Some heart disease symptoms are easy to blow off.
Coronary artery disease (also known as coronary heart disease) is the most common type of heart disease; it kills about 370,000 U.S. people annually. “The most common complication of coronary artery disease is a heart attack,” says cardiologist Nieca Goldberg, MD, medical director at NYU Langone Health in New York.
Think you know all the basic heart disease warning signs? Don’t count on it. In a survey of 72,000 people conducted by the Centers for Disease Control and Prevention (CDC), 92% of respondents recognized chest pain as a symptom of a heart attack, but only 27% were aware of all major symptoms.
Symptoms of heart disease can be subtle and so it’s important to know what the full range of heart disease warning signs can look like, as well as your personal risk factors for heart disease.
What Is Coronary Artery Disease?
“Coronary artery disease is essentially an accumulation of cholesterol (plaque) within the arteries that supply blood to your heart,” says Satjit Bhusri, MD, a cardiologist at Lenox Hill Hospital. This accumulation of plaque is called atherosclerosis, and over time, it can harden or rupture. Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. If the plaque ruptures, a blood clot can form which can block blood flow and cause angina or a heart attack. (Follow these rules to lower high cholesterol levels.)
What Are the Signs and Symptoms of Coronary Artery Disease?
“Angina is basically a term we use to describe when patients have symptoms because there’s not enough blood supply to the area of the heart supplied by that artery,” says Michelle Weisfelner Bloom, MD, a cardiologist at Stony Brook University Medical Center. Angina may feel like pressure or squeezing in your chest. You also may feel it in your shoulders, arms, neck, jaw, or back. “You don’t always have to have chest pain in the center of your chest, it can occur anywhere above the waist, and sometimes it’s lower down. People think of it as a stomach ailment.” says Dr. Goldberg. Angina pain tends to get worse with physical activity and get better with rest. Emotional stress can also trigger angina pain.
Angina varies from person to person. Some people have chronic stable angina, which means they have plaque in their arteries and have symptoms, but the severity or the amount of symptoms hasn’t changed in years. “A patient may know that after they walk five blocks, they might have shortness of breath and have to stop, or they might have a little chest pain and they have to stop, but that’s stable for them,” says Dr. Bloom.
Then there are people who have unstable angina, where the quality of those symptoms have changed. “Maybe it’s more frequent, maybe it’s happening more days of the week, maybe it’s happening more times in a day. That’s a situation we need to take seriously, because we need to make sure that the blockages haven’t built up to a point where they need to be fixed,” says Dr. Bloom.
The symptoms of coronary artery disease can pop up in many different ways. People can have shortness of breath (outside of what they used to have or are used to having), heart palpitations, or a non-specific-type of pressure in their chest, says Dr. Bloom. “It doesn’t necessarily need to be something that they feel is chest pain.”
Who’s at Risk for Coronary Artery Disease?
The most common risk factors for heart disease are:
- Family history
- High blood pressure
- High cholesterol
- Lack of exercise
Learn more about the connection between diabetes and heart disease here.
Knowing your individual risk factors for heart disease is one of the most important steps you can take to prevent a heart attack or other cardiac issue. That’s because each risk factor you have worsens other risk factors you might have. So if you have two risk factors, your risk of heart disease increases fourfold, and if you have three or more risk factors, your risk increases more than tenfold.
“I always tell patients that you can’t control your family history, but you can control your diabetes, you can control your weight, you can control your cholesterol,” says Dr. Bloom. By changing your lifestyle, being on the right medication, and having good follow-up with your doctor, you have the power to delay, prevent, or even reverse coronary artery disease, she says. (These 7 heart-healthy lifestyle tweaks are a great place to start.)
Dr. Goldberg is a cardiologist and medical director of the NYU Langone Health Joan H. Tisch Center for Women’s Health.Satjit Bhusri
Dr. Bhusri is an attending cardiologist at the Lenox Hill Heart & Vascular Institute and an assistant professor of cardiology at Hofstra Northwell School of Medicine.Michelle Weisfelner Bloom
Dr. Bloom is an associate professor of medicine at Stony Brook University Medical Center, a fellow of the American College of Cardiology, and a fellow of the Heart Failure Society of America.
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Coronary artery disease is the most common
heart disease that we see in our country.
00:00:07,530 --> 00:00:12,063
The most common complication of coronary
artery disease is a heart attack.
00:00:12,063 --> 00:00:17,155
00:00:17,155 --> 00:00:22,043
So coronary artery disease is
essentially an accumulation of
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cholesterol within the arteries
that supply blood to your heart.
00:00:27,810 --> 00:00:30,460
Angina is basically a term
00:00:30,460 --> 00:00:35,420
that we use to describe when patients
have symptoms because there's not enough
00:00:35,420 --> 00:00:39,410
blood supply to the area of
the heart supplied by that artery.
00:00:39,410 --> 00:00:43,330
So, when we talk about coronary artery
disease, it really is a spectrum.
00:00:43,330 --> 00:00:45,840
There are people that live
a very long time, and
00:00:45,840 --> 00:00:49,640
they have those plaques in their arteries,
but they're stable.
00:00:49,640 --> 00:00:52,330
And we call that chronic stable angina,
00:00:52,330 --> 00:00:56,620
meaning that a patient may know
that after they walk five blocks,
00:00:56,620 --> 00:00:59,390
they might have shortness of breath,
and they might have to stop.
00:00:59,390 --> 00:01:01,810
Or they might have a little chest pain,
and they have to stop.
00:01:01,810 --> 00:01:05,980
But that's stable for them,
meaning that it's gone on for years.
00:01:05,980 --> 00:01:09,660
It hasn't changed in the amount
of symptoms that they have.
00:01:09,660 --> 00:01:12,160
Then there are people that
have unstable angina,
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where the quality of those
symptoms have changed.
00:01:14,630 --> 00:01:15,960
Maybe it's more frequent.
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Maybe it's happening
more days of the week.
00:01:18,130 --> 00:01:20,220
Maybe it's happening more times in a day.
00:01:20,220 --> 00:01:24,230
And that's a situation where we need to
take it seriously, because we need to make
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sure that the blockages haven't built up
to a point where they need to be fixed.
00:01:29,648 --> 00:01:33,410
Or the cholesterol ruptures, and you
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have a blood clot causing a heart attack.
When someone has coronary
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they may present in a lot different ways.
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People can just have shortness of breath,
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out of proportion to what they used to
have or what they are used to having.
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Somebody can have palpitations.
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Someone can just have a nonspecific
type of pressure in their chest.
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It doesn't necessarily need to
be something that they feel is
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You don't always have to have chest
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pain in the center of your chest,
It can occur anywhere above the waist, and
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sometimes it's lower down.
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And people think of it as a stomach
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One symptom that is commonly missed
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that people should be aware of is a sudden
decline in your exercise tolerance.
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Activities of daily living
become more of a battle for
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I started to get a little bit of mild
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pressure over here, It was so mild I just
thought maybe I had strained something at
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the gym, but it happened three days
in a row, didn't think much of it.
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But on the fourth day it happened
the same time into each of my runs,
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maybe 10 to 12 minutes into the run.
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And this time it was a little different in
that it actually radiated a little down
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the side of my arm into here and
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I had to go to somebody
The most common risk factors for
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heart disease are family history, high
blood pressure, high cholesterol, obesity,
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lack of exercise and diabetes.
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I always tell patients you can't control
your family history, but you can control
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your diabetes, you can control your
weight, you can control your cholesterol.
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So, there are many things that we
actually can reverse by just changing
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our lifestyles, and
being on the right medications, and
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having good followup with your doctor.
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Heart Disease Facts. Atlanta, GA. Centers for Disease Control and Prevention. (Accessed on February 10, 2021 at https://www.cdc.gov/heartdisease/facts.htm)Coronary Heart Disease. National Heart, Blood, and Lung Institute. (Accessed on February 10, 2021 at https://www.nhlbi.nih.gov/health-topics/coronary-heart-disease)