Would you be able to recognise all of the symptoms of heart disease? The doctors in the audience can put their hands down, this isn’t med school and you aren’t impressing anyone – especially as it appears that Joe and Jo Public hasn’t got the foggiest.
A survey commissioned by HeartFlow (opens in new tab), a new piece of diagnostic tech that helps doctors identify coronary artery disease, found that the public weren’t that familiar with 12 symptoms listed by the venerable NHS. Of the respondents, 26% didn’t even identify chest pain.
To be fair, one of the symptoms was listed as “pain, tightness, numbness or a burning sensation in the back,” which sounds a bit like the type of pain you can get from sitting at your desk all day. To get more detailed advice, Coach spoke to Dr Timothy Fairbairn, senior cardiologist at Liverpool Heart and Chest Hospital.
Fairbairn is keen to emphasise that it can be beneficial just to be aware of the symptoms and not hesitating to get anything alarming checked. “Any contact with the GP may be beneficial,” says Fairbairn, “even if the symptom doesn’t turn out to be heart-related. You can have a full heart MOT, and have your cholesterol and blood pressure checked. What we really want to do is trying to prevent these things from occurring, so getting a full check-up from your GP in terms of your cardiovascular risk factors is very important.”
Fairbairn’s top three symptoms of heart disease are chest pain or tightness, breathlessness, and palpitations, but keep reading if only to put your mind at ease. Turns out chest pain doesn’t automatically mean you’ve got a bum ticker…
We’re guessing chest pain is an obvious symptom of heart disease and you should see a GP quickly. Right?
The key thing to remember is that for the majority of people, chest pain won’t be because of the heart. However, for one in four it might well be the heart so everybody should be aware of the symptoms and take it seriously. But we don’t want people to suddenly panic – they should make an appointment to see their GP. The majority of people who come to get investigated with chest pains can actually be reassured it’s not their heart – it might be muscular, it might be heartburn, it might be something else and we can treat them appropriately.
About ten years ago the NHS did a big awareness drive, with the image of a middle-aged man with a belt around his chest. That chest tightness is the most important symptom.
Chest pain is the one that we worry about the most. It’s known as angina and it’s caused by a lack of blood flow to the heart – usually caused by furring up of the heart blood vessels – which can result eventually in a heart attack, and that’s something we obviously want to prevent. So first we diagnose whether someone has coronary heart disease, and then we try to get them on the right treatments so we can reduce the risk of any heart attacks.
The symptoms listed included pain, tightness, numbness or a burning sensation in the arms, jaw, neck, back and abdomen. That encompasses a lot, so when is it indicative of heart disease?
Typically the chest tightness associated with heart disease happens when people are doing things. If it’s occurring when you’re active, and then it goes away when you stop, that’s typical of an anginal type heart symptom.
If you get any other symptoms along with it, that increases the likelihood that it’s your heart. So if you feel sick, or sweaty, or the pain goes down your left arm and to your jaw, those are classic anginal type symptoms and that should be ringing warning bells.
The majority of back pain is musculoskeletal, and related to the fact that many of us sit in poor-quality chairs for long periods of time in front of computer screens. But if you’re getting back pain on exertion and it goes away when you’re resting, you should be thinking “this could be my heart”.
Heart palpitations were another major symptom. How would you describe that feeling?
A palpitation is normally what we describe as a fluttering sensation in your chest where you can feel your heart beating quite prominently. That usually means either you can feel your heart going very very fast or you can feel that it’s irregular – going all over the place, quite chaotic.
If you’re experiencing this ask yourself if your heart rate is going erratically fast inappropriately, ie not when you're exercising, or if it’s inappropriately high when you’re only doing a mild amount of exercise.
If you have a Fitbit or an Apple Watch or Garmin or other device that tracks the heart rate and show that it’s going extremely fast, that is helpful. And people should know their maximal age-predicted heart rate, so when they’re exercising they know where their heart rate should be going to.
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Is there a way to tell if you’re breathless because you’re unfit, or if it may be heart disease?
It is often useful to try to gauge what your symptoms are in relation to what you normally can do and what your peers can do. Often people will come in with symptoms and say they thought it was just part of the aging process. If you ask the husband or wife and they say, well they’re not keeping up the pace with me and I’m the same age, often that’s a tell-tale sign. You need to see what people of a similar age and maybe previously similar fitness are doing, and if things have changed you should seek some advice.
If someone is getting breathless and decides to improve their fitness, should they get a check-up first to be on the safe side?
If people are deciding to do competitive sports, particularly if they’re in middle age, then they should probably have a physical MOT. See their GP, have an ECG, have their heart listened to, have their blood pressure checked – nothing complicated. For the majority of young people, there’s no reason to suggest that that would be required. Most cardiac events during exercise are related to relatively rare, inherited cardiomyopathy conditions. The key thing with those is if you have a family history of someone having a sudden cardiac event or cardiac death, you should make sure you get an opinion from a doctor before you do any form of competitive sport.
How can you tell when heartburn is a symptom of heart disease?
Heartburn’s probably the one that’s the most difficult. It happens most commonly before meals or after meals – but we see that with angina as well. But if they feel they’re getting it because of exertion, that’s more of a red flag. That’s why people should go and get an opinion from a GP.
How about dizziness or light-headedness?
If you’re getting a bit light-headed when you’re standing up that’s most commonly due to low blood pressure and that’s not uncommon. People can do things to address that themselves, like making sure they’re staying hydrated. And if it doesn’t get better, getting an opinion from a GP would be sensible.
Dizziness or light-headedness on exertion depends on various things – your age and how hard you’re pushing yourself, for example. As you get older the potential for heart valve disease increases, so those kind of symptoms or fainting during exercise is more concerning.
Jonathan Shannon has been the editor of the Coach website since 2016, developing a wide-ranging experience of health and fitness. Jonathan took up running while editing Coach and has run a sub-40min 10K and 1hr 28min half marathon. His next ambition is to complete a marathon. He’s an advocate of cycling to work and is Coach’s e-bike reviewer, and not just because he lives up a bit of a hill. He also reviews fitness trackers and other workout gear.
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