11 silent signs of heart trouble you shouldn’t ignore

Is your heart healthy? In a 2015 study published in JAMA, eight out of 10 men and women with scarring on their heart muscle – evidence of a previous heart attack – had no clue their heart had been in danger. The name for this kind of heart trouble is silent myocardial infarction (SMI). One reason people may miss SMIs is that they don’t listen to what their heart is telling them. Here’s how to understand your heart’s language and figure out if you have an unhealthy heart.

If you usually run a couple of kilometres every day with ease but suddenly are overcome with a flu-like fatigue, that may be a sign your usually healthy heart is not pumping enough blood throughout your body. “Activities that used to be easy and now are suddenly met with new difficulty can be a red flag that something is wrong,” says Erin Michos, MD, associate professor of medicine and director of preventive cardiology at Johns Hopkins School of Medicine. If a good night’s sleep doesn’t fix your overwhelming exhaustion, make an appointment with your doctor right away.

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One of the classic signs of heart trouble is erectile dysfunction. Anxiety, depression and stress can also inhibit your ability to get intimate with your partner. But your bedroom troubles also could stem from blocked arteries, which prevent blood from flowing properly to your penis.

Vascular erectile dysfunction is the most common type of sexual dysfunction and is often caused by two kinds of diseases – atherosclerosis and endothelial dysfunction. Atherosclerosis causes the arteries to harden and narrow, causing heart attacks and strokes. Endothelial dysfunction prevents your blood vessels from relaxing properly, which decreases blood flow throughout your body. “Erectile dysfunction symptoms often precede the onset of heart symptoms by at least two years,” says Dr Michos. “The detection of erectile dysfunction offers a window to intervene and stop cardiac disease in its tracks.” Obesity, diabetes, high blood pressure or cholesterol, and lack of an exercise regimen also are risk factors for heart disease so see your doctor for regular check-ups to stay healthy.

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A healthy heart starts with normal blood pressure. A diagnosis of high blood pressure could increase your risk of heart attack, stroke, or heart disease. If you don’t lower those numbers, it could damage your arteries and cause plaque to build up around your artery walls down the line, which slowly blocks blood flow. When your blood is constantly pushing against your blood vessels at a high rate, it forces your heart and blood vessels to work harder and less efficiently.

“People intuitively think that they’re going to know that they have high blood pressure, but a lot of times that only comes when the blood pressure is remarkably high,” says Lawrence Phillips, MD, assistant professor in the Department of Medicine and director of the Nuclear Cardiology Laboratory at NYU Langone Medical Center in New York City. “I encourage everyone to get their blood pressure checked because blood pressure is one of the most modifiable risks.”

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While frequent coughing fits could be just another nasty cold, they also can be one of the signs of heart trouble. “Sometimes when there is fluid in the lungs from congestive heart failure, one can have wheezing and a cough, which can mimic asthma or lung disease when it really is a cardiac problem,” says Dr Michos. Fluid starts to accumulate in your lungs when your heart isn’t pumping blood properly, which backs up your blood vessels and causes fluid to leak into unusual places like your lungs. An unhealthy heart also could be the culprit behind chronic obstructive pulmonary disease, an umbrella term for progressive lung diseases that make it hard for you to breathe.

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Obstructive sleep apnoea often causes people to snore and stop breathing on and off while they sleep. This sleep condition has been linked to a higher risk of heart attacks or atrial fibrillation, a type of heart arrhythmia. As people with sleep apnoea sleep, their oxygen levels fall and their body panics and tells blood vessels to tighten up to increase oxygen flow to the heart and brain, causing breath to falter.

“You always have to think about your heart,” says Suzanne Steinbaum, DO, attending cardiologist and the director of Women’s Cardiovascular Prevention, Health, and Wellness at The Mount Sinai Hospital in New York City. “Go to your doctor and get checked. Get your blood pressure checked. Get blood tests and, under some circumstances, a stress test.” People with sleep apnoea are often also at risk for high blood pressure, another unhealthy heart symptom.

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Hairless legs could mean that your legs lack oxygen because your arteries are narrowed, which reduces your blood flow. Without that nutrient-rich blood, your hair follicles can’t grow. “With peripheral arterial disease (PAD), you can get hair loss or slow hair growth on the legs due to poor circulation,” says Dr Michos. To make sure you stay healthy, visit your doctor to get an accurate diagnosis for your hair loss.

If you notice that you’re having trouble squeezing your feet into your shoes or that your socks are a bit snug, it may be one of the signs that your heart isn’t healthy. When your heart isn’t pumping blood efficiently, your veins get backed up and end up pushing excess fluid into your body tissues, causing body parts like your feet, legs, abdomen, and even your scrotum to swell. If you feel swollen in unusual places, try pressing on your skin. If it leaves a pitted indent, like a dimple, in your skin, that means your tissues are harbouring excess fluid and you should see a doctor.

Most people assume that chest pain is the first sign of heart trouble, but the reality is that heart symptoms can manifest in other parts of the body. “Women compared to men are more likely to have these ‘atypical symptoms’ that can often lead to their heart pain being unrecognised and untreated,” says Dr. Michos. “It is important to know that warning signs of an unhealthy heart do not always manifest as chest pain.” The signs of heart attack in women can include nausea and fatigue, to name a few. Neck or jaw pain could also be a sign of angina, an underlying heart problem that occurs when your heart lacks oxygen-rich blood. Angina may feel like a constricted pressure or squeezing in your chest but could also radiate to other parts of your body like the neck, jaw, back, or shoulders.

If you find yourself running or climbing the stairs and feeling unusually winded, that’s usually one of the warning signs that your heart isn’t healthy. “The biggest thing I tell people first is to develop a knowledge of their own risk in their body,” says Dr Phillips. “They should know what’s normal for them so they can know when something is different from their normal.” Ask your doctor to conduct a thorough health evaluation. It’s best to be proactive about your heart health now and learn how to reduce your risk of a cardiac arrest in the future.

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