Dr Brian A Gould

Cardiac Problems and Symptoms


Angina is classically a constricting sensation experienced in the mid chest and spreads to the neck/throat and often the left arm. It usually provoked by activity and settles with rest. It may be aggravated in the cold or on exercise after meals. Some patients may experience a more severe pain and others shortness of breath.

It is due to insufficient blood supply to the heart muscle caused by deposits of cholesterol (plaques) under the arterial wall which constrict the flow of blood through the lumen (the passage through which blood flows).

The process of plaque formation occurs faster in smokers; in patients with elevated cholesterol; high blood pressure and in diabetics.

It is important to see your doctor if you experience chest discomfort/pain. He will check out underlying causes as noted above and arrange further investigations to confirm the diagnosis i.e. ECG and possibly an exercise stress ECG. Whilst your symptoms may be controlled by medication you may be referred to a cardiologist who after assessment might arrange a stress Echo cardiogram or coronary angiogram.

Heart Failure

When the heart muscle is damaged it becomes less efficient.

Symptoms include breathlessness which may be apparent on effort or when you lay flat in bed. You may find it more comfortable to sleep propped up in bed. Other symptoms include swollen ankles, for example. Even your abdomen may be affected by fluid retention. Pressure on the skin leaves a dimple which subsides slowly.

Causes include heart attack, high blood pressure, valvular heart disease and any disease which weakens the heart muscle.

If you experience these symptoms you should consult your doctor.

Investigations may include blood tests, ECG, Cardiac ultrasound (Echocardiogram).

Treatment with medication will improve the symptoms but in some cases the underlying cause e.g. valve disease may be treatable. The management of patients with heart failure is complex and usually requires specialist help.


High blood pressure does not usually make you feel unwell. It is often found by chance at a routine medical.

Over several years it may lead to problems with your cardiovascular system i.e. the small arteries supplying the brain, heart and kidneys. As a result diseases such as stroke, heart attack or kidney disease may develop.

Only 2% of patients have an underlying cause and 98% have no specific cause. Treatment is aimed at lowering the blood pressure to reduce risk.

The object of treatment is to reduce cardiovascular risk by treating all risks, for example, stop smoking; lower cholesterol; diagnose and treat diabetes; exclude and treat underlying kidney disease. Investigations will include routine blood tests. Some patients may require ECG, chest x-ray and cardiac ultrasound.

Some patients' blood pressure fluctuates between high and low and others only have high blood pressure when they have the measures taken by a doctor (white coat hypertension). In these cases 24 hour blood pressure monitoring may be arranged.

Heart Valve Problems

The heart is a muscle which pumps blood around the body. The valves ensure the blood flows in the right direction. There are four valves. The mitral and tricuspid valve separates the top chambers (atria) from the pumping chambers (ventricles).

The aortic valve and pulmonary valve prevent blood flowing back into the ventricles after it has been pumped out.

There are 2 types of valve problem:-

1. Stenosis (Narrowed)

2. Incompetent (Leaking)

Symptoms of Heart Valve Problems

Many patients may have no symptoms but if the heart is not working efficiently patients may experience breathlessness, swollen ankles fatigue, and blackouts may be present.

If you experience these symptoms you should consult your doctor. He may listen to your heart and hear a noise/murmur. Further tests include blood tests, ECG and cardiac ultrasound (echocardiogram).

Treatment varies from medication to, in very severe cases, surgery.


Most people are not aware of their heartbeat. 'Palpitation' is the term used to describe awareness of the heartbeat.

There are many types of palpitation and descriptions of the sensation may vary. For example - it feels as if the heart has:

  • stopped
  • skipped a beat
  • jumped

Palpitations are usually used to describe extra heart beats or ectopic beats which for the majority are harmless. They may be caused by stress, smoking and excess caffeine and alcohol intake. In a few cases they are due to underlying cardiac problems - they may feel as if a bird is fluttering inside the chest due to a sustained rapid palpitation. This may be innocuous but may be associated with unpleasant symptoms - chest pain, shortness of breath, feeling dizzy and rarely, blackouts.

If you feel unwell with these symptoms you should consult your doctor. He may arrange further tests. Blood tests to check the salts in the body and to check your thyroid function; a 24 hour ECG to try and document the type of abnormal heart beat; a cardiac ultrasound to check for any abnormality of the heart muscle/valves.