worried-woman-hand-on-heart
Shortness of breath could mean heart disease, so don't ignore it.
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If your arteries start collecting plaque, your heart may have trouble getting enough blood. And if blood flow runs low, the heart complains—with pain. This is often one of the first symptoms of coronary artery disease (CAD).

You may notice a sharp pain in your chest, known as angina. The pain—often described as pressure, heaviness, tightness, squeezing, burning, or a dull ache—will likely last a few minutes before fading.

The pain is hard to pinpoint, although some people describe it by holding a fist to their chest. (Note: Burning chest pain following a meal is more likely to be acid reflux than angina. If an antacid eases the pain, it's heartburn.)

Unpredictable pain can mean heart attack
At first, you're only likely to notice angina when you're exercising. The pain should ease quickly as you rest.

But if plaque continues to build, your heart may start complaining any time of day in any situation. It may even wake you up in the middle of the night. Unpredictable or unstable angina is a powerful predictor of a heart attack.

When breathlessness is cause for concern
A heart that isn't getting enough blood is also not getting enough oxygen. For that reason, people with coronary artery disease may feel breathless and unusually tired. Of course, everyone gets breathless and tired sometimes.

Chest Pains
Heart Disease Ignoring Chest Pains Doctor-Patient Video
Symptoms were hard to ignore  Watch video
But you should be concerned if you suddenly lack the strength or the breath to do something that usually comes easily, says cardiologist Nieca Goldberg, MD, medical director of the New York University Women's Heart Program. "If you ignore it, the symptoms could become even stronger," she says.


Male CAD risk
Men have another early warning system. Erectile dysfunction (ED)—trouble achieving or keeping erections—is extremely common in men with coronary artery disease. The arteries feeding the penis can clog just as surely as the arteries around the heart.

A recent European survey found that two out of three men in 15 cardiovascular rehabilitation clinics had ED before they were diagnosed with heart trouble.

Stroke and other problems
In addition to ED, you could also have clogging in other arteries (a process known as atherosclerosis). For example, blockages in the carotid artery of the neck can lead to strokes.

"We have come to understand is that this is a much more systemic process than we traditionally thought," says Stephen Nicholls, MBBS, PhD, a research cardiologist at the Cleveland Clinic. "It's a really very diffuse disease."

"By the time a patient sees a cardiologist for coronary artery disease, they've usually got plaque in other major arteries in the body," he says.

"I think we are starting to becoming more appreciative of the role of atherosclerosis in the development of problems elsewhere; it clearly is the leading cause of stroke," says Dr. Nicholls. Atherosclerosis can play a role in kidney failure and cause peripheral arterial disease, an insufficiency of blood supply to the legs that can cause pain and difficulty walking.

"Once you've got plaque somewhere, you pretty much have plaque everywhere," says Dr. Nicholls.
Last updated: May 16, 2008