Symptoms of Heart Disease

Symptoms of Heart Disease


Angina is a central heaviness or discomfort experienced by individuals with coronary artery disease.  Typically, it comes on with exertion or emotional stress, but can also occur in cold weather or at rest.  It is directly the consequence of an abnormal blood supply to the heart muscle and this is invariably due to narrowing or obstruction of the coronary arteries.  The discomfort is typically felt in the centre of the chest, may radiate to the neck, jaw or down the left or right arm.  Occasionally, it will radiate through to the back.  Rest often alleviates the symptoms within minutes.  If not addressed promptly, this may be a forerunner of a heart attack, and so always requires investigation.  Investigations for angina include non-invasive tests such as cardiac CT or stress magnetic resonance, imaging, also occasionally stress echo can be used.  If the symptoms are very severe and the doctor is convinced that the diagnosis is that of angina, then it is possible to proceed directly to invasive coronary angiography.  


Breathlessness is a sensation of shortness of breath occurring either during exertion or lesser levels of physical activity, sometimes even occurring at rest.  There are many causes of breathlessness, but they may be broadly broken down into cardiac causes, respiratory causes and anaemia.  Cardiac causes usually relate to impairment of the pumping function of the heart causing heart failure, but may also relate to abnormalities of the heart valves, particularly narrowing of the main outflow valve known as aortic stenosis.  Breathlessness may also relate to abnormalities of heart rhythm, so called arrhythmias, particularly those such as atrial fibrillation.  It is also noted that narrowing of the coronary arteries causing coronary artery disease can present with breathlessness, rather than angina.  Other causes of shortness of breath include problems with the respiratory system, such as infections of the lungs or fibrosis or inflammation within the lungs.  Also, if the level of haemoglobin: the red pigment which carries oxygen in the blood is too low, this may also leave an individual feeling breathless.  


Palpitation is simply a term used to describe any awareness of the heartbeat.  Most of the time an individual will not feel the heart beating, but sometimes during vigorous physical exercise, or whilst lying down in bed at night, it is possible to be aware of the heartbeat.  Beyond these normal variants, people are aware of different patterns of abnormal heartbeats, rapid runs, bursts of a fast tachycardia, heavy heartbeats or missed or extra heartbeats.  The key thing in management of palpitations is achieving the correct diagnosis and this is usually achieved using an ECG and then a small portable heart recorder which the individual wears for up to 7 days, recording all the heartbeats, and this is then downloaded and examined in detail on the computer.  If the palpitations are quite infrequent, but very disabling, then tiny implantable recorders can be used, and these can remain under the skin of the individual for up to 18 months at a time.  


Almost every individual have at least one episode of loss of consciousness in their life.  These may occur as a child whilst standing in the playground, or under unusual circumstances of illness.  However, it is important to investigate the underlying cause of loss of consciousness to make sure it is a benign cause, and not one requiring treatment.  Normally, the blood supply to the brain is very well regulated by the autonomic nervous system, but a variety of factors can upset this, causing alteration or loss of consciousness.  These range from abnormalities of the heartbeat, with the heart either racing too quickly and decreasing blood flow, or pauses between the heartbeats, again decreasing blood flow and causing blackouts.  There may also be swings in blood pressure, where the blood pressure drops too low, transiently causing the individual to lose consciousness.  Beyond these cardiovascular causes of loss of consciousness are a number of neurological causes, which can be investigated in parallel.  The investigation of loss of consciousness invariably requires confirmation of a normal regular heartbeat by using a 24 hour ECG recorder and looking at changes in blood pressure, often using a tilt table test.  These are always performed on an outpatient basis.  Occasionally, if the episodes of loss of consciousness persist, but are very infrequent, a tiny implantable recorder may be placed under the surface of the patient’s skin which remains in place for a long period of time to allow any changes in heartbeat to be monitored carefully.  


There are a number of causes of swollen ankles, ranging from the effects of gravity on an individual seated for a long period of time to medication, but it also may be a feature of heart failure or raised pressures on the right side of the heart.  Investigations will include blood tests and an ultrasound examination of the heart called an echocardiogram to look at the heart function and assess pressures within the heart chambers.