Sudden shortness of breath is a cardinal symptom of CAD.

Sudden shortness of breath is a cardinal symptom of CAD.(ALTRENDO/GETTY IMAGES)

For several years before her heart attack, Tammy Estep, 50, of Buffalo, N.Y., tried to ignore the warning signs from her heart. "I'd get really short of breath, and I'd have pressure in the center of my chest and numbness in my arm," she says. "My heart would race and jump around. There were times when I could look at my chest and see my heartbeat. I knew what was happening, but I tried to deny it."

Looking back, it's obvious that she was suffering the effects of coronary artery disease, or CAD. Her heart wasn't getting enough blood, and it was doing what it could to sound the alarm.

Pain, tightness—or no warning at all
Not everyone with CAD gets a warning. "For many people the first sign of coronary artery disease is a heart attack or sudden death," says Thomas Lee, MD, cardiologist and editor in chief of the Harvard Heart Letter.

Still, it makes sense to know the symptoms of CAD, especially if you're at risk for the condition. You may notice a sharp pain in your chest, a symptom 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 most people describe it by holding a fist to their chest. (Note that a burning chest pain following a meal is more likely to be acid reflux than angina. If an antacid eases the pain, it's heartburn.)

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.

[ pagebreak ]Symptoms can be overlooked
Doctors can sometimes diagnose CAD from a person's symptoms alone. But as Estep discovered, symptoms can sometimes be overlooked—even by professionals. A cardiologist in the small Ohio town where she lived dismissed her breathlessness and the pressure in her chest.

Eventually a doctor at a teaching hospital in a nearby city performed an angiogram, a test that involves snaking a catheter through a vessel in the leg all the way to the heart.

Male symptoms
Men have another early warning sign of heart trouble. 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 ever diagnosed with heart trouble.

Trouble breathing
A heart that's not 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. 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 NYU Women's Heart Program. "If you ignore it, the symptoms could become even stronger," she says.

When Estep heard that the exam found five severe blockages around her heart, she started crying. "Finally, people had to believe me," she says.