By Richard N. Fogoros, MD 

 Medically reviewed by Richard N. Fogoros, MD

There are many different kinds of heart disease, and while each can produce its own set of symptoms, there are some key ones that many types share. These frequent symptoms include chest pain or discomfort, palpitations, lightheadedness or dizziness, fainting, fatigue, and shortness of breath. However, sometimes heart disease has no symptoms at all, especially if it's in the early stages.

Frequent Symptoms

Here are some of the symptoms most frequently found in many types of heart disease:

Chest Pain or Discomfort

Few symptoms are more alarming than chest pain, and while many other conditions can cause chest pain, cardiac disease is so common—and so dangerous—that this symptom should never be dismissed or considered insignificant.

Chest pain is an imprecise term. It's often used to describe any pain, pressure, squeezing, choking, numbness, or other discomforts in the chest, neck, or upper abdomen, and it's often also associated with pain in the jaw, head, shoulders, or arms.

Depending on its cause, chest pain may last from less than a second to days or weeks; might occur frequently or rarely; and might occur completely randomly or under predictable circumstances. Sorting through these variations can help your healthcare provider determine the actual cause of your chest discomfort, in particular, whether it represents angina or some other serious problem.1

Palpitations

Noticeable differences in your heartbeat, whether that means it's rapid, unusually strong, or irregular, are classified as palpitations. They are an extremely common symptom of heart disease.

Many people who complain of palpitations describe them either as "skips" in the heartbeat (that is, a pause, often followed by a particularly strong beat) or as periods of rapid and/or irregular heartbeats.

Most people with palpitations have some type of cardiac arrhythmia, an abnormal heart rhythm. There are many types of arrhythmias, and almost all can cause palpitations. The most common causes of palpitations are premature atrial complexes (PACs), premature ventricular complexes (PVCs), episodes of atrial fibrillation, and episodes of supraventricular tachycardia (SVT).2

Unfortunately, on occasion, palpitations can signal a more dangerous heart arrhythmia, such as ventricular tachycardia.3 Palpitations are more likely to signal a serious cause if they're accompanied by episodes of lightheadedness or dizziness.

Lightheadedness or Dizziness

Episodes of lightheadedness or dizziness can have many causes including anemia (low blood count) and other blood disorders; dehydration; viral illnesses; prolonged bed rest; diabetes; thyroid disease; gastrointestinal disturbances; liver disease; kidney disease; vascular disease; neurological disorders; dysautonomias; vasovagal episodes; heart failure; and cardiac arrhythmias.

Because so many different conditions can produce these symptoms, if you experience episodes of lightheadedness or dizziness, you ought to have a thorough and complete examination by your healthcare provider.

Fatigue, Lethargy, or Daytime Sleepiness

Fatigue, lethargy, and somnolence (daytime sleepiness) are very common symptoms. Fatigue or lethargy can be thought of as tiredness, exhaustion, or loss of enthusiasm that makes it difficult to function at your normal level. Somnolence implies that you either crave sleep or, worse, that you find yourself suddenly asleep during the daytime, a condition known as narcolepsy.

While fatigue and lethargy can be symptoms of heart disease (particularly heart failure), these common and non-specific symptoms can also be due to disorders of virtually any other organ system in the body. If you suffer from fatigue or lethargy, you need a general medical evaluation in order to begin pinning down a specific cause.

Somnolence is often caused by nocturnal sleep disorders such as sleep apnea, restless leg syndrome, or insomnia. All these sleep disturbances, however, are more common if you have heart disease.

Dyspnea (Shortness of Breath)

Dyspnea, the medical term for shortness of breath, is most often a symptom of cardiac or pulmonary (lung) disorders. Heart failure and coronary artery disease frequently produce shortness of breath among other symptoms. If you have heart failure, you may commonly experience dyspnea with exertion, or orthopnea, which is dyspnea when lying flat. You may also suddenly wake up at night gasping for breath, a condition known as paroxysmal nocturnal dyspnea. Other cardiac conditions such as heart valve disease or pericardial disease can produce dyspnea, as can cardiac arrhythmias.4

Syncope (Fainting/Loss of Consciousness)

Syncope is a sudden and temporary loss of consciousness or fainting. It's a common symptom (most people pass out at least once in their lives) and often does not indicate a serious medical problem. However, sometimes syncope indicates a dangerous or even life-threatening condition, so it's important to figure out the cause.

The causes of syncope can be grouped into four major categories: neurologic, metabolic, vasomotor, and cardiac. Of these, only cardiac syncope carries a serious threat of causing sudden death.5 Vasomotor syncope, commonly called vasovagal syncope, is by far the most common cause. It happens when your body reacts to certain triggers such as severe emotional stress or seeing blood or needles. Neurologic and metabolic syncope are relatively rare.

Any loss of consciousness should be evaluated by a healthcare provider.

By Condition

These are the symptoms that are common to some of the major types of heart disease, including atherosclerotic disease, cardiac arrhythmias, heart valve disease, heart infections, and heart failure.

Atherosclerotic Disease

Atherosclerosis is caused by a buildup of plaque within blood vessels. Symptoms occur when the atherosclerotic plaques restrict blood flow to one or more of the body's vital organs, particularly the heart or the brain.6 Symptoms of atherosclerosis often include:

• Pain or discomfort in your chest, including tightness or pressure (angina)

• Shortness of breath (dyspnea)

• Numbness, weakness, coldness, or pain in your legs or arms

• Pain in your neck, jaw, back, upper abdomen, or throat

• Nausea

• Fatigue

Cardiac Arrhythmias

While many people with cardiac arrhythmias (abnormal heartbeats) have no symptoms whatsoever, any type of arrhythmia has the potential to produce palpitations, weakness, or lightheadedness.

Other symptoms can include:7

• Slow heartbeat (bradycardia)

• Fast heartbeat (tachycardia)

• Pain in your chest

• Shortness of breath

• Feeling dizzy

• Fainting (syncope)

Heart Valve Disease

Symptoms of heart valve disease depend on which of the four valves isn't working right, but they can include:8

• Shortness of breath

• Fatigue

• Irregular heartbeat

• Swollen feet or ankles

• Pain in your chest

• Fainting

Heart Infections

If you have an infection in your heart, symptoms may include:9

• Fever

• Chills

• Night sweats

• Shortness of breath

• Fatigue

• Weakness

• Swelling in your legs, feet, or abdomen

• Abnormal heartbeat

• Pain in the center or left side of your chest that often gets worse when you lie down or take a deep breath

• A dry cough that may be persistent

• Rash or strange spots

• Weight gain

Heart Failure

Heart failure occurs when the heart becomes unable to pump blood sufficiently to meet the body's needs. It is a consequence of many different types of heart disease. In its early stages heart failure may not produce any symptoms. As it gets worse, the most prominent symptoms are shortness of breath (dyspnea) when exerting yourself and/or when you're resting, becoming easily fatigued, and an irregular heartbeat that may feel fast or like it's pounding.10

Other symptoms can include:

• Swelling in your legs, ankles, and feet

• Feeling dizzy or lightheaded

• Fainting

• Weakness

• Fatigue

• Exercise intolerance

Complications

Potential complications of heart disease illustrate the importance of getting treatment and living a healthy lifestyle. They include:11

• Heart failure: One of the most common complications of heart disease, heart failure occurs when your heart becomes damaged and weak, leaving it unable to pump your blood the way it should. Heart failure can be the result of many different types of heart disease such as heart attack, coronary artery disease, high blood pressure, congenital heart defects, valve disorders, and heart infections.

• Heart attack: A blockage in one or more of your coronary arteries can cause a heart attack. Atherosclerotic disease is usually the culprit of this complication.

• Stroke: Also usually caused by atherosclerotic disease, a stroke occurs when the arteries to your brain are blocked and don't allow enough blood flow. This is an emergency because your brain tissue starts to die within minutes of this occurring.

• Sudden cardiac arrest: Often caused by a cardiac arrhythmia (abnormal heartbeat), sudden cardiac arrest happens when your heart stops working, causing you to lose consciousness and stop breathing. If you don't get emergency treatment, it will result in death.

When to See a Healthcare Provider

The symptoms most commonly caused by heart disease can also be produced by other medical conditions, from very serious to entirely benign. If you experience any of the above symptoms, you need an evaluation by your healthcare provider to identify the cause. These are symptoms that should never be ignored.

If you have a family history of heart disease or you're worried about your risk for developing it, be sure to talk to your healthcare provider. Staying proactive where your heart health is concerned can help you detect any problems early, giving you a better potential outcome.

When to Go to the Hospital

You need to seek emergency treatment if you have any of these symptoms:

Chest Pain

Chest pain should always be considered a serious symptom because it can indicate an emergency situation. If you're experiencing chest pain and any of these factors apply to you, you should seek emergency care:

• You have a strong family history of early heart disease.

• You're 45 years old or older and you have any of the risk factors for coronary artery disease, including obesity, smoking, family history, diabetes, high cholesterol, or a sedentary lifestyle.

• The pain is worse than any other chest pain you've had.

• The pain feels like it's spreading to your neck, shoulders, upper abdomen, arms, back, or jaws.

• The pain is crushing, tight, heavy, or feels like squeezing.

• You also feel nauseous, fatigued, weak, short of breath, dizzy, sweaty, or you've fainted.

• You feel like something is very wrong.

• The pain keeps getting worse as the minutes pass.

• The pain is unlike anything you've experienced before.

Heart Attack Symptoms

If you have symptoms of a heart attack, be sure to seek emergency medical care. These symptoms include:12

• Chest or arm pain, pressure, or discomfort that may spread to your neck, back, or jaw

• Shortness of breath

• Heartburn, indigestion, nausea, or pain in your abdomen

• Breaking out in a cold sweat

• Fatigue

• Feeling lightheaded or dizzy

Stroke Symptoms

If you have symptoms of a stroke, you need to seek emergency medical care. These include:13

• Difficulty speaking or difficulty understanding someone else when they're speaking

• Confusion

• Weakness

• Numbness or paralysis of your arms, face, or legs, usually on one side of your body

• Visual disturbances such as blurry, black, or double vision in one or both eyes

• Severe headache

• Dizziness and loss of coordination

• Fainting

• Difficulty breathing

If you're with a loved one and suspect he or she is having a stroke, use these measures to help you determine if there's a problem:14

• Ask your loved one to smile. If one side of his or her face droops, this can indicate a stroke.

• Ask your loved one to raise both arms. If one arm starts to fall down or he or she can't raise one arm, this is a sign of stroke.

• Have your loved one repeat a sentence back to you. Slurred or unusual speech is another symptom.

Call 911 immediately if any of the above symptoms occur. With a stroke, every minute counts. The longer your loved one goes without blood to his or her brain, the more damage there can be.

Sudden Cardiac Arrest

A sudden cardiac arrest is dramatic, happens fast, and can result in death if it's not treated immediately. If a loved one has these symptoms, call 911 right away:

• Collapsing suddenly

• No pulse

• Not breathing

• Unconscious

Sources

National Heart, Blood, and Lung Institute. Heart Attack.

American Heart Association. About Arrhythmia.

American Heart Association. Tachycardia: Fast Heart Rate.

Malik A, Brito D, Chhabra L. Congestive Heart Failure (CHF). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing

Koene RJ, Adkisson WO, Benditt DG. Syncope and the risk of sudden cardiac death: Evaluation, management, and prevention. J Arrhythm. 2017;33(6):533-544. doi:10.1016/j.joa.2017.07.005

American Heart Association. Atherosclerosis.

National Heat, Lung, and Blood Institute. Arrhythmia.

American Heart Association. Symptoms of Heart Valve Problems.

National Heart, Lung, and Blood Institute. Heart Inflammation.

National Heart, Lung, and Blood Institute. Heart Failure.

American Heart Association. What Is Cardiovascular Disease?

Cleveland Clinic. Early Signs of a Heart Attack.

American Heart Association. About Peripheral Artery Disease (PAD).

American Stroke Association. Stroke Symptoms.

Centers for Disease Control and Prevention. About heart disease.

Centers for Disease Control and Prevention. Women and heart disease.

By Richard N. Fogoros, MD
Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology.