Recognising Early Signs and Symptoms of Heart Disease

Heart disease is a significant concern worldwide. It claims thousands of lives each year. In England and Wales, ischaemic heart disease (IHD) accounts for around 10% of all registered deaths. This makes it the second leading cause of mortality. 

Despite these alarming statistics, there is a glimmer of hope as the number of deaths attributed to IHD has shown a gradual decline over the years, with a notable decrease of 48.1% from 2001 to 2019. This encouraging trend shows how important early detection and intervention are in mitigating the impact of cardiovascular issues.

In this article, we aim to guide you through the early signs and symptoms of heart disease to ensure that people seek help early and have better outcomes.

Understanding Heart Disease

Heart disease encompasses a spectrum of conditions that affect the structure and function of the heart. They pose significant health risks if left untreated. Among the most prevalent are coronary artery disease, heart failure, arrhythmias and congenital heart defects. Each of these conditions presents unique symptoms, yet they share a common thread in their potential to compromise cardiovascular health.

Coronary artery disease (CAD)

Coronary artery disease (CAD) is arguably the main issue when talking about heart disease. It occurs when the arteries supplying blood to the heart muscle become narrowed or blocked. This happens due to the build-up of plaque—a combination of cholesterol, fat and other substances. The restriction in blood flow can lead to chest pain (angina), heart attacks and even sudden cardiac death if not addressed promptly.

Heart failure

Another prevalent cardiovascular condition is heart failure. This means the heart is unable to pump blood efficiently to meet the body’s needs. There are many reasons why this occurs. It can be due to a weakened heart muscle (from a heart attack or from coronary artery disease), a disease that affects the muscle or heart valves, or high blood pressure.

Arrhythmias

This refers to irregular heart rhythms. These can manifest as an erratic heartbeat, a heartbeat that is too fast (tachycardia) or a heartbeat that is too slow (bradycardia). Some arrhythmias are harmless but others can be life-threatening. They can cause complications like sudden cardiac arrest or stroke.

Abnormalities in heart rhythms can be caused by a number of factors, including:

• Electrolyte imbalances
• Systemic disorders
• Thyroid problems
• Diabetes that is uncontrolled
• Stress
• Overuse of caffeine
• Certain medications

Congenital heart defects

Congenital heart defects are structural abnormalities present at birth, affecting the heart’s valves, walls or blood vessels. These defects can vary widely in severity, ranging from minor anomalies that may go unnoticed to complex malformations requiring immediate medical attention. Early detection and intervention are crucial in managing congenital heart defects. This helps to prevent complications and ensure optimal outcomes.

An earlier diagnosis means appropriate treatment can be started sooner. This might include:

• Lifestyle modifications
• Medication
• Surgery
• Cardiac rehabilitation

When treatment is started sooner, it may mitigate the progression of the disease and improve long-term prognosis and quality of life.

Risk Factors

Heart disease is influenced by a range of risk factors. These may be modifiable; in other words, risk factors that can be changed or influenced by actions or interventions. Other risk factors are non-modifiable. This means they can’t be changed or controlled. 

Modifiable risk factors

• Smoking: Tobacco use increases the risk of heart disease. Quitting smoking (or never starting) can greatly reduce the risk. Second-hand smoke is also a modifiable risk factor. The chemicals in tobacco smoke damage the heart and blood vessels. This increases the risk of atherosclerosis (the build-up of plaque inside the arteries), heart attacks and sudden cardiac death.
• Diet: Consuming certain substances in excess (unhealthy fats, sugars and processed foods) contributes to heart disease. Having a balanced diet that is rich in fruits, vegetables, whole grains and lean proteins lowers this risk.
• Obesity: Linked to diet as a modifiable risk factor is weight. Being overweight or obese raises the risk of heart disease significantly. Maintaining a healthy weight through a proper diet is crucial.
• Physical activity: A lack of physical activity and a sedentary lifestyle can contribute to other risk factors like hypertension and obesity. Regular exercise can improve heart health and reduce this risk.
• High blood pressure: Hypertension is a major risk factor. Lifestyle modifications like reducing salt intake and managing stress can help reduce this. Prolonged elevation in blood pressure can damage the arteries, which increases the risk of heart failure, coronary artery disease and stroke.
• High cholesterol: Elevated cholesterol levels in the blood increase the risk of heart disease. This is particularly true for low-density lipoprotein (LDL) cholesterol, which contributes to the build-up of plaque in the arteries. This narrows their diameter and impedes the flow of blood to the heart.
• Diabetes mellitus: Both type 1 and type 2 diabetes pose a significant risk for heart disease. This is because individuals with diabetes are more prone to developing cardiovascular complications due to things like insulin resistance, inflammation and abnormal lipid metabolism. Type 2 diabetes is considered a modifiable risk as it can be improved by lifestyle modifications in some cases.

Non-modifiable risk factors

These are risk factors that are aspects of a person’s biology or personal history that cannot be changed or controlled. They cannot be altered through lifestyle changes or interventions.

• Age: The risk of many diseases, including those of the heart, tends to increase with age.
• Genetics and family history: A family history of certain diseases can increase a person’s risk of developing those conditions. Genetic predispositions contribute to the risk of heart disease.
• Gender: Biological differences between men and women can influence disease risk. Men, for example, generally have a higher risk of developing heart disease at a younger age. Women, however, may have a higher risk after they’ve gone through the menopause.
• Ethnicity: Some ethnic groups may have a higher predisposition to heart disease than others. For instance, African Americans have a higher risk of diabetes and hypertension compared to other groups.
• Previous medical history: A history of heart attack or stroke may increase the risk of similar events.
• Birth factors: Factors related to prenatal and perinatal conditions like low birth weight, premature birth or exposure to substances in utero can influence long-term health outcomes.
• Medical conditions: Some medical conditions, like Down syndrome or Marfan syndrome, are associated with an increased risk of specific health conditions, including heart disease.

Routine health screenings and keeping on top of existing medical conditions is important in enabling early detection of disease to facilitate timely interventions.

Early Signs and Symptoms

Recognising the first, subtle signs and symptoms of heart disease is crucial as it means treatment and prevention can begin sooner. 

While some symptoms may be obvious and easily identifiable, others are more insidious. They may present as vague discomforts that could easily be overlooked or attributed to something else. We can detect heart disease earlier by understanding the various symptoms in different individuals. 

Chest discomfort or pain

This is commonly described as pressure, squeezing or fullness in the chest area. It is the main described symptom of heart disease. The discomfort can radiate to the arms, shoulders, neck, jaw and back. The discomfort can be made worse by emotional stress or physical exertion—and it can also appear different in females. 

Not all cases of heart disease will show chest symptoms. There may be no chest pain at all.

Shortness of breath

Otherwise known as dyspnoea, shortness of breath is also a common symptom of heart disease. It often manifests as difficulty breathing or ‘air hunger’. This may be worse during exercise or while lying down. This could be because of fluid build-up or lower cardiac output when lying down.

Fatigue

Persistent tiredness or weakness is another symptom of underlying heart problems. This is because the heart struggles to pump blood around the body and isn’t enough to meet the body’s needs.

Dizziness

Feeling dizzy, light-headed or experiencing fainting can occur due to inadequate blood flow to the brain. This can stem from heart conditions including arrhythmias or heart valve disorders.

Nausea

Often, but not always, accompanied by vomiting, nausea can also be a warning sign for heart disease. This is especially so if it coincides with other symptoms like shortness of breath or chest discomfort.

Irregular heartbeat

An irregular heartbeat, palpitations or the feeling of a fluttering heart can be a sign of arrhythmias or another cardiac abnormality.

Swelling

Swelling in the legs, ankles, feet or abdomen, otherwise known as oedema, is a common symptom of heart failure due to fluid retention. Sudden weight gain, which is not related to dietary changes, can also indicate a build-up of fluid.

Gender and Age Disparities

The symptoms of heart disease often manifest differently based on age and gender. This presents unique challenges. Women, for example, often experience atypical symptoms. And, as many of the advertised symptoms are those of men, it can lead to a delayed diagnosis. Older adults also show different warning signs compared to younger people. This further complicates getting a diagnosis. When these disparities are recognised and understood, it means everyone, regardless of age and sex, can get an earlier diagnosis.

Symptoms common in women

For many women, the symptoms of heart disease are subtler. They’re also not like those experienced by men. Although both men and women do get chest pain, women are more likely to experience shortness of breath, nausea, vomiting, back or jaw pain and extreme fatigue. 

These symptoms are often dismissed or attributed to another cause, which means delays in diagnosis and an increased risk of adverse outcomes. As a result, women may be underdiagnosed and undertreated.

Symptoms at different ages

In older adults (those aged above 65), there are often different symptoms or warning signs. Chest pain is still prevalent but older individuals also experience confusion, weakness, delirium and fainting. As these symptoms are non-specific, they are often mistaken for age-related changes or other medical conditions. This can also lead to a delay in diagnosis and treatment.

Combatting disparities

Despite the disparities, it’s important to be vigilant and proactive in monitoring heart health. Early detection of heart disease involves recognising subtle changes. Routine health screenings like blood pressure measurements, cholesterol tests and cardiac evaluations are important in assessing overall heart health and identifying risk factors. 

There is also an important need to educate the general public about the disparities—and unfortunately, many healthcare providers too.

Seeking Medical Help

Knowing when to seek medical attention is important. A timely diagnosis allows for more effective management and treatment of a heart condition. It can be easy to dismiss symptoms, especially if they’re transient; some indicate a serious underlying condition that requires immediate intervention. 

Anyone experiencing any of the following symptoms should consult a healthcare professional:

• Chest pain or discomfort: Any chest pain (tightness, pressure, discomfort) shouldn’t be ignored. Even if pain is intermittent or mild, it could be serious This is especially true for pain that radiates to the arms, shoulders or other parts of the upper body.
• Being short of breath: Difficulty breathing, especially when at rest or during exertion, can indicate heart failure. It’s also a sign of pulmonary embolism.
• Palpitations or irregular heartbeat: Sensations of fluttering or otherwise abnormal heartbeats, require investigation. If this is accompanied by light-headedness, dizziness or fainting, you should seek immediate medical attention.
• Unexplainable fatigue: Where there is persistent or extreme fatigue, including weakness or exhaustion, it needs to be investigated. This is especially true if it is interfering with daily activities. Though this is not always a sign of heart disease, it could be a sign of another underlying health condition.
• Oedema: Swelling in the legs or the abdomen, like fluid retention, is a symptom of heart failure or another circulatory problem. This needs to be evaluated by a healthcare professional.
• Sudden weight gain: Unexplained weight gain, especially if it is significant or rapid, could indicate fluid build-up. This needs prompt investigation.
• Nausea, vomiting or abdominal discomfort: Though there are many causes for these problems, if they are accompanied by another symptom, including sweating, they could be a sign of a cardiac event.

If there are known risk factors like high blood pressure, high cholesterol, diabetes, obesity, or a family history of heart disease, it is important to get regular health screenings and address any of these symptoms quickly.

Preventive Measures

Maintaining heart health requires proactivity. This includes lifestyle modifications and preventive measures that aim to promote overall well-being and reduce risk factors. With healthy habits and informed choices, it is possible to lower the risk of developing heart disease. 

Regular exercise is important for heart health. It promotes cardiovascular fitness and strengthens the heart muscle. The general advice is to aim for at least 150 minutes of moderate-intensity exercise per week. Alternatively, 75 minutes of vigorous exercise. This should also be supplemented with muscle-strengthening activities twice or more per week. Activities like brisk walking, cycling, swimming or dancing can help improve heart health and overall fitness. 

A balanced diet is also crucial. This should include whole, nutrient-dense foods like fruits, vegetables, whole grains, lean proteins and healthy fats. Processed foods, sugary drinks and snacks, and high-sodium foods should be minimised. 

Combined, the above contribute to maintaining a healthy weight, which is essential for heart health. Excess body fat increases the risk of hypertension, diabetes and other cardiovascular problems. Your body mass index should be between 18.5 and 24.9 through a combination of healthy eating, physical activity and portion control.

Managing stress is important too. Chronic stress contributes to elevated blood pressure, inflammation and unhealthy coping behaviours (like alcohol). Stress-reducing techniques like mindfulness, yoga, deep breathing or other calming hobbies can promote relaxation and emotional wellness. 

Limiting alcohol consumption is also recommended. Excessive drinking raises blood pressure, contributes to weight gain and increases the risk of heart rhythm abnormalities. Alcohol, if consumed, should be in moderation. 

Another substance to avoid is tobacco. Smoking, including passive smoking, damages blood vessels and increases the risk of cardiac events and strokes. Smokers should seek support to quit by engaging in smoking cessation programmes like those available on the NHS.

Finally, anyone seeking to improve their heart health and minimise their risks should make sure they take any prescribed medication as recommended.