Am I at risk of heart disease? And the most ignored symptom
A cardiologist reveals the warning signs of heart disease you shouldn't ignore, and the steps you can take to reduce your risk.
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A cardiologist reveals the warning signs of heart disease you shouldn't ignore, and the steps you can take to reduce your risk.
This week TV presenter Davina McCall revealed on her podcast, Begin Again that she has cardiovascular disease (CVD).
The 59-year-old said she wanted to encourage a more open conversation about the condition and warned women in particular not to dismiss possible symptoms.
"Heart attacks and cardiovascular disease is rife out there" she said. "Particularly in women post-menopause."
"If there's one takeaway today, it's not to brush things off."
It’s a warning echoed by Dr Gajen Sunthar Kanaganayagam, a consultant cardiologist in the private HCA Centre at The Harley Street Clinic, and at Imperial and Chelsea and Westminster NHS Hospitals in London.
“Heart disease is very common," he said: "And I often see patients over 60 who experience gradual or seemingly harmless symptoms, not realising anything is wrong until the disease has progressed significantly.”
“But there are definitely symptoms and risk factors they could have been looking out for, which might have avoided this happening,” he adds.
CHD is caused by a build-up of fatty deposits in the arteries, which restricts the flow of oxygen-rich blood to the heart muscle.
The term Cardiovascular Disease (CVD) is an umbrella term for all diseases of the heart and circulatory system, including CHD but also inherited conditions, as well as: atrial fibrillation, a heart rhythm disorder; heart failure, where the heart can’t pump blood effectively; heart valve disease, when one or more of the heart’s four valves don’t work correctly; and stroke, where blood supply to the brain is cut off, causing brain cells to become damaged.
Heart disease is sometimes referred to as a 'silent' killer because, in most cases, people may not realise they even have it until they have a heart attack or stroke. However, there are symptoms to look out for.
There are some people who will be hit with a heart attack out of the blue, and they won’t have too much in the way of a warning when something horrific happens, but this tends to be the exception rather than the rule,” stresses Dr Kanaganayagam.
"Most of the time in cardiology, there are warning signs. In addition, if you are proactive about getting some basic health checks done, such as cholesterol and blood pressure tests, you’ll be doing yourself a big favour, as those two things can be treated and controlled to reduce your risk.”
“I will always ask my new patients about breathlessness, dizziness, chest pain and especially how they feel during and after exertion,” says Dr Kanaganayagam.
“I’ll ask how they feel when climbing the stairs, and if they suddenly start sweating or feeling unwell. Symptoms related to exertion are really important and shouldn’t be ignored.”
Angina is caused by the heart muscle not getting enough oxygenated blood.
“The textbook angina symptom is a central chest tightness that becomes worse with exertion, and radiates up to the jaw and goes into the left arm,” says Dr Kanaganayagam.
“I’ve had patients tell me that they’d had pain in the left arm, but not in the chest, and therefore thought it couldn’t be related to the heart and vice versa, but that is obviously wrong. If you are getting any part of this, you should go and see a doctor.
“Atypical angina causes a stabbing pain, or a burning chest discomfort, and for a cardiologist this is also an alarm bell, especially if the patient has risk factors for heart disease, such as diabetes or high blood pressure.
“Sometimes, this type of discomfort can be mistaken for indigestion even. I had one patient in her 70s tell me that her chest pain felt like it was being caused by her bra being too tight, and this is something women often describe to us – a band-like tight sensation around the chest. This can be a tell-tale sign of a narrowing of the arteries caused by heart disease. All of these symptoms need checking out.”
The signs of a heart attack can include chest pain – a feeling of pressure, heaviness, tightness or squeezing across your chest. It is usually severe, but some people only have mild pain similar to indigestion, and they don’t realise they’ve had one. This is the so-called “silent heart attack”, says Dr Kanaganayagam.
“Sometimes in older patients with heart disease, they won’t get angina, but they’ll notice breathlessness and difficulty walking up a slope, or climbing up the stairs,” says Dr Kanaganayagam.
“This can also be due to another heart problem, such as a leaky heart valve, which is also much more common in older people, or heart failure, where the heart is unable to pump blood around the body properly.
“If this is a new symptom that you didn’t notice six months before, or if it is progressing, get it checked out. There are now excellent medications for heart failure, as well as surgical and non-surgical procedures to fix heart valve problems.”
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“In people age 75-plus, the commonest heart valve disorder is a condition called aortic stenosis, a severe narrowing in one of the valves of the heart,” says Dr Kanaganayagam.
“Symptoms of this include dizziness or feeling faint when walking, chest tightness and breathlessness. If you have any of these three symptoms, you should see your doctor. It’s easily diagnosable just by your doctor listening to your heart with a stethoscope.
"This should ideally be followed up with an echocardiogram, an ultrasound scan of the heart that uses soundwaves to create moving pictures of the heart showing its structure and function.
“Where aortic stenosis causes symptoms, and goes undiagnosed and untreated, 50% of people die within two years, so it’s a very serious condition. However, it is eminently treatable with valve replacement procedures that can be done using surgery, or minimally invasive techniques where a catheter is inserted into the leg. If aortic stenosis is spotted and treated early with a valve replacement, you can potentially save someone’s life.”
“Probably the most ignored symptom of heart disease in people over 60 is leg and ankle swelling,” says Dr Kanaganayagam.
“This can start as a very minor swelling of the feet, and then gradually progress up the leg. The way to test it is to press your thumb firmly down over your swollen ankle or shin for 10 seconds – if it leaves a dent, you may have peripheral oedema [fluid build-up in soft tissue], potentially a sign of heart failure or a valve problem.”
Dr Kanaganayagam stresses that everyone can get leg swelling after long flights or car/train journeys, but if the swelling persists for a few days, it needs checking out.
“If you notice a fluttering sensation in your chest [an irregular heart rhythm], a common thing we would be on the lookout for in the over-60s is a condition called atrial fibrillation [AF], which, unless it is managed, can lead to stroke,” says Dr Kanaganayagam. “Other symptoms of AF can include breathlessness and dizziness."
Treatments for atrial fibrillation include medication to control the heart rate, such as beta blockers, calcium channel blockers and digoxin, as well as procedures such as catheter ablation and cardioversion to restore a normal heartbeat.
“High blood pressure and raised cholesterol don’t usually have any symptoms, but they are very important risk factors for developing CVD,” says Emily McGrath, senior cardiac nurse with the British Heart Foundation.
“This is why it’s worth having regular check-ups with your GP, such as the NHS Health Check, which is offered in England to everyone aged 40 to 74 every five years unless you have a chronic health condition, in which case you should already be being monitored. You can also buy your own blood pressure monitor and check it regularly.
“Obviously, there are some risk factors you can’t change, such as your age, family history and ethnicity. However, you can introduced lifestyle changes such as eating healthier, doing enough physical activity to maintain a healthy weight, giving up smoking, drinking alcohol within safe limits, and managing stress.”
If you do have high blood pressure and raised cholesterol, medication can also help. Statins can reduce cholesterol, blood pressure pills such as ACE inhibitors can relax blood vessels, while beta blockers are often prescribed to slow the heart rate.
If you have diabetes, your risk of developing a heart attack increases by a multiple between two and four. Avoiding developing it, or losing weight to put it into remission, can help reduce your risks, as can medication to control your blood glucose levels.
“Diabetes causes the lining of the arteries to become unhealthy, so that any cholesterol in our bloodstream is much more likely to stick on the inside of the vessels, causing problems such as a narrowing of the arteries," explains Dr Kanaganayagam.
"It also increases the viscosity [stickiness] of the blood, which makes heart attacks and strokes more likely, Good control of blood sugar can help reduce this risk.”
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