More Indians are developing heart disease without typical warning signs like chest pain. Understand the hidden risk factors, less obvious symptoms and why early detection is important for protecting heart health.
For years, heart disease has been associated with a familiar picture: a middle-aged man with crushing chest pain, breathlessness, sweating and perhaps pain spreading to the left arm. That image is still relevant, but it does not tell the whole story.
Heart disease can develop quietly. In some people, the first sign may be unusual fatigue, breathlessness while doing routine activities, indigestion-like discomfort or a gradual reduction in exercise capacity. Some may have no obvious symptoms at all until a serious cardiac event occurs.
1. A “healthy-looking” person can still have heart disease
Being young, slim or physically active does not automatically mean the heart is healthy.
High blood pressure, high cholesterol, diabetes, smoking, family history and abdominal obesity can increase cardiovascular risk even when a person appears fit. Indians also tend to develop metabolic risk factors at relatively younger ages, making it important not to judge heart health by appearance alone.
2. Diabetes can make heart disease unusually quiet
People with diabetes deserve particular attention because nerve damage associated with long-standing diabetes can sometimes reduce the typical pain response.
As a result, significant coronary artery disease may occasionally be present without the classic chest pain. Some patients may instead experience breathlessness, unusual tiredness, sweating or a sudden drop in their ability to exercise.
This is one reason people with diabetes should not wait for chest pain before taking cardiovascular risk seriously.
3. Women may not have the “classic” symptoms
Women can experience chest pain during a heart attack, but symptoms may also include unusual fatigue, shortness of breath, nausea, dizziness, back or jaw discomfort, or a feeling of being unusually unwell.
These symptoms are easily attributed to acidity, exhaustion, anxiety or hormonal changes. That can be dangerous if a cardiac problem is actually developing.
Persistent, unusual or unexplained symptoms should not automatically be dismissed.
4. Reduced stamina can be an early clue
One of the most overlooked signs is a change in exercise tolerance.
Someone who could previously climb three flights of stairs comfortably may begin stopping after one. Another person may find that a familiar walk leaves them unusually breathless or exhausted.
There may be no dramatic pain, but a noticeable and persistent change in what the body can comfortably manage deserves attention.
5. “It’s just acidity” can sometimes delay care
Chest discomfort is frequently attributed to gas or acidity, particularly in India.
Heart-related discomfort can sometimes feel like pressure, heaviness, burning or indigestion rather than sharp pain. It is not always possible to distinguish heartburn from cardiac pain based on sensation alone.
New, severe or unexplained chest discomfort should therefore be assessed rather than repeatedly treated as acidity at home.
6. Family history matters more than many people realise
A strong family history of premature heart disease can increase risk even when cholesterol, weight and lifestyle appear reasonable.
Someone whose parent or sibling developed heart disease at a relatively young age should discuss this history with a doctor. It may influence how cardiovascular risk is assessed and whether additional testing is appropriate.
What should people actually watch?
Heart health is not simply about waiting for chest pain.
Blood pressure, blood sugar, cholesterol, waist circumference, smoking, physical activity, sleep and family history all contribute to the overall picture. Regular assessment becomes particularly important when several risk factors occur together.
Most importantly, symptoms that are new, unexplained or clearly different from a person’s usual pattern should not be ignored simply because they do not resemble the “classic” heart attack symptoms.
Heart disease does not always arrive dramatically. Sometimes the warning is much quieter—a gradual loss of stamina, unexplained breathlessness or persistent fatigue. Recognising these less obvious signs can mean seeking help before a silent problem becomes a major cardiac event.
-This article is authored by Dr N Dhananjaneya Reddy, Consultant-Interventional Cardiology, Arete Hospitals