Chest pain, breathlessness, palpitation and lightheadedness can be concerning but there are other possible causes - routine tests can usually establish whether they are due to a heart problem or not.

Chest Pain

Most chest pain is not due to the heart. But discomfort, heaviness or tightness in the centre of the chest, particularly on exertion, can be a symptom of angina. Angina is caused by a narrowed coronary artery, and can sometimes cause breathlesness rather than pain.

Preliminary Investigations:

  • Blood tests
  • Rest ECG
  • Echocardiogram (cardiac ultrasound)
  • Exercise stress ECG

Depending on results, further investigations maybe required:

  • CT coronary angiogram
  • Stress echocardiogram
  • Cardiac MRI
  • Invasive coronary angiogram

If these tests are normal, then it unlikely that you have angina or narrowing of the coronary arteries.

If you do have angina, then the treatments can range from tablet therapy, to coronary stenting (angioplasty), to by-pass surgery (CABG).

Palpitation

Palpitation is a symptom or awareness of the heart beat and is usually felt in the chest or in the neck. It may be due to anxiety or due to extra heart-beats which actually can feel as if the heart is “missing” or “skipping” a beat – these are usually benign but can be a sign of underlying heart disease.

Occasionally, palpitations may be due to a short-circuit within the heart’s electrical wiring causing it to beat rapidly, known as “SVT” or “AF” – these can be treated with tablets or ablation. Some patients with AF require anti-coagulation to prevent strokes.

Preliminary Investigations:

  • Rest ECG
  • Echocardiogram (cardiac ultrasound)
  • 24hr/48hr heart rate monitor (Holter monitor)

If these tests are normal then this may be reassuring. But if symptoms are ongoing then you may need:

  • 7 day heart rate monitor
  • Reveal device implantation
  • Personal smartphone ECG device (Alive Cor)

Treatment can consist of:

  • Tablet therapy
  • Controlled, external DC defibrillation under sedation
  • Invasive ablation therapy
  • Pacemaker/defibrillator implantation

Lightheadedness and fainting

Many people have fainted or had a near-faint in their lifetime – usually these are “vasovagal” faints provoked by the environment (hot room/standing on a train) or by certain triggers (needles, seeing blood) . Vasovagal faints are benign and do not imply a problem with the heart. Occasionally such faints can occur without obvious triggers due to abnormal interaction between blood pressure and heart rate receptors in the body. Other causes of fainting can be due to a heart problem or sometimes epilepsy.

Preliminary Investigations:

  • Blood tests
  • Rest ECG
  • Echocardiogram (cardiac ultrasound)
  • 24hr/48hr heart rate monitor (Holter monitor)

If these tests are normal then this may be reassuring. But if symptoms are ongoing then you may need:

  • 7 day heart rate monitor
  • Reveal device implantation
  • Tilt table test

Treatment can consist of:

  • Tablet therapy
  • Increasing fluid and salt intake
  • Pacemaker/defibrillator implantation