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There are two major heart attack symptoms that everyone is aware of: sudden and severe chest pain that feels like a clenched fist and pain radiating down the arm. But it’s possible other warning signs may have cropped up on the way to that cardiovascular event, and not been recognized as heart failure.
“Unlike an actual heart attack, heart failure can happen gradually, and that’s why people often mistake the symptoms for something else, like indigestion or being out of shape,” says Robert Greenfield, M.D., cardiologist and medical director of non-invasive cardiology and cardiac rehabilitation at MemorialCare Heart & Vascular Institute at Orange Coast Medical Center in Fountain Valley, Calif. “But the longer you go without seeing these as signs of heart trouble, the more damage you may have over time.”
Sometimes called congestive heart failure, this condition occurs when there are problems associated with how the heart is pumping blood. That doesn’t mean your heart has suddenly stopped working. In some cases, the heart may not pump with enough force to deliver the blood into your circulatory system, and in other cases, not enough blood is getting into your heart so the amount pumped out is reduced. As symptoms worsen, emergency treatment may be required.
According to the National Heart, Lung, and Blood Institute, about 5.7 million people in the U.S. have heart failure, and it can affect both children and adults. Currently, there’s no cure, but treatments like lifestyle changes and medications can make a huge difference in terms of longevity and quality of life.
Like many conditions, the earlier you catch it, the better your outlook. Here are 10 signs that your ticker may not be operating the way it should.
You can’t seem to catch your breath.
Quick anatomy refresher: The heart and lungs are best pals when it comes to functionality, working together to make sure your body has oxygen-rich blood. The right side of the heart takes in blood that’s been depleted of oxygen and pumps it over to the lungs so it can get an oxygen refresh. Since heart failure affects how well this elegant system operates, shortness of breath is a major sign of trouble, says Dr. Greenfield. People will feel “air hunger,” meaning no matter how deeply you inhale, you don’t feel like you’re getting enough oxygen.
Exercise seems much harder than it should be.
The feeling of air hunger can happen at rest but it’s especially acute with exertion—even walking across a room can feel like too much effort. If you’re trying to get in an actual workout, increased activity raises your heart rate, which means it’s trying to pump faster and you could find yourself really gasping for air then. “People often think they’re just out of shape when they can’t catch their breath,” Dr. Greenfield says. “They think they need to get to the gym. But what they need is to get to the doctor.”
Lying down flat is a major problem.
When you lie down, some of the blood in your legs goes back into your bloodstream, and that creates an increased amount returning to the heart. Usually, the heart can compensate through its pumping mechanism. But with heart failure, it can’t keep up and that can cause more shortness of breath, says Dr. Greenfield. You can often find some relief through propping your head up, relieving the pressure on your lungs, which is why a cardiologist might ask how many pillows you use to avoid feeling winded.
Legs and feet swell up.
When your heart isn’t operating properly, it pumps less blood to your kidneys, and as a result, that organ compensates by retaining fluid. Most often, this shows up first in your lower extremities, according to Adriana Quinones-Camacho, M.D., cardiologist at NYU Langone Health in New York. Also called edema, this puffiness in your legs, arms, and feet tends to affect both sides, and causes stretched, shiny skin. It’s also a telltale sign of edema if you press a finger into the swelling and that indentation stays for several seconds.
You’re suddenly gaining weight.
The fluid buildup that may be in your legs can “back up” higher into the abdomen and arms. This rapid weight gain is often mistaken for fat accumulation, but it’s actually “water weight” from fluid retention, says Dr. Quinones-Camacho. This can happen suddenly, she adds, like seeing an additional five pounds over a few days, particularly in the belly.
…or having to pee much more often.
All that fluid you’re retaining has to go somewhere eventually. That’s when you may find yourself always having to pee, especially multiple times in the middle of the night. Sometimes, people brush this off as a sign of aging, says Dr. Quinones-Camacho, or drinking too much water close to bedtime. Unfortunately, some people try to correct the issue by cutting down on water intake during the day, but this can make fluid retention worse, since the body starts holding on to water in order to prevent dehydration. That cycle gets even uglier with heart failure because dehydration causes strain and increases your heart rate.
You’re tired all the time.
The way the body compensates during heart failure is to divert blood to vital organs, especially the brain, and channel it away from less-important areas like your muscles and limbs. That can lead to a feeling of weakness and fatigue, says Dr. Greenfield.
Nausea or lack of appetite have come out of nowhere.
Another area of the body the heart considers non-vital when there’s trouble? Your digestive system. With blood being diverted, your stomach and gastrointestinal tract are getting less blood, and that can slow their functions way down, Dr. Greenfield says. You might have a range of effects, including indigestion, lack of appetite, nausea, and constipation.
You’re lightheaded or feel confused often.
Even though the heart prioritizes brain function when there’s an issue, heart failure might be caused by a circulation issue, according to Dr. Greenfield. When that happens, not enough blood may be reaching your brain, and that can lead to symptoms like dizziness, mild disorientation, confusion, or even challenges with memory and concentration. In extreme cases, you may experience fainting.
And your hands and feet are always cold.
Multiple woolen layers of socks and mittens are doing nothing to help your icy feet and hands? That could be another symptom of a circulation issue, potentially brought on by heart failure. But this is the kind of sign that’s not enough on its own, Dr. Greenfield says, especially because it’s common for people to have colder hands and feet in general. However, if you experience this as well as several others on the list, they could all be connected.
It’s critical to see your doctor. Although there are certain tactics that can help address minor symptoms—prop your head up at night, drink more water, and don’t smoke—this isn’t an issue to try to tackle on your own.
“The sooner you can get your heart checked out, especially if your symptoms are more minor, the more chance you have to improve your heart function and avoid potential heart attack,” says Dr. Greenfield.
Of course, there are great heart-healthy lifestyle habits that will be invaluable for long-term change. But if you’re experiencing any of the symptoms listed here, it’s possible you may need short-term interventions, like medication, to make sure your heart gets back on track.