Key takeaways

Crushing chest pain is not the only indicator of a heart attack; symptoms can be subtle, such as shoulder aches, which may signal artery blockages.
Cardiovascular disease encompasses various heart conditions, including coronary artery disease, congestive heart failure, and arrhythmias, with risk factors like high blood pressure and smoking.
Uncommon signs of heart problems include extreme fatigue, digestive issues, and skin symptoms, indicating diverse heart conditions like coronary artery disease and congestive heart failure.
Immediate medical attention is crucial for heart attack symptoms, which can vary between men and women.

Everyone knows that crushing chest pain is often a sign of a heart attack. But there are some types of cardiovascular disease whose symptoms are far more subtle.

Take this patient who went to the doctor about shoulder aches and pain. Her doctor told her to lighten her load, and carry her purse on the other side. A few days later, the pain had not subsided. The woman went to see Martha Gulati, MD, division chief of cardiology at the University of Arizona College of Medicine in Phoenix. Sure enough, Dr. Gulati found blockages in her arteries.

Because signs of a heart condition aren’t always obvious, it’s important to keep an eye out for more than just the “classic” symptoms. Here’s how to tell if you’re just out of shape or if you’re experiencing symptoms of heart problems.

What causes heart disease?

Heart disease, or cardiovascular disease, can be used to describe a variety of heart and blood vessel problems. Sometimes, a person is born with cardiovascular disease–this is called congenital heart disease. Other times, heart disease develops over the course of your life due to your lifestyle, genetics, infections or diseases, and medications.

Most common types of heart disease

Cardiovascular disease is an umbrella term that encompasses several types of heart issues:

Coronary artery disease: Coronary artery disease is the most common heart disease. It results when there’s a buildup of LDL (bad cholesterol) in your arteries. If unmanaged, this can lead to a heart attack (myocardial infarction) or even cardiac arrest and death.
Congestive heart failure: This happens when you have a dysfunctional heart muscle, which is either too weak to pump out blood effectively or too stiff to fill with blood properly. About 5 million people struggle with congestive heart failure in the U.S., and more than half die within five years of being diagnosed.
Valvular heart disease: When one of the four heart valves doesn’t work properly, either because of an illness, a birth defect, or damage to the heart over time, you will experience valvular heart disease. It is most common in older people, and less common than other heart diseases. Some people may go their entire lives without knowing they have a valve problem.
Atherosclerosis: This is when plaque builds up on the walls of your arteries. Atherosclerosis affects about 3 million people annually. It often has no symptoms and may never cause an issue, but if it occurs within the coronary arteries, which supply the heart muscle with blood, the atherosclerosis is termed coronary artery disease and can cause heart attacks. If it occurs within arteries leading to the brain, atherosclerosis can lead to a stroke..
Arrhythmia: These are conditions in which the heart beats too fast, too slow, irregularly, or skips beats. The category includes some of the most common heart conditions. In the setting of the arrhythmia atrial fibrillation, older adults with other risk factors may want to take a blood thinner to ward off strokes. Other arrhythmias, such as ventricular tachycardia, can result in cardiac arrest.
Cardiomyopathy: Cardiomyopathy refers to a collection of diseases of the heart muscle that cause difficulty pumping blood and may potentially lead to congestive heart failure. Dilated cardiomyopathy is when the pumping chambers, or ventricles, of the heart become enlarged. Hypertrophic cardiomyopathy is when the heart muscle becomes thickened. Arrhythmogenic cardiomyopathy relates to issues with the heart’s rhythm. Restrictive cardiomyopathy means the heart is stiff and/or scarred. Often, cardiomyopathy goes undiagnosed.
Heart infections: Bacteria, viruses, or fungi can cause infection or inflammation of the heart. When the infection occurs in the lining of the heart valves, it is called endocarditis. Inflammation that occurs in the heart muscle itself is referred to as myocarditis, and inflammation of the sac that surrounds the heart is called pericarditis. Although rare in most people, infections like endocarditis are more common in individuals who have had heart surgery, are over the age of 65, or have used injected street drugs.

Risk factors for heart disease

In the United States, heart disease is the leading cause of death. The following risk factors increase your chances of developing heart issues:

High blood pressure: According to the Centers for Disease Control (CDC), high blood pressure is a leading risk factor for heart disease. That’s because it causes damage to the arterial linings, which increases the likelihood of plaque buildup that can narrow the arteries traveling to the heart and brain. High blood pressure is one of the most common medical conditions in the world. It can be controlled with medications, and should be—unchecked blood pressure problems can cause heart attacks from coronary artery disease and cause strokes from atherosclerosis of the cerebral arteries. It’s also important to watch your sodium intake, as consuming too much contributes to high blood pressure.
High LDL cholesterol: Another leading cause of heart disease, high levels of low-density lipoprotein cholesterol (LDL) can increase your risk of heart disease. When cholesterol builds up inside your arteries, blood flow to your heart and other important organs is compromised. If you have high cholesterol, manage it with medication, or make lifestyle changes like eating a healthier diet and getting more exercise to lower it naturally–under your healthcare provider’s guidance, of course.
Diabetes: If you have diabetes, you are two to three times as likely to develop heart disease. Not only are people who have diabetes more likely to have other risk factors like high blood pressure and high cholesterol, prolonged levels of high blood sugar cause damage to blood vessels in the heart.
Smoking or exposure to secondhand smoke: According to the FDA, smoking causes 1 out of 4 deaths from heart disease—it causes long-term damage to your heart and blood vessels. If you aren’t a smoker, but you’re exposed to secondhand smoke, you’re still at risk. It is estimated that secondhand smoke increases the risk of heart disease by 20%.
Unhealthy lifestyle: If you’re overweight or obese, you’re at risk of heart disease and many of its other risk factors, including diabetes, high blood pressure, and high cholesterol. The same goes for a sedentary lifestyle, which can increase your risk of obesity, too. To reduce these risk factors, skip the sugary, processed foods in favor of a healthy eating with lots of fresh fruits and vegetables, whole grains, lean proteins and low-fat dairy.

What are the signs of heart problems?

Different symptoms can indicate different heart problems. Watch for these most common symptoms of a bad heart–though they might seem innocuous, they could mean your heart health is at risk.

1. Extreme fatigue

Could indicate: Coronary artery disease; congestive heart failure; valvular heart disease

There are many conditions that can cause fatigue. Yet, persistent, unexplained tiredness could be a sign that your heart is not pumping well, or is encountering some other problem—like a blockage or a valve issue.

2. Shortness of breath

Could indicate: Atherosclerosis; coronary artery disease; congestive heart failure; valvular heart disease

Sure, you get winded easily if you’re a little out of shape, but don’t write it off too quickly. If you find yourself gasping for air after a small amount of exertion, like walking out to the car or up the front steps, it could be heart-related.

3. Change in exercise tolerance

Could indicate: Coronary artery disease; congestive heart failure; valvular heart disease

Dr. John Osborne, the director of cardiology at LowT Center/HerKare and volunteer for the American Heart Association (AHA), regularly sees patients who could mow the lawn easily a few months ago, but now struggle—and they end up having heart disease. If tasks that used to be painless are now difficult, consider seeing a doctor.

4. Digestive concerns

Could indicate: Coronary artery disease; congestive heart failure

Lightheadedness, nausea, vomiting, or stomach pain can be common signs of a heart attack—these are especially common symptoms of heart disease in women, who often have different symptoms than men. It can start with a vague sense of not feeling well in the digestive area or heartburn, but these, along with breaking into a cold sweat, can indicate coronary artery disease.

5. Sleep apnea, snoring, or waking up during the night

Could Indicate: Arrhythmia; coronary artery disease; congestive heart failure

Heart disease could be behind your poor night’s sleep. Your blood flow and heart rate change when you go to sleep when everything is functioning normally. If there’s something wrong, it could be waking you up at 1 a.m. Sleep problems can be signs of heart failure. Heart failure can cause sleep apnea or make fluid build up in the lungs, and arrhythmia can make you feel like your heart is racing—both of which can interrupt your dreams.

6. Swelling

Could indicate: Congestive heart failure; valvular heart disease

Especially in the lower legs, ankles, or feet, swelling can be a symptom of heart failure. If you have puffed up so much that your finger leaves an indent when you touch your body, it might be time to check with a medical professional.

7. Chest discomfort or angina

Could indicate: Atherosclerosis; coronary artery disease; valvular heart disease

Feelings of squeezing, tightness, uncomfortable pressure, or heaviness can be signals that something is wrong with your heart. People commonly describe cardiac distress as feeling like an elephant is sitting on their chest.

8. Leg cramps

Could indicate: Atherosclerosis

Leg pain, or difficulty walking, can be a sign that your circulation is impaired. Blockages in the arteries carrying blood flow to the legs could be to blame.

9. Heart rhythm and rate changes

Could indicate: High or low blood pressure; congestive heart failure; valvular heart disease; arrhythmia

When your heartbeat feels unusual—too fast or uneven—that is called having palpitations. It’s a feeling similar to when you’ve had too much caffeine or feel panicked. But if you’re just sitting and reading a book, and your heart starts to race, it could mean you’re at risk for heart disease.

10. Shoulder, arm, neck, back, abdomen, or jaw pain

Could indicate: Atherosclerosis; coronary artery disease

When your heart is struggling, it can make other parts of the body call out in pain. Arm pain is a classic heart attack symptom, but it can also occur in the shoulders, back, stomach, or jaw.

11. Dizziness or lightheadedness

Could indicate: Arrhythmia; high or low blood pressure; congestive heart failure; valvular heart disease

Feeling faint usually means there’s not enough blood flow to the brain. While there are lots of causes, abnormal heart function could be one of them—especially when you feel dizzy upon standing up. And if you experience dizziness after consuming a meal, you may have a condition called postprandial hypotension, or low blood pressure after eating–this is often a long-term consequence of arterial stiffness from high blood pressure.

12. Persistent cough

Could indicate: Coronary artery disease; congestive heart failure

Heart failure can make fluid build up in your lungs, which can trigger coughing or wheezing.

13. Weakness in extremities

Could indicate: Atherosclerosis

Weakness in the legs goes hand-in-hand with changes in exercise tolerance and shortness of breath. It could be a type of fatigue associated with heart trouble.

14. Excessive sweating

Could indicate: Congestive heart failure; coronary artery disease

Excessive sweating, or diaphoresis, may be an early sign of heart failure. According to a 2021 study published in the American Journal of Cardiovascular Disease, profuse sweating is a symptom frequently reported by cardiovascular patients prior to heart failure. If you are experiencing diaphoresis, especially if it occurs with other heart attack symptoms, seek immediate medical attention.

If you experience any of the above signs of heart disease—either acutely or worsening over time—first stop what you’re doing and wait for it to resolve. Then, call your primary care physician and make an appointment to get it checked out. If it doesn’t resolve and you begin to experience other urgent symptoms, like more intense pain or difficulty walking, call 911 and go to the emergency room as these could be signs your heart is failing.

15. Skin symptoms

Could indicate: Coronary artery disease, congestive heart failure, valvular heart disease, atherosclerosis, arrhythmia

Your skin and nails may hold warning signs of heart disease. Watch out for the following symptoms:

Swelling in the feet/legs, or edema, may indicate that your heart isn’t working properly.
Blue or purple skin discoloration, or cyanosis, could mean you have a blocked blood vessel.
A net-like pattern on the skin that is blue or purple in color can indicate a blocked artery.
Cholesterol deposits on the eyelids, hands, or back of the legs appearing as yellowish-orange, waxy growths may indicate high cholesterol.
Waxy bumps that appear on the skin in clusters can also be an indication of high levels of a type of cholesterol called triglycerides in the blood.
Swollen fingertips and nails that curve downward may mean you have a heart infection or heart disease.
Red or purple lines that appear under the nails not caused by an injury may indicate heart disease.
Smooth and waxy lumps on the skin can be a sign of protein buildup in the heart which can impair its function.
Painful lumps in your fingers and/or toes could mean that you have a heart or blood vessel infection.
Brown or red splotches on the soles of your feet or palms of your hand may also be an indication of a heart or blood vessel infection.

Compare cardiovascular disease symptoms
Symptoms	Coronary artery disease	Congestive heart failure	Valvular heart disease	Athero-sclerosis	Arrhythmia	High or low blood pressure
Extreme fatigue	X	X	X
Shortness of breath	X	X	X	x
Change in exercise tolerance	X	X	X
Digestive concerns	X	X
Sleep problems	X	X			X
Swelling		X	X
Chest pain	X		X	X
Leg cramps				X
Heart rhythm changes		X	X		X	X
Pain in other parts of body	X			X
Dizziness or lightheadedness		X	X		X	X
Persistent cough	X	X
Weakness in extremities				X
Excessive sweating	X	X
Skin problems	X	X	X	X	X

What are the signs of a heart attack?

Heart attacks are a medical emergency. Keep watch for these common symptoms so you can help yourself or others.

Chest pain. This could manifest as chest pressure, squeezing, discomfort, or the feeling of “an elephant on your chest,” Dr. Gulati says.
Arm pain. This includes your jaw, shoulder, and arm, and is usually on the left side; it could be localized to one spot.
Stomach problems. This includes indigestion, heartburn, acid, nausea, stomach pain, or reflux that doesn’t correlate with a meal, especially in the case of silent heart attacks, Dr. Osborne says.
Lightheadedness. If you’re dizzy, light-headed, or passing out, that’s a sign of an emergency.
Sweating. This typically manifests as a cold sweat, but any sudden excess sweating without warning is a symptom.
Shortness of breath. This includes difficulty taking a deep breath or asthma-like symptoms.
Fatigue. Your heart struggling to keep you alive can make you very tired very fast.

Symptoms of a heart attack in women can be a little different than the symptoms of a heart attack in men. Although chest pain is the most common heart attack symptom in both genders, women may experience it much less intensely. For example, they may feel pressure or tightness in their chest rather than outright pain. In addition to the above symptoms, women may experience different neck, jaw, shoulder, upper back or upper abdominal discomfort.

What should I do if I or a loved one is having a heart attack?

If you suspect you or someone around you is having a heart attack, you need to act quickly. First (and most importantly), call 911. Do not attempt to drive yourself or anyone you know to the hospital. While the ambulance is on the way, the 911 operator might instruct you to take these steps if you’re having a heart attack:

Chew an aspirin. The 911 operator may have you do this to help thin the blood and start to break up the blood clot causing issues.
Unlock the door. If you’re alone and you pass out, the paramedics will still be able to enter easily.
Stop what you’re doing and try to relax. You need to immediately remove any extra strain on your heart, so sit or lie down. If coughing hard or banging on your chest helps you feel better, do it, but Dr. Osborne notes that it doesn’t really make any difference in the course of a heart attack.

If you’re not the one having the heart attack, administer CPR if necessary.

How is heart disease diagnosed?

First, your provider will ask about your personal and family history of heart disease. Then, they may prescribe lab and imaging tests such as the following:

Blood tests: Blood tests to measure your cholesterol and triglyceride levels as well as tests to check for certain proteins and other substances that are linked to heart disease and poor heart health will likely be performed.

Imaging tests: A chest X-ray can show heart problems like blood vessel damage, fluid around your heart, and changes to its size. A computerized tomography (CT) scan of the heart takes X-ray images at different angles around the heart. A magnetic resonance imaging scan (MRI) of the heart uses a magnetic field and radio waves to produce images of the heart.

Exercise or stress tests: Your heart may be monitored while you walk on a treadmill or ride a stationary bike so that your provider can see if symptoms of heart disease occur during exercise.

Electrocardiogram (ECG or EKG): This test checks your heart for abnormal rhythm, or arrhythmia. You may also be asked to wear a Holter monitor, or portable ECG device over the course of a day to check for the same.

Echocardiogram: To determine how blood moves through your heart and its valves, sound waves are used via an echocardiogram.

Cardiac catheterization: In this procedure, a catheter is inserted through a blood vessel in the groin or wrist and fed to the heart. Dye is injected through the tube so that your doctor is able to see the heart and arteries during an X-ray.

What is the treatment for heart disease?

If you have heart disease, the condition might be treated with medications, which can also be used to manage symptoms and reduce the risk of future cardiac events. To treat a constricted or blocked artery, your doctor might use angioplasty to open the artery and place a stent in the vessel, or in severe cases, coronary artery bypass surgery may be warranted–this involves grafting a blood vessel from the aorta to the coronary artery. Or, if you have a damaged valve, heart valve surgery can be done to repair or replace it. For heart arrhythmias, the implantation of a pacemaker or cardioverter defibrillator can improve your quality of life and keep your heartbeat stable.

What are common heart medications?

If you need heart medication, there are hundreds of options for your cardiologist to choose from. These are the most common medication categories (and how they work).

Blood thinners: Stop blood from clotting
Antiplatelet agents (including aspirin): Stop blood platelets from sticking together and forming clots
Angiotensin-converting enzyme (ACE) inhibitors: Expand blood vessels and help blood flow more easily and reduce blood pressure
Angiotensin II receptor blockers (ARBs): Stop blood pressure from rising
Angiotensin-receptor neprilysin inhibitors (ARNIs): Enhance artery opening and blood flow and reduce sodium and fluid retention
Beta blockers: Make the heart beat slower and stronger
Calcium channel blockers: Stop calcium from entering the heart and blood vessels and reduce blood pressure
Cholesterol medications: Lowers high cholesterol levels
Digitalis: Make heart contractions stronger
Diuretics: Remove excess fluid from the body
Vasodilators: Relax blood vessels and brings more blood and oxygen to the heart and can reduce blood pressure as well

How can I prevent heart disease?

Incorporate healthy lifestyle changes to enhance the efficacy of heart medications. The following lifestyle changes can reduce your risk of heart disease.

Control your blood pressure
Keep your cholesterol at a healthy range
Maintain a healthy weight
Eat a healthy diet low in processed foods
Get plenty of exercise
Keep the alcohol to a minimum
Don’t smoke, or quit if you’re a smoker
Find ways to manage stress
Get 7-9 hours of sleep each night
A poor diet and lack of physical activity can put you at a higher risk of heart disease.

Frequently asked questions about heart symptoms

What is a dangerous heart rate?

Generally, a healthy heart rate is between 60 (or 50 if you’re really healthy) and 100 beats per minute—so anything above or below those numbers could be a problem. On either end of the spectrum, you might be feeling dizzy, faint, or lightheaded, or pass out, Dr. Osborne says. If it’s above 100 beats per minute, that’s when you might have chest pain and shortness of breath.

Either way, though, high or low, head to the doctor. An abnormal heartbeat at these levels could mean thyroid problems, heart failure, atrial fibrillation, or any number of other health problems.

How long does a heart attack last if untreated?

When we hear about heart attacks, it’s typically something that’s come on out of nowhere and was unexpected. But some heart symptoms—depending on the situation—can last for several days.

“Everybody’s different,” Dr. Gulati says. “[For] some people, symptoms will come on suddenly, and that usually means that maybe a clot broke off or something initiated the cascade of a thrombus or blood clot formation. But other people may have ongoing symptoms of angina [reduced blood flow to the heart] that just get worse over time. It might be a response to stressful situations or both physical and emotional stress may bring it on.”

For example, you could get chest heaviness while walking, but it goes away once you begin to rest. Or you could have chest heaviness and shortness of breath, and feel excessively hot and sweaty when exercising—so you stop.

“Those are usually warning signs that there’s something going on,” Dr. Gulati says. “Angina presents in many different ways to different people. Some people, it will be sudden in onset and they’ve never experienced a symptom before, and for other people, they may have been experiencing small but subtle things that have been gradually getting worse.”

Other symptoms that could last for several days or even months, Dr. Osborne says, include swelling, waking up short of breath at night, not being able to sleep flat, breathlessness, and the inability to take a deep breath.

When should I be worried about heart palpitations?

Though they may be scary at the time, brief heart palpitations are usually not serious. Dr. Gulati says that some people are just more aware of their heartbeats than others and are more likely to notice skipped beats or other palpitations. But she and Dr. Osborne both agree that it’s time to seek medical help when those palpitations come along with fainting, dizziness, pain, or shortness of breath.

What are the signs of heart problems in women vs. men?

Men and women experience many of the same symptoms, but some are more common in men than women and vice versa. These are the most common signs of heart problems in men and women.

Men are most likely to experience:

Chest discomfort towards the center of the chest (feelings of pressure, fullness, pain, or squeezing)
Pain and discomfort in the arms, back, chest, neck, jaw, or stomach
Shortness of breath with or without chest discomfort
Breaking out in a cold sweat
Nausea
Feeling lightheaded

Women most commonly experience:

Chest discomfort towards the center of the chest (feelings of pressure, fullness, pain, or squeezing)
Pain and discomfort in the arms, back, chest, neck, jaw, or stomach
Shortness of breath with or without chest discomfort
Breaking out in a cold sweat
Nausea/vomiting
Feeling lightheaded
Heart palpitations
Sleep disturbances
Unexplained fatigue

Although sometimes there are no clear warning signs of a heart problem, there is often treatment available. If you notice one of these unusual signs there might be a problem with your ticker, don’t delay. See your doctor, and find out what you can do to treat it.