What are the symptoms of a heart problem developing?

Although people may have no symptoms the main symptoms are:
• Chest pain
• Breathlessness
• Light headedness or blackouts
• Palpitation

Whilst all of these symptoms often are caused by non cardiac conditions, it is important that they are evaluated by a clinician to see if further investigation of the heart is needed.

What is cardiac chest pain?

The heart is a muscular pump which requires a blood supply. This is provided through the coronary arteries that run around the outside of the heart. When these are narrowed or blocked the heart muscle is deprived of blood and the oxygen it carries and this causes pain.

Typical cardiac pain is felt in the centre of the chest as a discomfort or tight/squeezing pain. It may go into the jaw of arm and is associated with breathlessness and sweating. As the heart needs more blood supply when working harder the pain may only come on when the person is exercising and is relieved by resting.

Although the description above is typical the chest pain can be described in just about any other way. The longer I have been treating cardiac patients the more unusual the presentations of cardiac chest pain I have come across. It is a good idea to see a practitioner to be sure if you have been experiencing chest pain. If severe and out of the blue this should be done as an emergency by phoning for an ambulance.

What is palpitation?

This is a fluttering sensation, often felt in the chest. Most people experience this symptom at some time in their lives. People can often describe what they are feeling accurately and this helps the doctor to determine the likely cause of the palpitation. The extra beats arise from either the top (atria) or bottom (ventricle) chamber of the heart. Occasionally the fluttering can arise due to the heart missing a beat.

Occasional extra beats or jumps in the chest are usually perfectly harmless and can be ignored UNLESS they are associated with other cardiac symptoms such as light headedness or chest pain or signs of structural heart disease.

A permanently irregular beat or a fast beat should always be investigated further. If associated with symptoms it should be done as a matter of urgency.

What is a blackout?

A blackout is a lay term for loss of consciousness. Blackouts can be divided into conditions where there is loss of blood supply to the brain (syncope or fainting) and abnormal electrical discharges in the brain (fits/epilepsy).

Most people will have had the experience of fainting at some stage of their lives; given the correct combination of circumstances we will all faint. The majority of faints that occur are perfectly harmless and the person will recover quickly. If uncertain of the cause an early appointment with the a medical practitioner is needed. Emergency assessment is essential even if full recovery has occurred if there is a history of:

• heart failure (history or physical signs)
• transient loss of consciousness during exertion
• family history of sudden cardiac death in people aged younger than 40 • years and/or an inherited cardiac condition
• new or unexplained breathlessness

When seen a full clinical history is essential as is an examination for heart murmurs. An ECG is performed.

Further investigations should be tailored to the patients likely cause but will usually include a 24 hour tape where the heart beat is monitored for a day by a recording device worn around the waist and connected to the skin.

How easy is it to pick up heart problems before I have symptoms?

Taking a detailed history and examination will pick up a proportion of patients with heart abnormalities. Simple blood tests with also pick up abnormal cholesterol and glucose levels which are associated with a higher chance of getting heart problems and also anaemia and high thyroid activity. An ECG is a simple quick test which can show abnormalities related to heart muscle damage or problems with the wiring of then heart.

More complex tests can show even more abnormalities… but there is a trade off. The tests themselves may expose you to a risk for 3 main reasons:

1) The test maybe inconclusive or a false positive and you may need other tests to prove you are normal.

2) Some tests expose you to X rays which at higher dose increase the risk of cancer. For example it is predicted for every 800 middle aged woman who have a CT scan of the coronary arteries it will cause 1 of them to have breast cancer.

3) Some tests have a small risk of causing damage directly. Even a simple exercise test can very rarely induce a heart attack. Other tests are more directly invasive. For example to clearly see the coronary arteries requires a coronary angiogram. This involves placing a fine catheter through the artery in the wrist or leg up to the heart. Dye is put into the arteries at the same time as taking X ray pictures. Although generally safe there is a small risk of causing a heart attack.

As tests expose you to risks themselves it is important to be selective in performing further tests on patients, particularly those who have no symptoms. I was horrified to meet someone who had been advised to have an annual coronary CT scan at a clinic in London. He had no symptoms and his first scan was normal. Every year he would get unnecessary X ray radiation.

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