What are the specific warning signs or symptoms that suggest the possibility of underlying heart disease?

Cardiovascular disease is the number one cause of death in both men and women in the United States. What complicates the matter is that the clinical presentation is not always the same between individuals. The three main symptoms to always keep in mind are chest pressure/discomfort, shortness of breath, especially with activity, and palpitations.

First, not all patients describe their chest syndrome as pain. The word pain can be misleading as most describe it more as a squeezing or pressure sensation. When this is present, it is important to relate it to the presence or absence of exertional symptoms. If one is experiencing chest discomfort with activity that improves with rest, this is concerning for underlying coronary artery disease. At this point, you will need to see a cardiologist for testing to rule out a significant stenosis in the arteries that feed the heart muscle.

Next, shortness of breath with exertion can also suggest a stenosis in the heart arteries but can also be seen with other cardiac problems such as significant valvular heart disease or heart failure. Associated symptoms may include swelling in the legs and/or abdomen and difficulty lying flat to sleep at night. The patient may describe having to sleep on an incline to avoid shortness of breath. In this case, the patient will also benefit from an echocardiogram to evaluate cardiac structure and function in addition to testing for coronary artery disease.

Finally, palpitations also often suggest an underlying cardiac diagnosis. This may be described as the sensation that the heart is skipping beats or fluttering. Some patients can also describe a rapid heartbeat that occurs intermittently. There are a host of arrhythmias that could be involved, with some also being associated with severe secondary cardiovascular issues. Specifically, atrial fibrillation or atrial flutter, especially in those with other underlying diagnoses such as diabetes and hypertension, can increase your risk for stroke. This needs to be diagnosed so that the appropriate medications can be started to lower the future risk for neurovascular events.

A patient can be screened initially with an EKG. Unfortunately, EKGs are often unhelpful if the patient is not actively having symptoms at the time of the tracing. Therefore, a Holter monitor or event recorder will often be ordered by a cardiologist to obtain data over a range of 24 hours to 30 days.

In summary, if the patient is experiencing chest pressure/discomfort, shortness of breath, or palpitations, especially with exertion, it is of utmost importance to get evaluated by a cardiovascular specialist. A host of underlying cardiovascular diagnoses may be contributing to symptoms and should not be ignored, given the high risk for morbidity and mortality associated with coronary artery disease and congestive heart failure.

Dr. Reza Ahmadian completed his Cardiology fellowship in San Antonio and served 11 years in the US Air Force, reaching Major. Born in Memphis, he joined the Stern Cardiovascular Foundation in 2019, specializing in General Cardiology and cardiac imaging. For more information or to schedule an appointment, visit Sterncardio.com or call 901.271.1000.

By Dr. Reza Ahmadian