6 subtle signs you may have a heart problem

Could you have heart disease and not know it? Be on the lookout for these red flags.

Hope Winsborough
Older woman at a doctor visit.

Gripping chest pain and shortness of breath: These are the most classic signs of a heart attack. For decades, that scenario has played out in countless TV shows, films and public health ads. 
But heart problems, especially during the early stages, don’t always have such loud warning signs, says Van Crisco, M.D., an interventional cardiologist at First Coast Heart and Vascular Center in Florida. Often, your body sends more subtle clues that your heart health may need some attention.  
Here are 6 warning signs of heart disease. If any sound familiar, call your health care provider for a checkup. 

You get winded during routine activities 

Maybe you feel a bit out of breath when you move from the couch to the kitchen, for example. Or going upstairs starts to feel like a workout. That could be because your heart is struggling to pump oxygen-rich blood throughout your body. 
Many different heart problems can first show up in your respiratory system, says David Schopfer, M.D., a cardiologist at the National Heart, Lung, and Blood Institute. And it can all be traced back to reduced oxygen flow, often due to clogged arteries that block the flow of blood to your heart. This condition is also known as coronary artery disease, or CAD.  
CAD is the top cause of death in the U.S., according to the National Center for Health Statistics. And your risk goes up as you get older. But the good news is that CAD, and heart disease in general, is highly treatable.  

A healthy lady on a walk
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Lifestyle changes, such as getting more exercise, reducing your stress and eating more heart-healthy foods can go a long way toward improving blood flow, says Dr. Schopfer. Your provider may also recommend medications to help prevent blockages.  
A sudden shortness of breath that wakes you up in the middle of the night is also of concern, says Laurence Sperling, M.D., founder of the Emory Center for Heart Disease Prevention in Atlanta. That could mean heart failure, he says. Let your provider know if this has happened to you. It should be checked out right away. If your breathing doesn’t quickly return to normal after you’re awake, call 911. 
By the same token, let your provider know if you suddenly feel pain in your legs while walking, but the pain goes away as soon as you stop, says Dr. Schopfer. That could be a sign of circulation problems or peripheral artery disease. It’s common, but it often goes undiagnosed, he says.  

A healthier heart begins with your Annual Wellness Visit   

This important yearly checkup can help you keep tabs on your heart health. To get started:  

  1. Schedule your appointment. Use our online search tools to find a network provider. Sign in to your plan website and click on Find Care.  
  2. Download your Annual Care Checklist. Use this list of health topics to get the conversation started with your provider. Go to the Health & Wellness section of your plan website and type Annual Care Checklist into the search bar.
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Your stomach feels “off”  

Or your back, shoulders, neck or both arms, for that matter. This one may seem broad, and it is. That’s because many heart-related symptoms can be quite subtle, says Dr. Crisco.  
“When it comes to a complaint or discomfort, humans are not wired well enough to know the difference between their heart, stomach, esophagus or lungs,” says Dr. Crisco. “I tell patients, ‘Anything between your earlobes and your belly button can be your heart talking to you.’”  
Dr. Schopfer agrees: “Sometimes the crushing pain of a heart attack isn’t felt in the chest but rather more in the back muscles or shoulders and neck, or even in what feels like the stomach or abdomen. The nerves involved in heart function cross over the entire torso. They all kind of merge in the same general area.”  
As a result, your brain can’t recognize that the pain is related to a heart problem.  
“These nerves are not as precise as the pain receptors in, say, your skin,” adds Dr. Schopfer. “If you feel something on one side of your body on your skin, you know what side it’s on. But the nerves inside your chest are different. If there is a blockage near the bottom of your heart, you may feel something similar to indigestion.”  
Bottom line: If you’re noticing any new discomfort in these areas that you can’t trace back to an activity from earlier in the day (like lifting a heavy object) or a big meal, call your provider right away. If the pain is severe and doesn’t let up, you could be having a heart attack. Call 911. 

You get dizzy  

Getting dizzy or lightheaded can be chalked up to a number of things that aren’t always heart-related. Dehydration [link: https://www.renewuhc.com/article/nutrition/dehydration-how-spot-it-and-help-prevent-it] and inner ear problems are two common culprits. But persistent or frequent episodes could also signal a heart rhythm problem known as arrhythmia, says Dr. Schopfer. 
Atrial fibrillation, or AFib, is one type of arrhythmia often associated with dizziness. And the risk of AFib becomes more common with age. Like CAD, arrhythmias are treatable, usually with a combination of medications and lifestyle tweaks. If it’s more advanced, a pacemaker may be needed to help your heart keep a steady beat. 
Other heart issues tied to dizziness include blocked arteries (which lower blood pressure) and faulty heart valves that have difficulty maintaining blood pressure. 
“If you feel slightly dizzy for a short time and it goes away, it may not be a problem,” says Dr. Schopfer. “But if it happens every day, or always happens after a certain activity for no obvious reason, you should see your provider to get it checked out.”  

Your limbs swell  

Lots of things can cause your feet, legs or arms to swell, including varicose veins and arthritis. But pay attention, because swollen limbs are often a sign of heart failure, Dr. Schopfer warns. With this chronic condition, the heart doesn’t pump blood as well as it should.  
“If your heart isn’t pumping efficiently, your kidneys can’t get rid of fluid efficiently,” says Dr. Schopfer. “The result can be increased swelling of your limbs. It can be sudden or gradual.” 
As with the heart conditions mentioned earlier, heart failure can be managed with a combination of medications and lifestyle changes, such as cutting back on salt and keeping a close eye on your blood pressure and weight.

You’re beat 

Like really, really exhausted. Older adults often blame fatigue on poor sleep, worry or just age. So they may not bring it up during an Annual Wellness Visit or other health exam. But extreme tiredness can be a sign of a heart condition, Dr. Crisco notes. Again, the problem could be your heart struggling to get enough oxygen to your lungs, brain and other body systems, he says.  
“Feeling tired may be just that — you’re tired. But it’s something to discuss with your provider,” says Dr. Crisco. 

You’re not on your feet much 

You’ve heard it before, but it’s worth repeating: Exercise is vital for overall health. In fact, the most overlooked symptom of heart disease and heart failure is a sedentary lifestyle, says Dr. Schopfer. 
“Really sedentary people are more prone to heart disease than they might think, because they’re not doing activities that may reveal a change in their baseline health,” says Dr. Schopfer. “If your baseline is very little physical activity, the subtle signs we’re talking about may not ever arise.”  
Dr. Sperling agrees, adding this final message: Talk to your provider about your risks and the preventive steps you can take. The best time to do this is during your Annual Wellness Visit. You can get checked from head to toe and set up recommended medical screenings. This visit is also a good time to ask your provider to help you create easy-to-reach health goals. Your provider might also suggest heart health tips, such as a simple walking plan or a few new healthy foods to try. 
“The optimal approach to heart health is prevention,” says Dr. Sperling. “At every age and every stage of life, meaningful changes can be made.” 

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