Chest Pain
This is probably the symptom that causes most concern amongst patients. However there are many causes of chest pain and careful evaluation is necessary. Chest pain that is aching in nature, and which is brought on by exertion (walking or other exercise) in usually referred to as angina, and can be due to a narrowing of the arteries feeding the heart muscle. This is more likely if you have risk factors such as diabetes, high blood pressure, or a strong family history of heart disease.
Investigation may include an exercise ECG, an echocardiogram, a CT coronary angiogram or a coronary angiogram.
Treatment may include medication, a coronary stent or a coronary bypass operation.
Palpitations
An awareness of the heart racing or skipping beats can be a sign of cardiac arrhythmia. This can be an important symptom, particularly if the palpitations are worse during exercise or associated with dizziness or blackouts. One of the commonest types of arrhythmia is called atrial fibrillation, and is important to diagnose as it can be a cause of stroke. However many palpitations are entirely benign and can be caused by stress, anxiety or excessive caffeine.
Investigations would normally include an ECG, echocardiogram and some form of ECG monitoring.
Breathlessness
This is another very common symptom and can reflect many different types of heart dysfunction. The most important is so-called ‘heart failure’, where the heart muscle does not contract as efficiently as normal. There can be many causes for this, including valve abnormalities, heart rhythm abnormalities as well as damage due to previous heart attacks.
Investigations would usually include an ECG and an echocardiogram.
Dizziness or Blackouts
There can be many causes for dizziness. The commonest episodes would be due to low blood pressure, or a phenomenon known as vaso-vagal syncope. However it would be important to rule out cardiac arrhythmias and ensure that a pacemaker is not required.
Investigations would usually include an ECG, echocardiogram and ECG monitoring.
Cardiac Risk Factors
Many patients seek advice regarding risk factors such as high blood pressure or high cholesterol. These are very common conditions but the treatments can be confusing, and it is always useful to know that drugs are necessary and appropriate before they are started. We now have a number of techniques for assessing the overall risk for any patient with these risk factors, and it is sensible to see if lifestyle changes can help before medication is advised.
For example a test such as a CT coronary angiogram can help decide if statins are necessary to treat a high cholesterol.