TIME Exercise/Fitness

This Study Busts Your Work Out Excuse

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Air quality may not be the best in cities, but the benefits of physical activity can outweigh the harms of breathing in pollutants

Exercising outdoors is certainly preferable to being cooped up in a stuffy gym, but if you live in an urban area, the pollution from cars and buses may give you pause. It shouldn’t. Zorana Andersen from the center for epidemiology and screening at the University of Copenhagen and her colleagues report in the journal Environmental Health Perspectives that being active trumps some of the negative health effects that breathing in polluted air might have.

MORE: Pollution: Dangerous to Joggers

In a study involving 52,061 people who were followed for around 13 years, Andersen found that those who were more active were less likely to die during the study than those who were more sedentary, regardless of the pollutant levels where they lived. The researchers asked the participants to detail their physical activities, including their leisure sports, how much they walked, whether they biked or walked to work, and whether they spent time gardening. They compared these responses to the levels of nitrogen dioxide near their homes; NO2 is a gas produced from the burning of fossil fuels in cars, and is an ingredient for other harmful pollutants such as ozone and particulate matter, which can cause respiratory illnesses. Previous studies found that walking along a busy London street, for example, caused a drop in lung function and that cycling or running near high traffic roadways also compromised people’s respiratory functions slightly.

In Andersen’s study, however, people who participated in sports showed a 22% lower risk of dying from any cause during the 13-year followup, while those who cycled regularly showed a 17% lower risk and people who spent time gardening showed a 16% lower risk compared to those who didn’t do either of those activities — and regardless of the pollution levels where they lived.

MORE: Ozone Can Harm the Heart in as Little as Two Hours

“We found an even more positive message around physical activity than we even hoped for,” says Andersen. “Physiologically it’s plausible that you inhale more particles [of pollution] when you exercise in polluted areas, and we thought maybe the accumulated lifetime effect of this would reduce the benefit of exercise. But we don’t see that.”

Essentially, the benefits of being active were strong enough to overcome some of the negative effects of breathing in pollutants. That makes sense, she says, because even if people aren’t exercising to avoid inhaling pollutants, they are still exposed to them, and Andersen’s study shows that even if exercises might be exposed to slightly higher levels of compounds like NO2, that still doesn’t negate the positive effects of physical activity on their heart, blood sugar levels and more. In fact, for specific conditions, the benefits of exercising remained quite high; active people even in highly polluted areas had a 66% lower chance of dying early from diabetes compared to those who didn’t exercise.

She notes, however, that some cities may have significantly higher pollution levels than Copenhagen, where the participants lived, and it’s not clear yet how greater concentrations can affect the exercise-pollution-mortality balance. So if you have a choice for working out, biking or walking in a less polluted area, however, such as a park or a quieter side street, that might be a good idea. But don’t worry too much if you don’t. “Being active prolongs life more than staying away from air pollution,” says Andersen. “So pollution shouldn’t be a barrier to exercise.”

TIME Diet/Nutrition

Eating Eggs With Raw Veggies Boosts Nutritional Benefits, Study Says

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Cooked eggs increase carotenoid absorption in salads

Next time you’re eating a raw-vegetable salad, consider adding cooked eggs to the mix. A new study suggests that mixing eggs with raw vegetables increases carotenoid absorption almost ninefold, entailing a range of benefits including longer life span, fewer chronic illnesses and a reduced cancer risk.

Researchers at Purdue University in Indiana served 16 subjects three different varieties of the dish: an eggless salad, a salad with 1½ scrambled eggs and a salad with three scrambled eggs. There was a threefold to ninefold increase in carotenoid absorption from the salad containing the most eggs, according to Science Daily.

The salubrious ingredients — from beta-carotene to lycopene — serve as antioxidants protecting against cancer and heart disease.

“Americans underconsume vegetables, and here we have a way to increase the nutritive value of veggies while also receiving the nutritional benefits of egg yolks,” said the study’s researcher Wayne Campbell.

“Next time you visit a salad bar, consider adding the cooked egg to your raw veggies,” added Campbell. “Not only are lutein and zeaxanthin available through whole eggs, but now the value of the vegetables is enhanced.”

[Science Daily]

TIME medicine

Who Should—And Who Shouldn’t—Take Vitamin D

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Here's what experts say, based on the latest evidence

Does your diet need a little extra D? For researchers, it’s one of nutrition’s most vexing questions. “It’s the wild, wild west,” says Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School. “The issue has become murkier over time rather than clearer.” Research is mixed about whether doctors should routinely test for vitamin D levels, like they do for cholesterol, and whether people should be supplementing their diets with vitamin D pills.

Case in point: a study just released in JAMA Internal Medicine showed that vitamin D did not lower the risk of falls among an elderly population in Finland. The study, which compared the effects of exercise against vitamin D supplements on falls and resulting injuries, did find, however, that exercise cut the chances of more severe injury from falls in half compared to those who didn’t exercise.

MORE Want to Stay Healthy? Don’t Rely on Vitamins

But that doesn’t mean that vitamin D isn’t worth taking at all. The Institute of Medicine (IOM), and the U.S. Preventive Services Task Force (USPSTF) both recently reviewed all of the evidence on vitamin D and its health effects and concluded that in many cases, D supplementation is beneficial—with some important caveats. The two groups say that 600 international units (IU) are generally enough for most healthy adults and that higher doses of vitamin D don’t necessarily produce more health benefits. They also stress that those benefits are limited to bone health; there isn’t enough evidence to support the idea that taking the vitamin can protect against heart disease, cancer, diabetes or cognitive decline, all benefits suggested by some smaller studies.

“More isn’t necessarily better,” says Manson, who served on the IOM committee. “In some cases, it can be worse.”

Overdoing vitamin D can lead to calcium in the urine, which can cause kidney stones. Extremely high doses—around 10,000 IU a day—can trigger calcium deposits in the blood vessels, which can lead to clots that cause heart attacks. The IOM panel recommended no more than 4,000 IU of vitamin D daily to avoid these potential problems.

MORE Want to Build Endurance? Cut Back on Vitamin C and E Supplements

When people are tested for vitamin D deficiency and come up short, some researchers caution against treatment. In addition to the dosage risks, there’s also evidence that the lab tests for the type of vitamin D circulating in the blood, 25-hydroxyvitamin D, may not be the most reliable measure of a person’s D levels. Plus, not all labs use the same standard test for picking up 25 hydroxy D, and they set different standards for what are considered normal levels. “Clinicians are often left chasing a number, and trying to get patients’ blood levels up to a certain point,” says Manson. “But when you think about how many people are screened for vitamin D, and the concerns about the reliability in how it’s measured, and the differences in what is considered normal ranges across laboratories, it’s really concerning.”

Better data may be coming soon, however. Several large trials are underway in which people are randomly assigned to take different levels of vitamin D supplements so researchers can study their health outcomes, from bone problems to heart disease, cancer, diabetes and more. Manson is overseeing the largest of these, called VITAL, which has 26,000 participants. The results from these studies, which are being conducted in the U.S., Europe, Australia and New Zealand, should be available in 2017. “We should have conclusive answers in about three years,” Manson says.

The studies will also look specifically at whether vitamin D levels and metabolism differ across racial and ethnic groups. Some studies have hinted that disparities by race in heart disease and certain cancer risks may be due to vitamin D, and the randomized trials will hopefully provide more information on whether that’s true.

In the meantime, Manson says doctors and patients should follow the IOM and USPSTF guidelines: doctors should not order vitamin D blood tests for all of their patients, and people shouldn’t take more than 600 IU of the vitamin if they are otherwise healthy. The only people who may need regular testing for vitamin D deficiency, and possible supplementation, are those with malabsorption problems like Celiac disease, those who have had bypass surgery, or people who have already had fractures and have been diagnosed with osteoporosis. People taking certain medications, including treatment for tuberculosis, may also need to consider vitamin D pills.

For everyone else, however, universal screening isn’t necessary—and there isn’t any reason to take more than the recommended daily allowance of vitamin D.

Read next: The 4 Most Confusing Things About Sugar

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TIME Innovation

Five Best Ideas of the Day: March 26

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. Al Qaeda and ISIS are locked in an ideological war, and for once, it’s good to be their mutual enemy.

By Daniel Byman and Jennifer Williams in Lawfare

2. For the millions left behind by America’s new economy, disability claims — legitimate or otherwise — are skyrocketing.

By Chana Joffe-Walt in Planet Money by National Public Radio

3. Maybe universities shouldn’t measure prestige by the number of applicants they turn away.

By Jon Marcus in the Hechinger Report

4. When younger women have heart attacks, they’re twice as likely to die as their male counterparts. Is medicine’s gender bias to blame?

By Maya Dusenbery in Pacific Standard

5. Can the triumph and tragedy of soccer help Harvard students appreciate the humanities?

By Colleen Walsh in the Harvard Gazette

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Heart Disease

New Class of Cholesterol Drugs Shows Promise For Heart Disease

The experimental drugs show promise, but medical experts remain cautious

Experimental drugs intended to lower cholesterol may also significantly reduce the risk of heart attacks and strokes, according to two new studies.

New research published in The New England Journal of Medicine show that a new class of cholesterol drugs, called PCSK9 inhibitors, may not just lower levels of bad cholesterol, but may also reduce the likelihood of adverse heart events.

The two drugs, evolocumab (under development by Amgen) and alirocumab (under development by Sanofi and Regeneron) appeared to reduce the risk of cardiac events like heart attack by around half, according to new studies.

PCSK9 inhibitors keep levels of low-density lipoprotein (LDL) cholesterol in the blood in check. In some cases they’ve shown to be even more effective than statins, one of the most prescribed drug categories. The experimental drugs are given by injection.

As the New York Times reports, it’s still too early to tell whether the drugs could be used to prevent adverse heart disease events, and the initial studies were only meant to assess the safety of the drugs as cholesterol moderators. Many in the medical community want to see more data.

The drugs have long been shown to be effective at lowering cholesterol, but there may be more widespread use if they also significantly lower heart attack and death risk. Reuters reports that both companies have already submitted their drugs for approval by the U.S. Food and Drug Administration (FDA).

Both studies were presented at the American College of Cardiology annual meeting.

TIME Heart Disease

Depression and Stress Could Be ‘Perfect Storm’ for Heart Disease Patients

The combination of depression and stress may increase the chance of a patient dying of heart disease

Intense stress and depression in people with coronary heart disease creates a “perfect storm” that can increase the risk of death, according to a new study in the journal Circulation: Cardiovascular Quality and Outcomes.

Overall, patients with both conditions are nearly 50% more likely to die or experience a heart attack as a result of heart disease than those with low stress or depression. The results were most apparent in the first two and a half years after observation began.

“The increase in risk accompanying high stress and high depressive symptoms was robust and consistent across demographics, medical history, medication use and health-risk behaviors,” said lead study author Carmela Alcántara, a researcher at Columbia University Medical Center.

The study, which looked at nearly 4,500 adults, expanded on previous research that found that both depression and stress can independently increase the risk of heart disease. The study suggested that some previous research may have misattributed the cause of heart-disease death to stress or depression independently. In reality, the study suggests, the interaction between stress and depression may have led to death rather than either independent factor.

The study traced participants for an average of nearly six years and asked patients to self-report symptoms of depression and stress. Overall, 6.1% of study participants had both high stress and intense symptoms of depression. Only 5.6% of the total sample had high stress alone, and 7.7% had intense symptoms of depression alone.

Researchers said the results suggest that doctors may want to consider additional methods to treat heart disease that include interventions to treat stress and depression.

TIME Heart Disease

7 Weird Things That Can Mess With Your Heartbeat

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Heart symptoms should never be taken lightly, but factors as innocent as caffeine and thirst may be the cause

A few weeks ago I thought I was having a heart attack. My morning started out normal: I woke up at my usual hour, feeling what I thought was a little bit of tiredness. But as I went about my morning routine, things grew scary. I broke out in a cold sweat as I brushed my teeth. My skin turned white as paper. And then, scariest of all: my heart was pounding like crazy. As a health writer I know these aren’t textbook signs of a heart attack, but I also know that dangerous cardiovascular events in women can be more subtle than those in men.

Later that day I went to urgent care, but an EKG and blood tests showed nothing out of the ordinary. Turns out my heartbeat went haywire as a result of a side effect from a medication. The technical term for this: heart palpitations, which can be brought on by many things.

“When a person says they’re having heart palpitations they’re referring to a sensation of their heart beating differently. Or they may simply have an awareness of their heart beating,” explains Shephal Doshi, MD, director of cardiac electrophysiology at Providence Saint John’s Health Center in Santa Monica, California.

Learn about some top triggers of palpitations, plus what to do about them.

Read more: 9 Subtle Signs You Could Have a Heart Problem

Panic attacks

If you feel as if your heart is racing like it’s going to beat out of your chest, it could be a panic attack, Dr. Doshi says. Shaking, sweats, and an overwhelming feeling of impending doom are also common symptoms. Panic attacks are generally not dangerous, though they can feel absolutely terrifying. “Sometimes you may have an arrhythmia [an abnormal heart rhythm caused by a disruption in the heart’s electrical signaling] that’s actually causing the panic attacks, so see a doctor to rule out something more serious,” Dr. Doshi adds. Otherwise, recurring panic attacks can be treated with talk therapy to identify triggers and anti-anxiety medications.

Read more: 12 Signs You May Have an Anxiety Disorder

Caffeine

So your heart’s beating faster than normal. Before you start worrying, did you just have a big cup of Joe? “Caffeine is a stimulant,” says Brian Kolski, MD, an interventional cardiologist with St. Joseph Hospital in Orange, California. This means that it “stimulates the autonomic nervous system (the involuntary nervous system which controls heart rate and more), which can cause an increase in palpitations.” Dr. Kolski recommends seeing your doctor if palpitations become excessive or are accompanied by dizziness, lightheadedness, or chest pain—even if you suspect it’s caused by caffeine.

Read more: 12 Surprising Sources of Caffeine

Decongestants

Decongestants such as pseudoephedrine (the active ingredient in Sudafed) are also stimulants. “Some people who may be sensitive to these drugs can experience heart palpitations,” adds Dr. Doshi. Over-the-counter meds are usually safe, but you should talk to your doctor or pharmacist if you have any other medical conditions. If you have a heart arrhythmia, for example, your doctor may advise against taking certain decongestants, Dr. Doshi says.

Read more: 10 Products to Help You Find Sinus Relief

Dehydration

Losing too much fluid, not drinking enough, or a combination of the two can quickly lead to dehydration, which, when severe, can lead to heart palpitations along with dry mouth, dark urine, and muscle cramping. “Dehydration can cause changes in your body’s electrolytes and also lowers blood pressure,” Dr. Doshi says. “This puts stress on the body and, as a result, could cause an abnormal heartbeat.” Prevent it with regular trips to the water cooleryour body needs 2.2 liters (or about nine cups of fluid) every day to function properly, per the Institute of Medicine.

Read more: 7 Easy Ways to Drink More Water

Prescription meds

Many prescription medications, including those for asthma or thyroid problems, can cause palpitations, says Dr. Kolski. “Some medications affect how other medications are metabolized, while others cause changes in the electrical conduction system of the heart.” These heartbeat changes aren’t normally a cause for alarm, but they can be bothersome. Make sure your doctor knows about every drug or supplement you’re taking before you start any new medications. Also, pay close attention to the possible side effects listed on the drug information that comes with your medicine when you pick it up from the pharmacy, so you won’t freak out if it happens. If your regular medicines are messing with your heartbeat day-to-day, talk to your doctor to see if there’s a different drug that might work better for you.

Read more: 19 Signs Your Thyroid Isn’t Working Right

Anemia

Most commonly caused by iron deficiency, anemia means your body isn’t making enough healthy red blood cells to carry adequate oxygen to your tissues. Although it doesn’t always cause heart palpitations, people with anemia may sometimes feel their heart beating harder, says Kolski. “Since you have fewer red blood cells, a faster heart beat increases oxygen delivery when you’re anemic.” Other symptoms include fatigue and hair loss.

Read more: 15 Signs You May Have an Iron Deficiency

Heavy metals

People who work in construction, as metal workers, or in other industrial settings can be exposed to mercury, cadmium, and other heavy metals regularly. Long-term exposure can lead to inflammation, blood clots (thrombosis), and other heart-related problems. “Heavy metal exposure can be directly toxic to heart muscle,” Dr. Kolski says. “[It] can also cause problems with electrolytes. Anything that causes a derangement in electrolytes can cause heart palpitations.”

Read more: 10 Best Foods for Your Heart

In general, heart symptoms should never be taken lightly; if you ever feel like something’s up with your heart, see a doctor ASAP (in the ER or an urgent care center) for a full evaluation.

This article originally appeared on Health.com.

TIME Heart Disease

Statins May Seriously Increase Diabetes Risk

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Statins can lower cholesterol and even tamp down inflammation to keep the risk of heart disease down. But these commonly prescribed drugs may increase the risk of diabetes, and by a considerable amount

Doctors may have to weigh a serious potential risk before prescribing statins, the cholesterol-lowering drugs that are among most prescribed drugs in America. In a study published in Diabetologia, scientists from Finland found that men prescribed statins to lower their cholesterol had a 46% greater chance of developing diabetes after six years compared to those who weren’t taking the drug. What’s more, the statins seemed to make people more resistant to the effects of insulin—which breaks down sugar—and to secrete less insulin. The impact on insulin seemed to be greatest among those who started out with the lowest, and closest to normal, levels of blood glucose. And the higher the dose of the statin, and the longer the patients took them, the greater their risk of diabetes.

Previous studies have suggested that statins can raise blood sugar levels, and increase the risk of diabetes by anywhere from 10% to 20%, but none have documented an effect this large. Doctors often consider statins for patients who are at higher risk of heart disease, and one of the risk factors for future heart trouble is diabetes. So how do these results affect that decision?

“It’s a good news-bad news scenario,” says Dr. Robert Eckel, past president of the American Heart Association and professor of medicine at University of Colorado School of Medicine. “Although there is convincing evidence that patients on statins are at increased risk of new-onset diabetes, the benefit accrued [from statins] in reducing risks of heart attack, stroke and fatal heart disease trumps the effects of being new onset diabetics.”

In other words, the good that statins can do for people who are not yet diabetic but at higher risk of heart problems outweighs the increased risk of diabetes.

MORE New Guidelines for Cholesterol Treatments Represent “Huge Change”

And while the increased risk that the Finnish scientists found — 46% — is noteworthy, Eckel points out that the study involved only white men, and therefore may not be generalizable to a broader population. It’s not clear what the men’s family history or personal history of diabetes was; some may have had other risk factors for the disease that put them at higher risk of developing diabetes anyway, even if they didn’t take a statin.

Those who developed diabetes while taking statins were similar on many metabolic measures to those who developed diabetes but weren’t taking statins, suggesting that “that statin treatment increased the risk of diabetes independently of the risk profile of the background population,” the authors write. In a separate, U.S.-based study on statins, researchers found that those who went on to develop diabetes while taking statins also had risk factors for the disease before they started taking the medications.

MORE Should You Take Statins? Study Says Heart Benefits Outweigh Diabetes Risk

Which means that for confused patients, and their doctors, the current advice about who should take statins doesn’t change. The results, in fact, highlight the need for a discussion rather than just working through a checklist before prescribing statins. For patients who may not yet be diabetic, but are vulnerable to developing the disease and also may need a statin, Dr. Neil Stone, lead author of the 2013 American College of Cardiology and American Heart Association cholesterol guidelines, says he stresses the importance of lifestyle changes in diet and exercise.

“If you have a patient who is prone to developing diabetes, you’re getting into a higher risk group, because they also have risk factors associated with heart disease. So they have the potential to benefit from statins. If they are going to take a statin, I tell them we are going to help you get more fit, and work with your lifestyle. It’s even more important because if you don’t do that, and the patient decides to take the statin and go on with their unhealthy habits, then they are going to be even more prone to developing diabetes,” says Stone.

The patient’s family history of diabetes is another important part of the decision to start someone on a statin. It’s all about making sure that each patient’s risks and benefits are weighed carefully. And the potentially greater risk of diabetes created by statins should be part of that consideration. “Communication here is everything,” says Eckel.

Read next: New Hormone Discovered That Curbs Weight Gain, Diabetes Just Like Exercise

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TIME Heart Disease

Moderate Amounts of Coffee May Help Keep Arteries Clear, Study Says

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Coffee in your veins may actually be healthy

Drinking three to five cups of coffee per day may help to reduce signs of blocked arteries, says a new study out of South Korea.

Published Monday in the medical journal Heart, the study involved more than 25,000 male and female workers, who previously showed no signs of heart disease, looking for calcium buildups indicating plaque growth that can cause heart attacks and strokes.

The results showed that those who drank the least amount of coffee, and the most, had a larger amount of calcium in their arteries than those who consumed a moderate amount.

Interestingly, researchers also discovered that the findings were consistent through different subsectors, such as smokers, drinkers and those with obesity issues.

“While this study does highlight a potential link between coffee consumption and lower risk of developing clogged arteries, more research is needed to confirm these findings and understand what the reason is for the association,” Victoria Taylor of the British Heart Foundation told the BBC.

Taylor also noted that the results should not be generalized because different cultures have distinct lifestyle and dietary customs that may also contribute to cardiovascular health.

TIME Heart Disease

9 Subtle Signs You Could Have a Heart Problem

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These signs can also be caused by a bunch of other things

Thanks to more education about healthy eating and advancements in treatment, fewer people die of heart disease than in the past. That said, clogged heart arteries are still the number-one cause of death in the United States. Although heart attack symptoms can be a scary first sign of trouble (and keep in mind women have different symptoms than men), sometimes the body offers up more subtle clues that something is amiss with your ticker. The following is a list of symptoms that might be worth a chat with your doctor. But they may also be caused by a bunch of other things, so don’t freak out. (Many of these are also symptoms of anemia, so check out 15 Signs You May Have an Iron Deficiency.) Only your real doctor—not Dr. Google—can really tell you if these symptoms mean anything at all.

You’re extremely tired

This isn’t just lack of sleep tired; it is extreme fatigue. Think of how you feel when you get the flu, except this doesn’t go away. “A lot of women kind of blow this off assuming it’s nothing and that they will feel better, but in reality it could be a sign of your heart,” says Suzanne Steinbaum, DO, Director of Women’s Heart Health at the Heart and Vascular Institute at Lenox Hill Hospital in New York City. The reason why you feel that way: It comes down to a lack of oxygen. “The heart is struggling and straining to deliver the oxygen to your body.” That said, plenty of people feel tired for lots of reasons. If this is your only symptom, you can talk to your doctor, but don’t conclude you have heart trouble based on this alone.

Read more: 15 Signs You May Have an Iron Deficiency

Your feet swell

Feet swelling can occur for a bunch of garden-variety reasons, such as pregnancy, varicose veins (which are unsightly but not dangerous), or when you travel and have limited ability to move around. It can also be a sign of heart failure, a chronic condition in which the heart pumps blood inefficiently. “Swelling can also occur when the heart valve doesn’t close normally,” says Michael Miller, MD, professor of cardiovascular medicine at the University of Maryland School of Medicine. Some medications for blood pressure and diabetes could also cause swelling, says Dr. Miller. “Heart-related foot swelling is usually accompanied by other symptoms that include shortness of breath and/or fatigue,” he says. If you recently developed foot swelling, see your doctor to determine the cause and how best to treat it.

You have extreme pain when you walk

If your hip and leg muscles cramp when you climb, walk, or move, then feel better when you rest, don’t shrug it off as due to old age or a lack of exercise (though those things certainly could be the culprits). It could be a sign of peripheral arterial disease, also known as PAD. PAD is a buildup of fatty plaque in leg arteries that is linked to a higher risk of heart disease. If you have PAD there’s a 50% chance you also have a blockage in one of the heart arteries, says Dr. Miller. The good news? PAD (and heart disease for that matter) is a very treatable condition.

Read more: 14 Reasons You’re Tired All the Time

You get dizzy or light-headed

Again, this is one of those symptoms that can have many non-heart related causes. If you have ever been to a gym, you may have seen warning signs to stop walking, running, cycling or elliptical stepping if you feel dizzy or light-headed. This symptom could be caused by dehydration or because you “got up too quick,” but if it occurs on a regular basis then talk to your doctor to see if medication side effects, inner ear problems, anemia, or, less commonly, heart issues are to blame. This spinning state could be caused by blockages in arteries that lessen blood pressure or by faulty valves that cannot maintain blood pressure, says Dr. Miller.

You get short of breath, even though you’re fit

Despite your thrice-weekly cycling classes, you get winded walking up a flight of stairs or you’re coughing a lot. What gives? It could be asthma, anemia, an infection, or rarely a problem with the heart’s valves or its ability to pump blood. “Fluid buildup affecting the left side of the heart can produce wheezing that simulates bronchial asthma,” Dr. Miller says. “Once the valve is fixed, fluid no longer builds up in the lungs and the patient breathes easier.” Since exercise can strengthen the heart, get this symptom checked out so it doesn’t interfere with your ability to get a good workout.

Read more: 12 Worst Habits for Your Mental Health

You’re depressed

Depression is one of the most common problems in the world, and it affects 19 million Americans each year. Depression is probably not a sign that you have heart trouble (as if you need something else to worry about.) But mental wellbeing is linked to physical wellbeing; many studies suggest that people who are depressed are at greater risk of heart trouble. “People who have multiple risk factors for heart disease or who do have heart disease have a tendency to be depressed,” says Dr. Steinbaum. Either way you look at it, it’s another reason to seek help if you are depressed.

You get migraines

Sometimes a headache is just a headache. But in some cases, regular migraines suggest that something is amiss with your ticker. Migraines occur in 12% of the general population, but that stat rises to around 40% in patients with cardiovascular disease. And while there isn’t a clear-cut connection, the occurrence of migraines with auras has been related to some heart abnormalities, so it is possible that these attacks might have a connection to dysfunction of the heart. One theory is that they could both are the result of autonomic nervous system imbalances.

Read more: 10 Signs You Should See a Doctor for Depression

You can hear your heart beat when you fall asleep at night

“Some patients with a loud faulty valve can even hear the sound of their valve at night when they are trying to fall asleep,” Dr. Miller says. And while some patients adjust to the sound and often just change their sleeping position so as not to hear it, doesn’t mean you should ignore it. If you’re being lulled to sleep by the thump-thump of your heart, tell your doctor so he or she can find out why. A pounding heartbeat can also be a sign of low blood pressure, low blood sugar, anemia, medication, dehydration, and other causes.

Anxiety, sweating, and nausea attack you all at once

You’re suddenly anxious, sweating, and nauseous. These are classic symptoms of a panic attack, but they are also heart attack symptoms. If these early heart symptoms are followed up with shortness of breath (though you haven’t moved a muscle), extreme fatigue, or accompanied by pain, fullness, or aching in the your chest that may (or may not) radiate to the back, shoulders, arm, neck, or throat, then get to an emergency room immediately. Waiting more than five minutes to take action could change your chances of survival. In fact, those who arrive at the hospital within an hour of heart attack symptoms starting have better survival rate than those who wait.

Read more: 25 Surprising Ways Stress Affects Your Health

This article originally appeared on Health.com.

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