Conditions

Angina is chest pain that occurs when your heart doesn’t receive a large enough flow of the oxygen-rich blood that it needs to function well. This is caused by the narrowing of one or more of your coronary arteries¬ – the arteries that supply blood to your heart muscles. 

This is usually due to a build-up of plaques consisting of fatty acid deposits. When these deposits harden and form plaques, they restrict blood flow, making the arteries narrower than they should be. 

This condition is called atherosclerosis, and it almost always indicates that a patient has coronary artery disease. There are some, less common forms of angina but, in most cases, angina is caused by coronary artery disease.

This narrowing of the arteries is usually caused by cardiovascular risk factors such as smoking, diabetes, high blood pressure and high cholesterol. Triggers such as sudden physical exertion, exercise and stress can also bring angina on. 

It’s important to note that angina isn’t a disease itself but a symptom, a warning of a potential underlying heart problem.

The most common symptoms of angina include pain, discomfort, a burning sensation or pressure in the chest. You may also experience:

• A feeling of fullness in the chest
• Sharp chest pains (more common in women than in men)
• Chest pain spreading to your arms, neck, jaw or back
• Chest pain when you exercise

These key symptoms might be accompanied by:

• Dizziness
• Fatigue
• Nausea
• Sweating
• Shortness of breath
• Abdominal pain (more common in women than in men)

Early diagnosis is vital so that you can receive the right treatment and decrease the risk of having a heart attack or stroke. Once diagnosed, the first and most common form of treatment for angina is medication. 

If your symptoms are very severe or persist despite medication, intervention may be required to treat your underlying coronary artery disease. 

In many cases, it may be that a coronary angiogram and coronary angioplasty is a more effective route. It all depends on the individual case and what, given your particular circumstances, will deliver the best immediate results, as well as long-term quality of life.

We might recommend a coronary artery bypass graft (CABG), which involves diverting the blood around the blocked arterial section by grafting an artery from your arm or leg to above and below it. 

This umbrella term includes medical emergencies in which the blood supply to the heart is suddenly blocked or greatly reduced. Heart attack, myocardial infarction and unstable angina are all examples of ACS. Emergency care is always required.

If you think you’re experiencing ACS, you should call 999 right away, or rapidly make your way to your local emergency department. 

Chest pain or discomfort is usually the first symptom of ACS, sometimes accompanied by a tightness or pressure in your chest. You may have pain in your left arm, or in both arms, your upper abdomen and jaw. Nausea and sweating are also common.

Fast action is essential. If you suspect you have ACS, don’t hesitate. Call 999.

Depending on your individual circumstances, your treatment options include medicine and/or percutaneous and/or surgical intervention. 

We can try to restore blood flow to the heart through angioplasty and stenting. This is a procedure during which a deflated balloon is passed through a catheter via an incision in either the groin or the wrist. Once the catheter is inflated to open up the artery, a stent is inserted to maintain the patient’s blood flow to their heart.

Cardiac arrhythmia is the umbrella term given to the wide range of symptoms or conditions that can occur if the normal electrical activity of the heart has been disrupted. This causes an irregular heartbeat that can be either too fast or too slow. Arrhythmias can occur because of a congenital heart condition, or develop over time

Around two million people in the UK are impacted by arrhythmias which, while little more than a nuisance for some, can be extremely serious and life-threatening for others.

Often, arrhythmia problems are exacerbated by lifestyle choices such as a poor diet, smoking, excessive alcohol intake and a lack of regular exercise.

All cardiac arrhythmias need professional monitoring so that they can be treated with medication or lifestyle changes. If you’d like to book a cardiac assessment, contact our team and we’ll do everything we can to help.

The main types of cardiac arrhythmias we see in our clinic include:

• Atrial fibrillation (AF): A common irregularity of heart rhythm which often increases with age and puts you at a greater risk of a stroke.
• Bradycardia: A heart rate which is lower than normal at less than 60 beats per minute 
• Heart block: A condition which affects the flow of electricity in the heart causing a slower than usual heartbeat. Atrioventricular (AV) heart block, also known as congenital heart block, is the most common form.
• Supraventricular tachycardia (SVT): An irregular heart rhythm caused by an electrical abnormality in the middle of the heart or in its upper atria, making your heart suddenly beat very rapidly.
• Ventricular fibrillation: This causes cardiac arrest and is a fatal event unless normal rhythm is quickly restored by a direct current (DC) shock. It occurs in patients with heart disease.

The symptoms you experience will depend on the type of arrhythmia you have. Typically, you experience some combination of:

• Blackouts or fainting
• Chest pain
• Dizziness or light-headedness
• Fatigue
• Palpitations
• Racing heartbeat
• Shortness of breath
• Stroke

People with normal hearts may also experience arrhythmia. An excessive intake of caffeine or alcohol, certain drugs or stress can trigger it, though often there aren’t clear indications as to why. 

Arrhythmia can also indicate that you have a more serious underlying condition, such as heart disease or thyroid problems.

We can use a series of tests to help diagnose the underlying cause and determine the best treatment approach. These tests can include an electrocardiogram (ECG), ambulatory electrocardiogram, echocardiogram, implantable loop recorder, electrophysiology studies and a cardiac stress test. 

Sometimes we may need to repeat these tests over time to see how well you’re responding to treatment.

The good news is that most types of cardiac arrhythmia can be very effectively treated. We’ll work with you, alongside a multidisciplinary team of expert consultants, clinical nurse specialists and more to help arrive at your best treatment option, which are likely to include:

• A course of drugs, sometimes for blood thinning
• Catheter ablation
• A pacemaker or defibrillator implant
• Electrical cardioversion

Atrial fibrillation, often known as AF, is a common form of cardiac arrhythmia that often occurs in older people. 

When the heart’s two upper chambers (the atria) send out-of-control electrical signals to the heart’s lower chambers (the ventricles), it causes the heart to beat with an irregular rhythm. This can often accelerate up to 100 - 175 beats per minute (BPM). For reference, a normal heart rate is between 60 and 100 BPM. 

AF is often a sign that you have another, pre-existing heart condition such as coronary artery disease or high blood pressure.

As mentioned, the main symptom is a fast and irregular heartbeat. However, because your heart isn’t efficiently pumping oxygenated blood around your body, you may also experience low blood pressure with symptoms such as breathlessness, dizziness, tiredness and even fainting.

Other symptoms may include:

• Extended heart palpitations, including racing, pounding or fluttering
• Angina (chest pain)
• Anxiety
• Sweating

Every patient is unique, and the course of treatment we advise will depend on the underlying cause(s), and other factors such as your age and general health.

For some people, their condition can be managed with medication that can help restore a normal heart rate and rhythm. For others, procedures such as electrical cardioversion, catheter ablation or fitting a pacemaker may be the best option.

While this condition can sound alarming, it doesn’t necessarily mean that your heart has stopped pumping blood, just that it can no longer to do so efficiently and effectively.

This could be due to disease or injury which has weakened or stiffened your heart muscle. It’s likely to be more apparent when you’re exercising, and it’s more common in men than in women and in those over 75 years old.

Heart failure can come on without warning otherwise known as acute heart failure. It can also be a chronic, long-term condition. Common causes can include:

• Cardiac arrhythmia
• Cardiomyopathy
• Congenital heart defects
• Coronary heart disease
• Diabetes
• Drug use
• Heart attack
• High blood pressure
• Obesity
• Smoking

Common symptoms include: 

• Chest pain (if heart failure is caused by a heart attack)
• Difficulty concentrating or decreased alertness
• Fatigue and weakness
• Nausea and lack of appetite
• Persistent coughing or wheezing (sometimes with white or pink, blood-tinged mucus)
• Rapid or irregular heartbeats (palpitations)
• Shortness of breath (dyspnea) 
• Swelling in the legs, ankles and feet (oedema)
• Swelling of the abdomen 
• Very rapid weight gain

Typically, the recommended treatment options range from lifestyle changes to medication and, in some cases, surgery.

Lifestyle changes include eating a “heart-healthy” diet rich in fresh fruit and vegetables, and low in processed meats, fat and sugar; maintaining a healthy weight, cutting down on alcohol; giving up smoking and starting to take regular exercise (with advice from your consultant).

Medications that can relieve the symptoms of heart failure include beta blockers, ACE inhibitors, diuretics and digoxin.

Surgical procedures include having a small device implanted in their chest to help control their heart's rhythm. This can include a pacemaker, cardiac resynchronisation therapy-defibrillator (CRT-D), or an implantable cardioverter defibrillator.

For people with severe heart failure, options include heart valve surgery, coronary angioplasty, or a coronary artery bypass graft (CABG).

Put simply, it’s when one of the valves in your heart becomes diseased, affecting blood flow and putting a strain on your heart. 

With valve stenosis, the valve can’t open fully anymore, which obstructs, or restricts flow. With valve incompetence, the valve stops closing properly, allowing blood to leak backwards. 

The symptoms can include:

• Breathlessness
• Swelling of the ankles and/or feet
• Tiredness or fatigue

If your symptoms are minor, we may recommend simple, but regular observations to keep the condition under review. If you are experience significant impact on your daily life, however, we may recommend a course of medication or, in some cases, heart valve surgery.

This most common cause of cardiovascular disease impacts more than one billion people around the world. Also called hypertension, it’s not always clear what causes it, although there are certain factors that can increase a person’s risk. These include: 

• Age
• Being overweight
• Continued high stress levels
• Diet (particularly a high salt diet)
• Drinking too much alcohol\
• Family medical history 
• Smoking

High blood pressure can often be symptomless. However, if your blood pressure is very high, you may experience: 

• Headaches
• Nose bleeds
• Blurred or double vision
• Shortness of breath

In the first instance, making some healthy lifestyle changes is recommended. You could look to loosing weight, reduce your salt, alcohol or caffeine intake, do regular exercise and aim to get lots of sleep.

There are also a wide range of medications available to help with high blood pressure. Which of those we might recommended will depend on individual circumstance and background, including how high your blood pressure is.

This relatively common and inherited genetic heart condition thickens the heart muscle wall (also called the myocardium), making it harder for the heart to pump blood around your body. 

Many people with HCM won’t experience any serious symptoms. For others, the heart becomes bulky and can occasionally beat dangerously fast, or with an irregular rhythm. You may also experience:

• Chest pain
• Shortness of breath
• Dizziness or fainting

This condition develops as you age, so problems may become more apparent later in life. This will depend on how thick your heart muscle becomes, and whether that stops your blood from leaving your left ventricle, or creates an abnormal heart rhythm, or arrhythmia.

We’ll usually confirm an HCM diagnosis with either a cardiac MRI or echocardiogram. Based on your symptoms and family history of heart disease, the results will help us to ascertain whether you need treatment.

Potential treatment options may include medication or fitting an implantable cardiac device to help control your heartbeat. We may also advise you to avoid intense exercise and other physical activity.

It’s a good idea to bring other family members in for screening and/or genetic testing to try and find the faulty gene causing the condition.

Cardiomyopathy is the umbrella term for heart muscle disease. Often an inherited condition, it’s characterised by the walls of the heart chambers becoming either thin and stretched, or thickened and stiff. This makes it hard for the heart to pump blood around the body, and can lead to heart failure. 

Some of the symptoms you might experience are:

• A bloated stomach
• A feeling of pressure on your chest
• Breathlessness
• Dizziness or fainting
• Extreme tiredness
• Heart flutters or a rapid heartbeat
• Swollen legs and ankles

Left untreated, these symptoms can become progressively worse.

Typically we’ll conduct tests to make an accurate diagnosis. These include: 

• Cardiac catheterisation
• Cardiac MRI scan 
• Echocardiogram (also known as an Echo)
• Electrocardiogram (ECG)

If a diagnosis is confirmed, we’ll work with you to draw up a treatment plan that you can feel completely comfortable with. This can include medication, implanted devices such as a pacemaker, or surgical intervention. Sometimes a septal myectomy can be used to remove portions of your thickened heart muscle.