Hidden signs of heart disease, even if you have normal blood pressure and pulse

Women often experience heart attack symptoms differently than men.

Despite being the leading cause of death worldwide, heart disease is often known as a silent killer. That's because many people are not aware they have it. Heart disease accounts for one-third of all global deaths each year — more than all forms of cancer combined.

Because you can have heart problems with normal blood pressure and pulse, it's important to know what other signs to look for. Symptoms like fatigue and jaw pain, which can be overlooked or mistaken for something else, can be warning signs of an underlying heart issue.

What is heart disease?

Heart disease is a broad term that encompasses many different types of heart problems, such as abnormal heart rhythms, coronary artery disease, heart attack and heart failure. Despite its prevalence, more than half of U.S. adults are unaware that heart disease is the number one cause of death worldwide.

Common symptoms of heart disease include chest pain (angina), dizziness or fainting, irregular heartbeat (arrhythmia) and shortness of breath.

Lesser-known symptoms of heart disease

Chest pain is a hallmark symptom of heart disease, but other, less well-known warning signs can be overlooked. These symptoms include:

• Cough: A persistent cough, especially with white or pink mucus, can be a sign of heart failure. When the heart can't pump enough blood to keep up with demand, fluid can build up in the lungs.
• Fatigue: Feeling unusually tired despite getting an adequate amount of rest can mean your heart is struggling to pump enough blood to meet your body's needs.
• Jaw pain: Pain that radiates to the jaw can be a symptom of a heart attack or angina.
• Swelling in the ankles, feet, or legs: When the heart doesn't pump blood effectively, fluid can build up in the lower extremities. The swelling can be an early sign of heart failure.

What to know about silent heart attacks

A silent heart attack happens with few or no classic heart attack symptoms, making it hard to recognize when it's happening.

Low-level indicators

Experiencing discomfort in your jaw, pain in your chest or upper back and even indigestion can be signs of a silent heart attack. These indicators can be especially dangerous since you may not seek medical attention, which can increase your risk of future heart problems and complications.

Notable risk factors

The risk factors for a silent heart attack are the same as those for a heart attack:

• High blood pressure
• High cholesterol
• Obesity
• Smoking
• Lack of physical activity
• Poor diet
• Family history of heart disease

Certain populations have a higher risk of experiencing symptoms that are not classic for a heart attack. They include:

• Women: Women often experience heart attack symptoms differently than men. Instead of the classic sudden chest pain, women may have shortness of breath, nausea or vomiting, back pain or jaw pain. These symptoms can also be attributed to other conditions, so when they're caused by a heart attack, they can lead to delays in potentially life-saving care.
• People with diabetes: People with diabetes have a high risk for silent heart attacks because nerve damage (neuropathy) that can interfere with pain signals. High blood sugar can injure nerves throughout the body over time, so people with diabetes may experience no symptoms or very vague symptoms of a heart attack. The American Diabetes Association recommends routine screening for heart failure in people with diabetes to identify it early and stop it from progressing.
• Older adults: Pain perception can change with age and older adults may be less likely to experience chest pain during a heart attack. Other conditions that are common in older adults can also mask heart attack symptoms.

Be aware of all potential heart disease signs

If you've ever thought you can't have heart problems because your blood pressure and pulse are normal, it's time to reconsider. Heart disease can have subtle symptoms, so it's important to be aware of how it may present itself, especially if you're at a higher risk of silent heart attacks due to your age, gender or other risk factors. Your doctor can help you understand your personal risk for heart disease and the smart steps you can take to stay ahead of it.