Angina refers to narrowing (blockages) 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 - some people develop decrease in exercise capacity, tiredness, or shortness of breath with exertion. 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. To learn more, please go to: www.cardiologyspecialists.co.nz 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: smoker family history of heart disease high blood pressure high cholesterol diabetes are older (your risk increases as you get older) to read more about your heart risk, please go to: what is my heart risk? What tests am I likely to have? Electrocardiogram ECG 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. Exercise ECG 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 any time. 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. To read more, please go to: heart tests Echocardiogram 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). To read more, go to: heart tests 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 imaging of the coronary arteries. CT coronary angiogram: this is where you sit inside a CT scanner and contrast is injected through a vein in the arm while you hold your breath. It is important that your heart rate is regular and slow to get good images. This test is useful if the pain is atypical, you are at low to intermediate risk, and/or the exercise test is inconclusive. To read more, please go to: heart scans Coronary Angiogram and Heart Stents This test is performed when you have classic symptoms, and/or the exercise test is positive. 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 are not given a general anaesthetic but will be given some medication to relax you if needed. Local anaesthetic is put into an area of skin in the forearm just above your wrist. A needle and then tube are fed into an artery in the forearm 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. In some cases, a stent can be inserted at the same time as the angiogram by Dr Dougal McClean, if a severe coronary narrowing is found. To read more about heart stents and heart surgery, please go to: stents

Heart failure refers to the heart failing to pump efficiently. There are many diseases that cause this including cardiovascular disease, high blood pressure, viral infections, alcohol, and diseases affecting the valves of the heart. When the heart is inefficient a number of symptoms occur depending on the cause and severity of the condition. The main symptoms are tiredness, breathlessness on exertion or lying flat, and ankle swelling. Doctors often refer to oedema, which means fluid retention usually in your feet or lungs as a result of the heart not pumping efficiently. Tests looking for possible causes of heart failure include: · Chest X-ray · Electrocardiogram (ECG) · Echocardiogram (Cardiac ultrasound) · Angiogram Treatment You are likely to have several medications over time, started and monitored by your cardiologist and GP. These include medication to control the amount of fluid that builds up (diuretics), medication to protect your heart and slow it down as well as to thin your blood. To read more, please go to: shortness-of-breath

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. Some common terms; Sinus rhythm is the normal rhythm Arrhythmia means abnormal rhythm Ectopics refers to extra heart beat Atrial Fibrillation means irregular rhythm or quivering of filling chambers 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 (all over the place) and often fast. Symptoms include fatigue, palpitations (where you are aware of your heart racing or pounding), dizziness and breathlessness. Other tachycardias include supraventricular tachycardia (SVT) where the heart suddenly goes very fast. This can occur in young otherwise healthy people. To read more, please go to: www.cardiologyspecialists.co.nz Bradycardia The most common form of this is ectopic beats where the heart seems to pause followed by a stronger beat. This can be very common. Other causes include 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 too 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. Resting Electrocardiogram (ECG). This trace of the hearts 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 small portable recorder that's attached to your belt or hung from a shoulder strap. You can push a button to mark the recorder when you have a symptom. To learn more, please go to: www.cardiologyspecialists.co.nz

Your heart consists of 4 chambers that receive and send blood to the lungs and body. Disorders affecting valves can either cause stenosis (a narrowing) or regurgitation (leakage after the valve has closed). Depending on what valve is involved and how severe the damage is it may result in symptoms of heart failure (see above), as it makes the heart pump inefficiently. Suspicion of a heart valve problem is usually picked up by your doctor when they listen to your heart and hear a murmur. A murmur is heard with the stethoscope and is turbulence of blood flow that occurs through a narrowed or leaky valve. Not all heart murmurs mean serious problems but are best investigated further. To learn more, please go to: heart murmur Echocardiogram 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). To learn more about echo, please go to: heart tests

When an important coronary narrowing is found on coronary angiography, Dr Dougal McClean can insert a stent (spring) that is inflated using a balloon across the narrowing at the same time. This pushes the lesion into the wall of the coronary artery and improves the flow of blood through the artery. The stent is inserted via a catheter passed from a artery in the forearm. Most stents are thin metallic stents with a small coating of drug on the outside of the stent to prevent scar tissue forming. You will need to be on aspirin and clopidogrel for at least 6 months to prevent blood clots forming in the stent. To learn more about heart stents and heart surgery, please go to: stents

High Blood pressure (Hypertension) is a risk factor for stroke and heart attack. Dr McClean specialises in difficult to control blood pressure. Tests at Cardiology Specialist Diagnostics for blood pressure are: 24 hour Ambulatory Blood Pressure Monitor: this measure blood pressure serially over the 24 hours using a blood pressure cuff on your arm connected to a small recorder on your belt or shoulder harness, to assess white coat hypertension, and whether blood pressure decreases normally in the evening. 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 half an hour. Echocardiography is useful for assessing hypertensive changes in the heart including left ventricular hypertrophy (LVH), impaired left ventricular function, aortic root and proximal ascending aorta dilatation. To learn more, please go to: heart tests