Heart Symptoms

ANGINA

BREATHLESSNESS

PALPITATIONS

DIZZINESS or BLACKOUTS

FATIGUE, LETHARGY, LOSS OF ENERGY

HIGH BLOOD PRESSURE

HIGH CHOLESTEROL

HEART DISEASE IN WOMEN

WOMEN’S HEALTHY HEART SCREENING

 

ANGINA

“A man is as old as his arteries.”
Thomas Sydenham, MD, English Physician, 1624-1689

Historical note

The term “angina pectoris” was first used by Heberden in a lecture to the Royal College of Physicians of London in 1768 (Heberden, 1772)*

He described sufferers experiencing ‘a disorder of the breast…the seat of which and sense of strangling and anxiety with which it is attended make it not improper to be called Angina pectoris’. Evidence of the antiquity of coronary artery disease however, comes from the examination of Egyptian mummies, in which degenerative coronary disease has been demonstrated (Leibowitz, 1970)**

*Heberden W. Some account of a disorder of the breast. Medical Transactions of the Royal College of Physicians 1772;2:59-67, quoted by Leibowitz JO (1970) The history of coronary artery disease, pp. 83-104. London: Wellcome Institute of the History of Medicine.

**Leibowitz JO (1970) The history of coronary artery disease, pp. 1-14, 142-143, 147-148. London: Wellcome Institute of the History of Medicine

Link to BUPA health factsheet “Angina”
http://hcd2.bupa.co.uk/fact_sheets/html/angina.html

Animation of heart attack from Careflash
http://www.careflash.com/video/myocardial-infarction?lc=en

Symptoms of heart disease are often ignored because of the common misconception of the nature of cardiac symptoms. The best example of this is the symptom of “chest pain” – the most well known symptom of heart disease. If the chest pain is due to coronary artery disease, the medical term “angina” is used.
The vast majority of patients with angina do not regard their chest symptom as sufficiently severe to warrant the term “pain”. Patients usually believe heart related chest pains should be severe, debilitating and recurrent. None of these features are necessarily true, but can sometimes serve to reassure patients who may be in denial.

The term chest “discomfort” is a more likely to elicit an accurate history of angina. Other colorful descriptions include “lump in the chest”, “feeling of heat in chest”, “as if I had just swallowed boiled sweet which was has got stuck”, “heavy weight on my chest”, “belt tightening around my chest” or “throat soreness in cold weather” or “Doctor I get indigestion when I walk in cold weather”. Patients will frequently describe their heart symptoms as “indigestion” or “heartburn”.

Angina may not present with symptoms in the chest at all and can occur at the following sites:

Throat discomfort
Jaw discomfort
Teeth discomfort
Both arm, more often the left arm
Both Shoulders
Back discomfort
Upper abdomen

Breathlessness is well recognized as surrogate for angina (so called angina-equivalent), especially in diabetic patients.

The diagnosis of cardiac related chest pains (angina) usually requires a stress test. The gold standard test is coronary angiography which allows X-Ray visualization of the coronary arteries supplying blood to the heart. Other tests include CT coronary calcium scan, nuclear myocardial perfusion scan, MRI perfusion scan and stress echocardiography.

 

BREATHLESSNESS

Link to BUPA health factsheet “Heart Failure”

Link to BUPA health factsheet “Problems with Heart Valves”

Breathlessness is a very common symptom and can have a very insidious course. It is often ignored and attributed to “getting old” or “poor fitness”. Sometimes careful questioning reveals a more significant level of restriction. Some patients deny feeling breathless but complain:

I find that I cannot walk and talk at the same time  

I am not able to keep up with my wife when we go for a walk

I drive everywhere now that I cannot walk far

Some breathless patients have heart disease as the underlying cause. The most common cardiac cause for breathlessness is a weakness in the contractility of the heart muscle contraction – left ventricular systolic dysfunction. The underlying causes for heart muscle dysfunction include coronary artery disease, high blood pressure and intrinsic heart muscle disease (cardiomyopathy).

Occasionally, the heart valves may either leak or be significantly narrowed. Breathlessness is a common feature in heart valve disease. Heart valve disease may not cause symptoms but a heart murmur is found incidentally during a medical check-up.
 
The diagnosis of a cardiac cause of breathlessness requires an ultrasound scan of the heart (echocardiogram). This will shows the how well the heart muscle contracts and also demonstrate heart valve structure and function. Other tests (exercise test or coronary angiogram) may be required, if an underlying cause such as coronary artery disease is suspected.

PALPITATIONS

BHF booklet on palpitations

Link to BUPA health factsheet “Arrhythmia”

My heart is missing a beat

I feel a fluttering or thumping sensation in my chest

My partner (or I am) is aware that my heart beat is irregular when in bed

The awareness of an irregular heart beat is a frequent cause for concern, particularly as it can occur unpredictably and may be quite troublesome.

Associated symptoms include dizziness, blackouts, breathlessness, and fatigue or chest discomfort. There may be triggering factors such as stress, exercise or dietary intake

The diagnosis of palpations includes the recording of the heart rhythm over a period which may range between 24 hours (Holter monitor) or longer (7 day event monitor). A small device inserted under the skin may record the heart rhythm for 1 year in the event of very infrequent symptoms (Reveal device). Other tests required include blood tests, echocardiography and stress testing.

DIZZINESS or BLACKOUTS

Link to BUPA health factsheet “Pacemaker” 

Link to BUPA health factsheet “Heart Block”

Dizziness can a very debilitating symptom. This need not progress to be a full blown blackout but can come close to complete loss of consciousness. An abnormal heart rhythm can cause dizziness. The heart rhythm may either be too slow (treatable by pacemaker) or too fast. If there is a structural abnormality with the heart such as coronary artery disease, heart valve disease, heart muscle disease including various forms of cardiomyopathy, dizziness may be a serious feature of heart disease.

The diagnosis of dizziness includes the recording of the heart rhythm - 24 hours (Holter monitor) or longer (7 day event monitor). A small device inserted under the skin may record the heart rhythm for 1 year in the event of very infrequent symptoms.

FATIGUE, LETHARGY, LOSS OF ENERGY

We all experience fatigue and lethargy from time to time and this ubiquitous symptom is not in itself a sign of heart disease.

However, some common heart conditions such as left ventricular dysfunction (heart failure) or arrhythmias (heart rhythm disturbance) or heart valve disease, are frequently associated with such symptoms.

HIGH BLOOD PRESSURE

Link to British Heart Foundation (BHF) factsheet “Hypertension”

Link to BUPA health factsheet “High Blood Pressure”

High Blood pressure is estimated to affect 30% of the U.K. population and is notable for its lack of symptoms in patients. It is unusual for patients to complain of headaches and nose bleeds – commonly sought symptoms.

The almost complete lack of symptoms means that hypertension is often only found when damage has already occurred – such as after a heart attack. Other than heart attack risk, hypertension can cause heart failure, strokes, brain haemorrhage, kidney failure and peripheral vascular disease. High blood pressure frequently runs in families and even mildly elevated blood pressure can cause long term damage to heath, if not treated.

It is self evident that if blood pressure is not measured, then the opportunity to diagnose hypertension and treat accordingly is lost. An important message is that even mildly elevated blood should not be ignored, especially if there is a family history of hypertension. It is not infrequent to find patients who have suffered a cardiac event or a small stroke to mention that their blood pressure was “a little high, a few years ago”.

Hypertension requires investigations to check for underlying causes (uncommon) and to detect any existing organ damage. Sometimes making the diagnosis of hypertension is difficult because of artificially high clinic BP recordings as a result of anxiety.

In such situations a 24 hour blood pressure monitor is invaluable. This is also useful to monitor the effectiveness of drug treatment of hypertension.

A heart scan (echocardiogram) checks the effect of high blood pressure on the muscle of the heart (left ventricular hypertrophy).

HIGH CHOLESTEROL

Link to British Heart Foundation factsheet “Cholesterol”

Link to BUPA health factsheet “High Cholesterol”

This is one of the most easily treatable risk factors for coronary artery disease.

Treatment involves dietary modification and highly effective drugs called statins. It is a common misconception that diet alone is sufficient to treat hypercholesterolaemia.

This is because dietary modification can only account for a 15% change in the blood cholesterol level. The main determinant of the blood cholesterol level is the body’s own liver production - cholesterol is an essential building block for our cells.

The decision to treated a high cholesterol requires a full assessment including other risk factors, existing medical conditions and the finding of signs of cardiovascular and cerebrovascular  disease. Rarely, does the decision to treat hypercholesterolaemia depend sole on the cholesterol level, except in cases of severe hereditary hypercholesterolaemia (heterozygous or homozygous familial hyperchlesterolaemia).

Statin medication (prescribed for high cholesterol) do not only reduce the risk of heart disease by its effect on cholesterol lowering alone - although this is a major reason for its efficacy.

Other beneficial effects (known as pleiotropic effects) are thought to be important - such as improving the health of the lining of arteries to avoid a thrombotic event.

Thus treating high cholesterol with diet alone may not be sufficient and you may need the addition cardiac protective effect of statin medication.

 

HEART DISEASE IN WOMEN

 

“Heart disease in women - should be regarded a special case”

“Heart attacks are the leading cause of death for women - more than breast cancer”

Although there have been significant reduction in cardiovascular death rates in developed countries, the incidence of heart attacks (myocardial infarction) has not declined and has actually increased amongst women.

Cardiovascular Disease remains the leading killer of women - Cardiovascular Disease, of which Coronary Heart Disease is the most common manifestation, causes twice as many deaths as breast cancer and all other cancers combined.

However, the good news is that heart disease is largely preventable.

Why should heart disease in women be regarded as a special case?

Research shows that women are less likely to receive effective cardiovascular care compared to male counterparts, and this may contribute to worse outcomes in women compared with men

 

Women with heart symptoms do not have text-book symptoms and have a greater tendency to present with atypical symptoms.

 

Women with angina (heart pain usually felt in the chest) complain of indigestion, abdominal pain, breathlessness, nausea, and unexplained fatigue

Women often describe a “fullness” or “tightness” in the chest rather than pain

Women have chest symptoms which spread to back or stomach

Women can have isolated discomfort in the jaw, left or right arm, or abdomen

Women may feel dizziness or light-headedness with heart pain

 

If you experience these symptoms, seek medical attention. The sooner you get treatment, the greater your chance for a successful outcome and a secure future for a healthy heart.

• Heart attack symptoms may be more often silent in women and the proportion of unrecognized heart attack is greater in women than in men

• diagnostic tests such as exercise stress testing and procedures may not be as accurate in women,

• Women less likely to receive coronary angiography and are less likely to be referred for revascularization procedures such as coronary angioplasty.

• Women were also less likely to receive secondary preventive therapies

Prevention of Cardiovascular Disease is paramount to the health of every woman and fortunately, most Cardiovascular Disease in women is preventable

Since Coronary heart disease can be fatal on first presentation, and because nearly two thirds of women who die suddenly have no previously recognized symptoms, it is essential to prevent CHD.

Other forms of atherosclerotic/thrombotic Cardiovascular Disease, such as cerebrovascular disease and peripheral arterial disease, are critically important in women. Strategies known to reduce the burden of Coronary Heart Disease may have substantial benefits for the prevention of noncoronary atherosclerosis.

 

WOMEN’S HEALTHY HEART SCREENING

 

Dr Koh’s HEART CLINIC is committed to improving the cardiovascular health of women.

• Women are unique when it comes to heart disease and often experience different symptoms of heart disease than men.
• Evaluation and treatment needs to be specifically tailored for each individual woman.
• Our priority is to improve the cardiovascular health of women by offering personalized evidence-based, proven and comprehensive care for the diagnosis, and treatment of cardiovascular disease in women.

Risk Assessment
A comprehensive evaluation of your risk for cardiovascular disease is performed by carrying out a complete medical history and cardiac examination - in particular blood pressure assessment. This will become the basis of your unique prevention and treatment plan. Additional tests, such as blood test -Fasting glucose and cholesterol, LDL, HDL cholesterol, Triglyceride and an ECG may be needed to completely understand your risk.

Diagnostic Evaluation
Women with concerning symptoms for cardiovascular disease may require further diagnostic testing, such as non-invasive stress testing. 
Dr Koh’s Heart Clinic has access to the full range of non-invasive advanced cardiac imaging including myocardial perfusion scanning, CT calcium scoring, Cardiac MR scanning, CT coronary angiography.

Risk Management
Whether or not you are diagnosed with cardiovascular disease, managing your cardiovascular risk factors is of utmost importance to prevent progression of your disease or future cardiovascular events. 
Dr Koh’s Heart Clinic will help guide you in making healthy lifestyle changes

Treatment of Cardiovascular Disease
We have state-of-the-art cardiac services, as well as knowledgeable and skilled clinicians dedicated to providing the most up-to-date care in the field of women’s cardiovascular health.
Dr Koh’s Heart Clinic will help guide you in making healthy lifestyle changes.

By encouraging patients to be knowledgeable about their cardiovascular risk and taking appropriate steps to reduce it, you will be an active participant in your own cardiovascular health. Some of these are listed below:

• Blood pressure measurement and control
• Exercise plan - personalised recommendation
• Healthy eating plan
• Smoking cessation advice
• Hormone replacement therapy discussion