Providing independent clinical excellence since 2005
At SCVC, we know some medical terminology can be daunting or difficult to understand, and our clinical team are trained to discuss conditions with you in an understandable and clear way to put your mind at ease.
Here are some explanations of common cardiovascular conditions.
Angina is a description of a symptom, not a condition. However, this does not stop many people from confusing the two.
The classic description is of a vice-like chest discomfort or heaviness with radiation into the arm or neck that occurs on exertion. The symptom disappears upon resting and reappears after a certain distance. Angina can be caused by a number of conditions, including coronary artery narrowings, which restrict the blood flow to the heart muscle, aortic stenosis or narrowing of the aortic valve, high blood pressure, and thickening of the left ventricle muscle, creating a mismatch between supply and demand.
When none of the above are present, it can be referred to as Syndrome X, which is believed to be related to microvascular and/or endothelial dysfunction.
Cardiomyopathy is a term used to describe heart muscle disorders where the heart can dilate (dilated cardiomyopathy) or thicken, so-called hypertrophic cardiomyopathy or HCM. However, there are many other sorts, including viral cardiomyopathy, alcoholic cardiomyopathy, and tachycardia-induced cardiomyopathy. All patients with cardiomyopathy need to be thoroughly investigated by a cardiologist.
The normal human heartbeat is regular, with a resting pulse rate of between 40 and 100 beats per minute. The electrical circuits of the heart are complicated, and it is common for perfectly healthy people to experience extra or missed beats. Sometimes the heart can however race of its own accord. This tendency means that the feeling or sensation of palpitation is a very common symptom and also a reason for referral to a cardiologist.
In most cases, the condition can be deemed innocent or benign. However, some basic tests need to be undertaken before this conclusion can be made. Typically, a detailed history, examination, and 12-lead ECG are taken. In many cases, this is followed by a period of continuous monitoring using an ambulatory ECG monitoring system.
Coronary heart disease is the world’s most common serious medical condition and cause of premature adult death. It is due to atherosclerotic disease that causes deposits of cholesterol-rich plaque in the wall of the coronary arteries, which then either gradually cause occlusion or can abruptly rupture to cause a coronary thrombosis or heart attack. The condition can present with exertional symptoms, manifest as chest heaviness with radiation to the arm or neck.
There is a wide variation in presentation, and it is possible to have no symptoms with advanced disease, which is why screening for coronary heart disease is so important.
Approximately half of all patients with coronary artery disease present for the first time with either a heart attack or sudden death, explaining why there is a great deal of public interest in screening programs, particularly those that can detect the condition many years before symptoms develop, affording efficient and proven prevention measures.
A slow heart rate or pauses in the heartbeat can cause dizzy spells and is a common presentation to cardiologists. In some cases, the cause is potentially hazardous, and treatment with an artificial pacemaker is required. In many cases, however, slow heart rates can be linked to other less serious causes, including an overactive vagal nerve, or the use of other medication.
Breathlessness is a very common symptom and is caused by multiple issues, including reduced fitness, increased body weight, and lung and heart issues. From the cardiac point of view, we offer a one-stop-shop approach where important lung and heart issues are addressed with a screening panel, including a chest X-ray, 12-lead ECG, BNP, and D-dimer. The patient is seen in clinic either by a chest or cardiology consultant, meaning that patients and their GPs do not need to decide which they need to see first, as both major causes are assessed using our service.
Raised blood pressure is sometimes called ‘the silent killer’. It is still the case that a third of all patients do not know that they have it, in a third, it is poorly controlled, with only a third of patients with hypertension receiving adequate treatment. For this reason, we are passionate about accurate diagnosis and have a number of systems in place where patients either self-monitor or use the latest home apps to monitor their blood pressure.
The advice is simple: everyone should know their BP numbers. Raised blood pressure is considered to be one of the leading health issues as it causes heart failure in later life. It is also an important cause of stroke. Raised blood pressure also increases the risk of coronary heart disease. It is completely treatable in most cases without causing side effects, using a mixture of lifestyle changes and medication.
Heart failure is classified either as heart failure with preserved systolic function (HFpEF) or reduced systolic function (HFrEF). Both sorts of heart failure cause breathlessness, fatigue, and a tendency to accumulate salt and water, which gravitates, causing ankle and leg swelling.
All patients with heart failure need to be fully investigated with an ECG, blood tests, and an echocardiogram, along with a review by a cardiologist.
Every mammalian heart has four chambers, and each has a valve that functions to prevent blood from passing in the opposite direction to normal flow. Heart valve defects are an important cause of heart failure and symptoms of breathlessness. They can mostly be detected by auscultation of the heart with a stethoscope.
All all four valves can be affected by conditions, the common conditions in humans are of the mitral and aortic valve. The aortic valve is the heart’s main non-return valve that blood passes through as it leaves the heart. This valve has a propensity to narrow with age, particularly in the 1 to 2% of the population born with two instead of the normal three cusps (so-called bicuspid valve).
The aortic valve can also leak, either due to defects of its leaflets or, in most cases, due to dilatation of the ring that it sits in, common enough in diseases that cause dilation or enlargement of the aorta, some of which, like high blood pressure, are quite common.
The mitral valve, separating the left atrium and the left ventricle, is the other valve that is also most commonly defective. Now that rheumatic fever in the UK is rare and mitral stenosis caused by rheumatic involvement is therefore also rare, the main condition causing mitral valve problems in adults is mitral regurgitation or leakiness, in many cases due to either dilatation of the mitral valve ring that it sits in within the heart, or rupture of one or more chordae tendineae (‘heart strings’), which, like parachute cords, support the mitral leaflet tips which prevent prolapse of the leaflets during each heartbeat.
All valve defects should be assessed with a combination of a bedside examination by a skilled practitioner, an echocardiogram, BNP blood test, and a 12-lead ECG. More sophisticated tests are needed in some patients who are being considered for mitral valve or aortic valve repair. Other techniques that are used include aortic valve surgery, TAVI, and minimally invasive mitral valve repair using MitraClip and Tendyne.