Conditions

Breathlessness can be caused by many things and can vary enormously from one person to another. The cause of breathlessness can sometimes be difficult to diagnose and it isn’t always very obvious where to start looking. Heart conditions can certainly cause people to become breathless. This can be due to problems with the hearts function (heart failure), valve problems (valvular heart disease) and coronary artery disease. There are other less common heart conditions that can make people feel breathless, but also as we get older, the heart muscle can become stiff which means it doesn’t relax properly. This can also make people feel breathless. Heart muscle stiffness can also be caused by other conditions, most commonly high blood pressure or abnormal thickening of the heart muscle. Investigations for cardiac breathlessness can range from simple blood tests to common investigations like echocardiography (cardiac ultrasound). We also organise for some people to have more detailed cardiac examinations like MRI scans or coronary angiograms. If the breathlessness is not thought to be from the heart, other causes need to be excluded. Anaemia and chest problems are two things that need to be ruled out. Sometimes breathlessness is a simple symptom from lack of fitness or maybe weight gain.

Understandably, people often worry when they experience chest pains that the pains are cardiac. Angina is a symptom that generally occurs on exertion and is usually predictable. Often described as a pressure feeling or a weight on the chest rather than pain as such, it can come on gradually or suddenly and needs investigation. There are a number of tests to look for coronary artery disease which is the usual cause for angina, and the tests all have pros and cons, but often will start with a CT coronary angiogram. Because angina like pains can also be caused by valvular heart disease, we will usually also organise an echocardiogram. If initial tests suggest a problem with the coronary arteries, we will usually undertake a coronary angiogram and possible fit coronary stents to restore blood flow. There are other causes of chest pain. Pericarditis is an inflammation of the lining that protects the heart called the pericardium. This is usually caused by a virus and is mostly short lasting and settles on its own. The pain is very different to angina. There are a large number of other causes of chest pains which can originate from the lungs, gullet (oesophagus), stomach, chest wall or even the back/neck. Usually the nature of the pain will help direct what investigations are needed once we have rule out heart disease.

Palpitations are an awareness of the heart beating, usually in an unusual way. This might be a rapid heart beat, an irregular heart beat or a sensation of the heart skipping or jumping. There are a number of ways that people might perceive this sensation. Palpitations are very common. Most people experience them intermittently through their lifetime and the vast majority of palpitations are benign but they can still be concerning and upsetting. They can also sometimes make you feel dizzy or more generally unwell. We usually investigate with a prolonged ECG monitor. The length of the monitoring will depend on how often the symptom occurs. We also usually do an echocardiogram to ensure that the heart is structurally normal. Treatments range from just reassurance, through medications all the way to cardiac ablations.

High blood pressure is a very common problem that usually requires medications to control it. It usually has no underlying cause but if occurring the younger people or if it is difficult to control, certain tests may be required to ensure that it is not caused by a problem with either the kidneys or adrenal glands (little glands that sit in the abdomen that secrete lots of different hormones and compounds that can effect blood pressure). Cholesterol is well understood to be a strong risk factor for coronary disease. Understandable, people are often reluctant to take medications (like statins) to reduce cholesterol. Lifestyle can make a big impact on lowering cholesterol, but sometimes this isn’t enough, and so we can look ways to assess an individuals risk to determine whether medication is required.