Cardiologist names four early warning signs that should prompt a heart check-up

A leading cardiologist has identified four warning signs that should prompt a medical review of heart health, saying the symptoms can be subtle and appear long before a serious cardiac event.

Dr. Oliver Guttman, a consultant cardiologist at The Wellington Hospital in London, told The Independent that chest discomfort often described in films as “crushing” rarely reflects how heart-related pain is experienced in real life. He said typical heart-related chest sensations are more likely to be intermittent and misleading — a heaviness, tightness or pressure, sometimes described as a band squeezing the chest, or a burning or aching feeling that can resemble heartburn or indigestion.

Guttman said such pain can radiate to the arms (often the left), shoulders, neck, jaw or back and may represent angina, a symptom of reduced blood flow to the heart caused by narrowed coronary arteries. "While angina itself is not a heart attack, it signals underlying coronary artery disease and increases the risk of heart attack if untreated," he told The Independent. He added that accompanying nausea, sweating, dizziness and anxiety may indicate the heart is under acute strain.

Shortness of breath during routine activities is the second sign Guttman highlighted. Although some breathlessness after vigorous exercise is normal, breathlessness when sitting still, waking gasping for air at night, needing extra pillows to sleep, or breathlessness that worsens over days or weeks can indicate the heart is struggling to pump blood efficiently. He said these symptoms can reflect fluid backing up into the lungs, a common feature in heart failure, and may limit routine tasks such as climbing a single flight of stairs or carrying household items.

The third warning sign is persistent, unusual fatigue or weakness. Guttman noted that everyone becomes tired occasionally, but heart-related fatigue tends to be extreme, persistent and not relieved by rest. Patients may find themselves exhausted after simple chores such as vacuuming or washing dishes, or experience sudden weakness that makes carrying groceries difficult. He said the sensation can occur because the heart is not delivering enough oxygen-rich blood to muscles and organs, and added that women may experience unusual fatigue as one of the earliest signs of heart disease, sometimes without classic chest pain.

The fourth sign described is frequent palpitations or irregularities in heartbeat. Guttman advised attention to fluttering or "skipping" sensations, sudden pounding or racing heartbeats at rest, or episodes in which the heart seems to "flip" or "thump" unexpectedly. Such episodes — lasting seconds to minutes and possibly recurring — can happen during quiet activities like reading. He said skipped beats may cause dizziness or light-headedness and that these symptoms can indicate arrhythmias such as atrial fibrillation, which increase the risk of stroke and heart failure. "Some irregularities are harmless, but persistent or severe episodes should be evaluated with an ECG or other heart monitoring tests," he said.

Guttman recommended regular check-ups, lifestyle management and prompt investigation of concerning symptoms. Early recognition and treatment, he said, can reduce risk and save lives.

The warnings come amid evidence of worsening cardiac outcomes in the United Kingdom. Data reported by the British Heart Foundation (BHF) show heart-related deaths rose by 18 percent, from 18,693 in 2019 to 21,975 in 2023. The charity also reported a 21 percent rise in people diagnosed with heart failure since 2020, with the number reaching about 785,000 in 2024 compared with 650,000 in March 2020.

The BHF said the recent shift follows decades of declining deaths from heart attack and stroke and may reflect several factors, including a more unhealthy population, health inequalities, the effects of the COVID-19 pandemic and pressures on the National Health Service. Other experts have pointed to the COVID virus as a possible contributor because of its known effects on the heart and circulation.

Clinicians recommend that anyone experiencing persistent chest discomfort, unexplained breathlessness, severe ongoing fatigue or recurrent palpitations seek prompt assessment from a general practitioner or cardiac specialist. Evaluation commonly includes an electrocardiogram, other heart-monitoring tests and assessment of cardiovascular risk factors such as blood pressure, cholesterol and diabetes. Treatment options vary by diagnosis and may include medications, lifestyle changes and, in some cases, interventional procedures.

Early diagnosis and management remain central to reducing the likelihood of heart attack, stroke and progressive heart failure, clinicians say, and public-health efforts continue to focus on prevention and timely access to care.