Symptoms that could signal a possible heart problem should not be ignored.

Trouble is, some symptoms are so common they could indicate hundreds of diseases.

Dr. Christopher Leach, a cardiologist with Northeast Georgia Heart Center in Gainesville, said the most common heart-related symptoms are chest tightness or pressure, shortness of breath, abnormal heartbeats and fainting.

"People show up at their primary physician with one of these problems, and they’re sent to us so we can rule out anything bad," Leach said. "Often what seems to be a cardiac symptom turns out to be something else."

And even if the problem is related to the heart, he said, most symptoms end up being benign conditions that will not cause a heart attack.

Still, people should always err on the side of caution and assume that chest pain means a heart attack unless there is evidence to the contrary.

"Chest pain, if accompanied by other symptoms such as nausea and sweating, needs to be evaluated immediately," Leach said.

Another clue is that heart attack pain, caused by the total blockage of a coronary artery, usually does not go away if the person lies completely still.

"If it’s angina, which is pain due to partial blockages in the heart arteries, often it occurs only during certain activities," Leach said. "When the person rests, it goes away."

Some conditions can mimic a heart attack so closely that both patients and doctors can be fooled.

"Chest pressure is very common with anxiety attacks, and it’s very difficult to differentiate from a heart problem until we run tests," Leach said.

Another "great pretender" is esophageal reflux, commonly known as heartburn. It’s caused by stomach acid backing up and irritating the esophagus, but it can produce an intense, crushing pain that makes the patient fear they’re having a heart attack, even if they know they have a history of reflux.

And they could be right. Leach said just because your pain has previously always been caused by reflux doesn’t mean it’s not a heart attack this time.

"I’ve had patients who had both heartburn and heart attacks, and they said it was hard to tell the difference," he said.

Leach said if you try all the usual heartburn remedies and they have no effect on the pain, it’s time to consider that the cause may be cardiac.

"Nobody wants to believe they’re having a heart attack," he said. "They’ve seen the commercials and heard the warnings, but they think, ‘It couldn’t happen to me.’"

Leach said people should ask themselves, "Is the problem unusual for me?"

For example, if your heartburn medicine has always worked in the past, and suddenly it doesn’t help. Or if you start having heart palpitations and you’ve never experienced them before.

But an odd heart rhythm usually doesn’t portend anything ominous.

"Everybody has extra or ‘skipped’ heartbeats sometimes," Leach said. "It varies widely among individuals. If you have no other symptoms, those extra beats are generally benign."

Multiple symptoms may increase the chances that a problem is cardiac-related. If a person has been experiencing a racing heartbeat and then has a fainting episode, for example, doctors would look much more closely at the heart as a possible cause.

Leach said fainting should always prompt an evaluation of the heart, especially in a person who has never fainted before.

Another common symptom, shortness of breath, is especially tricky. "It can be caused by congestive heart failure or atrial fibrillation (an abnormal heart rhythm)," Leach said.

But shortness of breath is also a sign of many other conditions, including lung diseases, anemia, obesity and anxiety.

Leach said the biggest diagnostic challenge of all may be fatigue, which can have an almost unlimited number of explanations.

"Women often have atypical symptoms of heart disease, without the usual chest pain," he said. "Sometimes they complain simply of tiredness. After testing, we may find that they have atrial fibrillation or a blockage."

Leach said the heart should always be investigated as a source of trouble when a person is at high risk for heart disease.

"We especially want to check out people who are in high-risk categories: over age 55, diabetic, smokers," he said.

But without examining the patient, doctors cannot rule out a heart problem even in a young person, Leach said.

"In Georgia, I’ve noticed that heart disease seems to occur in people significantly younger than the average in other parts of the country," he said.