Heart disease - what are the symptoms

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The problem with heart disease is that the symptoms often present when the disease is much advanced. This is partly because people ignore and compensate for the early warning signs, or if they do present to their physicians, they get palmed off with some specious excuse like "it's your age", or "you are just unfit".

Fatigue and inability to get fit are often the best warning signs that the heart cannot deal with an increased work load. This is why regular exercise is so important - the early warning symptoms come sooner.

One must always be on the look out for warning symptoms, pay attention to family history and screen for risk factors.

If you have a bad family history of heart disease, you must be screened for the risk factors - see Arteriosclerosis - what causes it and how to prevent it and Ischaemic Heart Disease - what really causes it?.

If there is a particular form of heart disease in the family, such as cardiomyopathy, look for that too.

Men are a particular problem because symptoms of heart disease seem to present later in them and men being men are less likely to take symptoms seriously!

Early symptoms of heart disease include

  • Angina - classically this is felt in the middle of the chest, behind the breast bone and is variously described as crushing, squeezing, tightening, "pressure like a weight". It may also go across the chest, typically into the left arm, but can be felt in the shoulder, neck and sometimes lower jaw. It is typically brought on by exercise, emotion and cold weather. It is relieved by rest. It is caused by inadequate blood supply to the muscle of the heart.
  • Angina is often mistaken for indigestion. This is one reason why "indigestion" needs investigating properly. It is quite common, especially for fit young men, to get stabbing left sided chest pains, in slightly stressful situations. Obviously, they need investigating properly but usually no heart disease is found.
  • Atypical chest pain - i.e. almost any chest pain can be a symptom of heart disease and needs evaluating by an experienced physician.
  • Shortness of breath - only too often this is put down to lack of fitness. Shortness of breath occurs because there is not enough blood being pumped round the lungs to pick up oxygen and drop off carbon dioxide. Most people when they exercise, especially if they are a bit unfit, get a bit short of breath at first but then get a "second wind". If you can't get your second wind, or, if in the process of trying to get fit you can't get beyond a certain level, I would be concerned.
If the left side of the heart starts to fail to clear the blood from the lungs quick enough, a back pressure builds up which causes fluid to build up in the lungs. This further impairs oxygen exchange and makes the shortness of breath dramatically worse. This is called pulmonary oedema. It can be heard at the bottom of the lungs and sounds like fine crackling paper when a deep breath is taken.
  • Palpitations - these are often felt when the heart is beating wrongly i.e. a dysrhythmias (irregular heart beat, or a beat which is too fast or slow) or cardiomyopathy. If you have a palpitation try to think how fast it is, whether it is regular or irregular and how long it goes on for - this helps to diagnose. The pulse can be felt in many places, most easily at the wrist or groin.
The normal pulse rate is anything between 60 and 80; the fitter you are, the lower the pulse rate. There is a slight variation with breathing - the pulse quickens slightly as you breathe in and slows as you breathe out. See Heart Dysrhythmias, Irregular Pulse, Missed beats and Palpitations.
  • Swollen ankles are caused when the right side of the heart fails to efficiently clear blood returning from the body. If the patient is sitting in bed, the swelling appears in their buttocks and over the sacrum. Typically it is pitting, i.e. when you press the swollen area for a few seconds, the imprint remains for a few seconds.

Fatigue and inability to get fit are often the best warning signs that the heart cannot deal with an increased work load.

Since the heart supplies blood to the whole of the body and impairment of blood supply can cause almost any symptom, this means almost any symptom could indicate heart or arterial disease. This is another good reason for the environmental approach to medicine - keep digging until the symptom is explained!

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