New American Heart Association Report Outlines Most Common Symptoms of 6 Cardiovascular Diseases

According to a new scientific statement from the American Heart Association, symptoms typically overlap between diseases and can differ depending on the sex.

Heart attack, heart failure, valve disease, stroke, heart rhythm problems, and peripheral artery and vein disease are the six cardiovascular diseases (CVDs) with the most commonly reported symptoms, according to a "state of the science" study (PAD and PVD).

The symptoms experienced by men and women differ significantly.

A person's capacity to recognize changes in symptoms may be impacted by depression, which is prevalent across many CVDs.

To effectively manage cardiovascular disease and stop or slow its progression, effective ways of monitoring and assessing symptoms over time are essential.

The most prevalent symptoms of various cardiovascular diseases (CVDs) are highlighted in a review of recent studies, highlighting that men and women frequently have different symptoms. This is supported by a new scientific statement from the American Heart Association that was released today, August 18, 2022, in Circulation, the association's premier peer-reviewed magazine.

The statement also emphasizes how symptoms are felt over time, sometimes months or years apart depending on the condition, and in a range of intensities or degrees, emphasizing the gradual onset of cardiovascular disease. The scientific statement writing committee looked over recent studies on the signs of various cardiovascular conditions. They discovered that symptoms change with time and based on gender.

In the United States and throughout the world, cardiovascular disease is the main factor in fatalities. It encompasses a number of diseases, including the six that were discussed in this scientific statement: peripheral artery and vein disease, heart attack, heart failure, valve disease, stroke, and heart rhythm problems.

"A comprehensive awareness of these cardiovascular illnesses' symptoms is essential for efficient diagnosis and treatment decisions since they can have a significant impact on quality of life. "The scientific statement is a'state of the science' compendium detailing the symptoms associated with CVD, similar or different symptoms among the conditions, and sex differences in symptom presentation and reporting," said Corrine Y. Jurgens, Ph.D., R.N., A.N.P., FAHA, associate professor at Boston College's Connell School of Nursing and chair of the scientific statement writing committee.

It is challenging to measure symptoms because of their subjectivity. If people don't consider symptoms to be significant or connected to an existing medical problem, they might not recognize them or choose not to report them. Additionally, both disease state and symptoms may progress without any changes in the course of the disease                                                                                      

Some people might not think of cardiovascular disease symptoms including weariness, sleep difficulty, weight gain, and depression as significant or linked, according to Jurgens. However, research suggests that discrete symptoms like these may signify the necessity for hospitalization and acute events. It is necessary to provide "significant" symptoms a broader definition.

While there are many different forms of cardiovascular disorders, certain symptoms are prevalent and well-known while others are rare. For instance, the most typical and recognisable sign of a heart attack is chest pain. Shortness of breath, weariness, sweating, nausea, and lightheadedness are less common symptoms, though.

Establishing an individual's baseline symptom profile and monitoring symptoms over time may be useful in spotting changes and any worsening of symptoms, according to Jurgens.

Acute coronary syndrome (ACS), a general name for any cardiac condition brought on by a sudden reduction in blood supply to the heart, includes a number of conditions, including heart attack. Chest pain, which is commonly described as pressure or discomfort and may radiate to the jaw, shoulder, arm, or upper back, is the most frequently reported symptom of ACS, particularly heart attack. Shortness of breath, perspiration or a cold sweat, unusual weariness, nausea, and lightheadedness are the most typical co-occurring symptoms. These additional symptoms have frequently been labeled as "atypical," but according to a recent American Heart Association presidential advice, this description may have been inaccurate because there weren't enough women participating in the scientific trials that produced the symptom lists. In addition to chest pain, women are more likely than men to report additional symptoms.

One of the most well-known signs of heart failure is shortness of breath, which also drives many adults with the condition to the doctor. Early, more subtle symptoms, on the other hand, should be recognized as warnings to speak with a medical expert. They could also include fatigue, exercise intolerance (caused by fatigue and shortness of breath), insomnia, pain (chest and otherwise), mood disturbances (primarily depression and anxiety), and cognitive dysfunction. Gastrointestinal symptoms like upset stomach, nausea, vomiting, and appetite loss are also possible (brain fog, memory problems).

Compared to males with heart failure, women report a larger range of symptoms, are more likely to experience sadness and anxiety, and have a lower quality of life. Women are more likely than males to report various symptoms, just like a heart attack. Women with heart failure also have increased degrees of pain (not just chest pain), edema, and perspiration, as well as palpitations, digestive disturbances, and nausea.

According to Jurgens, "monitoring symptoms on a spectrum, rather than present or absent, with accurate and reliable indicators may enhance clinical treatment by recognizing more rapidly people who may be at risk for poor outcomes, such as a reduced quality of life, hospitalization, or death. In order to prevent bad heart failure outcomes, it is still necessary to figure out who needs more regular monitoring or intervention.

Breathlessness is a symptom of heart valve dysfunction, which is a prevalent cause of heart failure. Heart valve issues include narrower or stiffened valves (stenosis), valves that seal improperly (prolapse), valves that enable blood to flow backward (regurgitation), or improperly produced valves. Heart valves are the leaflet-like structures that regulate blood flow between the heart's chambers (atresia). People with moderate forms of valve disease may go years without experiencing any symptoms until gradually developing more symptoms resembling those of heart failure. Pulmonary hypertension, or high blood pressure in the lungs, is another complication of valve dysfunction. Aortic stenosis, which happens when the aortic valve narrows and inhibits blood flow from the heart, is one of the most significant and prevalent types of valve disease.

Women with aortic stenosis are more likely than men to have shortness of breath, exercise intolerance, and physical frailty, and they are also more likely to score lower on the New York Heart Association Functional Categorization, a widely used classification system for heart failure. Chest pain is more frequently reported by males with valve disease than by women.

Stroke When a blood vessel to the brain is blocked or breaks, it usually results in identifiable symptoms that call for immediate medical attention. The American Stroke Association advises everyone to keep in mind the acronym F.A.S.T. meaning Face drooping, Arm weakness, Speech difficulty, and Time to contact 9-1-1 to recognize stroke symptoms necessitating rapid medical assistance. Confusion, vertigo, loss of balance or coordination, and abnormalities in vision are some more signs of a stroke. It's important to recognize the signs of a stroke since receiving treatment right away could lower or eliminate the risk of long-term impairment or death.

In addition to the classic symptoms of a stroke, women are more prone than males to experience other, less common symptoms. These signs include a headache, mental confusion, unconsciousness, or stupor. A stroke may also affect a person's ability to think clearly, which may affect their capacity to notice emerging or deteriorating symptoms.

Some stroke-related symptoms may endure and necessitate ongoing treatment, regardless of whether they require rehabilitation or develop into disabilities. Assessments for sadness, exhaustion, pain, and anxiety should be done after a stroke. The majority of complaints of post-stroke pain occur 4-6 months following a stroke, albeit it may take months for this to happen.

Arrhythmias, also known as rhythm disorders, are frequently described as palpitations or the sensation of an aberrant heartbeat that may be irregular, rapid, fluttering, or halting. Other signs and symptoms include weakness, breathlessness, and lightheadedness, all of which are common to other cardiovascular conditions. Less frequently, individuals with heart rhythm problems may experience anxiety, dizziness, fainting or almost fainting, and chest pain.

While men are more likely to have no symptoms, women and younger persons with rhythm abnormalities are more likely to feel palpitations. Older people are more likely to have unusual symptoms or none at all. Different racial and ethnic groups have been observed to have different symptoms. In comparison to Hispanic or white individuals, data show that Black adults report having more palpitations, shortness of breath, intolerance to exercise, dizziness, and chest discomfort.

By affecting the arteries in the lower limbs, peripheral arterial disease, or PAD, reduces the blood flow to the legs. The characteristic symptom of claudication, which is discomfort in one or both calf muscles that arises when walking and goes away with rest, may emerge in people with PAD or they may not exhibit any symptoms at all. However, rather than calf discomfort, the most typical symptoms of PAD are pain in various areas of the legs as well as in the foot and toes. Men are more at risk for heart attacks and strokes than women when PAD is present, which is accompanied with symptoms.

According to Jurgens, evaluating quality of life, activity restrictions, and the psychological effects of the condition are all part of measuring vascular symptoms. However, current measures frequently depend more on the clinician's assessment than on the patient's self-reported symptoms and symptom severity.

People with PAD frequently experience depression, particularly women, the elderly, and members of various racial and ethnic groups. Additionally, those with more severe PAD are more prone to experience depression.

Similar to PAD, peripheral vein disease (PVD) might go unnoticed or cause leg pain. Leg pain and achiness, heaviness or stiffness in the legs, weariness, cramps, restless legs syndrome, and skin irritation are common symptoms associated with the legs. In one study, those under the age of 65 reported pain, heaviness, achiness, and exhaustion more frequently than people over the age of 65. Vein disease symptoms can occasionally appear in the absence of outward symptoms.

Patients with PAD are the ones who tend to have gender variations in vein and artery disease. Women are more likely to experience symptoms elsewhere than in the calf muscle or none at all. Women's symptoms are also made more difficult by misconceptions that PAD is more common in men or that other common illnesses, including osteoarthritis, have similar symptoms. Women are more prone than males to experience rapid PAD progression and quality of life issues.

According to statistics from a national survey, people with heart disease experience depression at a rate that is around twice as high as that of healthy individuals (10% vs. 5%). In a 2014 scientific statement, the American Heart Association recommended that depression be taken into account as a risk factor for poorer outcomes following an acute coronary syndrome episode or diagnosis.

The present statement emphasizes that sadness and/or anxiety are common among persons who experience chronic chest discomfort, heart failure, stroke survivors, and peripheral artery disease. Additionally, post-stroke cognitive alterations may influence how and if symptoms are felt or noticed. Throughout the course of any cardiovascular disease, the writing group suggests routine evaluations of cognitive function and depression levels since they have a significant impact on a patient's capacity to recognize symptoms and any changes in their condition.

According to Jurgens, regulating symptoms is crucial to treating cardiovascular disease. It's crucial to understand that many symptoms change in frequency or severity over time, that men and women frequently have different symptom experiences, and that conditions like depression and poor cognitive function may interfere with symptom recognition and reporting. By more promptly identifying those who may be at higher risk, monitoring and assessing symptoms with measures that adequately account for depression and cognitive function may assist to enhance patient care.

Vice Chair Christopher S. Lee, Ph.D., R.N., FAHA, Dawn M. Aycock, Ph.D., R.N., A.N.P.-B.C., FAHA; Ruth Masterson Creber, Ph.D., M.Sc., R.N., FAHA; Quin E. Denfeld, Ph.D., R.N., FAHA; Holli A. DeVon, Ph.D., R.N. The manuscript includes a list of the authors' disclosures.

The volunteer writing group created this scientific statement on behalf of the Council on Cardiovascular and Stroke Nursing, the Council on Hypertension, and the Stroke Council of the American Heart Association. Scientific findings from the American Heart Association assist people make well-informed healthcare decisions and raise awareness of the challenges surrounding cardiovascular illnesses and stroke. Scientific statements describe what is already known about a subject and what still needs to be studied. Although they provide information for the creation of guidelines, scientific statements do not offer treatment suggestions. The official clinical practice recommendations of the American Heart Association are provided by its guidelines                                                                                                                                                                               AMERICAN HEART ASSOCIATION