If you are having a heart attack, symptoms are usually strong and will arise suddenly. Unfortunately, when it comes to heart failure, the symptoms aren't so obvious, and usually don't develop overnight. In fact, if your heart is failing, you might not experience any symptoms at all. One of the most important ways to take care of your heart health is simply knowing the signs and symptoms—whether they are incredibly subtle or extremely obvious.

1 You Are Having Difficulty Laying Down and Breathing Simultaneously

Shortness of breath while lying down or orthopnoea is one of the most common signs of heart failure. It can be described as having difficulty laying down and breathing simultaneously. "People with this condition often have to prop themselves up with pillows in order to sleep at night because when they lie flat they may feel like they are being suffocated or drowning," explains Monique May, MD, board-certified family physician in Memphis, TN. The symptoms can be so bad, it can cause them to wake up in the middle of the night and have to sit up. "If it is severe enough they may actually sleep sitting upright in a recliner," Dr. May continues. It can also manifest as a cough, caused by congestion of the small airways from fluid build-up in the lungs from a failing heart.

The Rx: "If you are having to use two or more pillows to prop your head up so that you can breathe and lie down at the same time, it may be a sign that your heart is failing and you should see a doctor immediately," suggests Dr. May.


2 Your Legs Are Swollen

If you notice that your legs are starting to look unusually swollen, it could be a sign of heart failure. "Essentially when the heart fails, it is not pumping blood," explains Matthew Mintz, MD, Internal Medicine and Primary Care Physician practicing in Bethesda, Maryland and Clinical Associate Professor of Medicine at The George Washington University School of Medicine. "This leads to a backup of blood in the circulatory system, which in turn causes fluid to seep out." This excess fluid usually follows gravity, so ankles and leg swelling are usually the first signs.

The Rx: If you are noticing your ankles or legs are starting to swell – or any other parts of your body for that matter – you should make a visit to your MD.


3 You Are Fatigued

Dr. Mintz points out that fatigue is another common symptom of heart failure, as your major organs and brain are getting less blood. While most of us are tired from time to time, the Mayo Clinic describes fatigue as "unrelenting exhaustion" that "lasts longer, is more profound and isn't relieved by rest." It's basically an almost constant state of weariness that develops over time and reduces your energy, motivation and concentration that can impact your emotional and psychological well-being.

The Rx: If you are feeling unusually tired and you are experiencing other of these symptoms, you should definitely make an appointment to see your physician ASAP.

4 You Are Having a High Blood Pressure

While patients with advanced heart failure can have low blood pressure, one of the causes of heart failure is changes in the heart as a result of constant high blood pressure, explains Dr. Mintz. The problem? "Most people don't feel any different when their blood pressure is elevated, which is why high blood pressure or hypertension is called 'the silent killer,'" he says.

The Rx: Make sure to regularly have your blood pressure checked. "This can be done at your doctor's office, local pharmacy, or even local fire department – as long as there is not a fire!" Dr. Mintz says.


5 Your Shoes Don't Fit

Just as your legs might swell, your ankles could too. "You might find that your shoes feel a little tighter or that your socks will leave a line on your ankles when you take them off at the end of the day," says Joyce M. Oen-Hsiao, MD, director of clinical cardiology for Yale Medicine.

The Rx: If you are concerned about any swelling in your body, you should have it checked out by an MD.


6 You Have Problem Catching Your Breath While Exercising

If you are generally physically active, and then all of a sudden you are having trouble catching your breath, it could be a signal of something more than overexertion. "People with advanced heart failure are short of breath all the time," Dr. Mintz says. "However, early signs of heart failure occur when shortness of breath occurs with increased activity or exercise."

The Rx: Pay attention to your breathing, especially during workouts. If you start to feel unusually breathless, call your MD.


7 Your Belly Hurts

As Dr. Mintz previous mentioned, heart failure leads to excess fluid. "While it usually goes to the legs, it can also go to the belly, which in turn causes abdominal pain," he explains.

The Rx: Because abdominal pain can signify so many health issues, always report it to your physician.


8 Your Kidney Malfunctions

Heart failure is often paired with other organ dysfunction, including kidney, says W. David Xu, MD, a cardiologist specializing in advanced heart failure at MedStar Health in Baltimore. According to the National Kidney Foundation, these can include fatigue, sleeplessness, dry itchy skin, an increased need to urinate, and seeing blood or foam in your urine. While other common signs include leg swelling and shortness of breath while walking upstairs (mentioned above), he points out that if the kidneys work very well, these signs can be masked.

The Rx: Not to be redundant, but make sure to make routine visits to your MD for regular check-ups. Your MD is more likely to catch silent symptoms if you actually make an appointment to meet with them.


9 Your Upper Back Hurts

If you are feeling unexpected strain in your upper back, pay attention! "Upper back pain without any history of an injury may be related to your heart" states Dr. Allen Conrad, BS, DC, CSCS of Montgomery County Chiropractic Centre. Muscle pain and spasm can cause back pain, but if you are feeling pain between your shoulder blades without an injury, your pain may be related to your heart.

The Rx: Get a stress test. "This will evaluate whether your heart is pumping correctly," Dr. Conrad points out. "They will monitor your blood pressure, and an EKG will monitor the rhythm and make sure there are no irregularities. If an irregular pattern is noted, then a cardiac catheter is recommended as a minimally invasive test that can determine if a coronary blockage is present, and if a stent is needed to open it."


10 You Rapidly Gain Weight

If you are unexpectedly gaining weight, it could be a sign that something is going on with your heart. "This can be due to fluid retention, which is a sign of heart failure," explains Christina Murray, MD, Medical Director OU Medicine Cardiology, Pulmonary & Vascular Medicine. "Generally, the weight gain happens quicker than it would if it was just related to calories."

The Rx: Pay attention to your body! Anytime you are rapidly gaining or losing weight you should always speak to your physician.

11 You Experience Shortness of Breath Walking Uphill

"Shortness of breath while walking uphill can be a sign of coronary heart disease," states Dr. Allen Conrad, BS, DC, CSCS of Montgomery County Chiropractic Centre. Exertional angina is an early sign of heart disease, where the coronary arteries have been clogged and restricting blood flow. When you are out of breath from walking uphill, it may be from the reduced blood flow from a blocked artery.

The Rx: In addition to paying attention to your breathing, consider making an appointment with your MD to have your heart checked out. "A cardiac stress test can mimic this activity while monitoring your heart, and determine if you have any irregularities," says Dr. Conrad.

12 You are Feeling Gas-Like Chest Pressure

According to Michelle Reed, DO, if you start to feel gas-like chest pressure, you should have it checked out. "This is exactly what happened to my friend this week at the age of 53 this weekend," Dr. Reed revealed. "On Tuesday she had a cardiac catheterization after experiencing having chest pressure that could feel like gas or reflux, dizziness, chest pain." Symptoms may come and go or last longer with each time that it occurs. Adds Dean Mitchell, MD, Clinical Assistant Professor at Touro College of Osteopathic Medicine and Board-certified Immunologist, "Too many people brush off symptoms of unstable angina or severe gastric reflux as heartburn."

The Rx: "Never ignore substernal chest pain," warns Dr. Mitchell.

13 You Are Feeling Calf Pain on Exertion

If you have a cardiac history, always pay attention to any pain you might be experiencing in your calves. "Intermittent claudication is a classic lower leg sign that you have poor heart circulation and could be the symptom that signals you are at risk for a heart attack," warns Dr. Mitchell.

The Rx: If you have experienced heart problems in the past, you need to be hypersensitive to all heart health symptoms and keep your MD on speed dial.

14 You are Experiencing Jaw Pain or a Toothache

If you suddenly notice that your jaw or teeth are hurting and you also have a headache, it could mean you are having a heart attack. "This is more common in women and usually, people would go to the dentist instead of a cardiologist," Ami Beniaminovitz, MD, multi board-certified cardiologist with Manhattan Cardiology explains. "The pain may only last a few minutes but unfortunately, it may keep returning."

The Rx: If you experience a combo of mouth pain and a headache, forgo the dentist and all your MD ASAP.

15 You Experience Chest Pain that Radiates to Your Back

Chest pain can be a warning sign of a heart attack. However, if you feel it radiating to your back, "like a knife," explains Dr. Beniaminovitz, it can be a dissecting aortic aneurysm that can be life-threatening.

The Rx: Again, pay attention to combination symptoms. If you feel anything out of the ordinary, always inform your physician.


16 You are Experiencing Nausea and Sweating

If you are feeling queasy and suddenly notice you are drenched in sweat, it could be a sign that you are experiencing a heart attack warns Steven Reisman, MD, a cardiologist at New York Cardiac Diagnostic Centre. "Usually a drenching sweat can also occur with chest pain," Dr. Reisman points out.

The Rx: While sweating and nausea can signal a variety of things, if you are noticing them combined with other symptoms, don't overlook them!


17 You are Feeling Discomfort in Your Left Arm

Because your heart is on the left side of your body, a common place you will experience pain if you are suffering a heart attack is in your left arm. "It can be described as numb feeling or at times discomfort starting in the chest area and 'shooting' down the left arm," explains Dr. Reisman.

The Rx: If you haven't pulled a muscle or injured your left arm and it starts to bother you, don't brush off the pain.


18 You Experience Loss of Consciousness or Fainting

If you lose consciousness or faint, it is possible you are in the midst of a heart attack. "This is known as 'syncope' can occur at times as secondary to arrhythmia or abnormal heart rhythm during a heart attack," says Dr. Reisman.

The Rx: It should go without saying that if you ever pass out or lose consciousness, you should contact your physician immediately.


19 You Notice Abnormal Heart Palpitations

Our hearts are capable of doing a lot without our even realising. We're often only aware of it if we've exerted ourselves and it's beating faster than usual. Sometimes, however, we feel unusual sensations in the form of heart palpitations or ectopic heart beats. "It can feel like a fluttering or pounding sensation, or even feel like a thud," explains Daniel Atkinson, MD, GP clinical lead Dr. Daniel Atkinson at Treated.com. "Palpitations occur when a person's heart rhythm becomes abnormal and they are aware of this. Sometimes it can happen and we remain unaware. It's usually due to a disturbance in the electrical pathways through the heart."

These disturbances can be caused by lifestyle triggers (such as consuming too much caffeine or alcohol, or smoking) or emotional triggers (feelings of anxiety and stress, or in serious instances a panic attack). Ectopic heartbeats occur when electrical signals tell our hearts to pump before they've had adequate time to fill with blood. "Both heart palpitations and ectopic beats are usually harmless if they occur very occasionally," explains Dr. Atkinson. However, if they begin to occur frequently it could be a sign of an underlying heart condition. "These may include problems with the valves, heart failure, heart disease or to do with the muscles and walls of the heart becoming enlarged or thickened," he adds.

The Rx: If you are experiencing any abnormal heart palpitations, Dr. Atkinson advises to make an appointment with your doctor. "You should also seek urgent medical care if you struggle to breathe, have a severe tightness or pain stemming from the chest, if you feel dizzy or light-headed or if you (or someone else) faints or blacks out," he adds.


20 You Don't Notice Anything

The scariest type of heart attack is the one you don't even know you are having. According to the CDC one out of every five heart attacks goes undetected. Basically, the damage of the heart attack is done, only the individual may have no idea.

The Rx: Stay diligent about your doctor's visits. If you are at an increased risk factor for heart disease, make sure to have a cardiologist on your care team. If you notice anything out of the ordinary, reach out to them immediately.

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