Why valvular disease deserves more attention in heart health?

Valvular disease, according to Time magazine, is gaining increasing attention in the realm of heart disease diagnosis and treatment.

When a middle-aged man clutches his chest, sweats profusely, and gasps for air, the dramatic portrayal of a heart attack is often the first thing that comes to mind, Caliber.Az reports, citing the article.

Dr. Basel Ramlawi, a cardiothoracic surgeon with Main Line Health in Philadelphia, describes this as the “Bollywood drama” depiction of heart issues. “It’s the most dramatic—though not the most common—way patients present with heart problems.” In reality, heart conditions can manifest in subtle and varied ways.

For example, while some people having a heart attack may indeed experience chest pain, others—particularly women and individuals with diabetes who may have nerve damage that dulls pain—might not feel any chest discomfort at all. Heart issues can present with a wide range of symptoms. Given the critical role your heart plays in supplying blood to every organ in your body, even the most understated symptoms warrant attention.

“Your heart is the lifeline of your whole body,” Ramlawi emphasizes. “It’s the pump that delivers fuel to every other organ, and if it’s not functioning properly, the rest of your body suffers.” With this in mind, we asked cardiologists to highlight the subtle symptoms that patients often overlook, but which could indicate a serious heart problem.

A sinking feeling in your chest People who experience heart palpitations describe their symptoms in various and often colorful ways, notes Dr. Edo Paz, a cardiologist at White Plains Hospital in New York and senior vice president of medical affairs with the app Hello Heart. Some liken it to a goldfish flipping around in their chest, while others report a sensation akin to the sinking feeling when an elevator descends rapidly.

“It’s like that moment when you’re in a fast-descending elevator, and everything seems to drop,” Paz explains. Despite the urge to dismiss these unusual sensations, it’s crucial to discuss them with your doctor. They may perform an EKG and provide you with a heart monitor for further evaluation. You might be dealing with a heart rhythm disorder such as atrial fibrillation (Afib). “When evaluating palpitations, we aim to determine whether there’s an underlying arrhythmia,” Paz says. “An arrhythmia isn’t just a symptom; it’s a diagnosis.”

Paz recommends keeping a detailed log of your palpitations, noting any potential triggers—whether it’s an argument, exercise, or other factors. 

Many of his patients also use the ECG feature on their smartwatches, which can provide valuable data for their doctors. Whooshing in the ear If you experience pulsatile tinnitus, you might hear rhythmic sounds—such as whooshing or thumping—in one or both ears. While these noises can be annoying, they also represent an atypical heart symptom, according to Dr. Heather Gornik, a cardiologist and vascular medicine specialist at Case Western Reserve University School of Medicine. “Peripheral symptoms that seem unrelated to cardiovascular issues can sometimes indicate underlying heart problems,” she explains.

“One common example is patients who hear a pulsating sound in their ear, often synchronized with their heartbeat.” This pulsating sound can be a sign of carotid artery stenosis, which is the narrowing of the blood vessels that supply blood from the heart to the brain. It may also indicate the rare vascular condition fibromuscular dysplasia, which predominantly affects women and can lead to artery blockages, tears, and aneurysms.

“People often dismiss this pulsating sound,” Gornik says, “but it’s a symptom that should be taken seriously.” If you suddenly begin experiencing persistent whooshing in your ear, she advises contacting your doctor promptly. Pain or fatigue in the legs while walking If you notice that you can’t walk as far as you used to or that your legs feel unusually tired or painful, don’t ignore these signs. “Your legs can provide important clues about your cardiovascular health,” says Dr. Heather Gornik. 

One potential issue is peripheral artery disease (PAD), a condition where the arteries supplying blood from the heart to the legs become clogged. PAD is linked to an increased risk of heart attack, stroke, and early death. “It often presents as leg pain while walking or general leg fatigue, so it’s crucial to diagnose it early,” Gornik explains. If these symptoms persist for a week or more, Gornik advises seeing your doctor.

They will likely perform a physical exam and an ankle-brachial index test, which measures blood pressure in your legs compared to your arms. “PAD can be serious, potentially leading to amputation,” she notes. “Moreover, if you have PAD, it’s a strong indicator that you may also have blockages in your heart arteries, so it’s important to manage your heart health as well.” Changes in your feet or legs Swollen feet, legs, and ankles—often referred to as peripheral edema—can be a significant indicator of congestive heart failure. According to Dr. Basel Ramlawi, when the heart is too weak to pump blood effectively, the blood accumulates in the lower parts of the body due to gravity. 

“If you notice swelling in both feet, and it persists or recurs over several days, it’s important to have it evaluated,” he advises. Dr. Heather Gornik also highlights the importance of monitoring for “abrupt color changes” in addition to swelling. Blood clots, which can cause swelling, might lead to color changes in your legs—such as turning them purple or, in some cases, making them appear pale or white. Blood clots are a medical emergency and can lead to severe conditions like heart attack or stroke. If you observe these color changes, seek medical attention immediately. Jaw or neck pain with exertion Angina, a term for chest tightness, can radiate to the jaw or neck. It is often triggered by physical exertion, such as walking uphill, or by emotional stress, according to Dr. William Zoghbi, chair of cardiology at Houston Methodist.

“The pain typically radiates,” he explains. “While people commonly think of pain in the arm, they may overlook the possibility of it extending to the jaw or neck.” If you experience pain or discomfort that occurs during physical activity and is relieved by rest, or if the symptoms come and go, it’s important to seek medical attention, Zoghbi advises. Your doctor will likely perform a stress test and imaging studies to determine if you have a condition that increases your risk of a heart attack or stroke.

Indigestion and nausea

After a heavy meal, you might experience chest discomfort or excessive belching. While it’s easy to attribute this to spicy tacos, Dr. William Zoghbi cautions that chest pain resembling indigestion or heartburn could be a sign of ischemic heart disease. Although it’s often dismissed as a routine gastrointestinal issue, it’s important to monitor these symptoms closely. If the discomfort worsens or persists, seeking medical advice is essential. Additionally, it’s crucial to pay attention to nausea. 

While chest pain and shortness of breath are the most common heart attack symptoms for both men and women, Dr. Edo Paz notes that women are more likely to experience atypical symptoms. Nausea, especially when accompanied by jaw or back pain, lightheadedness, or unusual fatigue, should be taken seriously and warrants prompt medical evaluation. Carpal tunnel discomfort paired with shortness of breath If you’re experiencing carpal tunnel symptoms, such as wrist pain after typing, a “pins and needles” sensation in your fingers, or hand weakness that makes it difficult to grip objects, it’s important not to overlook these signs.

Particularly when accompanied by shortness of breath, these symptoms could indicate cardiac amyloidosis, warns Dr. William Zoghbi. “This condition involves protein misfolding,” Zoghbi explains. “The abnormal protein, known as amyloid, begins to deposit in various parts of the body, including the heart, neurological areas, and the carpal tunnel.” The good news is that effective treatments for cardiac amyloidosis are now available, a significant advancement from just a decade ago. 

Sudden stabbing chest pain Classic chest pain often feels like pressure, fullness, or squeezing. It typically worsens with exertion and tends to subside before recurring later. In contrast, aortic dissection—a tear in one of the body’s major arteries—presents with sudden, sharp pain in the middle of the chest that radiates to the back. This condition can be life-threatening if not treated promptly, warns Dr. Basel Ramlawi. “If an aortic dissection goes unrecognized for even a day, 25 per cent to 50 per cent of patients could die,” he explains. 

“We often need to airlift them to a major emergency center for immediate open-heart surgery.” However, Ramlawi notes that many patients fail to recognize the severity of their symptoms and mistakenly attribute the pain to less serious issues, leading them to delay seeking medical help. If you experience sudden, severe chest pain that radiates to your back, it’s crucial to treat it as an emergency and seek medical attention immediately. 

Trouble with daily activities Valvular disease is becoming an increasingly important focus in heart disease diagnosis and treatment, according to Dr. Charles Davidson, an interventional cardiologist and vice chair of clinical affairs at Northwestern University Feinberg School of Medicine.

Unlike coronary disease, which involves blockages in the arteries supplying the heart, valvular disease affects the heart’s valves and typically develops gradually over five to ten years. Many patients may not experience symptoms until the disease has advanced, Davidson notes. Those who do notice issues might describe feeling “a little older or more tired,” but often dismiss these changes. “They might not think much of it,” Davidson says. 

This can lead to subtle adjustments in their daily routines—such as needing to stop after the first flight of stairs or taking breaks while cleaning the house. When asked about their ability to perform these tasks, patients with valvular disease might say they can manage but with limitations. Highlighting these changes in everyday abilities is crucial, Davidson emphasizes, as early detection can lead to more effective treatment.

“Don’t wait until you’re feeling awful,” he advises. “Getting checked early can be reassuring, and treatments have advanced significantly.” He points out that age is no longer a barrier to successful treatment, sharing that he has treated two men over 100 years old this year alone.