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Researchers have done a lot of work in recent years looking at the signs and symptoms patients experienced in the months or even years leading up to a heart attack.

Here are some signs that your heart needs to be checked by out by your doctor, especially if you have more than two.

1. Neck pain

Feel like you pulled a muscle in the side of your neck? Think again, especially if it doesn’t go away. Post-heart attack, some patients remember noticing that their neck hurt and felt tight, a symptom they attributed at the time to muscle strain. People commonly miss this symptom because they expect the more dramatic acute pain and numbness in the chest, shoulder, and arm. Women in particular are less likely to experience heart pain that way, and more likely to feel twinges of pain and a sensation of tightness running along the shoulder and down the neck, says Margie Latrella, an advanced practice nurse in the Women’s Cardiology Center in New Jersey and coauthor of Take Charge: A Woman’s Guide to a Healthier Heart (Dog Ear, 2009). The pain might also extend down the left side of the body, into the left shoulder and arm.

2. Sexual problems

Having trouble achieving or keeping erections is common in men with coronary artery disease, but they may not make the connection. One survey of European men being treated for cardiovascular disease found that two out of three had suffered from erectile dysfunction for months or years before they were diagnosed with heart trouble. Recent studies on the connection between ED and cardiovascular disease have been so convincing that doctors now consider it the standard of care to do a full cardiovascular workup when a man comes in complaining of ED, according to cardiologist Goldstein says. “In recent years there’s been pretty clear evidence that there’s a substantially increased risk of heart attack and death in patients with erectile dysfunction,” Goldstein says.

3. Dizziness, faintness, or shortness of breath

More than 40 percent of women in one study published in Circulation: Journal of the American Heart Association, reported having experienced shortness of breath in the days before a heart attack. You might feel like you can’t breathe, or you might feel dizzy or faint, as you would at high altitude. If you can’t catch your breath while walking upstairs, vacuuming, weeding the garden, or doing other activities that previously caused you no trouble, this is a reason to be on the alert.

4. Indigestion, nausea, or heartburn

Although most of us expect pain from any condition related to the heart to occur in the chest, it may actually occur in the abdomen instead. Some people, particularly women, experience the pain as heartburn or a sensation of over-fullness and choking. A bout of severe indigestion and nausea can be an early sign of heart attack, or myocardial infarction, particularly in women. In one study, women were more than twice as likely as men to experience vomiting, nausea, and indigestion for several months leading up to a heart attack.

5. Jaw and ear pain

Ongoing jaw pain is one of those mysterious and nagging symptoms that can have several causes but can sometimes be a clue to coronary artery disease (CAD) and impending heart attack. The pain may travel along the jaw all the way to the ear, and it can be hard to determine which it’s coming from, says cardiovascular nurse Margie Latrella. This is a symptom doctors have only recently begun to focus on, because many patients surveyed post-heart attack report that this is one of the only symptoms they noticed in the days and weeks leading up to the attack.

As a personal trainer and nutrition consultant, I have always believed in prevention. Lift weights, do cardio, remain lean but do not do crazy diet for a quick weight loss, check your hormones, eat an anti-inflammatory diet, sleep well and take your anti-oxidants. Fitness is not an option.

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