Early Warning Signs

Contributed by: 

Dr. Harinder Bedi

Cardiovascular Disease (CVD) involving the coronary arteries of the heart will manifest as angina or chest pain once fully developed. Angina can be described as discomfort, heaviness, pressure, aching, burning, fullness, squeezing, or painful feeling in your left chest. It can be mistaken for indigestion or heartburn. The pain will, classically, be on the left side of the chest and radiate to the jaw and left arm. At times, it may be limited to the jaw. It may be accompanied by chest discomfort, shortness of breath, pain or discomfort in the jaw, neck, back, arm, or shoulder.

At times, the classic symptoms may not be present, especially in a patient with diabetes; the patient may just feel nauseous, light-headed, or unusually tired. So, if someone feels even vague discomfort, he/she must immediately see a local doctor and get an ECG. In doubtful cases, the doctor may get an urgent simple blood test (Trop T/I) which is available in most places in India, to confirm or rule out an impending heart attack.

What is CVD? 

• Involves coronary artery Manifests as angina or chest pain
• Classically on the left side of the chest, can radiate to the jaw and the left arm
• In diabetics, classic symptoms may not be seen. They may just feel nauseous, light-headed, or unusually tired.
• May be accompanied by chest discomfort, shortness of breath, pain or discomfort in the jaw, neck, back, arm, or shoulder

Early Warning signs and symptoms of heart disease

Heart disease is a deadly killer, but if detected early can be controlled. The early signs of heart disease to be looked for – by leading questions, if need be – by the primary treating doctor are described as follows. 

Chest Pain

Chest pain is discomfort or pain that your patient may feel along the left chest or anywhere between the neck and left upper abdomen. It is still the most common symptom of poor blood flow to the heart or a heart attack. This type of chest pain is called angina.

The intensity of the pain does not always relate to how severe the problem is.

Some patients may feel crushing pain, while others may feel only mild discomfort.

• The chest may feel heavy or like someone is squeezing the heart. The patient may also feel a sharp, burning pain in the chest.
• Patient may feel pain under the breastbone (sternum) or in the neck, left arm, stomach, left jaw, or upper back.
• Chest pain from angina often occurs with activity or emotion and goes away with rest or a medicine called sublingual Sorbitrate – this is quite diagnostic.
• Indigestion can also cause chest pain – but always do an ECG even if you suspect 'acidity'.

Women, older adults, and people with diabetes may have little or no chest pain. Some people have symptoms other than chest pain, such as:

• Fatigue
• Shortness of breath
• General weakness
• Change in skin colour or greyish pallor (episodes of change in skin colour associated with weakness)

Other symptoms of a heart attack can include:

• Extreme anxiety
• Fainting or loss of consciousness
• Lightheadedness or dizziness
• Nausea or vomiting
• Palpitations 
• Shortness of breath
• Sweating, which may be very heavy

Shortness of Breath

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

Your patient may notice shortness of breath:

• During activity
• While resting
• When lying flat on the back -- it may even wake him from sleep

Coughing or Wheezing

Coughing or wheezing that doesn't go away can be another sign that fluid is building up in your patient's lungs. He may also cough up mucus that is pink or bloody.

Swelling in the Legs, Ankles, or Feet

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

Your patient may also have swelling in the abdomen (ascites) or notice some weight gain. A heart patient will likely have an additional poor blood supply to the legs. This may lead to:

• Pain, achiness, fatigue, burning, or discomfort in the muscles of the feet, calves, or thighs.
• Symptoms that often appear during walking or exercise and go away after several minutes of rest.
• Numbness in the legs or feet when the patient is at rest. The legs may also feel cool to the touch, and the skin may look pale.

Fatigue

Tiredness can have many causes. Sometimes it simply means that your patient needs more rest. But feeling run down can be a sign of a more serious problem. Fatigue may be a sign of heart trouble when:

• The patient feels much more tired than normal. It's common for women to feel severely tired before or during a heart attack.
• The patient says he feels so tired that he cannot do his usual daily activities.

Fast or Uneven Heartbeat (Palpitations)

If the heart cannot pump blood as well, it may beat faster to try to keep up. A fast or uneven heartbeat can also be a sign of an arrhythmia. 

When Should Patients Call a Doctor

If the patient has any of the above signs of heart disease, he must call his health care provider immediately. He should not wait to see if the symptoms go away or dismiss them as nothing.

So – do tell your patients to call the local emergency number if:

• They have chest pain or any of the above other symptoms 
• He knows that he has angina and gets chest pain that doesn't go away after 5 minutes of rest or after taking nitroglycerine
• He becomes extremely short of breath