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Angina

Angina

What is Angina?

Angina is a form of chest pain caused by reduced blood flow going to the heart and is a symptom of coronary artery disease. It is a relatively common condition, but it can still be hard to diagnose.

Those who have Angina often describe it as squeezing, pressure, heaviness, tightness feeling, or pain in the chest. It can either be a new pain that needs diagnosing by a cardiologist, or it could be a recurring pain that was previously treated.

Other causes of chest pain need to be excluded. These include:

  • Acid Reflux

  • Pleurisy

  • Pericarditis

  • Muscular pains

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Symptoms of Angina

There are various symptoms suggestive of Angina including:

  • Chest pain – including a feeling of pressure, squeezing, burning or fullness

  • Pain across your body including jaw, neck, shoulders, back or arms

  • Nausea

  • Fatigue

  • Shortness of breath

  • Sweating

  • Dizziness

 

What are the characteristics of Angina?

Characteristics of stable Angina

  • When your heart starts to work harder due to activities such as doing exercise or when you climb stairs

  • It can usually be predicted, and the pain can be similar to a type of chest pain you may have had previously

  • Tends to last for five minutes or less and disappears if you rest or take any angina medication you may have

 

Characteristics of unstable Angina

  • Even if you’re resting it can still occur

  • There is a change in your usual pattern of angina

  • Unexpected

  • Is more severe than usual and lasts potentially for up to 30 minutes

  • Angina medication doesn’t always work

  • Might signal a heart attack

 

Angina in women and non-causacians

The symptoms for women with angina can be different to the characteristics you get with classic angina symptoms, some of which include:

  • Nausea

  • Shortness of breath

  • Abdominal pain

  • Neck, jaw or back pain

  • A stabbing chest pain rather than pressure in the chest

 

Risk factors with Angina

There are various factors that increase your risk of coronary artery disease and angina including:

  • Smoking

  • Diabetes

  • High blood pressure

  • High blood cholesterol

  • A family history of heart disease

  • Older age – men over 45 and women over 55 are at greater risk

  • Lack of exercise

  • Obesity

  • Stress and lifestyle

 

It is important to see a doctor when your chest pain lasts for more than a few minutes and doesn’t go away when you rest or take any angina medication. It might be a sign of a heart attack.

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Aortic stenosis

Aortic Stenosis

What is Aortic Stenosis?

Aortic stenosis is a condition of the heart where the aortic valve is narrower than it should be and as a result the valve moves less freely. The heart has to work harder contracting to push blood through the valve. The harder the heart contracts, the more the heart muscles thicken, becoming less efficient at pumping blood through the heart and around the body.

In most common cases the tightness occurs at the valve itself, but can also be above the valve or below the valve.

There are a number of reasons why aortic stenosis can occur, including:

Bicuspid Valve. Congenital heart defect – most people are born with three triangular-shaped flats of tissue called cusps. Some are born with only two cusps or even rarely both with only one or up to four cusps. In mild cases of aortic stenosis, it is picked up at a routine six-week check up alongside a heart murmur which is picked up at birth. In severe cases, children with aortic stenosis may experience breathlessness and not feed properly.

Degenerative Aortic Stenosis. Calcium build up on the valve – over time, the heart valves can accumulate deposits of calcium which is a mineral found in your blood. Deposits of calcium can build up on the valves cusps when it flows over the aortic valve. Calcium build up is most common in older people with symptoms only showing between ages 70 – 80.

Rheumatic Heart Disease – after you’ve had a Streptococcal bacterial throat infection, rheumatic fever can cause your immune system that is fighting off the infection also attacking healthy tissue in the process. The scar tissue caused by rheumatic fever can form on the aortic valve, and narrow it, causing damage.

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Symptoms of Aortic Stenosis

Aortic stenosis can lead to symptoms:

  • chest pain-as the blood supply to the heart fails to cope with the added work

  • dizziness or blackouts-especially on exercise

  • breathlessness-as the heart begins to fail

  • sudden death -rare, but it can be the 1st presentation.

 

Once symptoms start, it is important to get assessed for treatment as soon as possible.

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Treatment of Aortic Stenosis

Mild aortic stenosis does not require follow-up.

Moderate aortic stenosis will require regular supervision.

Severe aortic stenosis will require very close observation, and if symptoms occur, treatment will be needed urgently.

Investigations

 

Treatments

Aortic Valve Replacement (AVR) – this involves either replacing or repairing the faulty valve to ensure function is fully restored to the heart. It can be done via a median sternotomy, or smaller cuts on the chest, through keyhole techniques.

Transcatheter Aortic valve insertion (TAVI/TAVR) – involves inserting a catheter into the blood vessel in your upper leg or chest and guiding up towards the aortic valve. The catheter is used to fix a replacement valve over the old one, putting less pressure on the heart than open-heart surgery.

Balloon Aortic Valvuloplasty (BAV) – using a balloon just to push open the valve is a temporary or emergency measure. it does not last, and is not a definitive treatment.

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Atrial Fibrillation

What is Atrial Fibrillation?

Atrial fibrillation (AF) is a condition of the heart that causes an irregular and often an abnormally fast heart rate. A regular heart should beat between 60 to 100 times a minute when resting and can be measured by feeling the pulse either in your neck or wrist. Atrial Fibrillation is associated with symptoms and a risk of stroke.

When atrial fibrillation happens, the hearts upper chambers contract randomly and often contract so fast the heart muscle can’t relax properly between contractions, reducing the hearts performance and efficiency.

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Symptoms of Atrial Fibrillation

In atrial fibrillation, the heart can beat very fast, and in some cases over 100 beats a minute. Other symptoms can also be experienced including:

 

Some people may not even know they have an irregular heart rate, particularly older people.

What causes Atrial Fibrillation?

Whilst the cause of atrial fibrillation is not fully understood, it does tend to affect those in a certain age group, usually over the age of 65 and can be triggered by certain situations including drinking too much alcohol or smoking. In addition, it can be associated with:

 

Are there any risks with Atrial Fibrillation?

Those who suffer from atrial fibrillation have an increased risk of having a stroke. In extreme cases, it can also lead to heart failure.

When the upper chambers in the heart do not pump efficiently, there is a risk of blood clots forming. When clots are formed and move around the blood circulation, these can block arteries in the brain and case a stroke. The risk of having a stroke with atrial fibrillation is increased by roughly 4 to 5 times.

Persistent atrial fibrillation can weaken the heart. If it is extreme, your heart may be unable to pump blood around the body efficiently, leading to heart failure.

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How to treat Atrial Fibrillation

Whilst atrial fibrillation is not usually life threatening, it can be uncomfortable and may require treatment.

There are a few ways to treat it:

  • Medication to prevent a stroke

  • Medication to control heart rhythm

  • Cardioversion to shock the heart into normal rhythm

  • Catheter ablation to destroy the area inside the heart that’s causing the abnormal heart rhythm

Our group of leading cardiologists are all experts in the diagnosis and treatment of Atrial Fibrillation.

Atrial fibrillation

Atrial Septal Defect

ASD

What is an Atrial Septal Defect?

An Atrial Septal Defect (ASD) is a hole in the wall that divides the upper chambers of the heart and is present from birth. The hole can vary in size, and may close on its own, or may need to be treated with device closure or surgery.

It is often diagnosed in adults when they have an ECG or echocardiogram.

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Symptoms of an Atrial Septal Defect

Whilst Atrial Septal Defect is congenital, many patients do not have any signs or symptoms until later in life, or it may be entirely asymptomatic, and is picked up on  routine echocardiography.

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Signs and symptoms may include:

  • Frequent respiratory or lung infections

  • Difficulty breathing

  • Shortness of breath with exercise

  • Heart murmurs

  • Swelling of the legs, feet or stomach

  • Stroke

 

Your Consultant will perform a Transthoracic Echocardiogram (TTE) which is an ultrasound of the heart to fully understand the extent of the condition and next steps.

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Risk factors with an Atrial Septal Defect

It is unknown as to why some babies are born with this heart defect, although studies have shown that some heart defects are thought to be caused by changes in their genes or chromosomes. It is also thought that these changes in genes combined with other risk factors including the environment, food, drink or other medicines during pregnancy can also cause heart defects.

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How to treat an Atrial Septal Defect

How the defect is treated depends on the age, symptoms, size of the defect and any other conditions.

Medication will be able to treat the symptoms of the defect, but there are no known medications to treat the defect itself.

In both child and adult, surgery may be the best option to close the hole.

  • Open Heart Surgery– this can be done usually without a median sternotomy, using minimal access techniques. This will be under general anaesthetic, and will mean a few days in hospital.

  • Device closure – Under general anaesthesia, with Transoesophageal echocardiography (TOE) and X-ray control, an “umbrella” device can be used to close the hole. This is a day-case procedure or overnight stay, with only a small puncture in the groin.

Your cardiologist will help you decide what the best treatment is for you.

The procedure to close the hole is called Cardiac Catheterisation.

Carotid artery stenosis
Heart failure

Carotid Artery Stenosis

What is Carotid Artery Stenosis?

The Carotid arteries are the major blood vessels in the neck supplying blood to the brain, neck and face.

Carotid Artery Stenosis is a narrowing of these large arteries usually as a result of a build-up of plaque within the arteries which can worsen over time causing them to block and lead to a stroke.

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Symptoms of Carotid Artery Stenosis

There are several symptoms of Carotid Artery Stenosis, most of which can come on quite suddenly. This is an impending stroke:

  • Weakness or numbness in the face, arms or legs

  • Trouble speaking

  • Vision problems in vision in one or both eyes

  • Dizziness

  • Severe headache

  • Drooping in one side of the face

 

How serious is Carotid Artery Stenosis?

Carotid artery disease is one of the most common causes of strokes, and if you have had a stroke in the front of the brain, your Consultant will ensure this is assessed.

The data for looking for the Carotid Artery Stenosis if you do not have symptoms is weaker.

There are several tests your consultant can do to help determine Carotid Artery Stenosis.

  • Carotid ultrasound

  • CT angiography

  • Magnetic resonance angiography (MRA)

  • Cerebral angiography

 

Treatment of Carotid Artery Stenosis

Carotid Artery Stenosis can be treated with:

  • Medical Therapy-treating with anti-platelet medication, statins, controlling blood pressure.

  • Carotid Artery Stenting- this is placed from the groin, to open up the artery, and reduce longer term risk.

  • Carotid Endarterectomy (CEA) – this is still the standard treatment for Carotid Artery Stenosis.

Heart Failure

What is Heart Failure?

Heart failure means the heart is not able to pump blood around the body as it should. The heart could have either become too weak or stiff to work properly,  but it doesn’t mean the heart has stopped working altogether.

Heart failure can occur at any age but is mostly common in older people. It is a long-term condition that tends to get worse over long periods of time. Whilst it cannot be cured, symptoms can be controlled for many years.

 

Types of Heart Failure

  • Systolic Heart Failure- the pump does not contract down properly

  • Diastolic Heart Failure-the pump can contract, but does not relax properly

 

Symptoms of Heart Failure

The main symptoms of heart failure are:

  • Breathlessness after activity or when resting

  • Feeling tired most of the time

  • Swollen ankles and legs

There are also a number of other symptoms that can occur:

  • Persistent cough

  • Fast heart rate

  • Dizziness

 

Causes of Heart Failure

There are a wide range of causes of heart failure including:

 

There are several tests your cardiologist can do to help check how well your heart is working:

 

Treatment of Heart Failure

Treatment for Heart Failure rests on Medical therapy:

  • Beta-blockers

  • Angiotensin Converting Enzyme (ACE) Inhibitors or Angiotensin Receptor Blockers (ARBs)

  • Aldosterone Antagonists-Spironolactone or Eprelonone

  • Entresto

  • Diuretics-they help symptoms but don’t change long term outcome

If there is a reversible cause, such as Coronary Artery Disease, that should be treated.

HR Problem

Heart Rhythm Problems

What are the causes of Heart Rhythm problems?

Heart arrhythmias occur when electrical impulses coordinating your heartbeats don’t work properly, causing your heart to either beat too fast, too slow or irregularly.

Heart rhythm problems may feel like fluttering or racing of the heart. Sometimes it may be harmless, but other times these heart rhythm problems can cause signs and symptoms, sometimes life threatening.

They include:

  • Bradycardia- slow heart rate

  • Atrial Fibrillation (AF)

  • AV nodal re-entry tachycardia (AVNRT)

  • AV re-entry tachycardia (AVRT)

  • Atrial Tachycardia (AT)

  • Ventricular Tachycardia (VT)

 

Symptoms of Heart Rhythm problems

There may not be any signs or symptoms of heart rhythm problems, but sometimes noticeable heart rhythm problem symptoms may include:

  • Fluttering in your chest

  • Racing heart (tachycardia)

  • Slow heart (bradycardia)

  • Chest pain

  • Shortness of breath

  • Light-headedness

  • Dizziness

  • Sweating

  • Fainting

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Risks of Heart Rhythm Problems

There are certain factors that may increase the risk of developing heart rhythm problems including:

  • Coronary artery disease or any other heart problems or previous surgery

  • High blood pressure

  • Congenital heart disease

  • Thyroid problems

  • Taking over-the-counter drugs or supplements

  • Diabetes

  • Obstructive sleep apnoea

  • Electrolyte imbalance

  • Drinking too much alcohol

  • Caffeine or nicotine use

 

Preventing and Treating Heart Rhythm problems

Living a healthy lifestyle can help to reduce your risk of heart disease. This includes:

  • Eating a balanced diet

  • Exercise

  • Avoid smoking

  • Avoid drinking caffeine and alcohol

  • Keeping a healthy weight

  • Reducing stress

  • Take over-the-counter medications with caution including cold and cough medications

Treatments include:

  • Medication

  • Ablation

High BP

High Blood Pressure

What is High Blood Pressure (Hypertension)?

Your blood pressure is recorded with two numbers, systolic pressure and diastolic pressure.

Systolic pressure – the force at which your heart pumps blood around your body

Diastolic pressure – the resistance to the blood flow in the blood vessels.

High blood pressure is a reading of 140/90mmHg or higher

Blood pressure readings between 90/60mmHg and 120/80mmHg are considered ideal although everyone’s ‘ideal’ blood pressure result will be slightly different.

Measuring blood pressure can be hard to do properly. Many patients have artificially high pressure if measured inaccurately.

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What causes High Blood Pressure?

Whilst the causes of high blood pressure are not always clear, there are certain things that can increase your risk including if you:

  • Are over 65 years old

  • Are overweight

  • Have a relative with high blood pressure

  • Each too much salt

  • Do not exercise enough

  • Drink too much alcohol or caffeine

  • Smoke

  • Do not get enough sleep

  • Have obstructive sleep apnoea

To investigate the causes of your high blood pressure, we can carry out the following tests:

For chest pain symptoms, and angina diagnosis, we can carry out the following investigations and tests:

 

Risks of High Blood Pressure?

Having high blood pressure puts extra strain on your blood vessels, heart and the brain, kidneys and eyes.

If high blood pressure persists, it can increase your risk of a number of serious and life-threatening health conditions including:

  • Heart disease

  • Heart attacks

  • Strokes

  • Heart failure

  • Peripheral arterial disease

  • Aortic aneurysms

  • Kidney disease

  • Vascular dementia

 

Treatment of High Blood Pressure?

Blood pressure needs treatment if it is too high, to reduce the risk of stroke or heart failure.

  • Lifestyle changes-lose weight, reduce salt, increase fresh vegetables and fruit, reduce fat.

  • Treating possible causes- for example Obstructive Sleep Apnoea

  • Medication-many drugs are available, and will be tailored to your condition

  • Renal Denervation- not yet a cure, but will be considered in resistant Hypertension

PFO

Patent Foramen Ovale (PFO)

What is a Patent Foramen Ovale?

A small flap-like opening called the foramen ovale is in the wall between the right and left upper chambers of the heart. It is essential in the womb, but normally closes after birth. A patent foramen ovale (PFO) is a flap that didn’t close.

This is present in 15-25% of all people and is usually of no consequence.  It usually doesn’t create any signs or symptoms.

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How to diagnose a Patent Foramen Ovale

Our expert cardiologists use the latest technology to help diagnose the patent foramen ovale (PFO). However, it should only be looked for if you have had a stroke, decompression illness, or some other rare conditions.

Tests

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Frequently Asked Questions

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What conditions linked to PFO?

As there are no signs or symptoms, a patent foramen ovale doesn’t cause complications. Some studies have found the disorder is more common in people with certain conditions:

  • Cryptogenic stroke

  • Decompression illness (DCI)

  • Orthodeoxya-Platypnoea Syndrome

 

Is Migraine associated with PFO?

Migraine itself has an association with PFO, but there is no convincing data that closing the PFO helps Migraine despite several research studies looking at this topic

 

If I have no symptoms, should I be screened for a PFO?

No

POTS

Postural Orthostatic Tachycardia Syndrome (PoTS)

What is Postural Orthostatic Tachycardia Syndrome?

Postural tachycardia syndrome (PoTS) is when the heart rate increases abnormally, occurring after sitting up or standing. Whilst it affects various types of people, it is most common in girls and women 15 to 50 years old.

Sitting up or standing pulls the blood down to your lower abdominal area, hands and feet. In doing so the blood vessels narrow quickly and your heart rate increases to maintain blood flow to the brain and heart. It is your autonomic nervous system that does this without thinking.

Those with PoTS have an autonomic nervous system that doesn’t work properly, so when there is a drop-in blood supply to the heart and brain when sitting up or standing, the heart races to compensate for this.

 

What causes Postural Orthostatic Tachycardia Syndrome?

The most common cause of PoTS is when people have a problem with their nervous system. It can develop suddenly after a viral illness or traumatic event. Other known causes include:

  • Joint hypermobility syndrome – unusually flexible joints and abnormally elastic blood vessels

  • Conditions such as diabetes amyloidosis, sarcoidosis, lupus, Sjogren’s syndrome, or cancer

  • Alcohol or metal poisoning

  • Inheriting faulty genes

 

Symptoms of Postural Orthostatic Tachycardia Syndrome

PoTS can come on suddenly or can gradually develop over time but symptoms usually appear with a few minutes of sitting up or standing. These symptoms include:

Some women find symptoms are worse when they are on their period.

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Testing for Postural Orthostatic Tachycardia Syndrome

If your heart rate increases by 30 beats per minute or more after 10 minutes of standing, PoTS will likely be diagnosed. And whilst self-care is usually the best course of treatment, the following tests are available to make a firm diagnosis:

  • The tilt table test – your heart rate and blood pressure are measured whilst lying on a bed, then the bed is tilted into an upright position whilst still measuring heart rate and blood pressure.

  • Active stand test – heart rate and blood pressure are measured after lying down, standing immediately, and after 2, 5 and 10 minutes.

  • An electrocardiogram (ECG)

  • An echocardiogram

  • 24-hour ambulatory blood pressure and heart rate monitoring

  • Blood test

 

Treating Postural Orthostatic Tachycardia Syndrome

PoTS requires specialist management.

  • Avoiding triggers- maintain hydration, avoid caffeine

  • Graded stockings

  • Medication

  • Pacemakers

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