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, which can cause damage to the 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 these 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 where 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 heart disease Are older (your risk increases as you get older)

Your heart rate is controlled by a complex electrical system within the heart muscle which drives it to go faster when you exert yourself and slower when you rest. A number of conditions can affect the heart rate or rhythm. Heart rate simply refers to how fast your heart is beating. Heart rhythm refers to the electrical source that is driving the heart rate and whether or not it is regular or irregular. As some types of arrhythmias can cause you to faint without warning, your doctor may restrict your driving until the condition is controlled. Some common terms: Sinus rhythm is the normal rhythm Arrhythmia means abnormal rhythm Fibrillation means irregular rhythm or quivering of one part of the heart Bradycardia means slow heart rate Tachycardia means fast heart rate Paroxysmal means the arrhythmia comes and goes Tachycardia The most common of these is atrial fibrillation. This is where your heart rhythm is irregular and often too fast. Symptoms include fatigue, palpitations (where you are aware of your heart racing or pounding), dizziness and breathlessness. Other tachycardias include supraventricular tachycardia (SVT) or ventricular tachycardia (VT); these have similar symptoms as atrial fibrillation but can also cause you to lose consciousness (faint). Bradycardia The most common form of this is called heart block. This is because messages from the electrical generator of the heart don’t get through efficiently to the rest of the heart and hence it goes very slowly or can pause. Symptoms of the heart going to slowly include feeling tired, breathless or fainting. Tests As well as having the following tests to diagnose what sort of arrhythmia you have, you might be investigated for evidence of heart diseases that cause arrhythmias with echocardiography, blood tests, or tests looking for evidence of cardiovascular disease. The first test you will have will be an electrocardiogram (ECG). This trace of the heart's electrical activity gives the diagnosis of the source of the arrhythmia. This is often normal at rest and more extensive testing is needed to try and catch the arrhythmia especially if it is intermittent. Ambulatory ECG Holter monitor This test is used to monitor your heart for rhythm abnormalities during normal activity for an uninterrupted 24-hour period. During the test, electrodes attached to your chest are connected to a portable recorder — about the size of a paperback book — that's attached to your belt or hung from a shoulder strap. Event recorder This is a test covering 1-2 weeks. You wear a monitor (much smaller than a Holter monitor) and if you have any symptoms such as dizziness you press a button on a recording device and it saves the recording of your heart rhythm made in the minutes leading up to and during your symptoms. Because you can wear this for a longer period of time it has a higher rate of catching your abnormal rhythm. Treatment Tachycardia Most treatments for these conditions consist of medication to stop the abnormal rhythm or make it slower if and when it occurs. Atrial fibrillation, if you have other problems, can increase your risk of stroke so blood-thinning medication is often used as well. Bradycardia Depending on how slow your heart goes and what symptoms you have you may be referred to the surgeons for a pacemaker. This is a small operation where a battery powered device is placed under the skin with wires that lead to your heart and provide it with electrical stimulation to prevent it from going too slow. You can't feel it doing this but will be aware of a small flat lump under your skin just below your collar bone.

A catheter is fed into an artery in the groin or arm and advanced though 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 heart’s condition 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 being experienced.

Angioplasty, or percutaneous coronary intervention (PCI), is a procedure designed to reduce or remove blockages in the coronary arteries (arteries supplying the heart with oxygen). The purpose of a PCI is to restore blood flow to the coronary arteries and ensure the heart is adequately supplied with oxygen. This may reduce or eliminate angina and can restore blood flow in the event of a heart attack. During this procedure, a specially designed catheter with a small balloon tip is guided to the point of narrowing in the artery. Once in place, the balloon is inflated to open the artery and stretch the artery to increase blood flow to the heart. A stent, a small stainless steel mesh tube, can also be inserted at this time to function as scaffolding and give a coronary artery support. A balloon catheter is used to insert the stent into the narrowed coronary artery. Once in place, the balloon is inflated and the stent expands to the size of the artery and holds it open. The balloon is then deflated and removed, and the stent stays in place permanently.

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Echocardiography, also referred to as cardiac ultrasound, is a test that uses high frequency sound waves to generate images of the heart. 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 and fluid around the heart (pericardial effusion). In transoesophageal echocardiography (TOE), the ultrasound transducer is guided through the mouth, down the throat and into the oesophagus. This allows very clear images of the heart to be obtained without the ribs or lungs getting in the way.