When should one worry that he or she might be having a heart problem?

Unfortunately, heart symptoms can be all over the board, and sometimes there are no indications for trouble until very late in the game. On top of this, classic heart-problem symptoms can just as easily be due to something not heart-related, like an esophageal spasm or musculoskeletal strain. That said, there are clues for heart trouble that help us know when to seek help.

It is helpful to take into consideration the age, gender, size, life-style, and situation of the individual in question. In general, there is a higher incidence of heart problems in people with a history of smoking, a family history of heart disease, older age, and if that person is male. But heart problems can occur in anyone, so never cover-up or ignore symptoms. Heart disease in some people, especially diabetics and women, can present with unusual or very minimal symptoms. Hypertensive and overweight snorers should have an inexpensive night-time oxygen test to see if a full sleep study is needed. Sleep apnea is a dangerous and important cardiac risk-factor, and I believe way more worthy of attention than cholesterol. If suspicious, talk to your doctor, since discovering sleep apnea could add years to your life.

A middle-aged or older person having a heavy sensation in the chest, neck, jaw, shoulder, or arm that comes with exertion and is relieved with rest, should be suspicious of a blockage in their coronary arteries. Called angina pectoris, this condition alone may not be dangerous unless coming on with progressively less exercise. Still, if you experience angina you see your doctor. If these symptoms come on suddenly, severely, and do not go away with rest, then you have a very urgent problem, so call 911.

Heart weakness, also called congestive heart failure, or CHF, can be caused by heart-valve disease, long standing high blood pressure, chronic alcohol use, certain viral infections, and more. The most common symptom of CHF is shortness of breath, but almost every illness, especially lung disease, can cause this too.

Heart rhythm problems are sneaky. Many of us, including me, have benign sporadic palpitations that are not dangerous and mean nothing, but still worth discussing with your care provider.

If you have runs of heart rate in the range of 150 beats per minute, or rates so fast or slow as to cause weakness or passing out, you should go the emergency room.

As complex as all these warning signs may seem, the most important way to diagnose heart disease starts with paying attention to symptoms.