Symptoms of Heart Disease

Symptoms of Heart Disease

There are three main categories of heart disease symptoms that lead patients to consult a doctor:

1. Chest tightness or pain: This may be a symptom of ischemic heart disease.
2. Fatigue or shortness of breath: These may be symptoms of heart failure.
3. Heart palpitations or fainting: These may be symptoms of arrhythmias.
4. It's important to distinguish these symptoms from those caused by anxiety or stress.

It should be understood that some patients may not have any symptoms, some may have vague symptoms, and some may present with complications, such as stroke resulting from a blood clot that has dislodged from the heart. In some cases, patients may not make it to the doctor due to sudden death.

1. Chest tightness or pain due to ischemic heart disease

Chest tightness or pain is a significant symptom that leads patients with ischemic heart disease to consult a doctor. Some people describe it as pain, while others describe it as tightness or pressure in the chest, as if something is squeezing or pressing on it. This sensation usually occurs in the center of the chest or slightly to the left. In some cases, it may feel similar to indigestion. The pain may radiate to the base of the neck, the back, the left arm, or the left shoulder. In some cases, the pain in the neck or shoulder may be more intense than the chest pain. This radiating pain is an important diagnostic clue.

If the heart's blood supply is not severely compromised, the pain and tightness may be mild and short-lived, occurring only during exertion, such as running, climbing stairs, crossing a bridge, or heavy lifting. The pain usually subsides within 3-5 minutes of rest and typically does not last more than 15-20 minutes. However, if the heart is severely deprived of blood, the pain may last longer than 15-30 minutes, occurring even during light activity or at rest. If the heart muscle dies due to lack of blood, the pain is usually the most severe, lasting longer than 30 minutes, potentially for hours, and persisting even at rest. In this case, even taking medication under the tongue may not relieve the pain, and other symptoms may be present, such as cold sweats, nausea, vomiting, the urge to have a bowel movement or urinate, or feelings of weakness, dizziness, or fainting. Doctors need to differentiate these symptoms from other conditions with similar presentations, such as peptic ulcers, gallbladder inflammation, hepatitis, acid reflux, pleurisy, bronchitis, pneumonia, inflammation or edema of the lungs, pulmonary embolism, inflammation of the chest wall, or inflammation of the chest muscles or nerves, or a ruptured or torn aorta.

2. Easy Fatigue from Congestive Heart Failure

Easy fatigue from congestive heart failure is a symptom of fluid accumulation in the lung sacs, which occurs when the heart does not pump efficiently or pumps with high resistance, such as in heart valve stenosis or very high blood pressure. This leads to an increase in pressure in the heart chambers, causing higher pressure in the lungs, pushing blood into the lung sacs (alveoli). This impairs oxygen exchange in the alveoli and results in fatigue. Initially, patients may feel easily fatigued during normal physical activity without any obvious reason. As the condition worsens, even minor exertion causes fatigue, and eventually, patients may experience difficulty lying flat at night due to the blood pooling in the heart and increased pressure in the lung sacs. Patients may need to sit up intermittently to relieve this discomfort.

In addition to these symptoms, a poorly contracting heart can also reduce the blood supply to the brain and muscles, causing weakness, dizziness, and confusion. If fluid accumulation is severe, high pressure in the capillaries of the lungs can push blood into the alveoli, causing frothy sputum mixed with blood, severe shortness of breath, and impaired oxygen exchange in the lung sacs. The reduced blood flow from the heart can lead to a life-threatening situation if not treated promptly.

   The right chamber of the heart receives deoxygenated blood from the body and sends it to the lungs for oxygenation. If the pressure in the lungs is high, the pressure in the right chamber also increases, causing elevated pressure in the veins and swelling of the jugular veins in the neck. Fluid and minerals stored in the veins are pushed out, resulting in fluid accumulation in various organs, such as the liver, stomach, and intestines. This can cause an enlarged liver, abdominal discomfort, bloating, loss of appetite, nausea, and vomiting. Fluid accumulation in the arms and legs may lead to swelling at the fingertips and toes or the buttocks and back areas, especially in patients who are mostly bedridden.

   Although these symptoms are present, there are several other conditions that can cause easy fatigue or swelling, such as:

• Lung diseases, like chronic bronchitis or emphysema.
• Kidney diseases, such as kidney failure or edema caused by protein loss in the kidneys.
• Liver diseases, like cirrhosis.
• Severe protein deficiency.
• Severe anemia.

3. Palpitations or fainting due to irregular heartbeats

In cases of irregular heartbeats, rapid or slow arrhythmias may occur, or sometimes a mix of both fast and slow beats, causing a combination of symptoms.

• If irregular heartbeats occur sporadically or in isolation, which can happen in both the upper and lower heart chambers, these arrhythmias are usually not life-threatening. Common symptoms that lead patients to seek medical attention include heartbeats that feel like they're skipping or pausing. Some patients feel strong, sudden beats as if something is hitting them, or they experience palpitations and uneven heartbeats.
• If the upper heart chamber has continuous irregular beats for an extended period, called atrial fibrillation, the upper chamber struggles to function. Some patients present with blood clot-related heart attacks or stroke due to blood clots forming in the heart and traveling to the brain.
• If the lower heart chamber has rapid arrhythmias, it can be life-threatening. Commonly observed symptoms include palpitations, fainting, and low blood pressure. If the rapid beats don't stop, it can be fatal.
• If the heart beats too slowly, there may not be enough blood supply to the brain, causing dizziness, lightheadedness, blurred vision, fainting, and even seizures.

4. Symptoms in patients with anxiety disorders

Symptoms can resemble those of ischemic heart disease or blood clot-related heart attacks, such as chest pain, palpitations, shortness of breath, cold hands and feet, and sweating on fingertips and toes. However, these symptoms often occur in adolescents or young adults and are more common in women than in men. Diagnostic clues include:

• Chest pain that feels like pinching, stabbing, or sharp.
• A specific, identifiable point of pain that intensifies when pressed.
• Chest pain that may occur multiple times a day and last for only seconds.
• Symptoms not associated with exercise, and exercise may even alleviate symptoms. Despite chest pain, patients can still function.
• Breathing difficulties are often accompanied by chest pain. Breathing becomes more comfortable with forceful exhalation, and severe cases may resemble asthma.

These symptoms tend to come and go, and are often stress-related. Sometimes, patients are aware of the stress, but most of the time, they're unaware. Close friends or family members can help identify stressors.

Best wishes from Vibhavadi Heart Center, Vibhavadi Hospital