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Heart disease often develops over time. You may have early signs or symptoms long before you have serious heart problems. Or, you may not realize you are developing heart disease. The warning signs of heart disease may not be obvious. Also, not every person has the same symptoms.

Certain symptoms, such as chest pain, ankle swelling, and shortness of breath may be signals that something is wrong. Learning the warning signs can help you get treatment and help prevent a heart attack or stroke.

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Chest pain is discomfort or pain that you feel along the front of your body, between (and including) your neck and upper abdomen. There are many causes of chest pain that have nothing to do with your heart.

Chest pain can occur when the heart is not getting enough blood or oxygen. The amount and type of pain can vary from person to person. The intensity of the pain does not always relate to how severe the heart problem is.

When the heart can't pump blood as well as it should, blood backs up in the veins that go from the lungs to the heart. Fluid leaks into the lungs and causes shortness of breath. This is a symptom of heart failure.

Swelling (edema) in your lower legs is another sign of a heart problem. When your heart doesn't work as well, blood flow slows and backs up in the veins in your legs. This causes fluid to build up in your tissues.

Narrowing of the blood vessels that bring blood to other parts of the body is not the same as heart disease but it may mean you have a much higher risk for heart attack than you otherwise would. It can occur when cholesterol and other fatty material (plaque) build up on the walls of your arteries.

If your heart can't pump blood as well, it may beat faster to try to keep up. You may feel your heart racing or throbbing. A fast or uneven heartbeat can also be the sign of an arrhythmia. This is a problem with your heart rate or rhythm.

Morrow DA, de Lemos J. Stable ischemic heart disease. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 40.

Introduction: Chest pain in children is common, but rarely heralds serious underlying cardiac pathology. Despite this, the anxiety of missing a potentially life threatening condition creates a large burden of referrals and diagnostic testing. We evaluated patients diagnosed with 1 of 9 serious cardiac diseases and detailed the clinical signs and symptoms of the patients presenting with chest pain.

Methods: Patients diagnosed between the ages of 7 and 21 years from January 2000 to December 2009 at Children's Hospital Boston (CHB) were identified from a database using diagnostic and billing codes for aortic dissection, coronary anomalies, dilated cardiomyopathy, hypertrophic cardiomyopathy, myocarditis, pericarditis, pulmonary embolus, pulmonary hypertension, and Takayasu arteritis. Patients with previously diagnosed congenital or acquired heart disease were excluded.

Results: Four hundred eighty-four patients were included and 35% presented with chest pain. Forty-one (24%) of these patients with chest pain were diagnosed in the outpatient cardiology clinic, while the remaining 130 patients (76%) were diagnosed in the emergency department (ED) or inpatient setting. Coronary artery anomalies were the most common diagnosis made in cardiology clinic, and 16 of the 23 (70%) patients with serious coronary anomalies had exercise-induced chest pain. Patients presenting to the ED or inpatient units tended to have other important nonspecific symptoms (35-44%), high-risk past medical histories (12%), physical examination findings (32%), and electrocardiogram (ECG) abnormalities (78%) that heighten clinical suspicion of cardiac disease.

Conclusions: Identifying underlying cardiac pathology in the CHB outpatient cardiology department in patients presenting with chest pain is rare, with only 41 cases over a 10-year period. The presence of exertional chest pain was important in identifying patients with coronary artery anomalies. A detailed history and physical examination, along with a critical review of an ECG, seem to identify those patients with rare diseases who need further diagnostic testing.

Angina, also known as angina pectoris, is chest pain or discomfort that occurs when part of your heart muscle does not get enough oxygen-rich blood. It is a common symptom of coronary heart disease, which develops when the arteries of the heart become partially or totally blocked.

Angina pain can feel like pressure, squeezing, tightness, or burning in your chest. The discomfort can also spread to your shoulders, arms, neck, jaw, or back, just like a heart attack. Angina pain can even feel like an upset stomach. Symptoms can be different for women and men.

Angina is very common, affecting approximately 11 million people in the United States. There are several types of angina, and the symptoms may vary depending on which type you have. Angina pain, also called an angina event, can happen when your heart is working hard, or it can happen when you are at rest.

To diagnose angina, your healthcare provider will ask you about your symptoms and may order blood tests, take an X-ray image, and do tests, such as an electrocardiogram (ECG) or an exercise stress test, to find out how well your heart is working. With some types of angina, you may need emergency medical treatment to prevent or treat a heart attack. To help you manage your angina, your provider may talk to you about heart-healthy lifestyle changes, medicines, medical procedures, and cardiac rehabilitation.

In addition, the AHA report that Black Americans, Latinx Americans, Native Americans, Native Hawaiians, and some Asian Americans have increased risks of high blood pressure and dying of heart disease, compared with their white counterparts.

An under-diagnosed condition called coronary artery spasm, also known as Variant angina or Prinzmetal angina, causes chest pain for many people. Professor Colin Berry explains the condition to Senior Cardiac Nurse Emily McGrath.

INOCA stands for Ischaemia with Non-Obstructive Coronary Arteries. This means there is restricted blood flow to the heart, but this is not caused by fatty plaques blocking the coronary arteries. Coronary artery spasm is one of the conditions included under this umbrella term, another is microvascular angina.

An angiogram is used to give an X-ray image of the heart arteries, while a doctor injects a dose of a chemical called acetylcholine, which should cause blood vessels to relax. If the blood vessel instead constricts (vasospasm), we can diagnose coronary artery spasm.

It is treated with a calcium channel blocker such as verapamil or diltiazem. These drugs work by stopping calcium being absorbed into the muscle cells of your blood vessels, which has the effect of relaxing the blood vessels. ACE inhibitors and statins may also help blood vessel health.

We have recently carried out the BHF- funded Coronary Microvascular Angina (CorMicA) study. The study found that half of patients having a coronary angiogram do not have any blockages in their heart arteries.

Four out of five patients with angina and no blocked heart artery had coronary artery spasm or microvascular angina, or both. Of these, approximately 17 per cent have coronary artery spasm on its own.

A further 20 per cent have it combined with microvascular angina. So at least one in three of the patients with angina, but with no blockages, have coronary artery spasm. (The other affected patients have microvascular angina without coronary artery spasm.)

Trigger finger is a painful condition that makes your fingers or thumb catch or lock when you bend them. It can affect any finger or more than one finger at a time. You can also have it in both hands. You might hear it called stenosing tenosynovitis.

You should be able to move your finger just after surgery. Raising your hand above your heart can ease swelling and pain. Full recovery may take a few weeks, but swelling and stiffness may linger for 6 months.

Trigger finger is a condition that makes bending and straightening your finger difficult. The ring finger is most commonly affected, but you can get it in your thumb, too. You'll have the sensation of your finger locking or catching. That's because the tendon isn't moving freely. Rest, splints, exercises, and medicine can help. If your condition doesn't improve, your doctor might suggest surgery.

Dr. Torbati: Unfortunately, there is great crossover between the symptoms of panic attack and heart attack, making it very challenging to discern between the two without a physician assessment and testing, such as an EKG.

These shared symptoms of heart and panic attack may also be caused by other serious conditions such as blood clots, lung infection or collapse, or tear in the large vessels of the chest for patients with certain pre-existing risk factors. So when in doubt, seek immediate medical attention.

Dr. Torbati: Patients should immediately go to the ER if they have new onset chest pain (tightness, squeezing, heaviness), shortness of breath, sweating, lightheadedness, pain that radiates to the jaw or arm, or a ripping sensation in their chest or back.

The saying "time is muscle" refers to the importance of treating heart attacks immediately to reduce damage to the muscle of the heart. Delays in diagnosis and treating heart attacks can cause permanent heart damage, physical disability, or death.

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