Signs of a bad heart: Don’t overlook these cardiac symptoms

Don’t just wait for symptoms.

Take care of your heart — before you have a scare. “Waiting for the symptoms sometimes can be treacherous,” says Dr. Clyde Yancy, chief of cardiology at Northwestern University Feinberg School of Medicine.

With sudden cardiac arrest, collapse and even death can occur immediately when the heart unexpectedly stops beating. While clinicians emphasize that recognizing symptoms of heart attack or other cardiac problems can be lifesaving, the focus should be on preventing a heart attack in the first place.

Prevention

Establishing a heart-healthy approach means eating a primarily plant-based diet that supports heart health, such as the Ornish, Mediterranean or DASH diets. In addition, physical exercise is key: Get at least 150 minutes of moderate intensity aerobic activity, such as brisk walking or slow biking, or 75 minutes of vigorous cardio, such as running or swimming, each week, per federal physical activity guidelines endorsed by the American Heart Association.

Lastly, it’s important to address other risk factors, from quitting smoking to managing stress. Lifestyle changes and medication to address risk factors, such as high blood pressure and cholesterol, are critical to avoid a heart attack.

Chest pain

In the majority of cases, heart attacks are caused by coronary artery disease. The most common form of heart disease, this occurs when the major vessels that supply blood to the heart — the coronary arteries — become too narrow.

One way that CAD can manifest is chest pain, or angina. This may feel like pressure or squeezing, or it could even be mistaken for indigestion. It’s not just behind the breastbone where you may feel this discomfort, either. In fact, it can extend to the shoulders, back, arms, neck and jaw.

Although this is a common symptom, not everyone with coronary artery disease, or for that matter, other types of heart disease, feels chest pain. So it’s important to pay attention to other possible signs and symptoms, too.

Weakness or fatigue

Sometimes the first sign of coronary artery disease is the feeling that you’ve lost your physical edge, or you’re not able to be as active as you used to be. Perhaps hard labor or exercises you used to sail through now leave you winded. Or maybe you find you experience weakness or fatigue without much exertion at all.

For that reason, experts say, even strong athletes shouldn’t ignore when they’ve lost a step — or just shrug it off as normal variation in fitness if there’s not an obvious reason for the change. If you have concerns about fatigue or changes in physical stamina that don’t have an obvious cause, it may be worth seeking a medical opinion.

If coronary artery disease is suspected, your doctor may recommend various tests to aid in diagnosis, from chest X-ray to check for heart damage to an exercise stress test to see how your heart handles exertion while you’re on a treadmill.

Heavy snoring — a harbinger of heart disease?

If you’re lightly sawing logs once in awhile, it may be no big deal. But those who snore heavily should be medically evaluated for obstructive sleep apnea, a sleep disorder that can leave a person gasping for air at night and strain the heart.

With sleep apnea, a person breathing frequently stops for brief periods throughout the night. As a result, they don’t get adequate oxygen, stressing the body. This can ultimately drive up blood pressure, and the sleep disorder can keep a person from getting a good night’s rest. Over time, that can increase one’s risk for cardiovascular disease and cardiac events, like having a heart attack.

Variable, not just high, blood pressure

Certainly high blood pressure raises a person’s risk of developing heart disease. But another possible sign of heart trouble to come, which may be overlooked, is variable blood pressure. That’s when, for example, it’s different at subsequent doctors visits, even if it’s not high; research has found that such fluctuations may be linked with higher heart disease risk.

A study published in JAMA Cardiology in January found variable blood pressure in young adults was associated with a higher risk for cardiovascular disease, including coronary heart disease, in middle age.

“We should care about the difference itself independently of the average blood pressure level,” says Dr. Yuichiro Yano, an assistant professor of family medicine and community health at the Duke University School of Medicine and lead author of this study.

Erectile dysfunction

Problems in the bedroom for men, namely erectile dysfunction, are also a reliable predictor of potential heart problems.

Doctors say the same circulatory problems that affect sexual function can also raise risk for heart attack and other cardiovascular issues. It’s essentially like a “penile stress test,” suggests Dr. Ralph Brindis, a clinical professor of medicine at the University of California, San Francisco, and past president of the American College of Cardiology.

“By having erectile dysfunction, that implies that there’s blood supply problems to the male organ, or endothelial dysfunction,” Brindis says. “And there is a relationship between erectile dysfunction and the possibility of underlying coronary artery disease.”

That’s another reason, experts emphasize, that men should tell their doctors about any concerns related to sexual dysfunction.

Swelling of the legs and other symptoms of heart failure

Coronary artery disease is the most common cause of heart failure, also called congestive heart failure. This is a chronic, progressive disease in which the heart can’t pump as much blood as the body needs. About 6.5 million Americans have heart failure, which contributed to about 1 in 8 deaths in 2017, according to the latest Centers for Disease Control and Prevention data.

In addition to having heart disease, risk factors for heart failure include having had a previous heart attack, narrowing or leakages of valves of the heart and high blood pressure for many years, Brindis says.

Symptoms of heart failure include:

Shortness of breath
Fluid retention and swelling in your ankles, legs and feet
Rapid or irregular heartbeat
Dizziness or faintness
Ongoing cough or wheeziness

Lifestyle changes, medications and in some cases surgery or medical devices — like an implantable cardioverter defibrillator to keep the heart in rhythm — are recommended to treat heart failure.

Heart palpitations: a symptom of arrhythmia?

A heart arrhythmia is essentially an electrical problem that causes an irregular heartbeat. Atrial fibrillation — a common, deadly form of arrhythmia — can cause stroke, heart attack and sudden cardiac arrest, in which the heart suddenly stops beating.

Although an arrhythmia may not cause obvious symptoms, some that may occur include:

Palpitations — a fluttering or feeling that your heart is skipping beats
Fast heartbeat called tachycardia
Slow heartbeat — bradycardia
Fainting, or syncope, or lightheadedness
Shortness of breath
Chest pain

Yancy says wearable technologies like Apple Watch and Fitbit have made patients more aware of irregular heartbeat, even in the absence of symptoms.

To make a proper diagnosis, a medical monitor may be used to monitor the electrical activity of the heart. This can help determine if a more serious problem, like Afib, is to blame, so treatment, like medication to control heart rate, can be provided.

Heart murmur: a sign of heart valve disease?

When the heart’s four valves are working as they should, they open and close to let blood in and out. But when a person has a heart valve disease, blood may flow in the wrong direction or seep back into a valve. Or a valve may become narrowed, restricting blood flow — as with aortic valve stenosis. A common, deadly form of heart valve disease, this type of stenosis can lead to complications, including heart failure, stroke and blood clots.

With advanced disease, a person may experience more obvious symptoms, like chest pain. But especially in the early stages, the only sign of a heart valve disease may be a heart murmur that a doctor hears through a stethoscope — like a swishing sound between heartbeats. To determine if this is innocuous or a sign of something serious, further evaluation and testing, like echocardiography to evaluate how your heart valves are functioning, may be needed to make a diagnosis.

Shortness of breath and other heart attack symptoms

The classic sign that someone is having a heart attack is, of course, chest pain. Still, how that’s felt can be nuanced. “Most people describe it as a chest discomfort, where it’s intense squeezing usually in the mid-part of the chest,” Brindis says. “But it can certainly radiate to the jaw, to the neck and also classically down the left arm.” In addition, it’s not a given that a person having a heart attack will have chest pain; many don’t.

So it’s important to keep in mind other symptoms of heart attack — which is due to a loss of blood supply to the blood-pumping muscle. Those include:

Shortness of breath
Feeling lightheaded or dizzy
Unusual exhaustion or tiredness
Nausea and vomiting
Breaking out in a cold sweat

Call 911 immediately if you think you or a loved one may be having a heart attack.

Pain in the jaw and other heart attack signs in women.

While chest pain is the most common heart attack symptom for men and women, women more often experience less obvious signs like shortness of breath, pain in the jaw or back, or nausea. Women are also more likely than men to delay seeking care for possible heart attack symptoms, Brindis says. That could be due to anything from not wanting to bother others to experiencing less obvious symptoms, he notes.

Experts emphasize that women and men shouldn’t ignore vague or unclear symptoms. Partners should speak up if it’s not clear what’s going on. Call for emergency medical services — since a person can be treated in an ambulance on the way to the hospital. Driving yourself or a loved one there isn’t advised, as that can delay care.

Possible signs of heart disease