Whenever a person experiences chest discomfort, he or she should consult a doctor. There are many causes for chest discomfort however the most important is angina which is a symptom of coronary artery disease (CAD) - the UK’s biggest killer.
Angina occurs when the arteries supplying the heart become narrowed by fatty deposits (similar to water pipes that get ‘furred up’). If a blockage occurs suddenly this may cause a heart attack. Although the blood supply may be sufficient at rest, when the heart works harder during exercise, it needs more blood and oxygen. If the blood that your heart needs cannot get past the narrowed arteries, patients experience angina.
The discomfort of angina feels like a dull, heavy or tight pain in the chest that can spread to the arms, neck, jaw or back. Angina is usually triggered by physical activity or stress and typically lasts for a few minutes. Prolonged chest pain occurring at rest, or not alleviated by angina medication, could be sign of a heart attack. Under those circumstances you should seek immediate medical assistance.
Why do I have angina and what tests will I need?
Many factors increase the chance of developing angina. These include increasing age, smoking, high blood pressure, elevated cholesterol, diabetes, obesity and inactivity and family history. Many of these are modifiable through lifestyle changes and medication.
If angina is suspected you will need further investigation, including blood tests, an ECG (electrical tracing of heart rhythm), an echocardiogram (ultrasound scan of the heart) or an X-ray of the heart’s arteries (either a cardiac CT scan or an invasive coronary angiogram).
What are the treatments for angina
Medications used to treat angina include “beta-blockers” or calcium channel blockers. Other agents such as “nitrates” can be taken by mouth or as a GTN spray under the tongue for transient angina relief. In addition aspirin is taken daily to prevent blood clots and “Statins” used to lower cholesterol.
If patients still experience angina despite medical therapy then procedures such as angioplasty and stenting (now called percutaneous coronary intervention (PCI)) or bypass surgery may be required. PCI is hospital procedure, where a fine wire is passed across the narrowed section of coronary artery allowing a tiny balloon to be positioned and then inflated across the narrowing. A small expandable stent (“wire mesh”) is then used as permanent scaffolding, keeping the artery open, restoring coronary blood flow improving angina. If patients have severe or widespread CAD then coronary bypass surgery may be appropriate.
Should I see a Cardiologist?
If you are experiencing any worrying symptoms such as chest discomfort, breathlessness, ankle swelling, palpitations (funny heart beats) dizzy spells or collapses your GP may need to refer you to a Cardiologist for specialist assessment.
Dr Brull is a Consultant Cardiologist who qualified at the Royal Free Hospital Medical School in 1992. Following a period in clinical research, he was appointed Consultant Cardiologist and Honorary Senior Lecturer to The Whittington Hospital and Heart Hospital, University College Hospitals in October 2003. Dr Brull has been Cardiology Clinical Lead at The Whittington since 2011.
He sees private patients in consulting rooms in Harley Street, at The Hospital of St John and St Elizabeth and at The 999 Medical & Diagnostics Centre in Golders Green. He has admitting rights at The Wellington Hospital and The Harley Street Clinic. Inpatient procedures are carried out at The Harley Street Clinic and at The Barts Heart Centre
About Dr Brull
Dr Brull is an expert in the diagnosis, investigation and treatment of all common cardiac conditions including:
Hypertension (high blood pressure)
Referrals for investigation of palpitations and collapse
Cardiovascular risk assessment
Perioperative cardiac assessment
Treatment of elevated cholesterol.
He is able to perform all the necessary diagnostic tests and will recommend specific drug treatment and lifestyle changes. His specialist interest is angioplasty and stenting (PCI).
To enquire abour Dr Brull's services:
Telephone: Jo Parman, Secretary: 020 7637 7677