Heart health red flags you should never ignore
Mary, a renowned women’s health doctor, 73, put her chest sensations down to work stress, and didn’t recognise she was suffering from angina until she had an attack of heart palpitations and had to call an ambulance.
“I’m a doctor and I had no idea. I felt no pain, only a sensation in my chest and then sometimes my left arm felt heavy. Now I’m now on blood thinners and beta blockers. I can’t believe it took me so long to realise I had angina.”
Heart disease is the leading cause of death in both men and women, yet many people don’t spot the warning signs or are waiting a long time for further tests. Currently, a quarter of those with concerning symptoms are waiting longer than six weeks for a diagnostic test whereas before the pandemic, it was only 3-4 per cent.
In early August, NHS England announced a change to the system in an effort to speed up testing. Traditionally GPs refer to specialists when conditions like heart failure and lung problems are suspected, but now GPs will be able to directly refer patients with concerning symptoms for tests.
NHS England says this will enable thousands more to get a diagnosis sooner, and by capitalising on the additional capacity provided by more than 100 community diagnostic centres offering a “one-stop shop” for tests in the community, patients can benefit from convenient triaging and testing near their homes, and avoid hospital admission or a trip to A&E.
A heart attack is when the blood supply to the heart muscle is interrupted; this is most commonly due to a blood clot. But it’s not an exact science. When the heart malfunctions, it causes the entire body to become oxygen-deprived, prompting a cascade of symptoms, some less obvious than others. So what are the red flag signs for an unhealthy heart that you should watch out for?
Uncomfortable pressure in chest
Most heart attacks involve discomfort in the centre or left side of the chest that comes in waves. It can feel like uncomfortable pressure, squeezing, fullness or pain. “If it has been going on for longer than 15 minutes, chest pain is the most important red flag,” says Dr Amal Muthumala, a consultant cardiologist with a special interest in heart failure and device implantation at North Middlesex Hospital and Barts Heart Centre, Barts Health NHS Trust. “Unfortunately some think it’s heartburn or indigestion, or that it will go away.”
Dr Oliver Segal, a consultant cardiologist specialising in cardiac electrophysiology (the treatment of abnormal heart rhythms) at University College London Hospital, Barts Heart Centre, St Bartholomew’s Hospital and the Harley Street Clinic, says: “Chest pain is always of concern because it may represent a heart attack or an attack of angina. But it can also represent other things, for example, an aortic dissection, where there’s a tear in the aorta, a blood clot to the lungs, or a pulmonary embolus. If the pain is severe, then calling an ambulance is definitely worthwhile.”
But diagnosing your symptoms can be tricky. Not everyone will call the sensation of pressure actual “pain”, warns consultant cardiologist Dr Sam Dawkins who is based at the Oxford Radcliffe Hospital and Cleveland Clinic, London. “I had a patient recently who said: ‘It’s a heaviness, like a book resting on my chest.’ But if you have a symptom that comes on with exertion, generally it’s going to be cardiac,” he says.
Don’t be embarrassed about making a fuss, says Regina Giblin, a senior cardiac nurse at the British Heart Foundation. “If you ring 999 and say chest pain or tightness, it’s a priority call, and they’ll have someone able to prioritise your symptoms. If they think it’s a heart attack, they’ll send an ambulance. The sooner they can open up the arteries and restore the blood flow, the better, because you protect the heart muscle but also then prevent the patient going into cardiac arrest.”
Excessive tiredness
Feeling worn out after a sleepless night or a stressful day is normal. But unusual fatigue and sleeplessness might be early warning signs of a heart attack. Some people suddenly get profound waves of tiredness, which may represent arrhythmia or exhaustion. And that could mean somebody has gone into an abnormal heart rhythm problem,” says Dr Segal.
“Waking up at night out of breath, needing more pillows, could suggest your heart isn’t pumping as well as it should,” advises Dr Muthumala. “And that’s why you’re propping yourself up. So get it checked out.”
A 2003 survey published in the journal Circulation gathered information from more than 500 women who had survived a heart attack. Approximately 95 per cent said they had noticed unusual bodily changes in the months before the event. The most common complaints were tiredness and disturbed sleep. Indeed, lack of significant chest pain may be a major reason why women have many more unrecognised heart attacks than men or are mistakenly discharged from emergency departments.
Sweating excessively
Unless you’re going through menopause or have just exercised, breaking out into a cold sweat or perspiring excessively could signal a heart attack. During a heart attack, your nervous system activates a “fight or flight” response that puts you in survival mode and could lead to sweating.
Unusual breathlessness
If you’ve been finding it harder and harder to climb the stairs, seek medical attention. Even though this doesn’t necessarily mean you’re about to have a heart attack, it could be a sign your heart is in danger. “It means your heart isn’t pumping properly or you have a narrowed or leaking valve,” says Dr Dawkins. “When I see patients with valve disease in clinic, I’ll say to them: ‘Are you breathless?’ They’ll often say no, but if I then say: ‘Think about what you could do a year ago, and now think about what you can do now, how is that different?’ they usually say: ‘Oh yeah, I’m a lot worse.’ Because it creeps up on the patient.
“Family members often recognise a problem first – they may notice a patient sounds short of breath when they answer the phone, for example. But if we can give them the right diagnostic tests and get them into the system sooner, we can avoid some hospital admissions.” Older people tend to be stoic and uncomplaining, Dr Dawkins adds, so healthcare professionals need to ask the right questions. Can they still play a round of golf without getting in the buggy, or mow the lawn? “A lot of patients will say: ‘I prefer to sleep in a chair.’ But what they mean is they don’t like lying flat because it makes them breathless, which is a sign of fluid building up in the lungs.” But, he stresses, cardiac symptoms are not caused by age; they are caused by a problem with the heart.
Feeling lightheaded
Many things make us feel dizzy, such as skipping a meal or standing up too fast. But dizziness or lightheadedness, together with chest pain and shortness of breath, may signify a decrease in blood volume and a drop in blood pressure, which means a heart attack could be on its way.
Unexplained pain in jaw, throat or teeth
It can feel as if the pain is radiating from your chest to your arms (usually the left arm), jaw, neck, back and stomach. When there’s a problem in the heart, such as a blocked artery, it can trigger the nerves in your heart to give a signal that something is wrong, because the vagus nerve is connected not only to the heart but also to the brain, chest, abdomen and neck.
“I saw one patient who had severe dental pain,” says Dr Muthumala. “And that was his heart saying ‘I’m in trouble’, because the automatic nerve supply that supplies the heart also shares the same supply to various other parts of the body. So when the heart is in trouble, it may not complain of chest pain, but ask for help in terms of jaw pain, throat or dental pain.”
Swollen legs or ankles
The heart’s primary function is to pump blood around the body. Heart failure is when your heart pump isn’t working correctly. People with heart failure have a tendency to retain fluid (oedema). This appears as swelling in your feet, ankles and legs because of excess fluid building up.
You may notice that your shoes don’t fit and socks appear tight or leave a prominent mark above the ankle. “Having swollen ankles most of the time is not normal,” says Dr Dawkins. “You need to have that investigated.”
Feeling sick
Gastric symptoms develop when the heart and other areas of the body aren’t receiving enough blood supply. It can be misjudged as acid reflux or heartburn, so talk to your doctor, especially if you’re having other heart attack symptoms.
Pasty and grey skin
“People with heart failure get a bad colour across their face – their skin becomes pasty and grey,” says Giblin. “Usually your loved ones look at you and say: ‘Your colour’s not right’. In some extreme cases, people’s lips go white or bluish.”
Heart beating fast or irregularly
The heart can become irritable when it lacks nutrient-filled blood and oxygen. If you feel like you’re having heart palpitations (a pounding, fluttering or irregular heartbeat), contact your GP immediately. “Rapid palpitations are potentially a serious cardiac symptom. It can represent atrial fibrillation, which is the commonest heart rhythm abnormality that can sometimes precipitate heart failure or cause a stroke,” says Dr Segal.
Persistent cough
Heart failure can cause fluid to build up in the lungs (pulmonary oedema) and in and around the airways. This can cause shortness of breath, coughing and wheezing similar to the signs and symptoms of asthma. If you have a persistent cough, which may be worse at night, talk to your GP.
Bloated stomach
Swelling or pain in the upper abdomen (stomach area) can occur due to fluid build-up (congestion) in the body, which is a sign of worsening heart failure. The discomfort is due to fluid retention and congestion in the liver and gut, because blood isn’t being pumped to the kidneys as well as it should be, making it harder for them to remove salt and water. “If you have heart failure and your weight goes up by two or three pounds [4?-6?lb] in a day, you need to see your GP, or even call an ambulance if you’re very unwell,” says Dr Muthumala.
Loss of appetite
People with heart failure can also notice a loss of appetite. This is because the liver and stomach can become enlarged due to excess fluid, making you feel sick.
And the good news?
The chances of surviving a heart attack are better the sooner emergency treatment begins, stresses Dr Segal.
“We talk internally in hospital about ‘door to balloon times’. So from the onset of symptoms to the onset of opening an artery is the key time window. And the shorter that is, the less chance there is of permanent damage to the heart muscle. And if you get no damage, that’s obviously the ideal. And the more damage you get, the more impact that will have on your life expectancy. Even if you manage to survive and go home, but you’ve suffered a big heart attack, your life expectancy will be severely reduced as a consequence. So the sooner you can get treatment, the better.”