Shortness of Breath
There are many causes of shortness of breath. Increasing age
and lack of physical activity cause some degree of breathlessness.
The main medical causes are heart and lung disorders. If the
heart muscle is not working properly, pressure builds up within
the heart chambers and in the lungs, causing the sensation
of breathlessness.
If the muscle damage is mild, breathlessness is only felt
with significant exercise. Increasing muscle damage causes
breathlessness even with mild activity and is more noticeable
when lying down in bed, such that a patient may start to sleep
with more pillows than before. The most common cause of breathlessness
in the Western world is ischaemic heart disease i.e. furring
up of the coronary arteries (atherosclerosis). This may occur
if the heart is starved pf blood during exercise or if an
artery blocks and causes a heart attack. Then the heart muscle
that was supplied by that artery will die, healing with time
to leave a scar. The larger the scar, the greater the effect
on the remaining healthy heart muscle and the more likely
it is that a patient may feel breathless.
Other causes of breathlessness include high blood pressure
(hypertension), malfunctioning heart valves (which may narrow
down and/or leak) and various abnormalities of the heart muscle
itself, which may be inherited e.g. hypertrophic cardiomyopathy
or congestive cardiomyopathy for example following a viral
infection of the heart or following a long period of alcohol
excess.
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Palpitation
Palpitation is a common symptom, which may or may not signify
an important underlying heart problem. An awareness of a normal
heartbeat is common and normal. We all experience extra heartbeats
from time to time and in most cases this is not dangerous,
although it may initially be concerning to the patient. Sometimes
the heart rhythm can change significantly and this needs careful
investigation, for example with an ECG (heart tracing) and
24-hour heart monitor. Occasionally a small device (the implantable
loop recorder) is inserted under the skin on the front of
the chest to monitor the heart beat continuously for a year
or longer. The device can store precise information about
the heart rhythm at the time of a patient's symptoms (e.g.
palpitations, blackout) and the information can be downloaded
at a later time for analysis.
There are many different types of rhythm change which, depending
on the precise rhythm abnormality, can be treated in several
different ways. Some patients may need regular medication,
or some a permanent pacemaker or an implantable defibrillator.
In some instances a sophisticated electrical study (electrophysiological
study; EPS) may be required mapping the electricity of the
heart with a view to stopping the abnormal electrical pathway
(radiofrequency ablation).
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Chest pain
Chest pains are the most common manifestation of coronary
artery disease. The most common symptom is of a chest tightness
or discomfort across the chest with the sensation often being
felt in the arm or jaw. The severity of the pain varies and
some patients feel no pain at all. In general the pain described
as angina comes on with exertion or stress and is relieved
by rest relaxation or the use of nitrate drugs (GTN). If the
pains occur at rest or for a prolonged period they may herald
unstable angina or an impending heart attack and in such instances
it is important to see a doctor urgently or dial 999. Many
patients have different sorts of pain from their coronary
artery disease and chest pains are sometimes very difficult
to pin down. Pain from the gullet may mimic heart pain and
vici-versa. The degree of chest pain does not necessarily
relate to the extent of any underlying artery disease and
patients may have what appear to be perfectly normal looking
coronary arteries despite having angina. Sometimes this due
to spasm in the arteries or disease in smaller arteries that
are not seen during an angiogram.
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Dizziness
There are many causes of dizziness some of which are nothing
to do with heart disease but need to be attended to by other
specialists. The common causes of dizziness are lowering of
the blood pressure either spontaneously or due to blood pressure
medication. Rapid heart rhythms (palpitation) may cause dizziness
as may slowing of the heart rate. Patients may need their
medication adjusting or new tablets and if the heart rate
is slow may require a pacemaker to be implanted. Complete
loss of consciousness is unusual but may be a manifestation
of sever heart rhythm abnormalities (rapid or slow) or of
heart valve narrowing such as aortic valve stenosis
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