Heart disease is found through a combination of recognizing physical symptoms, routine screening tests, and targeted imaging when risk factors are present. Many people have early signs they dismiss as normal aging or stress, and some forms of heart disease produce no obvious symptoms at all until a serious event like a heart attack. Knowing what to watch for in your body and which tests to ask about gives you the best chance of catching problems early.
Symptoms That Signal a Problem
The most recognizable warning sign of coronary artery disease is chest pain, called angina. It typically feels like pressure, tightness, or squeezing in the middle or left side of the chest. People often describe it as feeling like someone is standing on their chest. This pain can come and go, frequently triggered by physical exertion or emotional stress, and it eases with rest.
But chest pain isn’t the only signal. When the heart can’t pump enough blood to keep up with your body’s demands, you may notice shortness of breath or unusual fatigue during activities that didn’t used to bother you. These symptoms tend to creep in gradually, making them easy to brush off. Pain that spreads to the shoulder, arm, back, neck, jaw, or upper stomach is another red flag, especially when it appears alongside cold sweats, nausea, or lightheadedness.
Why Symptoms Look Different in Women
Women are more likely than men to experience heart disease symptoms that don’t fit the classic picture. While chest pain remains the most common heart attack symptom regardless of sex, women more frequently report neck, jaw, shoulder, upper back, or stomach pain. They’re also more likely to feel nausea, unusual fatigue, dizziness, and shortness of breath as their primary symptoms, sometimes without significant chest discomfort at all.
The underlying disease itself can differ too. Women are more likely to have a heart attack without a severe blockage in a major artery. They also tend to develop blockages in the smaller blood vessels that supply the heart, a condition called small vessel heart disease. These differences mean standard tests designed to find large blockages can sometimes miss the problem in women, which is one reason heart disease in women has historically been underdiagnosed. If your symptoms seem vague but persistent, especially shortness of breath, fatigue, or discomfort triggered by emotional stress or occurring at rest or during sleep, those patterns deserve medical attention.
Routine Screenings That Catch Early Risk
Heart disease often builds silently over years before symptoms appear. Routine screenings are the primary way to catch the underlying risk factors that lead to it. The American Heart Association recommends these core checks:
- Blood pressure: At least once a year if your reading is below 120/80, or at every regular healthcare visit.
- Cholesterol: Starting at age 20, then every four to six years for people at normal risk. More frequently if your risk is elevated.
- Blood glucose: Starting at age 45, or earlier if you’re overweight with at least one additional cardiovascular risk factor. Repeat at least every three years if results are normal.
For cholesterol, the numbers that matter depend on your overall risk. If you have no history of heart disease and your 10-year risk is low to moderate, an LDL cholesterol level below 100 mg/dL is a reasonable target. If you already have heart disease, the goal drops significantly, to below 70 mg/dL or even below 55 mg/dL for those at the highest risk of a repeat event.
Blood Tests Beyond Cholesterol
When heart disease is suspected or needs to be ruled out in an emergency, specific blood markers provide critical information. Troponin is the primary marker used to detect heart damage from a heart attack. Troponin levels rise within hours of heart muscle injury, peak around 12 hours, and stay elevated for up to two weeks. If you go to the emergency room with chest pain, this is one of the first tests they’ll run.
For heart failure, a different marker called NT-proBNP measures strain on the heart. Elevated levels suggest the heart is working harder than it should to pump blood. These tests don’t replace imaging, but they help doctors determine whether the heart has been damaged and how urgently further testing is needed.
Imaging and Stress Tests
When symptoms or screening results raise concern, imaging tests can visualize what’s happening inside the heart and its arteries.
A standard EKG (electrocardiogram) records the heart’s electrical activity and can reveal rhythm abnormalities or signs of past damage, but it has limited sensitivity for detecting blocked arteries on its own. Pairing it with exercise on a treadmill (a stress test) improves accuracy. If you can’t exercise due to joint problems or other limitations, medications can simulate the effect of exercise on the heart.
Adding imaging to a stress test increases diagnostic power further. A stress echocardiogram uses ultrasound to watch how the heart muscle moves during exertion. If part of the heart wall isn’t contracting normally under stress, it suggests that area isn’t getting enough blood. Most experienced physicians choose stress echocardiography for patients at intermediate risk who they consider less likely to have significant blockages.
Coronary CT angiography (CTA) provides detailed images of the coronary arteries themselves. It has high sensitivity for detecting plaque buildup and ruling out significant narrowing, and current guidelines give it a top-tier recommendation for evaluating stable chest pain. Beyond diagnosis, it helps doctors assess the size and location of plaque, monitor disease progression over time, and plan procedures if intervention is needed.
Coronary Calcium Scoring
A coronary calcium scan is a quick, noninvasive CT scan that measures calcium deposits in the walls of your heart’s arteries. Calcium buildup is a direct sign of plaque, so this score quantifies how much coronary artery disease is already present.
The scoring works on a simple scale. A score of zero means no calcium is detected, suggesting a low chance of heart attack in the coming years. A score of 100 to 300 indicates moderate plaque deposits and a relatively high risk of a heart attack or other cardiac event within three to five years. A score above 300 signals more extensive disease and higher risk. This test is particularly useful for people in the gray zone of risk, where it’s unclear from standard screening alone whether aggressive prevention is warranted.
Genetic and Hereditary Risk Factors
Some heart disease risk is inherited, and a blood test for a substance called lipoprotein(a), or Lp(a), can reveal one of the most important genetic risk factors. High Lp(a) levels, defined as greater than 50 mg/dL, are surprisingly common and significantly raise the risk of heart attack and stroke. Unlike regular cholesterol, Lp(a) is largely determined by genetics and doesn’t respond much to diet or exercise.
Your doctor may suspect high Lp(a) if you have a family history of early heart disease, specifically heart attack or stroke before age 55 in men or 65 in women, without typical risk factors like smoking, diabetes, or obesity. About a third of people with familial hypercholesterolemia (an inherited condition causing very high cholesterol) also have elevated Lp(a). Since Lp(a) levels are genetically fixed, you only need the test once in your lifetime. If your level is high, your close family members should be tested too.
What Smartwatches Can and Can’t Detect
Consumer smartwatches have become surprisingly accurate at detecting atrial fibrillation, the most common dangerous heart rhythm disorder. A 2025 meta-analysis of 26 studies covering over 17,000 patients found that smartwatches achieved 95% sensitivity and 97% specificity for detecting atrial fibrillation overall. Apple Watch showed 94% sensitivity and 97% specificity, while Samsung devices reached 97% sensitivity and 96% specificity.
These numbers are impressive, but they come with caveats. The studies excluded recordings that were too poor in quality for the device to interpret, meaning real-world accuracy will be somewhat lower. And the populations studied had higher rates of atrial fibrillation than the general public, which inflates how reliable positive results appear. A smartwatch notification about an irregular rhythm is worth following up on, but it’s a screening prompt, not a diagnosis. It also won’t detect blocked arteries, heart failure, or valve problems.