The heart is a pump that supplies the entire body with blood, but it also needs its own blood supply. Narrowing of these arteries by a disease called atherosclerosis can cause ‘Angina’.  Dr Nijjer said “this can be a feeling of chest discomfort when the individual is exercising or walking.” He added, “It may not be a pain, rather a feeling of pressure.”  

Dr Nijjer explained that the investigations to find this have changed. “The advances in CT scanning technology means for many patients a painless and quick scan will accurately show us the arteries and any narrowings.”  

If we do find a blockage, many patients can be helped by targeted medicines or by a procedure called angioplasty in which a tube called a stent is placed within the artery to open it. Dr Nijjer is an international expert in using measurements of coronary artery blood flow to best target the arteries that need stenting or ‘angioplasty’.  He explained “prior to these techniques, patients may have received a stent but not feel better.  Using specialised wires within the arteries we can measure the blood flow so we target the stents where the patient would gain most benefit.”  

Using these cutting-edge tools has been shown to beneficial in the latest research and getting the best results means going to a Cardiologist experienced in using the tools. Dr Nijjer said “when choosing to use a stent, I consider the patient’s lifestyle and their need to get back to the activities they love. In many cases, the procedure can be done through the wrist as a day-case and most patients go back to normal activity very quickly.”

Another common heart problems is heart failure. This frightening term describes a condition where the heart cannot pump blood adequately causing breathlessness or ankle swelling.

Dr Nijjer told us, “heart failure is life threatening if not treated. There are many possible causes, and identifying the causes and targeting it is essential.” The most common is a narrowing of the heart arteries, and treating them may improve the heart function. Dr Nijjer explained that a specialist ultrasound, called an echocardiogram, is often needed: “echocardiography allows us to directly see the heart and its valves. We can quantify its function and see where the problems are.”   Some patients will need a specialised MRI scan which involves going into a machine.

In claustrophobic patients, Dr Nijjer will use a special open MRI scanner to make it more comfortable. Dr Nijjer says “MRI can really help the diagnosis in complex cases. The level of detail we can see is unsurpassed and its revolutionised the way we diagnose and treat this life-threatening condition.”

An increasingly common issue involves irregularities of the heart rhythm. The beating of the heart is controlled by a complex system of wiring and sometimes the signals can go awry. Dr Nijjer explained “many people feel palpitations as extra heart beats or a racing of the heart. A clear description of the symptoms can really help diagnosis”. In most cases, patients will need an electrocardiogram and a ‘Holter’ monitor – where the ECG is recorded over 24 hours. 

Dr Nijjer explained that one arrhythmia in particular is increasing; “undoubtedly atrial fibrillation, or ‘AF’, is a major health problem as it can be triggered by high blood pressure or frequent alcohol intake. It dramatically raises the risk of stroke and we may need to thin the blood to reduce this risk.” Choosing which drug from the multitude available can be a tricky maze to navigate: Dr Nijjer added “there has been a revolution with new anticoagulants making life much easier than being on warfarin, but there are nuances when choosing the drug and a patient-centred approach is essential.”

Heart problems can also manifest as high blood pressure, dizziness, black-outs or collapses. In some, you may have heart problems that run in the family. Dr Nijjer said “it’s essential that we look at the patient as a whole as well as considering their family history.” Whatever the problems are, a careful review by an expert Cardiologist is essential.

Heart problems can also manifest as high blood pressure, dizziness, black-outs or collapses. In some, you may have heart problems that run in the family. Dr Nijjer said “it’s essential that we look at the patient as a whole as well as considering their family history.” 

We have found that some conditions have a strong family component. For example, if a first degree relative developed heart attacks at a young age, this can be an important factor in your individual risk. Blood pressure and cholesterol levels can similarly be linked in families.

There are a number of genetic disorders than can increase the risk of serious health problems. Some persistently elevated cholesterol levels are due to a genetic defect in the cholesterol receptors in the body (Familial Hypercholesterolaemia). In others, an abnormal thickening of the heart muscle can make you more prone to sudden collapses and significant arrhythmia (hypertrophic cardiomyopathy). Both these conditions, and many others, need careful assessment and consideration of genetic testing. 

Whatever the problems are, a careful review by an expert Cardiologist is essential.