HEART SYMPTOMS
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The five main symptoms which indicate that there may be an underlying problem with the heart are:
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Chest discomfort
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Breathlessness
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Ankle swelling
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Blackouts or near faints
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Palpitations​​​
​Please see below for a brief description of some underlying heart conditions that are associated with these symptoms.
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CHEST DISCOMFORT
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Chest discomfort / chest pain requires a thorough clinical assessment to correctly identify it’s cause as it can be a result of a variety of conditions, including heart disease. Heart disease causes a particular type of chest pain which is known as angina. This normally arises because of underlying coronary artery disease, which is the build-up of debris called plaque (known as atherosclerosis) in the wall of the blood vessels which supply the heart. When plaque builds up in the coronary artery it can result in a narrowing and insufficient blood supply to the heart muscle starving it of oxygen and nutrients which results in chest pain. This pain is made worse by exertion as this puts extra demand on the heart. In rarer cases, some people can suffer from angina due to other underlying conditions such as syndrome X or coronary artery spasm.
A heart attack occurs if a plaque ruptures and the fatty inflammatory material inside it is exposed to the blood stream. This can cause a clot to rapidly develop in the artery resulting in a complete blockage. This starves the heart muscle of vital oxygen and nutrients carrying blood. As a result the muscle then begins to die and emergency treatment is often required to restore the blood supply. A heart attack usually causes severe chest pain, tightness or indigestion, but may also cause breathlessness, sweating, nausea or make you feel extremely unwell. A heart attack is a life-threatening medical emergency that requires emergency treatment in a hospital so if you have severe chest pain or the above symptoms then you should contact your doctor immediately.
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There are some other Cardiac conditions that may mimic a classical heart attack including spontaneous coronary artery dissection (SCAD) and Takotsubo; these conditions also require emergency assessment and treatment in a hospital.
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Note that not all chest discomfort is due to heart disease and may not be serious.
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BREATHLESSNESS AND ANKLE SWELLING
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Breathlessness and swelling of the ankles may be related to fluid accumulations in the lungs and legs. These can be an indicator of an underlying heart problems including heart failure (when the heart becomes less efficient at pumping blood), disease of the heart valves, abnormal heart rhythms (arrhythmias) and angina equivalent (this is when breathlessness occurs instead of chest discomfort and is caused by an insufficient blood supply to the heart muscle).
Heart failure often causes breathlessness but may be picked up incidentally during other investigations and can be a result of a previous heart attack, a high blood pressure, diseases of the heart valves and cardiomyopathy.
PALPITATIONS AND BLACKOUTS OR NEAR FAINTS
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An abnormal heart rhythm (also known as an arrhythmia) may cause palpitations, dizziness, blackouts or near faints.
Palpitations are an awareness of ones heart beat. They are often harmless, but require investigation to exclude an underlying cardiac condition.
The commonest arrhythmia is atrial fibrillation which arises when the electrical activity within the heart chambers becomes chaotic causing the heart to beat at a fast and erratic rate. It’s important to identify and treat atrial fibrillation and a closely associated condition called atrial flutter as they cause a significant increase in the risk of having a stroke. Also, the heart can become less efficient at pumping blood causing heart failure.
​Blackouts or near faints can indicate a serious underlying heart problem including heart block, a slow rhythm abnormality, a narrowing of one of the heart valves known as aortic stenosis or long QT syndrome which can be inherited or acquired due to treatment with certain prescribed medications.