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Description

Heart disease often develops over time. You may have early signs or symptoms long before you have serious heart problems. Or, you may not realize you are developing heart disease. The warning signs of heart disease may not be obvious. Also, not every person has the same symptoms.

Certain symptoms, such as chest pain, ankle swelling, and shortness of breath may be signals that something is wrong. Learning the warning signs can help you get treatment and help prevent a heart attack or stroke.

Chest Pain

Chest pain is discomfort or pain that you feel along the front of your body, between (and including) your neck and upper abdomen. There are many causes of chest pain that have nothing to do with your heart.

But chest pain is still the most common symptom of poor blood flow to the heart or a heart attack. This type of chest pain is called angina.

Chest pain can occur when the heart is not getting enough blood or oxygen. The amount and type of pain can vary from person to person. The intensity of the pain does not always relate to how severe the heart problem is.

• Some people may feel a crushing pain, while others feel only mild discomfort.
• Your chest may feel heavy or like someone is squeezing your chest or heart. You may also feel a sharp, burning pain in your chest.
• You may feel the pain under your breastbone (sternum, so the pain is called substernal) or in your neck, arms, stomach, jaw, or upper back.
• Chest pain from angina often occurs with activity or emotion, and goes away with rest or a medicine called nitroglycerin.
• Bad indigestion can also cause chest pain.

Women, older adults, and people with diabetes may have little or no chest pain. Some people have symptoms other than chest pain, such as:

• Fatigue
• Shortness of breath
• General weakness
• Change in skin color or greyish pallor (episodes of change in skin color associated with weakness)

Other symptoms of a heart attack can include:

• Extreme anxiety
• Fainting or loss of consciousness
• Lightheadedness or dizziness
• Nausea or vomiting
• Palpitations (feeling like your heart is beating too fast, too strongly, or irregularly)
• Shortness of breath
• Sweating, which may be very heavy

Shortness of Breath

When the heart can't pump blood as well as it should, blood backs up in the veins that go from the lungs to the heart. Fluid leaks into the lungs and causes shortness of breath. This is a symptom of heart failure.

You may notice shortness of breath:

• During activity
• While you're resting
• When you're lying flat on your back -- it may even wake you from sleep

Coughing or Wheezing

Coughing or wheezing that doesn't go away can be another sign that fluid is building up in your lungs. You may also cough up mucus that is pink or bloody.

Swelling in the Legs, Ankles, or Feet

Swelling (edema) in your lower legs is another sign of a heart problem. When your heart doesn't work as well, blood flow slows and backs up in the veins in your legs. This causes fluid to build up in your tissues.

You may also have swelling in your stomach or notice some weight gain.

Poor Blood Supply to Extremities

Narrowing of the blood vessels that bring blood to other parts of the body is not the same as heart disease but it may mean you have a much higher risk for heart attack than you otherwise would. It can occur when cholesterol and other fatty material (plaque) build up on the walls of your arteries.

Poor blood supply to the legs may lead to:

• Pain, achiness, fatigue, burning, or discomfort in the muscles of your feet, calves, or thighs.
• Symptoms that often appear during walking or exercise, and go away after several minutes of rest.
• Numbness in your legs or feet when you are at rest. Your legs may also feel cool to the touch, and the skin may look pale.

A stroke occurs when blood flow to a part of the brain stops. A stroke is sometimes called a "brain attack." Symptoms of stroke can include difficulty moving the limbs on one side of your body, one side of the face drooping, loss of sensation on one side of your body, difficulty with speaking or understanding language.

Fatigue

Tiredness can have many causes. Sometimes it simply means that you need more rest. But feeling run down can be a sign of a more serious problem. Fatigue may be a sign of heart trouble when:

• You feel much more tired than normal. It's common for women to feel severely tired before or during a heart attack.
• You feel so tired that you can't do your normal daily activities.
• You have sudden, severe weakness.

Fast or Uneven Heartbeat (Palpitations)

If your heart can't pump blood as well, it may beat faster to try to keep up. You may feel your heart racing or throbbing. A fast or uneven heartbeat can also be the sign of an arrhythmia. This is a problem with your heart rate or rhythm.

When to Call the Doctor

If you have any signs of heart disease, call your health care provider right away. Don't wait to see if the symptoms go away or dismiss them as nothing.

Call 911 or the local emergency number if:

• You have chest pain or other symptoms of a heart attack
• You know you have angina and have chest pain that doesn't go away after 5 minutes of rest or after taking nitroglycerin
• You think you may be having a heart attack
• You become extremely short of breath
• You think you may have lost consciousness

References

Goff DC Jr, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S49-S73. PMID: 24222018 pubmed.ncbi.nlm.nih.gov/24222018/.

Gulati M, Bairey Merz CN. Cardiovascular disease in women. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 91.

Morrow DA, de Lemos J. Stable ischemic heart disease. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 40.

Writing Committee Members; Lawton JS, Tamis-Holland JE, Bangalore S, et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization. J Am Coll Cardiol. 2022,79 (2):e21–e129. PMID: 34895950 pubmed.ncbi.nlm.nih.gov/34895950/.

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