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Signs & Symptoms of Heart Disease

by Rashmi Gulati, MD

In coronary artery disease (CAD), the main type of coronary heart disease, the arteries that supply the heart with blood become clogged with deposits of plaque, a fatty material consisting of cholesterol and lipids that can calcify with time, hardening the artery, and setting the stage for the development of blood clots. This process and the resulting condition are known as atherosclerosis.

Heart disease can be entirely asymptomatic or associated with a range of symptoms. Angina is one of the most common symptoms of coronary heart disease. Angina is described as tightness and discomfort, with a sense of heaviness or pressure that can be felt in the chest, or radiating to the shoulder, neck, arm, or back. It may feel like a squeezing sensation or fullness in the chest with pain. It can be mistaken for indigestion or heartburn. Shortness of breath, weakness, dizziness, lightheadedness, heart palpitations (rapid, skipped or irregular heart beats, also known as arrhythmias) are additional common symptoms of CHD.

If undiagnosed or left untreated, the constriction of the coronary arteries can greatly diminish blood flow, and blood clots drawn to the plaque surface can close off the affected coronary artery entirely, resulting in a heart attack. If not treated immediately, the affected heart muscle can suffer serious damage, or death.

The American Heart Association estimates that there are 785,000 new coronary attacks, and another 470,000 recurrent each year. The five major symptoms of heart attack are:

Discomfort or pain in the chest, jaw, neck, or back
Sudden weakness, light-headedness, or faintness
Discomfort or pain in the chest
Discomfort or pain in the shoulder, or radiating into the arm
Shortness of breath

Peripheral vascular disease (PVD) may have similar symptoms to coronary artery disease due to the similar nature of the condition, involving constricted or narrowed blood vessels: chest pain, shortness of breath, weakness or lightheadedness. This disease often affects the arteries supplying the legs and feet.

Heart failure (HF) is also known as congestive heart failure when the cardiac output is low, or chronic heart failure when it is a longstanding situation, and typically associated with stable, treated symptomatology. The term does not mean the heart has stopped, but that the heart is unable to pump sufficient blood to meet the needs of the body. Heart failure symptoms may be more wide-ranging.

When the muscles on the right side of the heart are weak, the heart struggles to pump blood to the lungs, where the exchange of carbon dioxide for oxygen takes place. Right-sided heart failure may cause fluid to build up in the feet, ankles, legs, liver, abdomen and, in rare cases, the veins of the neck. When the muscles on the left side of the heart fail to pump with sufficient strength, oxygen-rich blood is delivered inefficiently to the rest of the body.

Heart failure causes shortness of breath during regular activity, general weakness, and fatigue. Difficulty breathing when lying down is also a symptom, as are weight gain and swelling in the legs, ankles, and lower back. A cough generating white mucus can accompany congestive heart failure.

Diseases or conditions involving the heart valves show symptoms that range from unusual fatigue and shortness of breath when lying down to swelling of the ankles or feet due to build-up of fluids. Heart valve problems can cause heart failure or insufficient blood flow, which in turn creates symptoms that are seen in heart failure. A chief symptom of a heart valve problem is an unusual heartbeat sound, referred to as a heart murmur, although not all heart murmurs are indications of heart disease or valve problems. A paradox regarding heart valve disease symptoms is that a severe dysfunction may manifest no symptoms, or, severe symptoms can sometimes accompany a minor problem.

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