Heart Symptoms

Typical symptoms we are asked to assess:

  • Chest pain
  • Shortness of breath on exertion
  • Palpitations/irregular heart beat
  • Dizziness
  • Heart murmur has been detected
  • High blood pressure
  • Abnormal findings on tests – ECG, chest x-ray etc.
  • Screening for heart disease. Insurance company requests family history/risk factors for heart disease screening of young adults for unsuspected heart disease as a prelude to taking up regular exercise or sporting activity

Chest Pain

Pain or discomfort in the chest can have many causes but the most significant and potentially worrying cause of pains in the chest is angina. Angina is due to narrowing or furring of the small arteries which supply the heart with blood. Angina is typically felt as a discomfort, heaviness or tightness in the chest which usually occurs on exertion or sometimes with emotion. Rather than discomfort, angina is sometimes felt as a feeling of breathlessness.

What tests can I expect?
After talking with you and an examination, it may be suggested that you undergo one or more of the following tests:

  • Simple blood tests
  • Echocardiogram
  • Electrocardiogram (ECG)
  • Exercise tolerance test
  • 24 hour, 12 lead ECG (Holter monitoring)

Depending on the results of these tests, further, more advanced tests may be required:

  • Coronary angiogram
  • Thallium scan
  • Myocardial perfusion scan (MIBI/thallium scan)
  • Stress echocardiogram

If I have angina, what treatment may be required?

  • Tablet (medical) treatment
  • Angioplasty and stenting
  • Coronary artery bypass surgery

Breathlessness

There are many causes of shortness of breath but frequently this symptom results from heart or lung problems. Distinguishing between the two can prove difficult but your doctor will have assessed you and will have reason to suspect that a heart problem is the cause of your breathlessness. A number of heart problems can result in shortness of breath including angina, heart valve disease and problems with the muscle or rhythm of the heart.
Palpitations and Atrial Fibrillation

A palpitation is a term used for an ‘awareness’ of the heartbeat.

Understandably such a symptom often causes great anxiety but very often people are simply aware of normal, but fast or forceful heartbeats or may be aware of occasional ‘extra’ (ectopic) heartbeats. However, an investigation is required to ensure that there is no important abnormality.

The heart has its own complex electrical circuitry and any aspect of this can develop problems which can lead to palpitations. Sometimes a ‘short circuit’ of the electrics of the heart can occur which can lead to a more sustained rapid heartbeat – this can feel very unpleasant.

In investigating palpitations it is very important to ensure that there is no abnormality in the structure of the heart as this may be the cause of the palpitations themselves and may mean the palpitations are potentially more dangerous.

A very specific type of palpitation is ‘atrial fibrillation’ (AF). This is a common rhythm disturbance and is a fast, completely irregular rhythm of the heart. This rhythm may come and go (called paroxysmal AF) or the rhythm may stay persistently irregular – although the rhythm in both cases is similar, the treatment may be quite different. One important complication of AF is that it is associated with the risk having a stroke – this risk may in many cases be very small but this will be discussed in detail by your cardiologist.

What tests can I expect?
After talking with you and an examination, it may be suggested that you undergo one or more of the following tests:

  • Electrocardiogram (ECG)
  • Echocardiogram
  • 24 hour / 48 hour ECG recording

Depending on the results of these tests, further, more advanced tests may be required:

  • Trans-oesophageal echocardiogram
  • 7-day event recorder
  • Implantable loop recorder (Reveal device)
  • Electrophysiology study

If I have abnormal heart rhythms what treatment may be required?

  • Tablet (medical) treatment
  • Cardioversion
  • Permanent Pacemaker
  • Ablation treatments
  • Implantable Defibrillator

Dizziness and fainting

Many people will faint or pass out at some point in their life, and such problems often cause. There are many causes of fainting but the underlying problem causing this is likely to be a problem with the heart, brain (epilepsy) or the fine control mechanisms of the blood pressure and pulse. Your doctor may find clues as to which is most likely cause before referring you to a cardiologist if necessary.

What tests can I expect?
After talking with you and an examination, it may be suggested that you undergo one or more of the following tests:

  • Simple blood tests
  • Electrocardiogram (ECG)
  • Echocardiogram
  • Exercise tolerance test
  • 24 hour / 48 hour ECG recording
  • Resting and 24 hour BP monitoring
  • Carotid massage with ECG monitoring

Depending on the results of these tests, further, more advanced tests may be required:

  • 7-day event recorder
  • Tilt test
  • Implantable loop recorder (Reveal device)
  • Electrophysiology study (sinus node recovery time or ventricular tachycardia stimulation study)

What treatment may be required?

  • Tablet (medical) treatment
  • Permanent Pacemaker
  • Implantable Defibrillator
  • Heart valve surgery

Heart Murmurs and Heart Valve Problems

A heart murmur is an abnormal sound that can be heard when examining the heart. Murmurs can often be caused simply by high rates of blood flow through the heart (for example during childhood or pregnancy) and are completely innocent. However murmurs can sometimes be as a result of a significant problem, particularly with one or more of the valves of the heart, and therefore should be investigated by a cardiologist.

Heart murmurs are often picked up by chance during an examination with no symptoms. Alternatively, heart valve problems may cause symptoms. such as breathlessness (particularly on exertion), tightness in the chest (angina) or dizziness/blackouts. In addition, certain types of valve problem can lead to palpitations and atrial fibrillation (AF).

What tests can I expect?
After talking with you and an examination, it may be suggested that you undergo one or more of the following tests:

  • Simple blood tests
  • Electrocardiogram (ECG)
  • Echocardiogram
  • Chest x-ray
  • Depending on the results of these tests, further, more advanced tests may be required:
  • Trans-oesophageal echocardiogram (TOE)
  • Coronary angiogram

If I have heart valve disease, what treatment may be required?

  • Tablet (medical) treatment
  • ‘Watchful waiting’ – Many heart valve problems are slowly progressive and will need to be checked from time to time to make sure that they are not worsening and leading towards problems.
  • Heart valve surgery
  • Catheter-based treatments – this is an emerging field in which some of our Consultants have a particular interest

High Blood Pressure (Hypertension)

Having a high blood pressure over many years greatly increases the risk of problems: furring in the arteries leading to angina; heart attacks and strokes. Happily, we are much better now at picking this up sooner rather than later and there is a wide range of extremely effective treatments to lower blood pressure and reduce the risks of problems in the future. Much of the time you and your GP will be able to achieve good control of blood pressure but if the levels are very high or control is difficult your GP may suggest you see a cardiologist to assess things in more detail.

What tests can I expect?

  • After talking with you and an examination, it may be suggested that you undergo one or more of the following tests:
  • Simple blood tests
  • Electrocardiogram (ECG)
  • Echocardiogram
  • 24-hour blood pressure recording

What treatment may be required for high blood pressure?

  • Lifestyle changes
  • Tablet (medical) treatment

Heart Failure

Heart ‘failure’ is the medical term used for symptoms resulting from a problem with the pumping function of the heart muscle. Typical symptoms are tiredness, breathlessness and fluid retention. Although heart failure is a concerning diagnosis it certainly does not mean an inevitably poor outcome as the term may suggest. Indeed over the last few years, major advances have been made in the treatment of the causes and symptoms of heart failure.

What tests can I expect?

  • After talking with you and an examination, it may be suggested that you undergo one or more of the following tests:
  • Simple blood tests
  • Electrocardiogram (ECG)
  • Echocardiogram
  • Exercise tolerance test (ETT)
  • 24 hour / 48 hour ECG
  • Chest x-ray

Depending on the results of these tests, further, more advanced tests may be required:

  • Trans-oesophageal echocardiogram (TOE)
  • Thallium (Perfusion) scan
  • Coronary Angiogram
  • Cardiac MRI
  • Cardio-pulmonary exercise testing

What treatment may be required for heart failure?

  • Tablet (medical) treatment
  • Coronary Artery bypass surgery (CABG)
  • Heart valve surgery
  • Biventricular pacemaker
  • Implantable defibrillator
  • Left ventricular assist device
  • Heart transplant
  • Screening for Heart Disease

Increasingly we are able to look for, diagnose and effectively treat medical diseases before they cause a problem. This is especially true for coronary heart disease, which is common and often asymptomatic until it presents dramatically with a heart attack or even sudden death. Happily, we have a number of ways of screening apparently healthy people for early signs of heart disease and are often able to reassure people that they have no signs of heart disease at all.

Anybody can develop heart disease but particular groups of people are more likely to develop heart problems and therefore these people benefit most from screening.

Examples include:
Smokers, people with diabetes, people with a strong family history of heart problems or sudden death, people with high blood pressure or cholesterol.

Sometimes we are asked to perform screening tests as part of a routine work-related medical assessment or for a mortgage or life insurance purposes.

What tests can I expect?
After talking with you and an examination, it may be suggested that you undergo one or more of the following tests:

  • Simple blood tests
  • Electrocardiogram (ECG)
  • Echocardiogram
  • Exercise tolerance test (ETT)
  • 24 hour Blood pressure reading

Depending on the results of these tests, further, more advanced tests may be required:

  • Thallium (Perfusion) scan
  • CT coronary angiography
  • Stress echocardiography
  • Coronary angiography

If you are found to have unexpected heart disease, the treatment options will be discussed with you in detail by your doctor.