Palpitations describe an abnormal awareness of the heartbeat. The beats themselves may be isolated or prolonged (arrhythmia) and may be felt to be abnormally fast or slow. Most palpitations are benign and will settle spontaneously but, in certain circumstances, may indicate an underlying problem with the heart or associated with other disease processes.

Dizzy Spells

There are many causes of dizzy spells and blackouts. Slow heartbeats (bradycardia) or missed heartbeats (heart block) may cause transient dizziness (pre-syncope) or complete blackouts (syncope).

Cardiac arrhythmia and bradycardia or heart block can occur when the electrical activation of the heart becomes abnormal, either in isolation or in association with other heart conditions and may require drugs or the implantation of a cardiac pacemaker.

Chest Pain and Breathlessness

Many types of heart disease cause difficulty in breathing or pain in the chest. Unless the condition is very severe, for example a heart attack (myocardial infarct or coronary thrombosis), pain or breathing difficulty characteristically occurs with exercise.

Heart related breathlessness is often worse lying flat at night.

Heart pain (angina) is felt in the centre of the chest and can occur in the throat or arm.

There are three common causes of chest pain and breathlessness :

  • Blocked or narrowed coronary (heart) arteries, (coronary heart disease, ischaemic heart disease).
  • A weak or enlarged heart (heart failure, cardiomyopathy).
  • Narrowed or leaking heart valves (aortic or mitral valve disease).

Heart Murmur

A heart murmur is a sound, heard through the stethoscope, of abnormal blood flow through the heart. The presence of a heart murmur may mean that a heart valve is narrowed or leaking or that there is an abnormal connection in the heart (hole in the heart). Some heart murmurs occur when the heart is entirely normal (innocent murmur).

High Cholesterol

There is a link between an elevated level of cholesterol in the blood and the development of blocked or narrowed arteries in the heart (coronary heart disease). Lifestyle measures and drugs to reduce cholesterol are very important for patients who have coronary heart disease and may also be important in preventing coronary heart disease if the risk is high.

High Blood Pressure (Hypertension)

Blood pressure is recorded as the highest (systolic) and lowest (diastolic) pressure as the heart beats and relaxes. Normal readings vary with activity and stress. Despite a widespread belief to the contrary it is almost never possible to sense high blood pressure. At rest individuals' blood pressures are different, partly from inheritance and partly from lifestyle (weight, alcohol intake, fitness etc). Some rare illnesses can cause high blood pressure.

Since blood pressure varies during activity and stress it is sometimes difficult to distinguish true hypertension from the stress of seeing a nurse or doctor (white coat hypertension). A continuous 24hr blood pressure monitor may be required to distinguish these. People with high blood pressure have an increased risk of heart disease and stroke.

Attention to fitness, weight, diet and alcohol intake may lower blood pressure; however most people need medication for complete control. If the blood pressure is difficult to control or if hypertension occurs in young people a specialist assessment is often advised.