If you experience shortness of breath when doing low level routine activity (such as walking) or chest pain, you should make an appointment to see your GP or a cardiologist.
During a cardiac consultation, the first step is to simply describe the symptoms of chest pain. Pain caused by narrowed coronary arteries causes characteristic symptoms and a summary of the pain experienced plus an electrocardiogram (ECG) – explained below – may be all that is necessary to make a diagnosis in the first instance.
Click on the plus icon to reveal further information about non-invasive investigations.
Every time the heart beats it causes natural electrical changes that can be picked up by electrodes placed at various points on the body. The equipment records the heart rate and rhythm and tests whether the heart is conducting electricity normally. It detects signs of damaged heart muscle or whether the heart is short of oxygen.
When the ECG is normal at rest, an exercise ECG may be helpful. The patient will be asked to use a treadmill to increase the work of the heart. If this exercise produces pain and the appropriate changes in the ECG, it confirms the diagnosis of angina.
This techniques uses ultrasound to actually see the heart working in real time. A sensor is placed firmly against the skin on the chest and moved around to build up an image of the heart. The resulting images show how well the heart chambers and heart valves are functioning and the cardiologist can use these results to determine whether heart disease is present. This test will also determine whether symptoms are caused by a narrowing of the heart valve; this is called aortic stenosis and further information about this condition can be found here.
A cardiac CT scan is a test that uses x-rays to get detailed, three dimensional images of the heart. More detailed than ultrasound, the images can detect the narrowing of blood vessels and internal structures of the heart, such as valves. The test is also useful in showing the absence of heart disease.
A myocardial perfusion scan uses a small amount of a radioactive chemical (a tracer) to see how well blood flows to the muscles of the heart (the myocardium). The tracer is easily detected by a special type of camera, and the cardiologist will view the heart using the camera, either while the patient is using a treadmill or at rest. This test is also referred to as the ‘thallium’ or MIBI scan.
A Holter monitor is like an exercise stress test (see above) but sensors are worn for 24 hours or more, providing a continual recording of the heart’s electrical activity during that time. Patients will be asked to keep a log of the time they do certain activities and list any symptoms. After the test, the results of the scan are analysed and linked to symptoms noted by the patient.
When angina is present despite drug treatment, or where there are features which suggest narrowing in the coronary arteries which may affect a patient’s life-span, coronary angiography (or cardiac catheterisation) is recommended.
Following local anaesthetic a long, flexible, hollow plastic tube (a catheter) is inserted into an artery in the groin. Using x-ray imaging, the catheter is steered through the blood vessels and into the coronary arteries. A special dye (contrast liquid) is injected into the tube and is easily detected by the X-ray. This shows clearly whether the coronary arteries are narrow or even blocked.
The procedure has some risks, but is an excellent way to establish the severity of the patient’s condition in order to decide on the best method of treatment.
Treatment of Coronary Artery Disease
The best way to improve the long-term outcome for patients with coronary disease is prevention. This includes quitting smoking, taking up a healthy diet and regular exercise.
People with diabetes, high blood pressure and elevated levels of cholesterol need to be identified and treated. The use of aspirin and statins (to reduce cholesterol) have been shown to improve the outcome of patients with coronary disease and reduce the risk of a heart attack.
Click on the plus icon to reveal further information about treatment of Coronary Artery Disease.
Drug treatments for angina work in two main ways:
- Beta-blockers reduce the amount of oxygen needed by the heart muscle.
- Nitrates and calcium channel blockers increase blood flow to the heart.
Aspirin should be taken by everyone with angina because it works by thinning the blood, which then clots less easily. Aspirin has been shown to reduce the risk of heart attack by 25% in people with coronary artery disease.
Treatment of a heart attack requires urgent reopening of the blocked artery to restore the normal blood supply to the heart muscle. This can be achieved by clot dissolving drugs (thrombolytic therapy) and / or emergency coronary angioplasty which is increasingly recognised as the gold standard for treatment.