Thanks to the far-reaching effects of the COVID-19 pandemic, the American Heart Association predicts that rates of heart disease, already the number-one cause of death in the US, will rise. This has to do with pandemic-related delays in seeking care…weight gain, inactivity and poor eating habits that developed while staying at home for extended periods …excess stress…the psychological toll of isolation…and heart damage from COVID-related cardiovascular complications. These risks increase with age, leaving the elderly most vulnerable.

Many of us may be unaware of our older loved ones’ new heart-related symptoms. Now that more people are vaccinated, it’s an ideal time to take a closer look and see if parents or other older relatives may be showing signs of heart disease.

Easy-to-Miss Warning Signs

When most people hear the words “heart disease,” they think of chest pain, labored breathing, high blood pressure and rapid heartbeat. And those certainly are indicators of heart disease, a heart attack or heart failure. (Contrary to how it sounds, heart failure doesn’t mean that the heart has stopped but rather that it can’t pump enough blood to keep up with the body’s demands.)

But did you know that your 80-year-old father quitting his golf game…your 90-year-old mother no longer wearing her trademark lipstick…extra pillows on your parents’ bed…or a switch from them cooking to eating frozen meals all could be signs of failing heart health?

Heart Disease Signs

Recognizing often-disguised heart-health warning signs could mean the difference between life and death for your aging loved ones. The next time you see them, ask yourself…

Are they no longer doing the things they used to love? Fatigue is one of the most common symptoms of heart failure, a symptom of heart disease and the leading cause of hospitalization in people over age 65. If your parent used to love playing golf several times a week but has stopped…or no longer gardens even though it gave him/her great joy, that could be a tip-off that heart ­failure–related fatigue is keeping them from their usual passions.

Depression also can cause people to disengage from formerly enjoyable activities, and depression and heart disease often go hand in hand. Depression can increase risk for heart attack and/or heart disease by increasing inflammation or causing platelets—cells that help with blood clotting—to become too sticky, clogging arteries in the process…or heart disease can fuel depression when one feels too tired to engage in favorite pastimes and begins to feel hopeless or worthless. At least one in five people with heart failure develops depression.

Are they cooking meals…or stocking premade and frozen foods? Cooking requires a surprising amount of mental and physical energy, from recipe planning to grocery shopping to meal preparation. That’s a lot of effort for someone who feels exhausted. Check your parents’ kitchen for evidence of cooking. Is the olive oil bottle full? Is the fridge produce drawer full of fresh vegetables—or worse, produce past its prime? Or is it relatively bare and the freezer full of frozen dinners? Complicating matters, premade, frozen and shelf-stable meals are notoriously high in sodium, which can aggravate existing heart issues.

Do you notice puffy weight gain? Heart failure can cause people to accumulate fluid around the liver and the ankles. It may appear to have developed out of nowhere and is more likely to happen if high-sodium foods are being consumed. A parent may report that it’s suddenly hard to button his pants.

Don’t mistake excess body fat for fluid—25% of adults over age 76 reported weight gain as a result of the pandemic, according to a 2021 Harris Poll conducted for the American Psychological Association. This type of weight gain tends to be all over the body, while fluid accumulation due to heart failure is localized around the middle and in the legs and ankles. It also feels different—when a physician thumps the belly of a patient with fluid buildup, it has a dull sound, like tapping a watermelon. Other signs: Swollen ankles…a visibly pulsing jugular vein in the neck…and tenderness under the right ribcage (from fluid accumulating in the liver).

How many pillows are they using? Heart failure can cause fluid to accumulate in the lungs, leading to shortness of breath, especially when lying flat. Patients often say that it feels like they’re suffocating when they lie down, so they prop themselves up to avoid that feeling. Some people take to sleeping in a recliner. Patients also may awaken from sleep with shortness of breath and have to sit bolt upright to breathe easily.

Does Mom pass “The Lipstick Test”? It’s always reassuring when an older patient reports to a doctor’s appointment wearing lipstick. It shows that she has the energy to keep up her normal routine. This is the type of clue you may not have noticed if you haven’t seen your parents in person in several months. Is mom still putting on lipstick? Is dad still shaving? Are they showering regularly? Do their clothes look wrinkled? If parents seem to be letting themselves go, it can be a tip-off to start asking more questions. Other signs: Is mail piling up that didn’t used to? Did they not decorate for the holidays even though they’ve been hanging Christmas lights for decades? These are similar red flags of low energy.

Are there bottles of antacid everywhere? If you spot antacids in the medicine cabinet, on the kitchen island and on their bedside table, ask about episodes of heartburn. Chest pain (angina) often masquerades as heartburn, especially chest pain that worsens with exertion, such as during a brisk walk. It even can be a symptom of a heart attack. The acid indigestion–like feeling can be accompanied by shortness of breath or fatigue. Although this “angina equivalent” can feel like heartburn caused by reflux, it has everything to do with the heart. Women are especially likely to experience atypical heart attack symptoms such as ­heartburn-like pain, fatigue and shortness of breath, as opposed to classic symptoms such as crushing chest pain.

Can they walk for six minutes straight…or sit and stand five times in a row? If your loved one gets winded from navigating stairs or struggles to get up from a chair, suggest taking a walk together. If he can’t walk for six minutes without stopping, he may have heart disease. Pay attention to whether he tries to make excuses to stop during the walk, such as chatting or tying his shoes.

You also can suggest they try the “5 Times Sit-to-Stand Test.” This is a simple way to look for a heart disease symptom called frailty. Frailty is an age-related syndrome involving deteriorations in several body systems, including stamina, strength, weight and fitness. How to do it: Have your loved one sit in a standard-height chair with his back against the back of the chair. Using a timer, ask him to stand up straight as quickly as he safely can, five times in a row without stopping, his arms remaining folded across his chest. Stop timing him when he stands for the fifth time. Someone age 70 to 79 ideally will finish in 12.6 seconds or less…someone age 80 to 89, 14.8 seconds or less.

Recent finding: A 2021 BMC Geriatrics meta-analysis concluded that frailty is an increasingly common heart disease symptom in older adults, affecting nearly one-fifth of heart disease patients.

Next Steps

If you recognize any of these symptoms, encourage your parent to schedule a visit with his primary care physician. If you can’t attend the visit, help make a list of concerns to show the doctor. (This is especially helpful for adults with memory issues.) With a little investigative work, you can help get Mom or Dad back to playing golf, gardening and feeling engaged with life.

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