Features March 2016 Issue

The 4 Cardiovascular Symptoms You Should Never Ignore

These signs could indicate worsening heart disease or peripheral artery disease, or could signal that a heart attack or stroke is right around the corner.

Maintaining good cardiovascular health is about more than eating a healthy diet, exercising every day, quitting smoking and taking your medications as prescribed. It’s also essential that you respond appropriately to changes in your health, especially when those changes could indicate a problem with your heart or the rest of your vascular system.

heart EKG illustration


“When patients begin to experience symptoms such as chest pain, difficulty breathing, or lightheadedness, it would be prudent to seek a medical evaluation to determine if it is due to a cardiovascular or pulmonary cause, or to a less serious and benign cause,” says cardiologist David S. Majdalany, MD, director of the Adult and Congenital Heart Disease Center at Cleveland Clinic. “The earlier the detection, the prompter the therapy.”

He adds that evaluating symptoms sooner than later also reduces the risk of long-term complications if the symptoms are due to heart disease or other illness.

Dr. Majdalany outlines four cardiovascular symptoms­—chest pain, leg pain, shortness of breath and lightheadedness­—and why you should pay close attention to them. This is especially true if you have risk factors for cardiovascular disease, such as hypertension, high cholesterol, diabetes, advanced age or a personal or family history of cardiovascular problems.

1. Chest Pain

Tightness or pressure in your chest is a common sign of heart attack. But it can also be a sign that you’re at risk of a future heart attack because you have blockage in one or more coronary arteries.

“Chest pain can be due to multiple causes, such as blockages and narrowing in the heart arteries, which cause reduced blood flow to the heart muscle,” Dr. Majdalany says. “It can also be caused by inflammation of the lining of the heart or the heart muscle.”

Chest pain related to blockage in the coronary arteries is called angina, and is usually felt in the left side or the center of the chest, Dr. Majdalany explains. It may feel like a squeezing sensation. If it occurs only after exertion and subsides with a few minutes of rest or after using a nitroglycerin tablet or spray, it’s probably stable angina. If that feeling lasts longer, is more intense or comes and goes regardless of your activity, it’s likely unstable angina, a more serious health threat.

“Unstable angina is a medical emergency and the patient should be transported expeditiously to a hospital for cardiac therapy,” Dr. Majdalany says.

Other causes of chest pain can include inflammation of the lining of the lungs (pleuritis), blood clot in the lungs (pulmonary embolism), indigestion, abnormalities in the swallowing tube, inflammation of the chest cartilage (costochondritis), muscle or joint pain from trauma or inflammation, or abnormalities in the aorta, which is the large blood vessel that distributes the pumped blood from the heart to the body.

2. Leg Pain

Pain in your legs can be caused by muscle strain or joint problems, such as arthritis. But a serious circulation problem can also cause leg pain. It’s called peripheral artery disease (PAD), and refers to blockages that affect the blood vessels outside the heart and brain. The affected arteries are typically in the legs—usually the calf or thigh.

“Common symptoms include pain with activity that improves with rest, in contrast to pain related to arthritis, which may not get better with rest and can occur at variable times,” Dr. Majdalany explains. “Affected patients can have cold extremities, wounds that are not healing, ulcers, or gangrene. After medical evaluation and testing, therapy would depend on the severity of the disease.”

Untreated, PAD symptoms can worsen, making exercise or even just short walks difficult. Less physical activity can then lead to weight gain and numerous other health problems. Severe circulation restriction could even lead to gangrene or the loss of a limb.

Managing PAD would include lifestyle adjustments such as weight loss (if necessary), smoking cessation, and management of blood pressure, cholesterol and blood glucose levels.

“Supervised exercise programs, as well as antiplatelet agents, such as aspirin, have been beneficial,” Dr. Majdalany says. Medications such as cholesterol-lowering statins and cilostazol (a vasodilator that helps improves blood flow in narrowed arteries) can also be helpful in more serious cases.

If symptoms don’t improve, surgery or the placement of a stent in the narrowed peripheral artery may be necessary, Dr. Majdalany says.

3. Shortness of Breath

Difficulty in catching your breath can be caused by problems such as lung or heart disease, sleep apnea, obesity, and even just being in poor physical condition.

“People with shortness of breath should seek a medical evaluation to determine the cause, as well as appropriate treatment,” Dr. Majdalany says. “Besides a physical exam, common testing would include a chest X-ray, blood tests, and EKG (to measure the heart’s electrical activity), ultrsound imaging of the heart, and lung-function testing. Additional tests may be warranted as well, depending on the results of the initial tests.”

If you find yourself winded after activities you used to do without much effort, tell your doctor and get an evaluation soon. Shortness of breath is a common symptom of heart attack as well as heart failure.

4. Lightheadedness

Feeling lightheaded or dizzy can also be a sign of heart attack or heart failure. But it can also signify low blood pressure or any of several health conditions. But Dr. Majdalany emphasizes that it has many cardiovascular disease origins.

“It’s commonly related to fluctuations in blood presure, dehydration, rhythm problems, inner-ear/vestibular pathology, anxiety and neurologic problems,” he says. “Medical evaluation/physical examination is the first step in determining the cause and deciding on optimal testing and treatment.”

Dr. Majdalany adds that if you are being treated for high blood pressure, lightheadedness may result from a sudden decrease in your blood presure. Reducing the dose of the medication or choosing a different drug may solve the problem.

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