Arrhythmia is often suspected due to symptoms of palpitation or during a routine pulse check by your own doctor. The specific arrhythmia diagnosis requires confirmation, either by 12-lead ECG or continuous Holter ECG monitoring, followed by evaluation of possible causes. Patients often require a series of blood tests and an echocardiogram to assess for structural abnormalities of the heart.
Atrial fibrillation is a common heart rhythm disorder, although there are several others including atrial flutter, SVT and atrial tachycardia. Treatment may be simple lifestyle measures alone however patients may require prescribed medical therapy to control symptoms. These include medications such as heart rate controlling drugs and anti-arrhythmic therapy. Certain patients will require anticoagulants, such as warfarin or direct oral anticoagulants, to reduce stroke risk. Selected patients may benefit from invasive procedures such as electrical cardioversion or catheter ablation procedures.
Angina is a common cause of chest pain caused by a process called atherosclerosis, leading to narrowing of coronary blood vessels and subsequent reduced blood supply to the heart. This is often called coronary artery disease or ischaemic heart disease. Investigation involves assessing the coronary artery anatomy, either with a cardiac CT scan or invasive coronary angiogram. Certain patients may need evaluation using a dobutamine stress echocardiogram, nuclear perfusion scan or cardiac MRI.
Treatment starts with prevention, initially by targeting and controlling known cardiac risk factors such as smoking, diabetes, high blood pressure, elevated cholesterol, and includes lifestyle modification with diet and exercise. Patients with angina often require anti-anginal medication to control symptoms and reduce risk of heart attack, known as myocardial infarction. Individual patients, after detailed assessment, may require a coronary angioplasty procedure with stent insertion or cardiac surgery.
Valvular heart disease encompasses narrowing, leaking, or a combination, affecting one or more of the four heart valves (mitral, tricuspid, aortic or pulmonary). These problems can be congenital, whereby patients are born with the problem, or acquired later in life due to degeneration or infection such as rheumatic fever.
Diagnosis is made by performing an echocardiogram in the first instance. In some patients, further tests such as a transoesophageal echocardiogram, CT or MRI scan may be required. Symptoms are variable but may include breathlessness, chest pain, palpitation, oedema, dizzy spells or blackouts. Medication can help alleviate symptoms and control aggravating factors such as high blood pressure and heart rate and rhythm. Surgical treatment may be considered after detailed assessment of symptoms and severity of valve disease.
Heart failure and cardiomyopathy are forms of heart muscle disease with several potential causes including heart attacks due to coronary artery disease, heart valve disease, previous infection of the heart, hypertension, arrhythmia and inherited in families due to an underlying genetic disorder. Symptoms include breathlessness particularly on exertion, or made worse by lying flat or waking you in the night. Patients may experience fatigue and swelling of the abdomen and legs.
Diagnosis is based on investigations including bloods tests such as natriuretic peptides, ECG, Chest X-ray and Echocardiography. Further assessment is then required to ascertain the precise cause of heart failure. There are many medical treatments available for this condition to both reduce symptoms and hospital admissions and also to improve survival. Some patients may require invasive procedures such as biventricular pacemaker and defibrillator insertion.
Syncope, or blackouts, are often caused by vasovagal syncope and can be triggered by several stimuli such as warm, crowded environments. Syncope may be due to postural orthostatic hypotension, causing a falling blood pressure on standing often caused by dehydration or prescribed medication. These conditions can often be managed by simple lifestyle modification and adjustment of medication. Syncope can however be due to specific conditions that require further specialist investigation including neurocardiogenic syncope, arrhythmia, inherited heart muscle disease, or heart valve disease such as aortic stenosis.
Any episode of syncope should undergo prompt initial assessment by your own doctor whom may then refer you for a specialist opinion by a cardiologist or neurologist depending on the specific features of syncope.
High blood pressure is very common but generally a silent condition, unless blood pressure is severely high or long-standing and having led to complications such as stroke, kidney disease or heart failure. Any consistent resting blood pressure above 140/90mmHg requires further assessment. The severity of hypertension is based on initial clinic or home readings and often supported by 24-hour ambulatory blood pressure monitor findings.
A detailed assessment of cardiovascular risk and any organ damage is required with investigations including blood tests for renal disease, diabetes and cholesterol, urinary protein levels, 12-lead ECG and Echocardiography. In combination this information helps determine when and which combination of medical treatment is required. Strict lifestyle modification is important by losing weight, stopping smoking, lowering dietary salt, controlling diet and diabetes and taking regular aerobic exercise.
Cholesterol is vital for normal and healthy bodily function however elevated levels of certain types of cholesterol, particularly LDL-cholesterol, is associated with atherosclerosis or narrowing of the arteries within the body. This process can lead to increased risk of heart attack or stroke. Investigation of cholesterol is by a simple fasting blood test. If elevated, an assessment of your overall cardiovascular risk and family history are essential to guide management. Initial treatment may be with simple lifestyle measures including stopping smoking, dietary modification, regular aerobic exercise and treatment of other cardiovascular risk factors such as hypertension and diabetes. Certain individuals will require medical treatment to lower cholesterol with drugs such as statins.