If we could really “wear our hearts on our sleeves,” then we would know right away when our heart was not doing well. Instead, there are a variety of direct and indirect signs that we may have an unhealthy heart.

Read on to learn clues that your heart may not be unhealthy.

1) Sexual performance

Erectile dysfunction in men, and difficulty achieving an orgasm in women, can be an indicator of poor blood flow to sexual organs, but also to the heart.

According to a Mayo clinic study, “men who experience erectile dysfunction between the ages of 40 and 49 are twice as likely to develop heart disease than men without dysfunction,” reported Science Daily. In addition, researchers found that men with ED had an 80 percent higher incidence of heart disease.(2)

While the cause is not exactly known, researchers think that plaque buildup narrowing blood vessels in the penis may also be occurring around the hear. It's also possible that arterial stiffening around the heart is occurring in the smaller blood vessels that feed the penis.

2) Sleep apnea or poor sleep habits

Sleep apnea has been linked to cardiovascular disease for many years. It's also been linked to obesity and the development of atrial fibrillation. One study showed that the risk of AFib was four times higher in those with obstructive breathing.(3)

AFib is the most common cardiac arrhythmia and can lead to stroke, hypertension and heart failure.

Another study on sleep habits measured the amounts of circulating calcium and arterial stiffness. They found that those who sleep less than five hours a night had 50 percent more circulating calcium. Those who sleep longer than nine hours had 70 percent more than those who sleep seven hours a night.(4)

"Adults with poor sleep quality have stiffer arteries than those who sleep seven hours a day or had good sleep quality. Overall, we saw the lowest levels of vascular disease in adults sleeping seven hours a day and reporting good sleep quality," reported co-lead author Dr. Yoosoo Chang to Medical Daily.

3) Aging physical features

This is a case of what you look like on the outside may indicate how healthy you are on the inside. Danish researchers monitored 11,000 people over the age of 40 in the Copenhagen City Heart Study, beginning in the 1970s.

However, they observed that certain aging signs were correlated with heart disease, while others were not.

“The Danish study found that people who had three or four signs of aging -- fatty deposits around the eyelids, receding hairlines, baldness, and creased earlobes -- were 39 percent more likely to develop heart disease and 57 percent more likely to have a heart attack over 35 years of follow-up, compared to people of similar age who looked younger,” reported Healthday News.(5)

4) Swollen or puffy legs and feet

Having swollen legs occasionally may not be a concern but swollen legs, feet or ankles may mean that your heart is not able to handle circulating your blood efficiently.

Sluggish blood flow allows fluid to seep out of your blood vessels into the surrounding tissue. This type of swelling is called edema, and can be a sign of heart failure and cardiovascular disease.

If you notice any of these signs occurring more than once or twice, make an appointment with your doctor to have tests run that evaluate the health of your heart and circulation.

Michele is an R.N. freelance writer with a special interest in woman’s healthcare and quality of care issues.

Edited by Jody Smith