This refers to narrowing of the arteries that supply blood to the heart muscle. The heart, like all other organs in the body, needs a constant supply of oxygen and energy. Narrowed arteries are unable to keep up with the demand needed to supply the heart muscle with blood. This can cause damage to the heart muscle if prolonged.
The most common symptom of this problem is chest pain that occurs when you exert yourself (angina). Typical angina chest pain is a heavy sensation in your chest associated with shortness of breath. It sometimes radiates to your arms and can make you feel like being sick, dizzy or sweaty. Not everybody experiences the same sensation and any one of those symptoms can represent angina. If your GP thinks you may have angina they will refer you for an assessment to plan treatment.
Heart Attack (Myocardial Infarction)
If an attack of angina lasts for more than 20 minutes then you may be having a heart attack. This is when a piece of the heart muscle has been deprived of oxygen for so long that it can die resulting in permanent damage to your heart and in some cases death. There are treatments available in hospital that can prevent heart attacks and save lives so if you have chest pain or symptoms of angina that last for more than 20 minutes you should call an ambulance and go to hospital as soon as possible.
Am I likely to have cardiovascular disease?
There are several risk factors that are scientifically proven to be associated with this disease. However even if you don’t have any of the following it could still happen to you.
You are more likely to have cardiovascular disease if you have any of the following:
- Are or have been a smoker Diabetes
- High blood pressure High cholesterol
- A family history of the disease Are older (your risk increases as you get older)
What tests am I likely to have?
An ECG is a recording of your hearts electrical activity. Electrode patches are attached to your skin to measure the electrical impulses given off by your heart. The result is a trace that can be read by a doctor. It can give information of previous heart attacks or problems with the heart rhythm.
Depending on your history, examination and ECG, you may go on to have some of these other tests.
You are likely to have blood tests done before coming to clinic to check your cholesterol level and looking for evidence of diabetes. These blood tests are done "fasting" which means you have the blood taken in the morning on an empty stomach before breakfast.
An ECG done when you are resting may be normal even when you have cardiovascular disease. During an exercise ECG the heart is made to work harder so that if there is any narrowing of the blood vessels resulting in poor blood supply it is more likely to be picked up on the tracing as your heart goes faster. For this test you have to work harder which involves walking on a treadmill while your heart is monitored. The treadmill gets faster with time but you can stop at anytime. This test is supervised and interpreted by a doctor as you go . This test is used to see if you have any evidence of cardiovascular disease and can give the doctor some idea as to how severe it might be so as to direct further tests and possible treatment.
Echocardiography is also referred to as cardiac ultrasound. This test is performed by a specially trained technician. It is a test that uses high frequency sound waves to generate pictures of your heart. During the test, you generally lie on your back; gel is applied to your skin to increase the conductivity of the ultrasound waves. A technician then moves the small, plastic transducer over your chest. The test is painless and can take from 10 minutes to an hour.
The machine then analyses the information and develops images of your heart. These images are seen on a monitor. This is referred to as an echocardiogram.
Echocardiography can help in the diagnosis of many heart problems including cardiovascular disease, previous heart attacks, valve disorders, weakened heart muscle, holes between heart chambers, fluid around the heart (pericardial effusion).
If doctors are looking for evidence of coronary artery disease they may perform variations of this test which include
- Exercise echocardiography. This technique is used to view how your heart works under stress. It compares how your heart works when stressed by exercise versus when it is at rest. The ultrasound is conducted before you exercise and immediately after you stop. Either a stationary bicycle or standard treadmill is used. Dobutamine stress echocardiography. If you’re unable to exercise for the above test, you might be given medication to simulate the effects of exercise. During this test, an echocardiogram initially is performed when you’re at rest. Then dobutamine is given to you via a needle into a vein in your arm. Its effect is to make your heart work harder and faster just like with exercise. After it has taken effect, the echocardiogram is repeated. The effect wears off very quickly.
Depending on the results of these tests you may go on to have an angiogram at a later date.
This test is performed by a cardiologist in a sterile operating theatre environment.
Most people will need to have routine tests before the procedure. These tests may require separate appointments and are usually planned the day before or the day of the procedure.
You will be asked not to eat or drink after midnight the evening before the procedure.
You are not given a general anaesthetic but may have some medication to relax you if needed. Local anaesthetic is put into an area of skin to the side of your groin. A needle and then tube are fed into an artery in the groin and advanced through the blood vessels to the heart. Dye is then injected so that the heart and blood vessels can be seen on X-ray. X-rays and measurements are then taken giving the doctors information about the state of your heart and the exact nature of any narrowed blood vessels. This allows them to plan the best form of treatment to prevent heart attacks and control any symptoms you may have.
After the procedure you will have to lay flat (without bending your legs) while the groin sheath is in place. After the groin sheath is removed, you must lay flat for a period of time to prevent bleeding.