Heart disease is the leading cause of death for both men and women, and its symptoms vary widely depending on which part of the heart is affected. Some people feel crushing chest pain. Others notice only unusual fatigue or shortness of breath during activities that used to feel easy. About 1 in 20 adults age 20 and older have coronary artery disease alone, and many don’t recognize the warning signs until significant damage has already occurred.
Coronary Artery Disease Symptoms
Coronary artery disease, the most common form of heart disease, develops when the arteries supplying blood to your heart become narrowed or blocked. The hallmark symptom is chest pain or tightness, called angina. It often feels like pressure or squeezing, as if someone is standing on your chest. This pain typically shows up during physical activity or emotional stress and eases with rest.
As the disease progresses, you may notice shortness of breath or extreme fatigue during activities you previously handled without trouble. These symptoms reflect your heart’s inability to pump enough blood to keep up with your body’s demands. A complete blockage can cause a heart attack, which is a medical emergency with its own distinct set of symptoms.
Heart Attack Warning Signs
A heart attack requires immediate emergency care. The major symptoms include:
- Chest discomfort: Pain, pressure, squeezing, or fullness in the center or left side of the chest that lasts more than a few minutes, or goes away and comes back
- Radiating pain: Discomfort in one or both arms, shoulders, jaw, neck, or back
- Shortness of breath: This can appear with or before chest discomfort
- Cold sweat, lightheadedness, or feeling faint
- Unusual or unexplained tiredness, nausea, or vomiting
Not every heart attack announces itself with dramatic chest pain. Some heart attacks are “silent,” producing symptoms so mild that people dismiss them as indigestion or muscle soreness. Silent heart attacks are often discovered weeks or months later during routine testing, when an EKG or imaging scan reveals damage to the heart muscle. Signs that a provider might pick up on include a fast or uneven pulse and unusual sounds in the lungs.
How Symptoms Differ in Women
Women are much more likely to experience atypical heart attack symptoms. While chest pain still occurs, women more frequently report indigestion, shortness of breath, back pain, nausea, abdominal discomfort, and persistent fatigue, sometimes without any obvious chest pain at all. These less recognizable symptoms mean women are more likely to delay seeking help, which can lead to worse outcomes. Any combination of unusual breathlessness, persistent nausea, or unexplained fatigue warrants attention, especially if the symptoms are new or don’t have an obvious explanation.
Heart Failure Symptoms
Heart failure doesn’t mean the heart has stopped. It means the heart can no longer pump blood efficiently enough to meet the body’s needs. When this happens, fluid backs up into the lungs and other tissues, producing a recognizable pattern of symptoms.
Shortness of breath is one of the earliest signs, particularly during physical activity or when lying flat. Many people with heart failure need to prop themselves up on pillows to sleep comfortably. Swelling in the legs, ankles, and feet is common as fluid pools in the lower body. The belly area can also swell as fluid accumulates in the abdomen. Rapid, unexplained weight gain over a few days, sometimes several pounds, is a telltale sign of fluid buildup rather than actual body mass increase.
Arrhythmia Symptoms
An arrhythmia is an irregular heartbeat. It can feel like a fluttering, pounding, or racing sensation in your chest. Some arrhythmias speed the heart up noticeably, while others slow it down. You might also experience:
- Chest pain
- Shortness of breath
- Lightheadedness or dizziness
- Sweating
- Fainting or nearly fainting
- Anxiety or a sense that something is wrong
- Unusual fatigue
Some arrhythmias are harmless and brief. Others, particularly those that cause fainting or sustained dizziness, can signal a serious problem. Arrhythmias are also a common complication for adults who had heart surgery as children to repair congenital defects. Scar tissue from earlier procedures can disrupt the heart’s electrical signaling years or decades later.
Heart Valve Disease Symptoms
Your heart has four valves that open and close to keep blood flowing in the right direction. When a valve narrows, stiffens, or leaks, the heart has to work harder to push blood through. Fatigue is often the first symptom people notice, sometimes long before anything else appears. As the condition progresses, shortness of breath during physical activity becomes more pronounced, along with palpitations (a flip-flop or skipping sensation in the chest), dizziness, and swelling in the ankles, feet, or abdomen.
A heart murmur, an unusual sound a provider hears through a stethoscope, is a classic sign. The sound comes from blood moving through a narrowed or leaky valve. Many people with mild valve disease live without symptoms for years, but worsening exercise intolerance or new swelling suggests the valve problem is progressing.
Congenital Heart Disease in Adults
Some people are born with structural heart defects that were repaired in childhood or went undetected. These conditions can cause new symptoms in adulthood as the heart ages or as surgical repairs wear down over time. The most common signs include tiring quickly during activity, swelling from fluid retention, and irregular heartbeats. Unexplained chest pain or sudden shortness of breath in someone with a history of congenital heart problems warrants prompt evaluation.
How Heart Disease Is Diagnosed
Because so many forms of heart disease share overlapping symptoms, diagnosis usually involves a combination of tests. An electrocardiogram (EKG) records the heart’s electrical activity and can reveal abnormal rhythms or signs of a current or past heart attack. The test is quick and painless. If symptoms come and go, a Holter monitor, a small portable device worn for a day or more, can capture irregular rhythms that a single EKG might miss.
An echocardiogram uses sound waves to create moving images of the heart, showing how well the chambers pump and whether the valves are opening and closing properly. Stress tests, usually done on a treadmill or stationary bike, measure how the heart responds to physical exertion and can reveal symptoms or blood flow problems that only appear during exercise. For people who can’t exercise, medication can simulate the effect.
Blood tests play a supporting role. After a heart attack, damaged heart cells release specific proteins into the bloodstream that can be measured. Other blood markers for inflammation, cholesterol, and blood sugar help assess overall cardiovascular risk. When more detail is needed, cardiac catheterization can directly visualize blockages in the heart’s arteries, and cardiac MRI can produce detailed images of the heart’s structure and function. A chest X-ray can reveal whether the heart is enlarged, which is a sign of several types of heart disease.