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Early Signs of Heart Disease

Early signs of heart disease can vary from person to person. However, it is important to recognize them as quickly as possible to receive early intervention and treatment. Some symptoms, such as chest pain, pain radiating down your arm, and chest pressure, are more easily recognized as heart disease. Other symptoms, such as digestive symptoms, fatigue, and difficulty sleeping, are more difficult to recognize as being associated with heart disease.

If you are currently experiencing symptoms that are associated with heart disease or think you may be having a heart attack, seek emergency care. It is critical to receive treatment as early as possible.

Understanding Heart Disease

According to data from the Centers for Disease Control and Prevention, heart disease is the leading cause of death in the U.S. for men and women and for people of most racial and ethnic groups. About one in every five deaths in 2021 was attributed to heart disease.

The World Health Organization reports that cardiovascular disease is the leading cause of death worldwide. Approximately 17.9 million people die from cardiovascular disease each year.

Heart disease encompasses arrhythmias, heart failure, valve disease, congenital heart disease, and coronary artery disease.

The heart is a four-chambered pump that delivers oxygen and nutrients to the body. Blood is collected and pumped throughout the body by the two upper chambers (atria) and the two lower chambers (ventricles). The left side of the heart pumps oxygenated blood to the body, while the right side pumps deoxygenated blood to the lungs for oxygenation.

When the heart’s muscular pump weakens or loses efficiency, it can cause heart failure. Heart failure is most often caused by cardiomyopathy, which is an abnormality in the heart muscle. Dilated cardiomyopathy, the most common form, occurs when the left ventricular muscle becomes stretched and thins, reducing its ability to pump blood.

Heart attacks, coronary artery disease, hypertension, congenital heart disease, valvular disorders, and endocarditis are all potential causes of heart failure.

If the heart cannot adequately pump blood, excess fluid accumulates in the lungs, abdomen, and lower extremities.

The sino-atrial (SA) node comprises specialized cells in the right atrium. The SA node sets a rhythmic pace for heart contraction. The heart rate varies based on demand. From the SA node, the electrical impulse travels to the AV node at the junction of the right atrium and ventricle. The impulse is slightly delayed at the AV node, allowing time for the atria to contract and the ventricles to fill with blood. Ventricular contraction follows this.

Abnormalities in the heart’s rhythm are called arrhythmias. Tachycardia is a condition in which the heart beats too quickly. Bradycardia occurs when the heart rate is too slow. An arrhythmia can cause some people to feel a racing, pounding, or irregular heartbeat in their chest. Sudden cardiac arrest is due to an electrical problem in the heart.

Blood vessels carrying oxygenated blood supply heart muscle with oxygen and nutrients. When cholesterol and fat (plaque) build up in the inner wall of these coronary blood vessels, the lumen of these vessels narrows, decreasing blood flow to the heart muscle. If a blood clot forms in the narrowed vessel, it can cause a heart attack.

Risk factors for coronary heart disease, such as smoking, high blood pressure, high cholesterol, and diabetes, can increase your risk of coronary heart disease and heart attack.

A graphic of a clogged heart blood vessel.

Warning Signs of Heart Disease

Many people envision a heart attack as crushing chest pain with shortness of breath, weakness, sweating, and pain in the left arm, shoulder, or jaw. While these are classic symptoms of heart disease, they are not found in all people having a heart attack, especially women. Women often develop symptoms of heart disease later in the disease process, 7 to 10 years later in life, and their symptoms are more non-specific.1

In fact, about one in every five heart attacks is silent. This means that heart muscle damage occurs without you even being aware.

Early signs of heart disease in men:

  • chest pain or discomfort
  • lightheadedness 
  • dizziness
  • palpitations
  • fatigue
  • shortness of breath
  • fainting

Early signs of heart disease in women:

  • pain in the arm, neck, shoulder, jaw, or back
  • nausea or vomiting
  • indigestion
  • shortness of breath 
  • fatigue
  • breaking out in a cold sweat
  • sleep disturbances
  • lightheadedness

Chest Pain

Chest pain or discomfort is a common symptom of heart disease for both men and women. The pain location may vary. Many people describe the pain as a sense of discomfort, pressure, fullness, or a squeezing pain.

Chest pain is found in many medical conditions, but it should always be taken seriously because the quicker you seek medical care for heart disease, the more quickly blood flow can be restored to your heart muscle, and the less heart muscle you may lose.

Shortness of Breath

Shortness of breath can indicate insufficient blood is pumped into the lungs to be oxygenated and then distributed to the body cells. Excess fluid can collect in the lungs when the heart does not pump effectively. This makes it difficult for oxygen to diffuse from the inhaled air into capillaries in the lungs.

Shortness of breath when doing moderate exertion, such as climbing a flight of stairs that did not cause symptoms before, can be an early sign of heart disease. New onset shortness of breath or shortness of breath when lying down should also be evaluated.

Fatigue and Weakness

When your heart is not working efficiently, body cells may not get the optimal levels of nutrients and oxygen. This can cause fatigue and weakness.

Heart Palpitations

Heart palpitations are the sensation of having a fast beating, fluttering, or pounding heartbeat. You may experience a flip-flopping sensation. Palpitations can be normal and harmless or caused by temporary triggers such as caffeine, stimulants, or environmental stressors. They may also be an indicator of heart disease.


Decreased blood flow to the brain can cause dizziness and lightheadedness. Many forms of heart disease, including heart attacks and palpitations, can decrease the heart’s ability to pump blood.

When your heart is beating too slow, it can decrease blood flow to the brain, but it can also occur when the heart is beating too fast. Excessively fast heartbeats can mean the heart does not have enough time to fill before it is pumped from the heart.


When the heart does not pump effectively, fluid collects in the abdomen, lungs, and lower extremities. This is called edema. More fluid leaves the blood vessels and enters the body tissue, collecting in the feet and ankles.

A personal medical history form

Common Risk Factors for Heart Disease

For most medical conditions, both modifiable and unmodifiable risk factors contribute.

Non-modifiable Risk Factors

Non-modifiable risk factors for heart disease include:

  • Older age
  • Sex: Men have a higher risk of heart disease earlier in life
  • Heredity: A family history of heart disease can increase your risk for heart disease

Family history and genetic factors are important to recognize because even though you cannot change them, it is important to know your history to evaluate your heart disease risk.

Some risk factors for heart disease are secondary to lifestyle choices. Modifying these risk factors can reduce your risk for heart disease and improve your overall health.

High Blood Pressure

Blood pressure is the force blood places on the inner walls of blood vessels. Systolic blood pressure is the upper number in blood pressure. It is measured when the heart is contracting. Diastolic blood pressure is the lower number and is measured when the heart relaxes.

Systolic blood pressure increases more steeply in postmenopausal women than in men. This may be related to a decline in estrogen levels post-menopause. Isolated systolic high blood pressure is more common in women over the age of 75. It is an important risk factor for heart failure and strokes.

Moderate to high blood pressure is associated with more risk for blood vessel dysfunction and cardiovascular disease in women than in men.1

High Cholesterol Levels

High levels of low-density lipoproteins (LDL) cholesterol can increase the build-up of cholesterol and fats in the inner lining of blood vessels. This narrows the lumen of arteries and increases the risk that a blood clot may form in the blood vessel and increases the risk of a heart attack or stroke.

Increased cholesterol in blood vessel walls can decrease their flexibility, which increases the risk of high blood pressure.

Low levels of high-density lipoproteins (HDL) cholesterol or “good” cholesterol can reduce your body’s ability to remove LDL cholesterol from blood vessel walls.


Under age 50, smoking is a greater risk factor for heart disease in women than men. The risk increases proportionately to the number of cigarettes smoked each day. Smoking increases the risk of a first heart attack more in women than men. Whether smoking remains a higher risk factor for women over men after age 50 is unclear.1

Obesity and Lack of Physical Activity.

Obesity is a risk factor for heart disease and a risk factor for metabolic syndrome, diabetes mellitus, high blood pressure, and high cholesterol, which are also risk factors for heart disease.

Central obesity, organ fat in the abdomen, increases risk and is more common in men and postmenopausal women.1

Unhealthy Diet

An unhealthy diet high in sodium, processed foods, refined carbohydrates, and saturated fats can increase your heart and blood vessel disease risk. Excessive alcohol consumption is also linked to an increased risk of heart disease.

Diagnostic Tests for Heart Disease

Depending on your symptoms and risk factors, your doctor may suggest that you have diagnostic tests to evaluate your heart function and structure.

Electrocardiogram (ECG)

An electrocardiogram is a device that records the electrical activity in your heart. An ECG (also called EKG) is a quick test that can be conducted in your doctor’s office. It is used to diagnose arrhythmias or irregularities in heart rhythm.

Echocardiogram (ECHO)

An echocardiogram is a diagnostic imaging technique that utilizes sound waves to examine the heart’s structure. It can also measure blood flow through the chambers. An ECHO is used in diagnosing heart valve abnormalities, defects in the heart muscle wall between chambers, and cardiomyopathy.

Blood Test

Blood tests can measure heart biomarkers, indicating damage to heart muscle cells. Blood tests may also be used to assess your risk of heart disease. Commonly ordered screening tests include blood glucose and lipid panels, which may include cholesterol levels and lipoproteins.

Magnetic resonance imaging (MRI)

A magnetic resonance imaging machine is used to construct an image of the heart and the surrounding structures. These detailed scans can be used to diagnose various structural heart diseases.

Exercise Stress Test

An exercise stress test uses exercise on a treadmill or medications that increase heartbeat and make the heart work harder to evaluate its ability to respond to increased exercise or stress. It is used to evaluate coronary artery disease.

Coronary Angiography

A coronary angiography or a cardiac catheterization is a test to evaluate blood flow through blood vessels in your heart. A thin tube is threaded through a blood vessel and into the heart. Once in the heart, it can measure pressures in the blood vessels and heart chambers, detect narrowed or blocked blood vessels in the heart, and check the function of heart valves.

A doctor explaining heart disease to a patient

When to Seek Medical Evaluation

Heart disease is preventable. Schedule a medical evaluation if you have risk factors for heart disease. Your doctor will discuss your modifiable and unmodifiable risk factors and run tests to assess the current condition of your heart and blood vessels. Your doctor can help you learn your important heart disease risk numbers, including blood pressure, blood cholesterol, resting heart rate, and body fat percentage.

If you have a family history of heart disease, schedule an online appointment with a TelegraMD doctor on call to discuss your risk factors, receive an online diagnosis, and develop an individualized plan to reduce your risk. If appropriate, your TelegraMD doctor can transmit an online prescription to your local pharmacy for pickup or delivery.

Many people find they can avoid costly doctor visits through telehealth, especially if they do not have insurance and want to discuss their symptoms with a healthcare professional.

TelegraMD doctors are available 24 hours a day, so you can access help when you need it, but they are not an appropriate source of healthcare if you are currently experiencing symptoms you attribute to a potential heart attack.


While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.


1. Maas AH, Appelman YE. Gender differences in coronary heart disease. Neth Heart J. 2010 Dec;18(12):598-602. doi: 10.1007/s12471-010-0841-y. PMID: 21301622; PMCID: PMC3018605.

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