Symptoms

Prevention

It is important to maintain the health of our heart in order to prevent or reduce the risk of medical problems from occurring.

Specific lifestyle advice, from either your General Practitioner or a Cardiac Specialist, should primarily focus on regular aerobic exercise and a healthy balanced diet, whilst targeting certain established risk factors including smoking, excess alcohol intake, stress, high blood pressure, diabetes, elevated cholesterol and understanding any family history of heart disease.

We offer a detailed tailored cardiovascular screening service for individuals and families which can be helpful in early diagnosis and treatment of coronary artery disease, familial cardiomyopathy and hyperlipidaemia.

Investigations may include:

• Detailed blood test profile including assessment of lipids and diabetes
• 12-lead Electrocardiogram (ECG)
• Echocardiogram
• Cardiac CT coronary calcium score
• CT coronary angiogram (CTCA)
• Carotid ultrasound

Chest pain

Chest pain can be due to angina, caused by poor circulation of blood to the heart, known as coronary artery disease. Cardiac chest pain can present in many different ways but typically occurs on exertion and is often described as a heavy or tight sensation, in the centre or left side of the chest, radiating towards to the left arm, neck or jaw. Chest pain has several potential causes including arising from the lungs, chest wall or stomach, or may not in fact be due to a heart problem.

An early specialist assessment is important for chest pain, especially if angina is suspected, and particularly if you have cardiac risk factors such as cigarette smoking, diabetes, high blood pressure, raised cholesterol or any family history of coronary artery disease.

Investigation of chest pain

Patients with suspected angina, after specialist cardiac evaluation, will usually need further investigations including:

• 12-lead Electrocardiogram (ECG)
• Exercise tolerance test (ETT)
• Non-invasive tests including CT coronary angiogram (CTCA), dobutamine stress echocardiography (DSE) or nuclear myocardial perfusion scan (MPS)
• Invasive procedures including coronary angiography

Treatment of angina

If a diagnosis of angina and coronary artery disease is confirmed, medical treatment usually starts with taking a blood thinner such as Aspirin, a cholesterol lowering drug (statin), emergency GTN spray and specific anti-anginal medication to control symptoms. It is important to specifically target and control known cardiac risk factors such as smoking, diabetes, high blood pressure, elevated cholesterol, and achieve lifestyle modification with diet and aerobic exercise.

Patients with angina may require further invasive procedures such as a coronary angioplasty procedure with stent insertion or cardiac bypass surgery.

Shortness of breath

Shortness of breath may be experienced on exertion or occur at rest and be due to a broad range of cardiac conditions including heart failure, cardiomyopathy, atrial fibrillation and valvular heart disease. Breathlessness due to an underlying heart condition is often associated with other cardiac symptoms such as chest pain, palpitation and leg swelling. Breathlessness can of course be due to reasons other than the heart such as lung disease, obesity, poor cardiorespiratory fitness or anaemia.

Investigation of breathlessness

Patients with breathlessness require detailed clinical assessment and often need further investigations including:

• Blood tests including natriuretic peptides (NTproBNP)
• 12 - lead Electrocardiogram(ECG)
• Echocardiogram
• Chest radiograph(CXR)
• Lung function / spirometry tests

Treatment of heart failure

Investigations of breathlessness may confirm an issue with the pumping or relaxation function of the heart and indicate a diagnosis of heart failure. There are many medical treatments available for this condition to both reduce symptoms, hospital admissions and to improve survival. These include well established drug therapies such as ACE inhibitors, beta-blockers, mineralocorticoid receptor antagonists (MRA), and newer agents such as Sacubitril/Valsartan (ARNI). Certain patients may benefit from invasive procedures such as biventricular pacemaker and defibrillator insertion.

Palpitation

Palpitation are common and often experienced as a fluttering sensation in the chest, either occurring alone or associated with chest pain, shortness of breath, dizzy spells or blackouts/syncope. Palpitation are commonly due ectopic beats but may represent an underlying arrhythmia, particularly if symptoms are recurrent or sustained nature and should be investigated promptly.

Investigation of palpitation

Patients with palpitation often require further investigation to assess for both slow (bradyarrhythmia) or fast (tachyarrhythmia) abnormal heart rhythm and for structural heart disease, including the following:

• Blood tests including thyroid function tests
• 12-lead Electrocardiogram (ECG)
• Echocardiogram
• 24 hour to 7 day ECG Holter (heart monitor)
• Event recorders
• Implantable loop recorders

Treatment of arrhythmia

If a diagnosis of arrhythmia is confirmed, medical treatment with drugs such as beta-blockers, calcium channel antagonists or antiarrhythmics may be required. Formal blood thinners, such as Warfarin or Direct Oral Anticoagulants (DOAC), may need to be considered for certain arrhythmias including atrial fibrillation or atrial flutter. Carefully selected patients may benefit from invasive procedures such as catheter ablation.

Dizzy spells and Syncope

Dizzy spells and particularly blackouts, often known as syncope, warrant specialist assessment and further investigation. Dizzy spells or syncope may be associated with other symptoms such palpitation, chest pain or breathlessness but can also occur without warning. Symptoms may simply be caused by dehydration and low blood pressure, sometimes due to hot weather, crowded spaces or excess prescribed medication.

It is important to consider other causes including arrhythmia, structural heart disease, inherited cardiac disease and neurocardiogenic syncope in addition to non-cardiovascular causes such as epilepsy.

Investigation of dizzy spells and syncope

Patients with dizzy spells or syncope may require further investigations including:

• Blood tests including thyroid function tests
• 12-lead Electrocardiogram (ECG)
• Echocardiogram
• 24 hour to 7-day ECG holter (heart monitor)
• Event recorders
• Implantable loop recorders
• Tilt table testing

Treatment of dizzy spells and syncope

This very much depends on the specific cause for symptoms. Treatment options can range from simple lifestyle advice, drug therapy, pacemaker or defibrillator insertion or cardiac surgery for structural heart disease.