Heart attack. Even the words sound ominous—cue the replay of The Godfather’s Vito Corleone dropping dead in his tomato garden. But heart disease? That doesn’t have the same dramatic ring—or gripping Hollywood movie plot—which might be why you have a much vaguer idea of what it looks like, or what symptoms to look out for.
In truth, heart attacks are one type of heart disease, but there are many others that are slow and insidious and bear no resemblance to the chest-clutching images on Netflix family dramas. And as they say, knowledge is power: So the more you know, the better.
Glamorous or not, though, heart disease is the No. 1 killer in the U.S, responsible for more deaths each year than all types of cancer combined. It’s worth knowing the warning signs and symptoms of an unhealthy heart, because early intervention can greatly improve your odds of beating it. “The most common red flag for heart disease is chest discomfort, often described as a feeling of pressure or fullness,” says American Heart Association President Mitchell S. V. Elkind, M.D., a professor of neurology and epidemiology at Columbia University’s Vagelos College of Physicians and Surgeons in New York City. “Pain can also occur in one or both arms, the jaw, the back or even the stomach. Shortness of breath is another warning sign, as is breaking out in a cold sweat, nausea, lightheadedness or fatigue.” Let’s take a closer look the top warning signs of an unhealthy heart.
What’s Your (Heart) Problem?
If you are an adult in America right now, you have a one in two chance of developing heart disease, according to a 2019 report in Circulation. Heart disease can make other conditions, like COVID-19, even worse. What your symptoms look like, though, can vary widely depending on which type of heart disease you have. “When we typically talk about heart disease, we’re referring to atherosclerosis, or plaque buildup in arteries that causes strokes or heart attacks,” says Luke Laffin, MD, a preventive cardiologist at the Cleveland Clinic. But there are other forms of heart disease, and while all are indications that your heart isn’t functioning properly, they are not the same. These are seven of the most common unhealthy heart problems:
Atrial Fibrillation: Often referred to as Afib, atrial fibrillation happens when the heart’s four chambers fire out of sequence, creating an erratic rhythm of heartbeats that limit or disrupt the heart’s ability to effectively pump blood.
Coronary Artery Disease: A type of atherosclerosis, CAD is the most common type of heart problem, caused by plaque buildup in the walls of the coronary artery, which supplies blood to your heart. As a consequence, the arteries narrow, partially or totally blocking blood flow to your heart.
Congestive Heart Failure: This condition, frequently caused by CAD, high blood pressure or diabetes, means your heart is not able to effectively pump enough blood to meet your body’s needs.
Heart Attack: Here’s the big one everyone knows about. Heart attacks affect 800,000 Americans every year. They are typically caused by plaque in a blood vessel that ruptures, leading to a blood clot that cuts off the blood supply to your heart. Despite what you see on TV, 20 percent of heart attacks have no symptoms at all.
Heart Valve Disease: Your heart has four valves, covered by flaps of tissue that open and close with every heartbeat, ensuring blood flows in the proper direction. In heart valve disease, infection, aging, birth defects and other reasons can lead to these valves malfunctioning.
Hypertension: Also known as high blood pressure, hypertension means that the pressure of your blood on the walls of your arteries is consistently too high, making it harder for blood to easily pass through and reach your heart. It is caused by plaque buildup, which narrows and stiffens your arteries.
Stroke: This form of heart disease is the leading cause of disability in the U.S., according to the American Stroke Association. It occurs when a blood vessel carrying oxygen from your heart to your brain develops a clot or ruptures, cutting off oxygen to your brain and killing brain cells.
High Blood Pressure: The Common Denominator
Regardless of the type of heart disease you have, one factor remains constant: High blood pressure is the No. 1 cause of strokes and a primary factor for all types of heart disease. “The heart pumps blood throughout the body, so when the pressure is high it means that the heart has to work that much harder to pump,” explains Dr. Elkind. “It is like pumping against a closed hose—eventually, the pump breaks down.” High blood pressure puts strain on both your heart and the blood vessels, he says. Left unchecked, it can lead to heart failure, heart rhythm problems and weakening of the blood vessels.
“High blood pressure, or hypertension, is called the ‘silent killer’ since people often don’t know they have it until something catastrophic, like a heart attack, occurs,” says Dr. Elkind. “Fortunately, there are lots of ways to lower blood pressure.” Start by getting yours checked regularly. Your blood pressure is measured by two numbers: Systolic (which should be under 130 and ideally under 120) and diastolic (which should read less than 80). You can have yours checked at the doctor’s office, or purchase an at-home kit to test it.
If either number is high, focus on eating better (cut the salt and sugar)—maintaining a healthy weight is one of the easiest ways to reduce blood pressure. There are some easy ways to lighten up your favorite baking recipes and Super Bowl snacks. The other piece to the puzzle: exercising more. The American Heart Association recommends 150 minutes of moderate-intensity exercise weekly, which breaks down to 30 minutes a day, five days a week. For those who still can’t get their blood pressure numbers in the healthy zone with lifestyle modifications, medications may need to be added.
What Does an Irregular Heartbeat Mean?
If your heart is beating too fast, too slow or unevenly, it’s possible you have an arrhythmia—the medical term for an irregular heartbeat. Many things can cause irregular heartbeats, from too much caffeine to not enough fluids to pregnancy and stress. Just because you have an irregular heartbeat does not mean your heart is in seriously bad shape—plenty of people have arrhythmias and live full, active lives.
But if your irregular heartbeat is accompanied by shortness of breath, weakness, feeling like your heart is racing or chest pain, it’s time to see your doctor. “The most common abnormal heart rhythm is atrial fibrillation, caused by chaotic electrical activity in upper chambers of the heart,” says Dr. Laffin. “What’s happening is that the upper chambers of the heart are not doing a concerted squeeze together to pump blood—they are fibrillating. Therefore, blood can pool in upper chambers and form a clot, which then moves downstream and can cause a stroke.”
Is Coughing Ever a Sign of Heart Disease?
Maybe you cough to clear your throat before speaking, or when you step out of your warm home into the cold, winter air. Maybe you cough because you caught a cold, or food went down the wrong tube. But chronic coughing, especially a cough that doesn’t clear if you’re being treated for asthma or COPD, is an uncommon but serious warning sign of heart failure, according to the Cleveland Clinic.
Here’s what happens: When your heart is weakened, it contracts less forcefully and struggles to pump blood from the pulmonary veins that connect your lungs to your heart. As a result, fluid backs up and leaks into your lungs, causing congestion (which is why you may have heard of this referred to as “congestive heart failure”). Your body’s natural reaction to congestion in the lungs is to cough and clear it. But since the heart’s pumping power is chronically weak, fluid is constantly present, and the cough continues.
How Arm Numbness Can Signal Heart Trouble
We’re not talking about the kind of numbness you feel when you’ve slept on your side wrong. Arm numbness that occurs suddenly may be caused by a stroke—symptoms of which are often referred to by the acronym FAST, which stands for facial drooping, arm weakness or numbness, speech difficulty, and time to call 911. During a stroke, the blood supply from your heart to your brain is cut off, along with many other pathways like those to your arms and legs, leading to a numb or weak sensation.
Numbness in your limbs (arms and legs, but more commonly legs) can be a sign of a slower-moving form of heart disease as well. Known as peripheral artery disease, this condition is caused by plaque building up in the vessels that lead to your extremities. As the pathway for blood narrows, your arms and legs receive less oxygen, and can slowly lose sensation.
Heart Attacks: A Real Pain in the Neck
Forget about clasping your chest when a heart attack strikes. It’s just as likely to send pain searing through your jaw, shoulder and back for good measure. “Heart pain can be ‘referred’ to other parts of the body, because the nerves that provide sensation from those areas intermingle when they reach the nervous system,” says Dr. Elkind. “So it can be hard to know exactly where the pain originates.” Because everybody is different when it comes to where they experience pain during a heart attack, it is wise to take any new pain seriously and talk with your doctor, he adds. These are some places you might feel pain:
Jaw: Women in particular may experience pain in the lower left portion of their jaw before a heart attack, according to the Cleveland Clinic. Although the pain is coming from your heart, the network of nerves in the area ensures that as the pain radiates outward, it travels to nearby places like your jaw, neck and back, where you may mistakenly believe the pain originates.
Shoulder: During a heart attack, pain may radiate from your chest up to your shoulders. In addition, a study in the Journal of Occupational and Environmental Medicine found that people with shoulder joint pain had 4.8 times the risk of any type of heart disease than those without shoulder pain. While researchers are still exploring possible reasons, one explanation may be a weaker heart results in poor blood flow to the area, limiting the body’s ability to heal itself after injury.
Back: The heart attack is in the front, but the pain is in your back? Actually, yes. It’s referred pain—the nerves that connect your heart and your brain cross paths with the ones that connect your back and your brain, and when the pain signal is strong, messages can get mixed up.
Related: How to Keep Your Heart Healthy
The Deal With Snoring
Ever wonder why you snore at night? The awkward sound is the noise of air passing over relaxed throat tissues that vibrate as you breathe. It can be harmless (if annoying to your partner), but experts now know that people who snore are at higher risk for a condition called obstructive sleep apnea (OSA). OSA occurs when the upper airway in your throat becomes constricted during sleep, briefly blocking oxygen flow. This, in turn, triggers your brain to release a cascade of stress hormones, like adrenaline and cortisol, which elevate your blood pressure and can lead to arrhythmia, or an irregular heartbeat.
A lot of times, OSA is spotted first by a caregiver or partner (it’s hard to tell if you snore when you’re already asleep). It’s worth talking with your doctor about the possibility of OSA, especially if you are overweight (a risk factor for OSA). Together you can tackle the problem and make sure it’s not leading to an unhealthy heart.
Heartburn: Not Actually a Heart Problem
Excessive burping, gas, indigestion and an overall burning sensation in your chest: That’s not much fun, and unless you just took down two fruitcakes and a quart of eggnog, you might be baffled by where it came from. As the pain in your chest grows, it’s logical to start to worry about a heart attack.
If the pain dissipates after you burp or pass gas, you can relax: In all likelihood, you have heartburn—which has nothing to do with your heart at all. Rather, heartburn is a sensation you feel in your chest but actually resides in your esophagus, the tube that connects the back of your mouth to your stomach. In heartburn, your stomach acids back up into the throat, irritating your esophageal lining. “There is an overlap in the sensations people feel with heartburn and heart attack and they can be mistaken for one another,” says Dr. Laffin. “Keep in mind that if the pain gets worse when you eat, it’s likely heartburn, while pain that worsens with exertion is more likely to be related to a heart attack.”
Still, because heartburn and heart attack symptoms can feel similar, it’s important to talk with your doctor, especially if you’re not getting any relief from OTC antacids for heartburn.
Is Nausea a Sign of a Heart Attack?
There are dozens of reasons why you might be feeling queasy or sick to your stomach, last night’s sushi dinner notwithstanding. But combined with other possible symptoms of an unhealthy heart—like shortness of breath or palpitations—you should take note if you suddenly start to feel nauseous. Sometimes, nausea or vomiting can be a sign of a heart attack. The symptom is 64 percent more likely to happen in women than men, according to a recent study in the Journal of the American Heart Association.
Although researchers are still figuring out the exact reasons for the correlation, the predominant theory has to do with your vagus nerve. This nerve runs from your brain to your gut, with branches that travel off to your lungs and your heart along the way. The vagus nerve is the major pathway by which the brain transmits information to your major organs, and your organs respond with signals to your brain. During a heart attack, the thinking is that these signals get crossed up, and your brain responds to the message from your heart that it is under duress by sending pain signals to your stomach, inducing nausea.
Dizziness and Stroke Connection
You stand up from your chair and feel so dizzy that you promptly sit back down. You don’t have chest pain—but you remember reading about lightheadedness being related to your heart. Could something be up? “The vast majority of dizziness has nothing to do with your heart,” assures Dr. Laffin. Still, “in people who have a stroke, depending on where the blockage is, if it affects the area of your brain that controls balance, then you might feel dizzy.”
If you are feeling dizzy and it lasts for more than a few minutes, or you have dizziness that keeps coming back for several days in a row, it’s good to check in with your doctor. In one study, researchers at the University of Michigan found that of 272 patients who saw their doctors for dizziness, about 11 percent were having a stroke.
Sweating It Out
Last but not least, if you are breaking out into what doctors call “cold sweats”—that is, you are perspiring even when it’s cold out and you are not physically exerting yourself—it’s possible (though rare) that you are having a heart attack. Think about it: Heart attacks are caused by clogged arteries. If your arteries are too jammed up to let blood flow, your heart goes into overdrive to try and get the blood it needs. Hence, you break a sweat.
While the symptom is more common in men than women, it can happen to anyone. On its own, breaking into a cold sweat does not mean you’re about to drop dead from a heart attack. But if you are also experiencing symptoms like dizziness and chronic coughing, or you have a numb sensation in your arm, it’s worth seeing your doctor to talk about what’s going on.
Heart disease is incredibly common. The biggest mistake you can make is waiting too long to get help—early treatment gives you a much better shot at getting back to your happy, healthy, active life. Your heart will thank you for it.
Mitchell S. V. Elkind, M.D., president American Heart Association, professor of neurology and epidemiology at Columbia University’s Vagelos College of Physicians and Surgeons in New York City
Luke Laffin, M.D., preventive cardiologist at the Cleveland Clinic in Ohio
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U.S. National Library of Medicine: “Heart Attack.”
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