There are many different types of heart disease, and each can produce its own set of symptoms. But there are some key symptoms that are common to several kinds of cardiac disease. If you should experience any of these symptoms, you should seek medical help in evaluating them.
1. Chest Pain or Chest Discomfort
Few symptoms are more alarming than chest pain. In the minds of many people, chest pain equals heart pain. And while many other conditions can cause chest pain, cardiac disease is so common - and so dangerous - that the symptom of chest pain should never be dismissed out of hand as being insignificant.
"Chest pain" is an imprecise term. It is often used to describe any pain, pressure, squeezing, choking, numbness or any other discomfort in the chest, neck, or upper abdomen, and is often associated with pain in the jaw, head, or arms. It can last from less than a second to days or weeks, can occur frequently or rarely, and can occur sporadically or predictably. This kind of variability can make it challenging to determine when chest pain is actually signalling a serious problem - which is why you should get help from a medical professional if you have chest pain.
Palpitations, an unusual awareness of the heartbeat, is an extremely common symptom. Most people who complain of palpitations describe them either as "skips" in the heartbeat (that is, a pause, often followed by a particularly strong beat,) or as periods of rapid and/or irregular heartbeats.
Most people with palpitations have some type of cardiac arrhythmia -- abnormal heart rhythms. There are many types of arrhythmias, and almost all can cause palpitations, but the most common causes of palpitations are premature atrial complexes (PACs), premature ventricular complexes (PVCs), episodes of atrial fibrillation, and episodes of supraventricular tachycardia (SVT).
Unfortunately, on occasion, palpitations can signal a more dangerous heart arrhythmia, such as ventricular tachycardia.
3. Lightheadedness or Dizziness
Episodes of lightheadedness or dizziness can have many causes, including anemia (low blood count) and other blood disorders, dehydration, viral illnesses, prolonged bed rest, diabetes, thyroid disease, gastrointestinal disturbances, liver disease, kidney disease, vascular disease, neurological disorders, dysautonomias, vasovagal episodes, heart failure and cardiac arrhythmias. Because so many different conditions can produce these symptoms, anybody experiencing episodes of lightheadedness or dizziness ought to have a thorough and complete examination by a physician. And since disorders of so many organ systems can cause these symptoms, a good general internist or family doctor may be the best place to start.
4. Syncope (Fainting/Loss of Consciousness)
Syncope is a sudden and temporary loss of consciousness, or fainting. It is a common symptom - most people pass out at least once in their lives - and often does not indicate a serious medical problem. However, sometimes syncope indicates a dangerous or even life-threatening condition, so when syncope occurs it is important to figure out the cause.
The causes of syncope can be grouped into four major categories: neurologic, metabolic, vasomotor and cardiac. Of these, only cardiac syncope commonly leads to sudden death.
Vasomotor Syncope, by far the most common cause of this symptom.
5. Fatigue, Lethargy or Daytime Sleepiness
Fatigue, lethargy or somnolence (daytime sleepiness) are very common symptoms. Fatigue or lethargy can be thought of as an inability to continue functioning at one's normal levels. Somnolence implies, in addition, that one either craves sleep - or worse, finds oneself suddenly asleep, a condition known as narcolepsy - during the daytime.
While fatigue and lethargy can be symptoms of heart disease (particularly, of heart failure), these common and non-specific symptoms can also be due to disorders of virtually any other organ system in the body. Similar to lightheadedness and dizziness, individuals with fatigue and lethargy need a good general medical evaluation in order to begin pinning down a specific cause.
Somnolence is often caused by nocturnal sleep disorders such as sleep apnea, restless leg syndrome or insomnia. All these sleep disturbances, however, are more common in patients with heart disease.
6. Shortness of Breath
Shortness of breath is most often a symptom of cardiac or pulmonary (lung) disorders. Heart failure and coronary artery disease frequently produce shortness of breath. Patients with heart failure commonly experience shortness of breath with exertion, or when lying flat on their backs. They also can suddenly wake up at night gasping for breath, a condition known as paroxysmal nocturnal dyspnea. Other cardiac conditions such as valvular heart disease or pericardial disease can produce this symptom, as can cardiac arrhythmias.
Numerous lung conditions can produce shortness of breath including asthma, emphysema, bronchitis, pneumonia, or pleural effusion (a fluid accumulation between the lung and chest wall).
Shortness of breath is almost always a sign of a significant medical problem, and should always be evaluated by a doctor.
Svavarsdóttir AE, Jónasson MR, Gudmundsson GH, Fjeldsted K. Chest pain in family practice. Diagnosis and long-term outcome in a community setting. Can Fam Physician 1996; 42:1122.
Zimetbaum P, Josephson ME. Evaluation of patients with palpitations. N Engl J Med 1998; 338:1369.
Neuhauser HK, Radtke A, von Brevern M, et al. Burden of dizziness and vertigo in the community. Arch Intern Med 2008; 168:2118.
Task Force for the Diagnosis and Management of Syncope, European Society of Cardiology (ESC), European Heart Rhythm Association (EHRA), et al. Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J 2009; 30:2631.