What are the Symptoms of Heart Disease
It is important to note that similar conditions may present differently between various persons, and conditions unrelated to the cardiovascular system may present in a manner which mimics heart disease. The chest pain associated with heartburn for example, which may also be felt in the chest, may be mistaken for that of a myocardial infarction. Infectious processes of the lung may also present with chest pain, but this will generally be pleuritic, or exacerbated by inspiration and relieved by expiration, unlike the pain of coronary heart disease which is unrelated to inspiration but may be exacerbated by exertion (stable angina,) with minimal exertion or at rest (unstable angina,) or lasting for a prolonged duration of more than 30 minutes (Myocardial Infarction, or a heart attack.) To understand how pain is characterized and how it may differ in various conditions, visit the Understanding Pain article. The most common symptoms of cardiovascular disease are.
Chest pain usually occurs in conditions in which the heart’s supply of oxygen is insufficient to satisfy it’s requirements. This results in ischemia of the tissues, or reduced delivery of oxygen, resulting in pain. This is typically known as coronary heart disease (CHD) or coronary artery disease (CAD.) Chest pain from cornoary heart disease is typically retorsternal (felt behind the sternum,) heavy or pressure-like in character, sometimes being described as if someone were sitting on your chest. Such pain may be brought about by exertion, such as with exercise or other strenuous activity, with minimal activity, or may even occur at rest. The pain may radiate to the neck and jaw or shoulder area, and is frequently associated with sweating (diaphoresis,) nausea, and in the case of a myocardial infarction or heart attach, may be associated with a feeling of impending death.
Shortness of Breath
Shortness of breath may be due to the inability of the heart to pump enough blood to maintain the body’s requirements. In heart failure for example, the heart may be simple unable to pump adequately due to a variety of conditions. If the left side of the heart is weak, it may not be able to eject blood it receives from the lungs in a timely fashion whereas the right side of the heart may be functioning normally and delivering blood to the lungs. This may result in the accumulation of fluid in the lungs, a condition knows as pulmonary edema, which may also present with shortness of breath, and can cause the other symptoms of heart failure such as orthopnea or paroxysmal nocturnal dyspnea.
Orthopnea/Paroxysmal Nocturnal Dyspnea
As mentioned above, the failure of the heart to pump enough blood to the body in left sided heart failure results in its accumulation in the lungs or pulmonary edema. The effects of this may be minimum while standing up due to the effect of gravity on the fluid buildup, but upon lying flat, such as when attempting to sleep at night, the effect of gravity is nullified. In addition, there is a redistribution of blood from the extremities as it is returned to the right side of the heart and then to the lungs. This postural increase in the amount and distribution of fluid in the lungs may then result in breathlessness as you lay flat. Patients often report being unable to sleep unless they prop the head up with a certain number of pillows. Paroxysmal Nocturnal Dyspnea is caused by mechanisms similar to orthopnea. This symptom presents as a sudden awakening at night (hence the name,) with a feeling of breathlessness. Patients often report awakening in the middle of the night gasping for air or rushing toward the window for a “breather.”
Although cough is usually caused by etiologies or causes related to the respiratory system, it may also be caused by cardiovascular disease. Taking the example of pulmonary edema mentioned above, patients with fluid buildup in the lungs may experience a cough which is often described as pink and frothy. In mitral stenosis, a valvular heart disease due to narrowing of the opening between the two left-sided chambers of the heart, patients may also experience heavy coughing, sometimes with blood-tinged sputum.
Normally, your heart beats without you paying much attention to it, or recognizing it at all for that matter. Heart beats which are noticeably pounding, irregular, or strong are known as palpitations. Although palpitations may be associated with irregular heart rhythms (arrhythmia,) and may be associated with heart disease particularly when accompanied by the other symptoms mentioned, they may also be triggered by various non-cardiac causes, including:
- Stress or anxiety
- Strenuous exercise
- Pseudoephedrine, a stimulant often found in cold medicines
- Hormonal changes
Lower Limb Swelling
Your heart receives blood from the remainder of the body via its right side, and then pumps blood back to your bodily tissues, after it has been oxygenated in the lungs, via its left side. If the right side of the heart is weak, such as in congestive heart failure, it’s ability to adequately pump blood forward is impaired. This results in the accumulation of blood in the venous system and a peripheral edema or tissue swelling which becomes most apparent in the dependent areas of the body due to the effects of gravity. Patients may then present with swelling of their feet and lower extremities. Such swelling is typically pitting which means it indents with pressure and then recurs due to the fluid nature of the swelling.
Heart disease is a major cause of morbidity and mortality, and learning to recognize the symptoms of cardiovascular disease may aid in prompt diagnosis and management. If you suspect you may be experiencing symptoms of heart disease, call 911 immediately and have yourself assessed by a health professional.
 Lloyd-Jones D, Adams RJ, Brown TM, et al. Executive summary: heart disease and stroke statistics–2010 update: a report from the American Heart Association. Circulation 2010; 121:948
 GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 385:117.