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Subtle Signs That You Have Heart Disease. Do You Know What They Are?

written by Dr. Christine Bishara - Jul 8, 2024

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Photo Credit: by

Cardiovascular disease remains a leading health concern worldwide. There are many causes of cardiovascular conditions, but in this article, we will focus on Coronary Artery Disease (CAD)-- the buildup of plaque in arteries supplying the heart, leading to reduced blood flow. This reduced flow can cause angina (chest pain) due to diminished oxygen to heart muscles or a heart attack– when a complete obstruction of an artery supplying the heart occurs.

Despite advances in medical treatment, coronary artery disease is still the leading cause of death in both males and females. Heart Disease Facts

Risk Factors:

There are numerous risk factors associated with CAD including a family history of heart disease, diet, stress, hyperlipidemia, smoking, and diabetes. Dietary and stress factors in my opinion should be addressed first and foremost since not only are they modifiable risk factors, but they can have big impacts on the reduction of CAD. We are also able to quantify how effective they can be by looking at certain populations where the incidence of heart disease is much lower than in the general population.

For example:

Dietary habits have long been linked to the development of heart disease and while heart disease runs in families, so do eating habits. Diets that incorporate processed foods, especially those containing seed oils such as canola, cottonseed, soybean, corn, and palm oil are just a few of the culprits. Processed foods and seed oils cause inflammation in the body which increases the risk of inflammation in the coronary arteries supplying the heart. Conversely, The Mediterranean Diet has been shown to decrease all-cause mortality by up to 50%--more than any medication on the market! Mediterranean Diet, Lifestyle Factors, and 10-year Mortality in Elderly European Men and Women. The HALE Project

Another example of the power of a healthy diet is seen in a study called the Human Microbiome Project which collected data on the microbiome of individuals in many nations worldwide. The study found that industrialized nations aren’t doing very well when it comes to CAD and health outcomes. The project looked at an interesting African tribe, called the Hadza tribe. This is one of the few remaining hunter-gatherer tribes. They eat mostly seasonal fruits and vegetables from their local environment with a small amount of animal protein from animals they hunt. Their diets change with the seasons. They have a very low incidence of heart disease and diabetes despite lacking access to medical care or healthcare facilities.

Chronic stress has also been shown to disrupt the balance of the gut microbiome and compromise the function of the gut barrier. What does this have to do with the heart? Inflammation within the gut can weaken the gut barrier, causing the inflammation to seep out into the bloodstream and deposit in the heart arteries. Over time, this inflammation hardens and turns into plaque–the stuff of which arterial occlusions are made. While stress increases the risk of heart disease, strong social connections seem to be protective against heart disease.

One example of the power of social connections on our heart health is from a 1960s study. You may have heard of the Roseto Effect before, but if you haven’t, it refers to a study done on a small town in Roseto, Pennsylvania. The town of Roseto, Pennsylvania caused researchers a great deal of confusion in the 1960s. Many of the townspeople smoked and ate diets high in fat, albeit, meals were made from fresh ingredients. Despite these risk factors, they had significantly lower rates of heart disease and tended to live longer than the national average. Researchers were baffled and spent some time studying what was affording the community members this extra protection and they eventually pinpointed what made Roseto different: the families who lived there had very strong social connections and close-knit communities. Many living in the community were Italian immigrants who frequently ate together and enjoyed many social activities with one another. This translated into a lower incidence of CAD.

The Roseto Effect has helped us understand that while diet is important, lower stress and strong social connections also play large roles in prevention.

What are the warning signs of CAD?

Remaining vigilant for signs and symptoms of heart disease is crucial for early detection and timely treatment. Heart disease often presents with a subtle warning. Those who are lucky present with symptoms before suffering a heart attack and can have interventions performed early. Many times, chest pain symptoms don’t always occur before a heart attack, but there are some other clues. Recognizing these clues and seeking medical attention can potentially save your life. The early warning signs of (CAD) include:

Chest pain (angina): This is the most common symptom and is usually felt as pressure, tightness, or squeezing in the chest, often brought on by physical exertion and relieved by rest. Many people will describe these symptoms as a “heaviness” present in their chest that isn’t affected by breathing or movement.

Shortness of breath: Difficulty breathing, especially during activity, can be an early sign of CAD as the heart struggles to pump blood effectively. Be especially mindful of these symptoms if you have diabetes which can numb nerve endings and make chest pain dull or not as obvious.

Fatigue: Feeling unusually tired or lacking energy without an obvious cause can be an indicator of reduced blood flow to the heart muscle.

Heart palpitations: Irregular, rapid, or pounding heartbeats may signal an underlying heart issue. Always let your doctor know if you have a new onset of these symptoms.

Swelling in legs/ankles (edema): Fluid buildup in the legs and ankles can occur when the heart doesn't pump blood efficiently.

Jaw pain or left shoulder pain: It's important to note that some individuals, especially women, have atypical or subtle symptoms like jaw or left shoulder pain. Back pain is also a symptom in women with heart disease and may sometimes be the only symptom. Any new onset pains that seem suspicious should not be ignored, as they may be signs of a heart blockage or impending heart attack. 6 Subtle But Serious Signs You Have A Heart Problem | HuffPost Life Heart Disease: Symptoms & Causes?


Preventive measures are always the best option when dealing with heart disease because they can significantly reduce the risk of developing it in the first place. Prevention allows individuals to avoid the complications, costs, and potentially life-threatening consequences of heart disease altogether.

We have mentioned diet and stress above, but here is a compilation of the most common factors–most of which can be modified:

1. Quit smoking and avoid secondhand smoke. Smoking is a major risk factor for CAD.

2. Eat a heart-healthy diet low in saturated and trans fats, high in fiber, and with plenty of fruits and vegetables. The Mediterranean diet is a great option. Avoid seed oils and processed foods.

3. Exercise regularly, aiming for at least 150 minutes of moderate activity per week. This comes out to roughly 20 minutes a day. Exercise does not have to be vigorous to be effective. Even walking daily can be a good option.

4. Maintain a healthy weight. Excess weight increases CAD risk.

5. Control blood pressure and cholesterol levels through lifestyle changes and medication if needed.

6. Manage stress through techniques like meditation, yoga, or counseling. Increase social connections.

7. If you have diabetes, keep blood sugar well-controlled to reduce CAD risk.


Lifestyle changes as discussed are often the first line of defense, as these can help manage symptoms and reduce risk. If these aren’t adequate to manage one’s risk factors, medications are commonly prescribed as a secondary treatment option.


Blood pressure control: Beta blockers and Calcium Channel Blockers can help control blood pressure and minimize the load on the heart.

Decreasing risk of clots and inflammation in arteries: A baby aspirin has also been shown to thin the blood in those who are high risk and can be a good preventive option.

Maintaining healthy cholesterol levels: Diet should be the first option for this but some people, especially those who have strong family histories of hyperlipidemia may benefit from cholesterol-lowering medications. Niacin and statins are the most commonly used.

Surgical or Interventional Procedures:

In patients who have been diagnosed with blocked coronary arteries, surgical or interventional procedures may be needed. These can include:

● Angioplasty and stenting to open blocked arteries

● Coronary artery bypass surgery to reroute blood flow around blockages

● Valve repair or replacement for valve diseases if these are present

● Pacemakers or defibrillators for arrhythmias

The Impact of COVID-19 On The Heart

The role of COVID-19 in exacerbating certain heart-related issues has been an active area of research and investigation. What is known to date is it can have a significant impact on the heart and cardiovascular system. The virus can directly infect and damage the heart muscle, leading to conditions like myocarditis (inflammation of the heart muscle) and cardiomyopathy (heart muscle disorder affecting pumping ability). It can also cause inflammation of blood vessels, leading to blood clots and reduced blood flow to the heart, increasing the risk of heart attacks and strokes. Additionally, the body's excessive immune response to the virus, known as a "cytokine storm," can further damage the heart and other organs. Long-term studies have shown an increased risk of various cardiovascular diseases, including heart failure, arrhythmias, and stroke, even a year after recovering from COVID-19. In a recent study, MRI indicated cardiac injury in 75% of convalescent patients who were exposed to COVID-19.


It is important to recognize that embarking on a journey towards better heart health does not necessitate drastic or overwhelming changes. Even small, incremental steps in the right direction can yield substantial benefits over time.

The information in this article is for education purposes only and should not be construed as medical advice without the supervision of your medical provider.



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