Heart disease does not always start with obvious chest pain. Sometimes the first clue is a sore jaw, swollen ankles, unusual tiredness, or pain in your legs.

These signs can have many causes. They do not always mean you have a heart problem. But some should not be ignored.

Coronary heart disease is the most common type of heart disease. About 1 in 20 U.S. adults age 20 and older has it. It can also stay silent until a serious problem occurs.

Knowing the warning signs can help you know when it is time to get checked. Here are 10 signs to watch for.

Chest Pain, Pressure, or Tightness

Heart-related chest pain may not feel like a sharp pain. It can feel like pressure, squeezing, heaviness, tightness, burning, or fullness in the chest.

Angina is one possible cause. It happens when the heart does not get enough oxygen-rich blood. Stable angina often starts during exercise or stress and improves after a few minutes of rest.

Chest pain that does not go away is different. Pain that starts at rest, lasts more than a few minutes, or comes with shortness of breath, sweating, nausea, or dizziness may be a heart attack.

Do not wait to see if it passes. Call 911 if you think you may be having a heart attack.

Stomach Pain or Indigestion

Sometimes a heart problem can feel like an upset stomach.

You may notice burning, pressure, nausea, or discomfort in your upper stomach. This can be hard to tell apart from normal indigestion. The American Heart Association lists stomach discomfort among possible heart attack symptoms.

The key is to look at the whole picture. Stomach discomfort is more concerning when it comes with chest pressure, shortness of breath, sweating, dizziness, or pain in your arm, jaw, back, or neck.

If these symptoms appear together, do not assume it is just something you ate. Call 911 and get emergency help.

Pain in Your Arm, Jaw, Neck, or Back

Heart-related pain does not always stay in your chest.

It can spread to one or both arms. It can also reach your jaw, neck, shoulders, back, or stomach.

This pain may feel like pressure, heaviness, aching, or discomfort. It can be easy to blame it on a pulled muscle or a bad sleeping position.

Pay closer attention when the pain appears with chest discomfort, sweating, nausea, dizziness, or shortness of breath.

These can be heart attack warning signs. Call 911 rather than waiting for the pain to go away.

Sudden or Unexplained Sweating

Sweating after exercise or on a hot day is normal. Sudden cold or clammy sweating is different.

Unexplained sweating can happen during a heart attack. It may appear with chest pressure, nausea, dizziness, or shortness of breath.

Sweating alone does not mean you have heart disease. But if you suddenly become sweaty and also feel chest pain or pressure, take it seriously.

Call 911 if these symptoms could be signs of a heart attack. Fast treatment can limit heart damage.

A Choking or Tight Feeling in Your Throat

Heart-related discomfort can sometimes reach the throat. Angina may feel like pressure, tightness, or even a choking sensation.

This can be easy to dismiss as a throat problem or acid reflux. But heart-related discomfort can also spread to the neck and jaw.

A new or unexplained tight feeling deserves attention, especially if it happens during activity or stress.

If the throat sensation comes with chest pain, nausea, sweating, dizziness, or trouble breathing, treat it as a possible heart emergency and call 911.

Sudden Nausea or Feeling Sick

Nausea by itself is common. It can come from food, an infection, medicines, or many other causes. It does not usually mean you have a heart problem.

But sudden nausea with chest discomfort is different. A heart attack can cause nausea, vomiting, or an upset stomach. This is especially important when nausea appears with chest pressure, sweating, dizziness, or pain in the arm, jaw, back, or neck.

Do not try to diagnose the cause at home. If nausea comes with chest pain or pressure, trouble breathing, fainting, or severe weakness, call 911 right away. Quick treatment can reduce heart damage.

Swollen Ankles or Legs

Swollen ankles are common. They can happen after standing for a long time. Certain medicines, kidney problems, liver disease, and other conditions can also cause swelling.

But swelling can sometimes be linked to heart failure. When the heart cannot pump blood well, fluid can build up in the legs and ankles. You may notice that your shoes feel tighter or that pressing the swollen area leaves a small dent.

Do not ignore swelling that keeps coming back or gets worse. Make an appointment with your doctor. New swelling with severe shortness of breath, chest pain, or fainting needs urgent medical care.

Leg Pain When You Walk

Pay attention to pain that follows a pattern. Your calf may start to hurt or cramp when you walk. The pain may improve after you stop and rest.

This can be a sign of peripheral artery disease (PAD). PAD happens when narrowed arteries reduce blood flow to the legs. It is also a warning sign of wider blood vessel disease.

Smoking and diabetes are important risk factors for PAD. High blood pressure and high cholesterol also raise the risk.

If you keep getting this type of leg pain, see your doctor. Do not assume it is simply a normal part of getting older.

Extreme Fatigue Without a Clear Reason

Everyone gets tired. A late night or a long day can leave you worn out.

Heart problems can cause a different kind of fatigue. You may feel unusually weak or tired even after enough sleep. Some people with heart failure feel tired because the heart cannot pump enough blood to meet the body’s needs.

New or severe fatigue should not be brushed off, especially if it comes with shortness of breath, swelling, dizziness, or chest discomfort.

Fatigue has many possible causes. Your doctor can help find the reason instead of guessing.

Racing, Fluttering, or Skipped Heartbeats

Have you ever felt your heart suddenly race? Maybe it feels like it is fluttering, pounding, or skipping a beat. These feelings are called palpitations.

Stress, caffeine, lack of sleep, and some medicines can trigger them. In some cases, though, palpitations are caused by an abnormal heart rhythm called an arrhythmia.

One common arrhythmia is atrial fibrillation, or AFib. It can make the heart beat irregularly and can increase the risk of stroke.

Talk to your doctor if palpitations keep happening, last a long time, or feel very different from normal. If they happen with fainting, severe chest pain, or serious trouble breathing, call 911.

Conclusion

Heart disease does not always announce itself with classic chest pain. Sometimes the first clue is unusual tiredness, leg pain, swelling, nausea, or a change in your heartbeat.

These symptoms can have many causes. That is why you should not try to diagnose yourself. But a new symptom that keeps coming back deserves attention.

Regular checkups can also help find heart risks early. Your doctor can check your blood pressure, cholesterol, blood sugar, weight, smoking history, and other risk factors.

Do not wait for a small warning sign to become a major problem. Recognizing changes early can help you get care sooner and protect your heart.