Most of us live busy routine lives. We wake up early in the morning to get ready to go to work. For those of us who have children, we have to get the children ready for school, after which we would ourselves rush to work.

Most of us work till late in the evening before returning home, feeling mentally and physically tired.

For some of us, work continues at home, getting the children to complete their school work and doing house chores before we retire to bed.

The following day, we go through it all again. The days fly past, and soon, we have lived busy routines for months and years.

Living this sort of busy life, we often forget to look after ourselves. Are we eating a healthy and balanced diet everyday? Or are we just stuffing any food into our tummies as long as we satisfy our hunger?

Are we working over lunch to complete our work so that it does not get brought home as “homework”?

All this brings upon dangerous stress.

In addition, we may be experiencing many symptoms from our bodies that we may ignore – probably because we feel that it is mild and we can still cope with it.

Only when the symptoms hamper our daily routines, do we take them seriously and seek medical attention.

Many of these symptoms, regardless of how subtle they may be, may point towards heart disease. Symptoms are usually mild to begin with, and if diagnosed early, the condition can be treated more effectively, thereby reducing the complications of the disease itself. There are 10 subtle symptoms of heart disease.

1 Feeling of extreme fatigue

Extreme fatigue is common at some point in our lives.

We tend to attribute this to recent situations, either staying up late to finish office projects or assignments, shifting house and attending to unpacking, mental stress of daily routines, or even ageing.

However, if the fatigue continues and worsens, it could mean that the heart is not able to pump enough oxygenated blood to the whole body to meet the body’s demands.

This could lead to experiencing early symptoms of a weak heart, i.e. heart failure.

If not diagnosed and treated early, the damage to the heart may be irreversible.

Heart failure may be due to coronary artery disease (clogging of arteries of the heart with cholesterol plaques), undiagnosed high blood pressure or heart valves that are not functioning optimally.

If you feel pain after walking a certain distance, which is relieved by rest, and recurs when walking again, this could be a symptom of peripheral artery disease – blockage of the leg arteries by cholesterol plaques. Photo: AFP

2 Swelling of the feet

There are many causes of swollen feet. Non-harmful causes may be linked to a sedentary lifestyle where the swelling of the feet is due to reduced circulation as a result of lack of walking.

Other causes may be due to varicose veins, a condition where the blood vessels of the legs are enlarged and tortuous, thus leading to fluid extravasation (leakage) into the surrounding tissues, giving rise to swelling of the legs and feet.

The danger is that this could be a sign of a weak heart. A weak heart will not be able to pump blood efficiently out to the surrounding organs. Blood tends to pool in the heart and gives a back-pressure to the veins, thus causing our legs or feet to swell.

3 Difficulty breathing

You may sleep on a single pillow and could gradually feel that one pillow is just not enough anymore.

You become short of breath sleeping on one pillow. This happens when water starts accumulating in your lungs.

You add another pillow to help you breathe easier. From then on, you start sleeping on two pillows.

In this situation, sleeping in an inclined position helps the water to pool at the base of the lungs, making breathing easier.

But why does water accumulate in our lungs? This is not due to an increase in water consumption, but rather, it may be due to either a weak heart, or damaged kidneys and liver.

Such sub-optimally (of less quality) functioning organs will not be able to handle water in the body efficiently, leading to water overload. Such excess water often accumulates in the lungs.

4 Feeling of one’s own heartbeat

You often feel your heart beat when you have been jogging or running for some time.

But sometimes you do feel your heartbeat racing when at rest.

Or you may feel that your heart has stopped beating for a few seconds before starting to beat again.

When such episodes are short-lived, you tend to ignore these symptoms.

Are these symptoms always harmless? Unfortunately, they are not.

Such racing heartbeats may be due to anaemia (lack of blood), low blood pressure, low blood sugar levels or abnormal heart rhythms.

These are all dangerous conditions. Early diagnosis and treatment ensure reduction in life-threatening complications from those conditions.

5 Dizzy spells

Dizziness is a common symptom. It does not denote a specific problem and its causes are many.

It may be related to anxiety, fatigue and lack of sleep.

However, it may also be due to serious conditions such as anaemia, low blood pressure (may be aggravated by change in body posture, e.g. standing up from a sitting position), low blood sugar levels and salt imbalances in our blood.

In addition, dizziness may denote abnormal heart rhythms.

All these conditions are linked to reduced oxygenated blood to our brain, thus leading to the dizzy spells.

Unless we get them checked, we should not attribute all dizziness to anxiety, fatigue or lack of sleep.

Dizziness due to abnormal heart rhythms may be a warning sign of cessation of normal heartbeats, which is a life-threatening condition. Unless investigated, this condition cannot be diagnosed.

Dizziness is a common symptom. It does not denote a specific problem and its causes are many. However, it may also be an indication of abnormal heart rhythms. Photo: dpa

6 Chest discomfort

We often hear of a close friend or relative who has passed away suddenly due to a massive heart attack.

Such heart attacks occur when the arteries of the heart get totally obstructed by blood clots and cholesterol plaques.

This causes sudden cessation of blood flow down that artery, and thus, the affected heart muscle dies due to lack of oxygen.

Heart attacks occur when the arteries of the heart get totally obstructed by blood clots and cholesterol plaques. Photo: AFP

The heart acts as a pump to send out blood that is rich in oxygen to all organs of the body.

The heart also receives blood rich in carbon dioxide and pumps it out to the lungs to get the blood oxygenated again.

Thus, a large area of heart muscle damage inevitably causes death due to pump failure.

Symptoms of chest discomfort could be a warning sign of a subsequent heart attack.

A typical chest discomfort due to blocked heart arteries occurs on exertion and is relieved at rest.

However, symptoms may not always be typical.

Although chest discomfort can also be due to many other causes, such as muscular disorders, gastrointestinal reflux disease (acid from the stomach reaching the oesophagus, throat or mouth) and anxiety disorders, this symptom must be investigated as heart attacks may be fatal.

Early diagnosis and treatment can reduce the risk of a heart attack.

In addition, patients with heart attacks who present themselves early to the hospital for treatment have much better survival outcomes compared to those who seek treatment late.

This is related to the larger area of heart muscle damage in the latter group of patients that confers a poorer outcome.

Moreover, heart muscles that are damaged do not regenerate. Thus, any heart muscle damage is permanent.

7 Episodes of anxiety, nausea, vomiting and profuse sweating

Although the above symptoms seem typical of a panic attack, it may not always be so.

Such symptoms in the absence of chest pain or chest discomfort may still be due to heart diseases involving blockage of the arteries of the heart.

Absence of chest pain in the presence of heart disease is often seen in women, the elderly and those who suffer from diabetes.

8 Pain in the legs when walking

We may feel extreme pain in our hips and legs when we walk a certain distance. This would make us stop walking to take a rest. The pain then gradually subsides and disappears altogether.

Then we continue to walk, only to feel the cramping pain again in our legs.

This is a symptom of peripheral artery disease – blockage of the leg arteries by cholesterol plaques.

This symptom is known as intermittent claudication (leg pain induced by exercise, usually due to obstruction of the arteries).

The walking distance needed to bring about this pain is known as the claudication distance.

It is well established that at least 50% of people with peripheral artery disease have blockage of their heart arteries as well, known as coronary artery disease.

Therefore, the symptom of intermittent claudication should prompt us to do a heart checkup, followed by treatment if necessary, to reduce the risk of a heart attack.

9 Jaw pain

Jaw pain is often linked to toothaches.

Dental problems such as tooth caries and gum infections may cause jaw pain.

However, if no such significant dental health problems are detected after a visit to a dentist, heart disease needs to be considered.

Many a time, jaw pain is the only symptom of coronary artery disease.

Nevertheless, it is usually thought to be a non-significant symptom.

Unless a visit is made to a doctor, the diagnosis of coronary artery disease may never be picked up early and a heart attack may ensue.

Jaw pain is often linked to toothaches. However, it could also be a sign of heart disease. Photo: 123rf.com

10 Upper back pain

Back pain is almost always linked to bone and muscle problems. However, upper back pain that is severe and persistent may be due to a tear of a major artery from the heart (known as aortic dissection). If treatment is not sought early, this condition is fatal.

Therefore, any severe back pain that is not relieved with painkillers needs to be evaluated further.

In conclusion, heart disease may not always be typical in its symptoms. Symptoms of heart disease vary among individuals.

In view of the dangerous and life-threatening nature of heart diseases, subtle symptoms, if they persist or worsen, need to be investigated.

A sound advice is to always consult your doctor to determine the cause of the symptoms that you are experiencing. Prevention is always better than cure.


Dr Sivarani Sathasivam is a consultant internal medicine physician and interventional cardiologist. This article is courtesy of Columbia Asia, Petaling Jaya. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.