Heart disease is a broad term that refers to several conditions that affect the structure and function of the heart. These changes make it harder for the heart to pump blood, which is how oxygen and nutrients move throughout the body and waste products are removed. Coronary artery disease is the most common type of heart disease in the US, but there are several other types of heart disease, such as heart failure and abnormal heart rhythms. While heart disease can be deadly, it is preventable in most people through lifestyle modifications.

Many people have no signs or symptoms of heart disease until they have a heart attack. Early signs of heart disease may include chest pain, shortness of breath, leg swelling, fatigue, dizziness, and fainting.

Symptoms of heart disease are variable depending on the type of heart disease.

Symptoms of coronary artery disease may include:

• Chest pain, tightness, pressure, or discomfort
• Shortness of breath
• Pain in arms, legs, neck, jaw, throat, belly, back
• Numbness and weakness in legs or arms

Symptoms of abnormal heart rhythms may include:

• Racing heart
• Chest pain
• Sweating
• Lightheadedness
• Shortness of breath

Symptoms of congenital heart defects may include:

• Chest pain
• Delayed growth
• Trouble breathing
• Low birth weight
• Difficulties with feeding

Symptoms of diseased heart muscle may include:

• Dizziness, lightheadedness, fainting
• Fatigue
• Shortness of breath
• Pounding heartbeat
• Swollen legs or feet

Symptoms of heart valve problems may include:

• Chest pain
• Fainting
• Fatigue
• Shortness of breath
• Swollen ankles or feet
• Irregular heartbeat

You should see a doctor if²:

• You have chest discomfort that doesn’t go away
• You have recurring heartbeat disturbances such as a racing heart
• You feel faint, dizzy, or lightheaded
• You have swelling in your legs
• Have experienced noticeable weight gain

Common types of heart disease¹:

• Coronary artery disease is when the arteries that supply blood to the heart muscle become hardened and narrowed, restricting blood flow to the heart. Coronary artery disease is usually caused by a buildup of cholesterol and other substances known as plaque in the walls of the arteries.
• Heart failure is when the heart can’t pump enough blood and oxygen to meet the body’s needs. Heart failure does not mean that your heart has stopped beating. Heart failure is usually caused by high blood pressure and other issues that make your heart work harder. It may also be caused by obesity and diabetes.
• Heart valve disease is when one or more of the valves in your heart doesn’t work properly. Our hearts have four valves with flaps that open when your heart beats and then close to ensure blood doesn’t flow backward. There are several causes of heart valve disease, including birth defects, infections, general wearing out with age, and heart attack.
• Arrhythmias (irregular heartbeat) are problems with the rate of your heartbeat. They can cause the heart to beat too quickly, slowly, or irregularly. The main causes of arrhythmia are issues with the heart’s arteries, valves, or muscles. Common causes include coronary artery disease, irritable tissue in the heart, high blood pressure, cardiomyopathy, valve disorders, electrolyte imbalances, heart attack, and heart surgery.
• Cardiomyopathy is when the heart muscle stiffens, enlarges, or thickens, making it harder to pump blood to the rest of the body. The cause of cardiomyopathy is usually unknown. It can be inherited or caused by other conditions such as a heart attack, high blood pressure, valve disorders, obesity, diabetes, and infections.
• Pericarditis is an inflammation of the thin tissue sac (pericardium) that covers the heart’s outer surface. It may be caused by a heart attack, chest injury, viral infection, or autoimmune disorder.
• Congenital heart disease is a problem with the heart structure that people are born with. The exact cause of congenital heart disease is still uncertain.

The cause of heart disease depends on the type of heart disease. Possible causes may include genetics, other diseases, medications, infections, and lifestyle.

The key risk factors for heart disease include³:

• High blood pressure: the force and friction of high blood pressure can damage the walls of the arteries, which can lead to plaque buildup that reduces blood flow. High blood pressure is responsible for approximately half of all deaths due to heart disease.⁴
• High cholesterol: high levels of cholesterol can lead to fatty deposits in blood vessels that restrict blood flow. Occasionally, these fatty deposits break free and can form clots that may ultimately cause a heart attack or stroke. 24% of heart disease deaths are due to high levels of bad (LDL) cholesterol.^5,6
• Smoking: chemicals inhaled from smoking can damage the heart and blood vessels, ultimately increasing the risk of plaque buildup in the arteries. Smoking causes 1 in 4 deaths from heart disease.^7,8
• Age: the prevalence of heart disease increases with age. In 2019, 9% of adults aged 55-64, 14% aged 65-74, and 24% aged 75 and older had heart disease.⁹
• Family history: people with a family history of heart disease are more likely to develop heart disease themselves. Patient’s with a family history of coronary heart disease are 1.5-2x more likely to develop the disease than someone with no family history.¹⁰
• Diabetes: people with diabetes are twice as likely to have heart disease and tend to get it at a younger age. High blood sugar can damage your blood vessels and the nerves that control the heart.¹¹
• Obesity: extra weight increases your risk of high blood pressure, high cholesterol, and diabetes, all of which are risk factors for heart disease. Obesity-related factors cause 11% and 14% of heart failure cases in men and women, respectively. For every 1-point increase in BMI, the rate of heart failure increases by 5% for men and 7% for women.^12,13
• Lack of physical activity: even if you have no other risk factors, a lack of physical activity can lead to heart disease. It also increases your risk of obesity, high blood pressure, high blood cholesterol, and diabetes, all of which are additional risk factors for heart disease. Physical inactivity is associated with a 24% increase in the risk of coronary heart disease. ^14,15
• Unhealthy diet: eating a diet high in saturated and trans fats can increase your bad cholesterol, which can increase your risk of heart disease.
  Drinking too much alcohol: Drinking too much alcohol can lead to high blood pressure and elevated triglyceride (a fatty substance) levels in the blood, both of which increase your risk of heart disease.

47% of Americans have 1 of the 3 key risk factors for heart disease (high blood pressure, high cholesterol, smoking).³

You can lower your risk of heart disease by:

• Managing your other medical conditions (blood pressure, high cholesterol, diabetes)
• Quitting smoking
• Increasing physical activity
• Eating a heart-healthy diet
• Maintaining a healthy weight
• Getting good sleep
• Reducing and managing stress
• Getting regular health checkups

You and your healthcare provider can use a cardiac risk calculator to assess your risk of developing heart disease. There are many different cardiac risk calculators out there that should give you similar results. However, here are two reputable cardiac risk calculators¹⁶:

• The American College of Cardiology (ACC) Atherosclerotic Cardiovascular Disease (ASCVD) risk calculator – assesses the chance of developing heart disease over the next ten years for people ages 20 to 79.
  • Factors assessed: age, sex, race, blood pressure, cholesterol level, medical history, smoking status, and statin/aspirin therapy.
• Reynolds Risk Score predicts the risk of heart disease over the next ten years in people who do not have diabetes.
  • Factors assessed: age, sex, blood pressure, cholesterol level, family history, and high-sensitivity C-reactive protein (hsCRP) level.

You can calculate your cardiac risk using an online risk calculator at any time. All you need is your health history and recent lab results to fill out a brief questionnaire. However, these calculators are only helpful prior to having a heart event. If you have had a stroke, heart attack, or heart failure, you should not use a cardiac risk calculator.

Heart disease can sometimes be detected early with regular health checkups and screenings. Detecting the earliest signs of heart disease is important as this is when the disease is most treatable. It also gives your healthcare provider more time to find effective treatment and prevent worsening of the disease.

To diagnose heart disease, your healthcare provider will review your personal and family medical history, ask you about current or past symptoms, and perform laboratory and noninvasive testing. Tests may include¹⁷:

• Blood tests – to measure cholesterol, blood sugar, and other markers of heart disease. Your healthcare provider will let you know if there are any specific instructions you need to follow before a blood test. For example, you may be required to be fasting or temporarily stop taking certain medications. A blood test usually only takes a couple of minutes. During a blood test, a tight band may be put around your upper arm to make it easier for the healthcare provider to find a vein. Then, they will insert a needle into the vein and draw the blood into a syringe. You will feel a slight prick when they insert the needle. Make sure to tell your provider if you have a fear of needles. Results usually take a few days.¹⁸
• Echocardiography – to view the heart’s structure and movements. This is a noninvasive test. There is no special preparation for an echocardiogram. Prior to the test, sticky electrode readers will be placed on your chest to monitor your heart rate and rhythm. You will then be asked to lie on your side or back for the test. They will place a handheld wand (transducer) with gel on the tip on different parts of your chest. You may be asked to hold your breath for short periods of time during this test.¹⁹
• Electrocardiography – to study heart rhythm and rate. On the day of your test, avoid applying any lotions to your chest. Prior to the test, sticky electrode readers will be placed on your chest, arms, and legs to monitor your heart rate, rhythm, and electrical activity. You will be asked to lie down and breathe normally while the electrical activity of your heart is recorded. The test is painless and only takes a few minutes.²⁰
• Cardiac stress test – to measure blood flow during stress. Your healthcare provider will let you know if there are any specific instructions you need to follow before a cardiac stress test. This may include fasting, avoiding caffeine and smoking, and temporarily stopping certain medications. You should wear comfortable clothing and exercise shoes for the test. Prior to the test, sticky electrode readers will be placed on your chest and arms to monitor your heart rate. During the test, you will walk on a treadmill or pedal on a stationary bike. The intensity of the exercise will increase over time and typically lasts 10-15 minutes.²¹
• Nuclear stress test – to measure the amount of blood the heart receives during rest and stress. Your healthcare provider will let you know if there are any specific instructions you need to follow before a nuclear stress test. This may include fasting, avoiding caffeine and smoking, and temporarily stopping certain medications. You should wear comfortable clothing and exercise shoes for the test. First, a substance called a radiotracer will be injected into your arm through an IV, and you will need to wait a few minutes for it to be absorbed. Then, you will lie down and have an image of your heart taken. Next, you will be instructed to walk on a treadmill or bike on a stationary bike. During this time, you will have a cuff on your arm to measure blood pressure and sticky electrode readers on your chest to measure your heartbeat. When you reach your peak heart rate, more radiotracer will be injected, and you will get second round of heart images that will show areas of your heart that do not get enough blood flow.²²
• Carotid ultrasound – to evaluate the risk of stroke. This is a noninvasive, painless test. You should wear a loose-fitting, open-necked shirt. During the test, you may be asked to lie down and position your head a certain way. An ultrasound technician will then apply gel to your neck and gently press a small, handheld transducer device against your neck. This usually takes 30-45 minutes.²³
• Cardiac catheterization – to assess blood vessel narrowing, blood flow, valve function, heart pressure, and presence of heart abnormalities. This is an invasive test. Your healthcare provider will let you know if there are any specific instructions you need to follow before cardiac catheterization. This may include fasting or temporarily stopping certain medications. Prior to the procedure, sticky electrode readers are placed on the chest to monitor your heart rate. During the procedure, an IV will be inserted into your hand or arm to administer a sedative agent to help you feel calm. The amount of sedative agent varies depending on the reason for the cardiac catheterization. Therefore, you may be fully awake or in a sleep-like state. Next, the doctor will insert a catheter tube into a blood vessel through the groin or wrist and guide it to your heart. The next part of the procedure depends on why you are having it done. The doctor may use energy to create tiny scars in your heart, insert dye for X-rays, insert a stent, replace a valve, or do a biopsy. After the procedure is done, you will spend several hours in a recovery room.²⁴
• Electrophysiology – to assess the cause of arrhythmia. This is an invasive test. Your healthcare provider will let you know if there are any specific instructions you need to follow prior to an electrophysiology study. This may include fasting and temporarily stopping certain medications. Before the study, blood testing may need to be performed. An IV will be inserted into your hand or arm to administer a sedative agent to help you feel calm and enter a sleep-like state. During the study, long, thin catheter tubes will be placed into your heart, usually via your groin. The next part of the procedure depends on why you are having it done. The doctor may send electrical signals to speed up or slow down your heart, deliver medicine to block electrical activity, or use energy to create tiny scars in your heart that block irregular electrical activity.²⁵

Coronary artery disease is divided into four stages. The stages help determine treatment.²⁶

• Stage 0 – Normal, no plaque
• Stage 1 – Mild plaque (total plaque volume 0-250, percent atheroma volume 0-5%)
• Stage 2 – Moderate plaque (total plaque volume 250-750, percent atheroma volume 5-15%)
• Stage 3 – Severe plaque (total plaque volume >750, percent atheroma volume >15%)

Heart failure is divided into four failure stages.27

• Stage A (at risk for heart failure) – At high risk of developing heart failure but no symptoms or functional/structural problems.
• Stage B (pre-heart failure) – Functional or structural problems but no current or previous symptoms of heart failure.
• Stage C (symptomatic heart failure) – Previous or current signs and symptoms of heart failure.
• Stage D (advanced heart failure) – Heart failure symptoms that interfere with daily life or lead to hospitalization.

Heart valve disease is divided into four stages.²⁸

• Stage A – At risk. Risk factors for heart valve disease present
• Stage B – Progressive. Mild or moderate disease. No symptoms.
• Stage C – Asymptomatic severe. Severe disease. No symptoms.
• Stage D – Symptomatic severe. Severe disease. Symptoms present.

Key screening tests for heart disease²⁹:

• Blood pressure – high blood pressure increases the risk of heart disease. Your blood pressure should be checked at each healthcare visit or at least once per year if it is below 120/80 mm Hg.
• Cholesterol – your cholesterol should be checked every 4-6 years for normal-risk adults or more frequently if you are at an increased risk of heart disease. This test measures your HDL (good) cholesterol and LDL (bad) cholesterol.
• Body weight – obesity increases the risk of heart disease. Your body weight should be checked at each healthcare visit.
• Blood glucose – high blood glucose increases the risk of developing diabetes, which, when untreated, can lead to heart disease. Your blood glucose should be checked every three years.
• Smoking, physical activity, diet – Smoking, lack of physical activity, and an unhealthy diet increase the risk of heart disease. You should discuss these factors with your doctor at each healthcare visit.

Possible screening test results for heart disease include:

• Blood pressure³⁰
  • Normal: systolic mm Hg (upper number) less than 120 and diastolic mm Hg (lower number) less than 80
  • Elevated: systolic mm Hg (upper number) 120-129 and diastolic mm Hg (lower number) less than 80
  • High blood pressure (stage 1): systolic mm Hg (upper number) 130-139 and diastolic mm Hg (lower number) 80-89
  • High blood pressure (stage 2): systolic mm Hg (upper number) 140 or higher and diastolic mm Hg (lower number) 90 or higher
  • Hypertensive crisis: systolic mm Hg (upper number) 180 or higher and diastolic mm Hg (lower number) 120 or higher
• Cholesterol³¹
  • Dangerous: total cholesterol 240 or higher, LDL cholesterol 160 or higher, HDL cholesterol under 50 for women
  • At-risk: total cholesterol 200-239, LDL cholesterol 100-159, HDL cholesterol 50-59 in women
  • Heart-healthy: total cholesterol under 200, LDL cholesterol under 100, HDL cholesterol 60 and higher
• Body weight³²
  • Underweight: BMI below 18.5
  • Normal: BMI 18.5-24.9
  • Overweight: BMI 25-29.9
  • Obese: BMI above 30
• Blood glucose³³
  • Diabetes: fasting blood sugar 125mg/dL or above
  • Prediabetes: fasting blood sugar 100-125 mg/dL
  • Normal: fasting blood sugar 99 mg/dL or below

Heart disease treatment depends on the type of heart disease you have but may include³⁴:

• Lifestyle modifications – eating a healthier diet, increasing exercise, stopping smoking.
• Medications – to lower cholesterol and blood pressure and to control and prevent heart disease symptoms.
  • Anticoagulants and antiplatelet therapies help prevent clots.
  • Angiotensin-converting enzyme inhibitors help treat heart failure and blood pressure.
  • Angiotensin II receptor blockers help control blood pressure.
  • Angiotensin receptor neprilysin inhibitors to treat heart failure with reduced ejection fraction.
  • Beta-blockers help reduce heart rate and lower blood pressure.
  • Calcium channel blockers help lower blood pressure and prevent arrhythmias.
  • Cholesterol-lowering medications help reduce levels of low-density lipoprotein cholesterol.
  • Digitalis increases the strength of the heart’s pumping action.
  • Diuretics help reduce the heart’s workload, lower blood pressure, and remove excess water.
  • Vasodilators to lower blood pressure.
• Surgeries or procedures – Some patients may need a procedure or surgery to treat heart blockages or problems that medication cannot.
  • Coronary artery bypass surgery – restores blood flow to part of the heart when an artery is blocked by using a healthy blood vessel from another part of the body.
  • Coronary angiography – widens narrow or blocked coronary arteries.
  • Valve replacement or repair – replace or repair a valve that is not functioning properly.
  • Repair surgery – to correct congenital heart defects and other problems.
  • Device implantation – can help regulate heartbeat and support blood flow.
  • Maze surgery – a pattern of scar tissue created to disrupt stray electrical heart signals, used to treat irregular heart rhythms.

You cannot cure or reverse heart disease, which is why prevention is so important. However, lifestyle changes and treatment can help you manage symptoms.

A cardiac rehabilitation program is recommended for people recovering from a heart problem that required medical care or surgery. A cardiac rehabilitation program is a supervised program that includes exercise, education on healthy living, and counseling to improve mental health. Benefits may include strengthening your heart and body, relieving heart symptoms, building healthier habits, reducing stress, improving your mood, increasing energy, and preventing future illness or death. Cardiac rehabilitation programs typically last 3 months but can be anywhere from 2 to 8 months long.

Symptoms of heart disease can be experienced throughout the whole body. A lack of oxygen due to heart problems can cause your skin to have a pale or bluish color. Breathing becomes more difficult as heart disease progresses. When your heart is weak and can’t pump blood properly, you may experience a buildup of fluid in your lungs or kidneys. Subsequently, this may cause swelling in your feet, ankles, and legs. You may also experience numbness or cramping in your calves. Heart valve problems may make you feel lightheaded and fatigued more often. You may also experience chest pain and shortness of breath. Heart disease can even impact your digestive system, leading to nausea and bloating.

Depending on the type of heart disease, ongoing review and treatment will vary. You should continue to get routine assessments that examine your blood pressure, pulse, weight, cholesterol, and lifestyle. It’s critical that you go to your follow-up appointments with your healthcare team. Some patients will require additional testing to monitor for heart disease progression. You will need to continue to treat your high blood pressure and high cholesterol, manage your diabetes and obesity, eat a heart-healthy diet, and get more active. Some patients will have to remain on medicine for heart disease for the rest of their life.

A 2017 study from the American Heart Association found that unmarried people with heart disease were 52% more likely to die from a heart problem than married people.³⁵

Another study found that more frequent partner hugs were associated with lower blood pressure in premenopausal women.³⁶

Further, studies show that males and females without a stable romantic partner produce higher levels of the stress hormone cortisol.³⁷

A systematic review done in 2011 analyzed how the partner relationship is affected by cardiac disease and identified the following five key themes³⁸:

• Overprotection – patients felt overprotected by their spouse regarding allowable activities and lifestyle changes, which sometimes led to arguments.
• Communication deficiency – some couples do not discuss heart disease at all. Partners may find it stressful and difficult to deal with a patient’s emotions and sometimes withhold feelings to not further upset the patient. Patients often withhold their feelings and emotions from their partners to not cause anxiety.
• Sexual concerns – 30% of heart failure patients report a cease of sexual activity, and 60% reported some type of sexual problem. Sexual concerns and sexual dysfunction can last up to 6 months following a heart disease event. There is a fear of resuming sexual activity based on a fear of triggering another heart disease event.
• Changes in domestic roles – spouses may take over a patient’s household tasks and often feel guilty if a patient performs household work that could cause stress. This may lead to spouse anxiety and frustration.
• Adjustment to illness – some partners may feel stressed due to life or diet changes needed for the patient. Other spouses feel a sense of solidarity with the patient when making these changes.

Common myths about heart disease³⁹:

• You have to take it easy if you have heart disease – talk to your doctor about what exercise is right for you.
• You can eat anything if you are on a cholesterol-lowering drug – You should limit cholesterol and saturated fat in your diet.
• Higher blood pressure is fine in older people – if your blood pressure is above 140/90mm Hg at any age, you should talk to your doctor about lowering it.
• If you manage your diabetes with medication, it can’t cause heart disease – you should take your diabetes medication to lower your risk of heart disease, but it does not completely prevent it.
• Vitamins and supplements lower your risk of heart disease – vitamins and supplements are best absorbed when they are acquired through nutritious foods.
• Quitting smoking won’t reduce your risk of heart disease if you have been smoking for years – get help to quit smoking. Benefits of quitting start the minute you quit.
• Men have more heart disease problems – Heart disease is a leading killer in men and women. Everyone should have a baseline heart examination to monitor for heart disease.
• You should eat as little fat as possible if you have heart disease – you should eat a diet low in saturated, partially hydrogenated, and trans fat. However, unsaturated fats can be beneficial. Eat fatty fish, nuts, olive oil, and lean meat.
• A “small” heart attack is nothing to worry about – a small heart attack is a warning sign that you may have a serious heart disease.
• Angioplasty and bypass surgery can fix your heart – These surgeries may improve symptoms, but they do not cure the disease.

Facts about heart disease⁴⁰:

• Heart disease is the leading cause of death in the US for all genders and most racial and ethnic groups.
• Approximately 1 in every 5 deaths is because of heart disease.
• In 2021, nearly 700,000 people in the US died from heart disease.
• A person dies every 33 seconds from heart disease.
• Almost half of the population is at risk for heart disease.
• Coronary artery disease killed 375,000 people in 2021.