unfortunately, though, HBP does not produce any symptoms to alert you there’s a problem. You likely won’t learn you have high blood pressure without visiting your doctor, where measuring your BP is a standard part of just about any appointment.
Your doctor will use a device called a sphygmomanometer—you know, the one with the inflatable sleeve that wraps around your upper arm—to measure the pressure when your heart beats, known as your systolic BP, and the pressure between beats, or your diastolic BP.
You will see those two numbers written like this: 120/80. This reading is in the normal range. According to the CDC, you have high blood pressure if the top number is 130 or higher and the bottom number veers above 80 (and stays there). Your BP is considered "elevated," the first red flag that HBP is pending, with a systolic pressure as high as 129 (even if your diastolic pressure remains at 80 or below).
Coronary Artery Disease (CAD)
This is the most common form of heart disease, and it occurs when a fatty substance called plaque has built up on the walls of your heart’s arteries. This plaque restricts the normal flow of oxygen-rich blood. Plaque also can rupture, or break apart, which triggers the formation of blood clots that may completely block your artery and cause a heart attack.
The major symptoms of CAD are:
Angina. This is the medical term for chest pain or other type of discomfort caused by CAD. You may feel a tightness or squeezing sensation in your chest. It can spread to other parts of your upper body, such as your arms, shoulders, neck, jaw, and back. Angina also may feel like indigestion. The pain or discomfort tends to be brief.
Shortness of breath and fatigue. Restricted blood flow limits the amount of oxygen your heart gets (a condition called ischemia), and that can leave you exhausted and out of breath even after doing your normal activities.
Heart attack. While techinically not a "symptom," your first sign of CAD may be a heart attack. This occurs when you have what’s called silent ischemia, in which you don’t experience chest pain or other warning signs.
Your doctor will dig deeper in search of signs of CAD using some or all of the following tests:
Bloodwork: To determine if damage has been done to your heart, your doctor may draw blood to measure the level of the hormone brain natriuretic peptide (BNP) present. Normally, BNP is present in the blood in small amounts, but with heart problems this level rises and can be measured.
Electrocardiogram (EKG): This quick, painless test measures the electrical activity of your heart and can pinpoint abnormalities typical of CAD.
Echocardiogram: This is an ultrasound that produces sound waves to create images of your heart that help measure its strength and how well it functions.
Cardiac catheterization: During this invasive procedure, a thin tube is inserted into a blood vessel in your groin and threaded to your heart, where it can detect blockages.
If the flow of blood to your heart becomes blocked, and damage to, or death of, the heart muscle results, this is a heart attack. It often occurs when plaque buildup from CAD ruptures and triggers a clot to form. Heart attacks can be deadly and should be treated immediately. If you’re feeling obvious or unsettling symptoms, don’t hesitate: Call 911 immediately.
Sometimes, heart attacks have no symptoms, and not everyone who has symptoms will experience the same ones, but here are the most common:
Shortness of breath
Lightheadedness and dizziness
Jaw, shoulder, or arm pain
Chest pain is the most common symptom, but men are more likely to experience that pain than women. Women’s heart attack symptoms are more likely to include nausea and fatigue as well as vomiting.
The measurable signs of a heart attack include abnormal electrical activity as revealed by an EKG as well as the presence of blockages, which can be detected by cardiac catheterization. The doctor also will draw blood to test for a protein called troponin, which the heart releases only when it’s been damaged.
This is a progressive disease in which your heart becomes less and less able to pump an adequate amount of blood to meet your body’s needs. It has several hallmark symptoms, many of which you will definitely notice:
Exercise intolerance. This begins in the early stages of heart failure. Because your heart can’t pump enough oxygen-rich blood to your body, it takes less physical exertion to wear you out than it would have previously, leaving you feeling weak and fatigued.(If you suddenly struggle walking up the stairs to your bedroom, for instance, you’ll want to check in with your doctor.) This can create a vicious circle: Do less exercise, and your heart weakens, which makes regular activities even more challenging.
Shortness of breath. Heart failure often leads to fluid buildup in your lungs, and this makes it a struggle to breathe, a condition called dyspnea.
Persistent cough. Breathing problems may be accompanied by a persistent cough or wheezing. You may cough up mucus tinged with blood.
Swelling in your extremities. Heart failure leads to fluid buildup as your kidneys become less able to filter your blood. That commonly leads to swelling in your legs, ankles, and feet, but it also may occur in your abdomen, liver, and lower back. One noticeable sign: It becomes harder to put your shoes on.
Sudden weight gain. As fluids build up in your body, your weight goes up as well. This can happen rapidly and dramatically. You may have weight gains of as much as five pounds in a day. If you’re already being treated for heart failure, call your doctor if you gain more than two pounds in a 24-hour period.
Irregular heartbeat. Your heart may beat faster in an attempt to keep up with your body’s demands. Over time, heart failure can lead to a type of erratic heart beat called atrial fibrillation that ups your risk for blood clots.
Confusion, difficulty concentrating, and impaired thinking. When your heart can’t pump blood as well as it used to, your brain gets deprived along with the rest of your body. An inadequate amount of blood can compromise your cognitive abilities.
Your doctor looks for signs of heart disease via the following:
Blood tests. These reveal the presence of natriuretic peptides, hormones found in the heart only when you have heart failure.
Chest x-rays. These allow your doctor to see if your heart has enlarged, a key sign of heart failure. It will also provide a picture of fluid in your lungs.
Electrocardiogram (EKG). This is done to measure damage to your heart and to determine if it’s electrical circuits function properly.
Echocardiogram. The test uses sound waves to produce pictures of your heart so your doctor can see how well it’s working.
There are numerous types of abnormal heartbeats, some of them bothersome if benign, others virtually undetectable but potentially deadly. They can be too fast, too slow, or erratic. The most common type is atrial fibrillation, an irregular rhythm that can allow blood clots to form in the heart that can then cause a stroke. Arrhythmias don't always have symptoms. Many people with afib, as it's often called, may not even know they have it until it shows up on a physical exam, ECG, or other form of rhythm monitoring (such as a wearable device).
Also, the severity of your symptoms may not track with the seriousness of your arrhythmia. In other words, if you feel only mild symptoms, don’t assume you have a mild case. Here are the common symptoms:
Heart palpitations. This is when you feel a pounding in your chest or your heart’s racing. Sometimes this is normal. After exercise, for example, or if you’ve had a sudden fright. But sudden, unexplained palpitations may indicate an arrhythmia. Arrhythmias may also cause your heart to feel like it has skipped a beat, or added an extra one between regular beats. Most of the time this type of arrhythmia is harmless, but you should be concerned if it happens frequently or cause you discomfort.
Shortness of breath, fatigue, lightheadedness, and chest pain. When your heart doesn’t beat like it should, it can’t keep up with the body’s demand for oxygen, leading to any or all of these symptoms.
Fainting. Arrhythmias can cause a dangerous drop in your blood pressure, and this can cause you to faint. This is a medical emergency.
There are plenty of ways your doctor can detect the signs of an arrhythmia. They include:
Electrocardiogram (EKG). As with other forms of heart disease, this painless, non-invasive test shows your doctor any electrical abnormalities in your heart, including arrhythmias.
Holter monitors and event recorders. These are portable devices you wear throughout the day and night. They record your heart’s electrical activity over a few days or a few weeks. Why might you be asked to wear one? Your arrhythmia may not be active when your doctor examines you, so these devices will allow you to capture episodes that occur as you go about your daily routine. Holter monitors are always active and recording. Event recorders must be turned on when you begin to experience symptoms of your arrhythmia.
When your blood’s brain supply gets cut off, you have what’s called a stroke. Most often, it’s caused by a clot that develops in your heart and travels to your brain, where it blocks the flow of blood. Brain cells begin to die when they don’t get the oxygen that blood normally delivers to them. Strokes can be quickly fatal, and they’re the leading cause of serious long-term disability.
Know the following symptoms and call for help immediately if you spot them:
Difficulty understanding what others are saying
Paralysis or numbness, which often affects just one side of your body. Your face, legs, and arms are commonly affected.
Blurred vision or blackening of your eyesight in one or both eyes, and/or double vision
A sudden and severe headache, which may be accompanied by vomiting
Balance problems that make walking difficult
Here’s a quick cheat sheet to help you recognize a stroke in yourself or someone else.
Time to call 911
Your doctor or the doctor in the emergency room will look for the signs above when trying to determine if you are having a stroke. To look for definitive signs and to diagnose a stroke, you will likely undergo:
Computed tomography (CT) scan. This provides detailed pictures of your brain so your doctor can determine if a stroke is occurring.
Magnetic resonance imaging (MRI). An MRI provides images of your brain and allows your doctor to determine if it has been damaged by a stroke.
Carotid ultrasound. This uses sound waves to create a picture of your carotid arteries, which supply blood to your brain. When narrowed by plaque, they can make you vulnerable to a stroke.
Echocardiogram. This test can help determine where the stroke-causing clot originated.
Coronary Artery Disease Signs and Symptoms (1): Mayo Clinic. (n.d.) “Coronary artery disease.” mayoclinic.org/diseases-conditions/coronary-artery-disease/symptoms-causes/syc-20350613
Coronary Artery Disease Signs and Symptoms (2): American Heart Association. (2015.) “Silent Ischemia and Ischemic Heart Disease.” heart.org/en/health-topics/heart-attack/about-heart-attacks/silent-ischemia-and-ischemic-heart-disease
Heart Attack Signs and Symptoms (1): Mayo Clinic. (2020.) “Heart attack.” mayoclinic.org/diseases-conditions/heart-attack/symptoms-causes/syc-20373106
Heart Attack Signs and Symptoms (2): Merck Manuals. (2019.) “Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina).” merckmanuals.com/home/heart-and-blood-vessel-disorders/coronary-artery-disease/acute-coronary-syndromes-heart-attack-myocardial-infarction-unstable-angina
Arrhythmia Signs and Symptoms (1): UCSF. (n.d.) “Arrhythmias.” surgery.ucsf.edu/conditions--procedures/arrhythmias.aspx
Arrhythmia Signs and Symptoms (2): Merck Manuals. (2019.) “Overview of Abnormal Heart Rhythms.” msdmanuals.com/home/heart-and-blood-vessel-disorders/abnormal-heart-rhythms/overview-of-abnormal-heart-rhythms
Heart Failure Signs and Symptoms (1): American Heart Association. (2017) “Warning Signs of Heart Failure.” heart.org/en/health-topics/heart-failure/warning-signs-of-heart-failure
Heart Failure Signs and Symptoms (2): American Heart Association. (2017.) “What is Heart Failure?” heart.org/en/health-topics/heart-failure/what-is-heart-failure
High Blood Pressure Signs and Symptoms (1): Mayo Clinic. (2018.) “High blood pressure (hypertension).” mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410
High Blood Pressure Signs and Symptoms (2): Cleveland Clinic. (2020.) “High Blood Pressure (Hypertension).” my.clevelandclinic.org/health/diseases/4314-hypertension-high-blood-pressure
Stroke Signs and Symptoms (1): American Stroke Association. (n.d.) “Stroke Symptoms.” stroke.org/en/about-stroke/stroke-symptoms
Stroke Signs and Symptoms (2): American Association of Neurological Surgeons. (n.d.) “Stroke.” aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Stroke