10 Sneaky Signs You May Have Heart Disease

4. … or vaginal dryness

Blood-flow issues aren’t limited to men. In one study, 84 percent of men and 87 percent of women with heart failure reported some degree of sexual dysfunction. For women, the signs can include vaginal dryness and a lack of libido and clitoral sensation: Endothelial dysfunction leads to less elastic blood vessels, which impairs blood flow to the sexual organs.

“The first step of developing cardiovascular disease, or coronary artery disease, is the endothelial dysfunction,” says Ernst von Schwarz, M.D., a cardiologist, researcher and clinical professor at Cedars-Sinai Medical Center and the University of California Los Angeles. This leads to blood vessel issues as well as blood-flow abnormalities, plaque formation, artery calcification and blockage, and, eventually, a heart attack. 

To complicate matters, many women experience vaginal dryness as a symptom of menopause. According to research from AARP, 33 percent of women age 35 and older report this symptom when going through menopause.

5. Your ankles are swollen

When the heart isn’t efficiently pumping blood, fluid can swell both legs. In a study of adults with no history of cardiovascular disease, fluid in the lower extremities was associated with future hospitalizations for heart failure. 

Swelling can also occur when veins in the legs can’t return fluid to the heart. In cases related to heart failure, swelling often occurs in both legs. Swelling in one leg could be due to a blood clot or an infection. Call your doctor if leg swelling is accompanied by heart failure symptoms such as shortness of breath.

6. You’re fatigued for no reason

If everyday activities make you tired — like needing to rest while making the bed — you may have an obstructed coronary artery.

Most women cite fatigue as their first symptom before having a cardiac event, says Jean McSweeney, professor emerita at the University of Arkansas for Medical Sciences College of Nursing. Fatigue can occur months before a heart attack and may result from lower blood flow to the heart. If you feel unusually tired from mundane activities, call your doctor.

7. You wake up to pee

Waking up to pee isn’t only due to chugging too much liquid before bed. A weak heart pumps less blood to the kidneys, which can result in fluid buildup and swollen ankles and legs. At bedtime, gravity drains fluid in the legs back to the heart. The kidneys have more fluid to filter, increasing the need to pee.

Nighttime urination may increase with age, especially in men with enlarged prostates and women with incontinence issues. But waking more than once a night to pee is concerning, says Bhatt, especially if paired with swollen ankles.

8. You have bad breath

Bad breath is caused by out-of-control bacteria, and it can damage more than your social life. Bacteria can enter your bloodstream through bleeding or diseased gums, which is linked to inflammation, clogged arteries and stroke. “There’s a correlation between people who have periodontal disease and people with cardiovascular disease,” says Florida periodontist David Genet.

“While there may not be a direct cause and effect between medical diseases such as heart disease and dental health, they are closely interrelated. That connection is an important reason for us to schedule regular dental cleanings as part of our annual health screenings,” he added.

9. You spot fatty growths

Known as xanthomas, these lesions feel like calcium deposits in the tendons, and they can indicate sky-high cholesterol. Tendon xanthomas typically occur near the ankles and elbows, and are especially prominent in people with a family history of high cholesterol. One study found that the risk of cardiovascular disease was three times higher among those with familial hypercholesterolemia — a genetic predisposition to high cholesterol.

10. You’re feeling nauseous

Unexplained queasiness could be a sign of heart failure, says Cleveland Clinic cardiologist Nicholas Ruthmann, M.D. When the heart struggles to pump blood, fluid and pressure can build up in the lungs, abdomen and lower extremities. Bloating and water retention may lead to nausea, feeling full quickly and decreased appetite.

There’s also a link between queasiness and heart attacks (women are more likely to report nausea as a heart attack symptom). Those with heart failure or a heart attack history should watch for persistent nausea that occurs with bloating, weight gain, swelling in the legs or ankles, and shortness of breath. If these symptoms occur alongside acute chest, jaw or shoulder pain, call 911.

Editor’s note: This story, first published Feb. 11, 2022, has been updated to include new information.