The Hidden Signs Of Heart Disease
Heart disease is one of the most common health conditions in the UK, yet many people don’t realise that the warning signs can be easy to miss.
We often imagine heart problems to appear dramatically – a sudden, crushing chest chain or a collapse – but for many people, early signs of heart disease are subtle, gradual, and easy to mistakenly attribute to stress, ageing or a busy or unhealthy lifestyle.
Heart And Circulatory Diseases Cause Around 1 In 4 Deaths In The UK
Detecting heart disease early makes a significant difference. Modern cardiology offers highly effective ways to diagnose, manage, and even prevent many heart conditions before they become serious. According to the British Heart Foundation, heart and circulatory disease cause around 1 in 4 deaths in the UK, and around 7 million people live with cardiovascular diseases. But with awareness of heart disease – and its symptoms – increasing, we hope to see these numbers decline in future.
Understanding Your Own Risk Factors
Dr Sukhjinder Nijjer, Interventional Cardiology Consultant Cardiologist explains:
“Knowing your own risk factors for developing heart disease is really important. Individuals often start thinking about their heart health in later life, but it can actually be more challenging to reverse the issues by then.”
“Conversely, if people are thinking about it when they're in their 30s and 40s, then actually there's a good opportunity to reverse issues from and actually prevent a condition from developing.
“That looks like knowing what your blood pressure is, your cholesterol levels, and whether you have a genetic predilection for developing heart disease. Thinking about these things early in life helps us identify and prevent issues, rather than deal with the consequences at the later stage.”
What Is Heart Disease?
Heart disease, also called cardiovascular disease (CVD), is an umbrella term for conditions that affect the heart and blood vessels. These conditions include:
Coronary Artery Disease: This is where the arteries that supply blood to the heart become narrow or blocked.
Arrhythmias, Or Irregular Heart Rhythms: These can cause palpitations or dizziness.
Heart Failure: This is a condition where the heart can’t pump blood effectively.
Valve Disease: Valve disease is where one or more of the heart’s valves don’t open or close properly.
Heart Muscle Disease (Cardiomyopathy): This refers to diseases of the heart muscle that affect its ability to pump blood effectively.
Congenital Heart Defects: Defects of the heart that are present from birth, and affect the heart walls, valves, or blood vessels.
Each condition can produce different symptoms, and not all are immediately recognisable as heart-related.
Why Heart Disease Symptoms Are Often Missed
Heart disease symptoms are not always obvious. They can be mild or intermittent, making them easy to overlook. People frequently write off early signs of heart disease as part of daily life: being unfit, getting older, or being stressed.
Women in particular tend to experience less typical symptoms than men, such as fatigue, breathlessness, or indigestion-like discomfort, rather than chest pain. Even those who appear healthy and exercise regularly are not immune; some forms of heart disease are inherited or develop silently despite a healthy lifestyle.
That is why screening and specialist assessment are so important, especially if you fall into the category of individuals most at risk of heart disease, which includes those with:
- A family history of heart disease
- High blood pressure or high cholesterol, or a family history of either
- Diabetes (particularly type 2)
- A history of smoking or vaping, or who currently smoke or vape
- Obesity
- Alcoholism, or excessive alcohol consumption
- Menopause
You don’t have to wait for symptoms to take your heart health seriously. A cardiac check-up is recommended if you can identify with any of the above concerns.
Case Study: When “Panic Attacks” Are Something Else
Dr Sukhjinder recalls a case involving a patient who had been told for years that she was experiencing panic attacks. Her symptoms came on suddenly: a racing heartbeat, a feeling that her heart was “jumping out of her chest”, and a sense of breathlessness and discomfort that would appear without warning. By the time she received medical care, her heart rate had often returned to normal, and routine tests showed nothing unusual.
As a result, she was repeatedly reassured and even prescribed psychiatric medication, with the assumption that her symptoms were anxiety-related. However, her episodes were later identified as supraventricular tachycardia (SVT), a condition in which the upper chambers of the heart suddenly begin beating very rapidly and irregularly. Because these episodes can start and stop abruptly, and may last only 10-15 minutes, they are often difficult to capture during standard examinations.
This type of misdiagnosis is more common than many realise, particularly in younger patients. What appears to be a panic attack can, in some cases, be an underlying heart rhythm disturbance that requires appropriate cardiac assessment and treatment.
Hidden Signs Of Heart Disease To Watch For
Dr Sukhjinder explains, “The classic symptoms that most people associate with heart disease are feelings of pressure or chest tightness in the chest, and a racing heartbeat. But there are more subtle signs and features that can suggest that something is not quite right with the heart.”
The hidden signs of heart disease can include:
Unusual Fatigue
Feeling unusually tired or lacking energy without a clear cause can be an early sign of heart disease because it can reflect the heart struggling to pump blood efficiently around the body. When this happens, muscles and organs receive less oxygen and nutrients, leading to persistent tiredness, weakness or reduced stamina, even during everyday activities.
Shortness Of Breath
Becoming breathless more easily than usual, whether during exercise or normal activity, can indicate a problem with heart function such as cardiomyopathy (weakness of the heart muscle).
Palpitations Or Irregular Heartbeat
You may first become aware of a fluttering, racing or skipping heartbeat when at rest, such as when you are laying in bed. This is usually caused by ectopic heartbeats, which are common and often harmless, however, if the feeling is persistent and left unchecked it can begin to impact heart function over time.
A smart wearable, such as an Apple Watch, can be used to track your heart rate if you are concerned that you may be experiencing palpitations or an irregular heartbeat. This can be used to demonstrate your symptoms to your consultant cardiologist.
Swelling In Legs And Ankles
Swelling in the legs can be a sign of systolic heart failure, the more widely recognised form of heart weakness. In this condition, the heart muscle loses its ability to contract effectively and pump blood around the body. As a result, pressure builds up in the circulation, causing fluid to accumulate in the lowest parts of the body - most commonly the feet and ankles due to gravity.
A lesser-known cause is diastolic heart failure, also referred to as heart failure with preserved ejection fraction. Here, the heart’s pumping function appears normal, but it struggles to relax and fill properly between beats. This leads to a similar build-up of pressure and fluid retention. It is often seen in people with long-standing high blood pressure, where the heart muscle becomes stiff over time. Although the symptoms can resemble those of systolic heart failure, this form can be more challenging to manage.
Finally, not all leg swelling is directly caused by the heart. Lymphoedema is a condition involving the lymphatic system, where fluid builds up due to damaged or impaired lymph vessels. This can occur after cancer treatments, infections, or other medical interventions. While it is not strictly a cardiac condition, it is often seen in similar clinical settings.
Chest Discomfort (Not Always Pain)
A feeling of tightness, pressure, burning or heaviness in the chest can be heart-related, even if it doesn’t feel like pain. Many people mistake this feeling for indigestion.
Dizziness Or Fainting
Episodes of light-headedness or fainting can be linked to rhythm problems or valve disease. This happens when the brain isn’t receiving enough blood flow, often due to the heart not pumping effectively or an abnormal heart rhythm.
Case Study: When Stress Masks An Underlying Heart Condition
Dr Sukhjinder tells us about a case where a young man working in the City began experiencing unusual sensations during periods of high stress. He noticed episodes where he felt slightly breathless and “not quite right”, but the symptoms were subtle and easy to dismiss. Like many in high-pressure jobs, he assumed it was simply stress and carried on without seeking help.
However, when he eventually underwent testing, the results told a different story. He was found to be experiencing episodes of Atrial Fibrillation (AF) – a condition where the heart beats irregularly and can become inefficient.
In his case, stress appeared to be the trigger. Because the symptoms were mild and non-specific, they could easily have been overlooked or attributed entirely to lifestyle pressures.
This case highlights an important point: even in younger individuals, and even when symptoms seem explainable, underlying heart rhythm disturbances can still be present and should not be ignored if they persist or feel unusual.
How Are Subtle Signs Of Heart Disease Diagnosed?
Listening To The Patient
As Dr Sukhjinder explains, diagnosing these subtle symptoms begins with a simple first step: listening. “Rather than jumping straight into a checklist of clinical questions, my first step is to allow patients to fully describe what they’ve been experiencing. Many arrive having already seen other healthcare professionals or having been given explanations that may not fully account for their symptoms. Understanding their journey – what they’ve felt, what’s been said, what’s helped and what hasn’t – is essential.”
Physical Examination
The next step is a thorough physical examination. This includes assessing pulse and blood pressure, listening to the heart for valve abnormalities, and checking the lungs for signs of fluid build-up. Your consultant may also look for swelling in the legs, examine the abdomen for signs of liver congestion, and assess for conditions such as enlarged aorta. These observations help build a clearer picture of how well the heart is functioning.
Initial Investigations And Advanced Imaging
From there, targeted tests are used to investigate further. Heart rhythm issues are often assessed using portable ECG monitors. An echocardiogram (an ultrasound scan of the heart) is commonly used to evaluate heart structure and function. Depending on the suspected issue, more advanced imaging such as CT or MRI scans may be recommended to assess blood flow or detect blockages.
Specialist And Invasive Procedures
In some cases, invasive procedures are needed, such as angiograms to examine the coronary arteries or specialised studies to map abnormal electrical activity in the heart. These are typically only considered after initial assessments, but they can be highly effective in both diagnosing and treating underlying conditions.
When To See A Heart Specialist
If you’re concerned about your heart health, even in the absence of clear symptoms, a proactive approach can make all the difference. At One Heart Clinic, dedicated screening packages are designed to identify potential risks early, before they develop into more serious conditions.
Our Healthy Heart Screening for Under 40s package focuses on early detection, combining a specialist consultation with key tests including an ECG, echocardiogram, comprehensive blood panel, and blood pressure check to build a clear picture of your cardiovascular health.
For those over 40, our Health Heart Screening for Over 40s includes all of these core investigations, alongside an advanced CT coronary calcium score to assess plaque build-up in the arteries.
If you notice any of the signs mentioned in this article, or you want to understand more about your risk and take measures to improve your heart health, consider booking a consultation. Early action can change your future health for the better.
Discover more