Don't Ignore These 10 Heart Symptoms

We don't always do a great job listening or responding to those signals. This is number one, a scary thing. You should respond to it as such, but it's interesting, many people don't. Your body may be telling you that there's something wrong with your heart. Early recognition is really important. Your heart can make you feel like you have the flu if there's something wrong, nausea, vomiting, even reflux-type symptoms. And there's actually a delay in diagnosis in many patients when it comes to their heart disease. Because you used to be able to walk three miles, you can only walk a mile. As that blockage tends to progress, you can no longer climb a flight of stairs. Because you're outstripping the fuel, you suddenly feel like you are going to black out. And that is a precursor of potential sudden death. I'm Dr. Jeremy London. I'm a board-certified cardiovascular surgeon. and I've been in clinical practice for the last 25 years. And in today's episode, I'm going to review 10 signs or symptoms that your body may be telling you that there's something wrong with your heart. Now, I can tell you that after 25 years at the bedside, our bodies do a phenomenal job at signaling information that something is wrong. The problem is we don't always do a great job listening or responding to those signals, myself included. We tend to explain shortness of breath or fatigue as I'm just getting older or I'm out of shape, brushing off symptoms that maybe really don't feel right, but explaining them away in some way that you don't undergo any further evaluation or just try to make yourself feel better. and I'm guilty of this same process, but I can tell you that after dealing with the end game of heart disease for so many years, that early recognition is really important. So I review these signs not out of fear, but really out of awareness, because early intervention is so important when we look at outcomes with heart disease. Now, just to give you a little broader contour of heart disease in general, there's basically three buckets that common heart problems occur in. The first is a fuel problem where there's blockages in the coronary arteries that supply the heart muscle themselves that limit nutrient and oxygen to the heart muscle itself. The second is valve issues, which is a structural or an architectural problem, and those valves can either be blocked or stenotic or leaking. And the third is electrical problems, slow heart rates, fast heart rates, irregular heart rates. All of these things can cause similar symptoms, and there's a lot of crossover between how these different buckets can present. And the idea today is not to make a diagnosis for you based on your symptoms, but just to raise a flag if these things are occurring so that you get further evaluation to figure out if you do in fact fall in one of those three categories. So let's jump into it. So to offer you a little closer view as to what may be going on with your heart that's causing specific symptoms, you need to understand basically what the heart is. And it's just a muscle, a muscle that, like any other muscle in our body, as it works, it requires blood and nutrients and oxygen. And the way that the heart muscle receives this is by the coronary arteries, which are small blood vessels that actually run on the surface of the heart, not inside the heart itself. And so what happens is, as you start to develop blockages or stenoses in those fuel lines, then the area below that blockage becomes starved of those things, the nutrients, the oxygen, and the blood flow. And then as you exert yourself, the symptoms tend to be exacerbated, or sometimes that's even how you uncover the early symptoms. As the blockage starts to develop, you notice that you used to be able to walk three miles, you can only walk a mile. As that blockage tends to progress, you can no longer climb a flight of stairs because you're outstripping the fuel for that portion of the blood of the heart muscle below the blockage. That pain, those symptoms, be it chest pain, shortness of breath, dizziness, whatever it may be, is referred to as cardiac angina. And it is a general term that's basically your heart's telling you that it's not getting what it needs. So before we jump into these 10 signs or symptoms, I want to be clear that this is only 10. There are many, many more signs and symptoms of heart disease, but I find that these are probably the 10 most common and the ones that are fairly easy for people to evaluate for themselves as well. But I don't want you to think that this is a finite list, and if your symptoms are not on this list, that you're not having cardiac angina or something related to the heart, these are a framework for you to work from. But I think that they'll be fairly encompassing for most symptomatic patients with heart disease. So let's jump into it. Number one is chest pain or discomfort in the chest. And this is really what most people are familiar with when it comes to cardiac angina or pain related to the heart. It's that pain typically just on the left or center of the chest feels like an elephant is sitting on your chest. Usually it's described as a pressure sensation, not as a sharp or sticking pain, feeling like you're actually being smothered. Many times people say it wasn't a pain at all. It was just very, very uncomfortable. So when should these symptoms worry you? Well, if these kind of symptoms are brought on with activity, in other words, you're stressing your heart muscle, the chest pain comes on, you sit down and you rest, and the chest pain is relieved, that is a red flag for cardiac angina and is worthy of evaluation. Now, as this progresses, if you were to start to have these symptoms at rest without provoking them with any type of exercise, that is truly a medical emergency. In other words, at rest, you've outstripped the blood supply to that portion of the heart muscle. You don't even have to exert yourself to bring the symptoms out. So even at rest, the symptoms come on that is a 911 phone call that needs to be evaluated immediately The other situation is what we refer to as stable angina In other words with predictable exercise or predictable exertion you're able to reproduce the symptoms almost every time. Also requires evaluation and should be done in a timely fashion, certainly by your family doctor, but almost always by a cardiologist as well. So the classic signs, chest pain, not foreign to most of us, but many times we don't recognize it as a problem because we will actually scale our lifestyle to prevent the pain from coming on. We don't take the stairs. We take the elevator. We park closer to the Walmart so that we can walk less distance. So we don't bring this pain on. So we scale our lifestyle. But recognize this chest discomfort, particularly if it's associated with exertion, and it requires evaluation. We would like to take a minute and thank our sponsor of this podcast episode, Function Health. Health isn't just what you see in the mirror. It's also what's happening inside your body. Knowing which biomarkers are in and especially out of range establishes your health baseline instead of guessing. Function Health is an all-in-one health platform that offers 160 plus lab tests ranging from heart health, hormones, early stage cancer detection, toxins, and vitamin deficiencies. Function offers five times more testing than the standard primary care panel. This level of blood work would normally cost thousands of dollars out of pocket, but with Function Health, it's a fraction of the cost. Scheduling is simple. With 2,000-plus lab locations across the U.S., and most visits last about 15 minutes. Once your results are ready, you will receive a clear, comprehensive summary from Function's clinical team. With real data, you can take action, retest over time, and track whether what you're doing is working. If you're interested in the blood panel my family and I get every six months, head to functionhealth.com slash London to sign up for less than a dollar a day. That's functionhealth.com slash London. Now let's get back to the podcast. So number two, shortness of breath. And I don't mean being winded after you've gone for a hard run or done a HIIT workout or something. I'm talking about shortness of breath with activities that typically had not brought on these symptoms previously. Walking up a flight of stairs, taking out your groceries, walking to the mailbox to get your mail. And this early breathlessness can be a sign that your heart is not pumping efficiently. Either the pump itself is not as strong or that actually you're not getting enough nutrient to the heart muscle itself to pump effectively. So even though this can easily be explained away because it's not formal chest pain, it can definitely be an important symptom that requires a response. The reason that you get this sensation of shortness of breath is that if your heart is not pumping effectively, then fluid backs up in your lungs. And that extra fluid actually prevents normal gas exchange of carbon dioxide that is normally carried out through the lungs and consequently you develop shortness of breath. So if your heart is not pumping effectively and you're not getting blood through this circuit, this closed circuit, then blood and fluid is actually backing up in your lungs and that causes the shortness of breath. Number three, arm or shoulder pain. Now we're taught classically that left arm pain is what you associate with heart problems. And that is certainly very common, but it doesn't have to be. It can be left arm, it can be right arm, it can be both arms, It can be pain between your shoulder blades. I even had one patient who presented with pain at the tip of her elbow. Every time she took the garbage out and when she came back and sat down, it went away. She saw orthopedist for months before someone actually recognized it as referred pain from her heart. The reason that this happens is because there are shared neural pathways from your heart and from the sensory nerves from your upper extremities. And sometimes when these actually cross, your brain can't tell the difference. So you get this referred type pain as a result of cardiac angina. But it's not one arm versus the other, and it doesn't have to be sharp pain. It can be dull pressure. It can come in many, many varieties. But just be aware that this can be the great masquerader when it comes to presentation with upper extremity or chest pain. Jaw and neck pain, and this one surprises many people, but it's not uncommon that we see patients with referred pain to one side of the jaw, both their jaws, or the back of their neck. And the reason is very similar to the upper extremity symptoms. There's crossover of these nerves. We see this more commonly in women, interestingly, but if unusual discomfort arises in these areas, it deserves evaluation. Number five, unusual fatigue. Now, I think this one is truly underappreciated because it's the easiest one to brush off. I'm just getting old. I'm out of shape, whatever the case may be. And when I'm talking about unusual fatigue, what I'm referring to is not I stayed up all night or I was traveling or what have you, but fatigue out of proportion to the activities. In other words, I went out to lunch and met a friend for a cup of coffee in the afternoon and I came home and I was so tired that I had to lay down for an hour. Like that feeling when you're getting a cold and you just feel like you're bone tired and you can't take another step. So fatigue, number one, that is extreme, but number two, that's out of proportion to your activity. Or number four, fatigue that is progressive over time, similar to the chest pain. In other words, I used to be able to walk three miles, but I make it about a mile and a half now and I get so short of breath that I have to sit down and catch my breath before I can go again. And this is also because it is shortness of breath and usually related to activity, this is a very easy one to scale. And I see patients doing it all the time. Well, how's your shortness of breath? Oh, it's not that bad. Well, how far are you walking? Well I not walking as far as fast as I used to Well why not Because I get short of breath So we create these scenarios for ourselves where we convince ourselves that the symptoms have gone away What we really done is just changed and scaled our lifestyle to accommodate these things. And that's very dangerous. And we're all subject to do this, myself included. I have done it. I can tell you. And listen to your body. When you see things that are out of proportion to how they've been, if you look back a month, two months, or six months ago. Pay attention to that, particularly with shortness of breath, because it can really be a subtle sign that there is some significant cardiac problem underlying. Number six is lightheadedness or a feeling of fainting or that you're about to black out. Now, this is number one, a scary thing, and you should respond to it as such, but it's interesting, many people don't. And it's the one scenario that really crosses all three of the buckets very specifically. Number one, it can mean that the heart is not pumping effectively because it doesn't have adequate fuel to supply it. So the blood flow is decreased. It can mean that a valve is blocked, particularly the aortic valve, and it's reached such a critical level that when you exert yourself even slightly, even if it's standing up out of a chair, you suddenly feel like you are going to black out. And that is a precursor of potential sudden death from aortic stenosis. So it can be this kind of soft symptom when you're going through it, but it's a really dangerous sign if you happen to have aortic stenosis. And the third reason is, of course, electrical. And that's if you're having a drop in your heart rate for some unclear reason or a rapid heart rate, both of those things can also cause this feeling of lightheadedness or dizziness. And so even though it's something that happens occasionally, you might stand up too quickly and you're like, oh my gosh, I'm lightheaded or dizzy, but it passes very quickly, probably not something to worry about. But if it becomes a persistent situation or it doesn't get better, then it's something that should absolutely be evaluated based on the multiple reasons that this could be. Number seven is cold sweats. And this is not sweating after a workout or you've sweat from a workout and now you're cold. This is that kind of weird, clammy feeling that you get maybe right before you get sick or after a fever is broken. When we're making rounds in the hospital and we walk into a room and we see a patient that's had this, we call it wet, not shower. They look just drenched and their color is terrible. This is typically a sign that the autonomic nervous system is under significant stress and that you're having this intense response because something significant is off in your body. And this can truly be a red flag that you need further evaluation for underlying cardiac problems. And so be aware of this feeling of impending doom and you break out in just inappropriate sweats, that it's something to pay attention to. Now, obviously, because this can occur with any stress response, it's most important if it is related to other things, the shortness of breath that we've discussed, chest discomfort, or progressive shortness of breath after a minimal activity. That's where it really becomes more of a red flag. But because it is a general response to stress and your fight or flight nervous system, I don't want to overstate this one that every time you get stressed or have a potential emotional situation and you break out into a sweat that you think it's your heart, it's typically when those things are associated with other heart-related symptoms that it really should put you in a mode of further investigation. We wanna take a minute and thank the sponsor of this podcast episode, Element. Now, hydration isn't just about drinking more water. It's about replacing what you lose. When you sweat from workouts, sauna sessions, or demanding jobs in the heat, you're not just losing water, you're losing electrolytes like sodium, potassium, and magnesium. That's why I choose Element as my electrolyte replacement of choice. Element's formula uses a science-backed ratio of sodium, potassium, and magnesium, and it truly tastes great. Electrolytes are used by every cell in your body, and even minimal dehydration can limit both cognitive and physical performance. Now, who benefits most from Element? If you exercise regularly, enjoy the sauna, or have a physically demanding job, replacing your electrolytes could make a difference. I mix a packet of Element, usually my favorite flavor, which is grapefruit salt, in 32 ounces of water before the gym or a run to ensure that I'm well hydrated. If you want to try Element for yourself, head to drinklmnt.com slash London, and you'll receive a sample pack of eight of their most popular flavors with any purchase. that's drinklmnt.com slash london and they offer a no questions asked refund policy so you can buy it try it and if you don't like it for any reason they'll give you a full refund now let's get back to the podcast number eight is nausea and vomiting and i know this sounds strange but yes your heart can make you feel like you have the flu if there's something wrong nausea vomiting even reflux type symptoms. Now, these symptoms are typically more common in women, what we call softer type symptoms, but they're actually the symptoms that I had when I had my heart issue. I had reflux symptoms. It's certainly not designated only to women, but it also depends on the location of the blockage or problem in the heart. Mine was on the back of the heart. That's more commonly associated with gastrointestinal-type symptoms. But the problem is that because it's not obviously cardiac in nature, these symptoms of nausea, vomiting, and flu-like symptoms can be brushed off as such, and there's actually a delay in diagnosis in many patients when it comes to their heart disease because they presented so differently. And this can be tough. It really requires some very specific questioning from a practitioner and a lot of intellectual honesty and appropriate history from the patient as well. That communication is really, really important to help delineate these things. Number nine is palpitations. Now, this is probably something that people worry about the most. The majority of palpitations are not dangerous The vast majority I going to say that again The vast majority of palpitations are not dangerous They are benign changes in heart rate, rhythm, or regularity that are self-limited and go away very quickly. So when should you worry about palpitations and heart rhythm problems? Well, number one, if you've never had them and they come on all of a sudden and they are persistent or become more and more regular over time, absolutely, that should be evaluated. Number two, if they're associated with other symptoms, chest pressure, chest pain, shortness of breath, radiating pain into the arms or the jaw, any of these things that we've talked about, If they're associated with those things, that also deserves investigation. And I want to go back to this persistent feeling like your heart is racing or irregular or abnormal because one of the most common diagnoses is atrial fibrillation, where the top part of the heart is beating very regularly and is transmitted in an irregular fashion to the lower chamber. So it becomes this very inefficient heartbeat. That typically is something that becomes more persistent with time. It's not just one or two episodes of feeling like your heart is racing. But because it is so common, if you feel like the frequency of the palpitations are either increasing or it is becoming persistent, it deserves evaluation to make sure that you don't have a primary rhythm problem. Number 10 is swelling in the legs, ankles, or abdomen. Now, obviously, legs can swell many different ways. You can get swelling in your body from injuries. Clearly, if you've sprained your ankle, it's not from heart disease. But when both legs are swollen or both feet are swollen or both calves are swollen and the abdomen is swelling, this is typically a sign that you need evaluation for potential heart failure. Now, what do I mean when I say heart failure? Well, this is in reference to the heart pump itself. What we're referring to is something called ejection fraction. In other words, how much of the blood is actually ejected from the heart with every heartbeat? Normal is around 65 to 70%. Well, when that is happening, then blood is moving normally through the circuit. Blood comes back, 65% to 70% of blood is pushed through, and that same amount of blood is brought back into the heart. Well, what happens is the heart muscle becomes weakened, whether it's from blockages from lack of nutrients or because there's been a blocked valve and it's been working against obstruction for a long time, or because there's been an inefficient heart rhythm and the heart is beginning to fail. The end result is this category of heart failure where the pump is just not pumping as strongly. So what happens is the fluid begins to build up. Well, why is it legs and ankles that we see at first? Well, that's the lowest point for gravity in our bodies, right? It's the bottom of the column. So when we're up and we're walking and we're doing things all day and our heart is not pumping efficiently, the ankles and legs will swell. Typically, patients will wake up in the morning and it won't look quite as bad, but they still remain swollen, again, because this is a primary pump problem. But I think that this goes very much in hand with the other discussions that we've had. You know, is this swelling associated with other symptoms, shortness of breath, early fatigability, all of these other signs and symptoms because none of these things happen in a vacuum. And again, when we're talking about heart failure as being the final common pathway of what happens with all these different types of heart disease, it's not surprising that if you really look closely at your course that got you to the leg swelling, these other things were signs and symptoms along the way. So it's important to keep all of this in context and to understand that evaluation is always the fail-safe if there's a question. If you're worried about it, then you need to be evaluated by a healthcare professional. I want to be clear on one specific critical action step. Because many of these things that we've talked about happen over the course of time. You have the latitude to think about it, to evaluate it. But if you or someone you're with or someone you care about is having ongoing crushing chest pain, whether it radiates into the jaw, the back, whether they have shortness of breath, all those things, but progressive tightness and pain in the chest that does not go away, that is a 911 phone call. Not to your friend, not to your spouse. You know, don't drive someone to the hospital yourself. Certainly don't drive yourself. But a 911 call to initiate EMS because treatment can actually begin in the ambulance on the way to the medical facility. And time is so critical when we talk about cardiac angina as well as saving cardiac muscle after a potential heart attack. So in closing, I want to circle back and recognize again that our bodies are incredibly intelligent at giving us signals. Number one, we have to be willing to listen to those signals. But listening to those signals is not enough. We have to respond to those signals because listening to them, yes, is important, but it's our actions that will ultimately determine the outcome. And acting early and early intervention when it comes to cardiac care, that's where the true wins occur. If you're listening to this point in the podcast, thank you so much for your time. I truly do appreciate it. If you enjoy this type of content, please check out our free newsletter. We'll leave the link below. If you're watching on YouTube, please like and subscribe. If you're listening on Spotify or Apple Podcasts, you can leave up to a five-star rating. And please follow along so that you get updates of future episodes. Thank you again, and I hope you guys have a great day.