Investigation and Diagnosis

We investigate all areas relating to your heart. Clicking on the relevant areas below will take you to more detailed information.

Chest pain
Palpitations and heart rhythm disturbances
Breathlessness
Dizziness and fainting
Heart murmurs and heart valve problems
Heart failure
High blood pressure (Hypertension)
High coronary calcium score

Chest pain

There are many causes for chest pain including angina, lung disease, musculo-skeletal problems and gastro-intestinal pain. It is important to identify the cause of the pain so that the most appropriate treatment can be given. Angina is caused by the narrowing (‘furring up’) of the small ‘coronary’ arteries which supply blood to the heart. The reduction in blood flow to the heart causes a discomfort, heaviness or tightness which typically occurs with exercise or, on occasion, with emotional stress. The pain may be associated with a feeling of breathlessness and tends to be relieved with rest. However, not all patients with heart disease experience ‘typical’ cardiac chest pain and our Consultant Cardiologists will carefully assess your symptoms and arrange investigations to determine the exact cause of the pain you have experienced.

Key investigations

  • ECG
  • Blood tests
  • Echocardiogram
  • Exercise stress test
  • Further tests

Depending on the results of these tests, more complex investigation may be required. These may include:

  • Myocardial perfusion scan
  • Stress echocardiogram
  • CT coronary angiogram scan
  • Coronary angiogram

Treatment options

  • Medical treatment (ie tablets)
  • Coronary angioplasty/stent procedure
  • Coronary artery bypass graft surgery

Palpitations and heart rhythm disturbances

Palpitations (ie awareness of your heart beat) are the most common reason why patients are referred to West Kent Cardiology Partnership. Patients often notice their heart beating forcefully, rapidly or irregularly. These symptoms are common and from time-to-time may be experienced by a large proportion of the population. They are most commonly due to disturbances of the heart rhythm caused by abnormalities in the electrical control of the heart. They need to be investigated carefully because in some cases they may prove to be a symptom of underlying structural heart disease. Treatment of rhythm disturbances is very variable depending on the precise problem and the key to treating these conditions is to record the rhythm disturbance on an ECG. This can be difficult if the problem is intermittent and a series of different monitoring investigations may be required if the problem proves to be elusive.

Key investigations

  • ECG
  • Blood tests
  • Echocardiogram
  • 24-hour ECG monitor
  • Exercise stress test

If the 24-hour monitor fails to demonstrate the arrhythmia then the following may then be used:

  • 7 day cardiac event recorder
  • Implantable recording device (Reveal device)

Treatment options

  • Lifestyle modification
  • Medical therapy (ie tablets)
  • Cardioversion procedure
  • Ablation therapy
  • Pacemaker implantation
  • Implantable defibrillator

Breathlessness

Breathlessness is a common symptom that our Consultant Cardiologists are asked to investigate and treat. It is important to determine the cause of the problem as breathlessness can be due to problems relating to either the heart or the lungs. Our Consultant Cardiologists will carefully assess your symptoms in relation to your medical history and will recommend some investigations to clarify the precise cause of your problem. Breathlessness can be due to a variety of heart problems and it is important therefore that this is fully investigated as a potential cause.

Key investigations

  • ECG
  • Blood tests
  • Echocardiogram
  • Exercise stress test
  • Spirometry
  • Chest x-ray

Depending on the results of the above you may require more complex, detailed investigations and these may include:

  • Chest CT scan
  • CT pulmonary angiogram scan
  • Myocardial perfusion scanning
  • Lung function tests
  • Coronary angiogram

Referral to Consultant Respiratory Physician

If it is felt that you have a lung problem causing your breathlessness our Consultants will recommend referral to a Consultant Respiratory Physician for specialist assessment. If requested we would be happy to refer you to Dr Robert Banks, a very experienced Consultant in this field, who consults on a weekly basis in our consulting rooms in Warwick Park.

Treatment options

Treatment of breathlessness will depend on the cause identified and will be discussed at length in your consultations with your Consultant.

Dizziness and fainting

Fainting is a common reason for patients to be referred to West Kent Cardiology. It can be a frightening occurrence and is important that if this occurs on more than one occasion that the cause is investigated. Very often these symptoms prove to be nothing more than a common faint which will not require any treatment. However in some cases fainting may prove to be a symptom of an underlying cardiac abnormality (heart rhythm disturbance or valvular heart disease) or a neurological problem (epilepsy). The investigations our Consultant Cardiologists will recommend will be aimed at establishing the cause of the symptoms so that the most appropriate treatment can be offered.

Key Investigations

  • ECG
  • Blood tests
  • Echocardiogram
  • 24-hour ECG recording
  • Exercise stress test

Depending on the results of these initial investigations then the following further investigations may be recommended:

  • 7-day cardiac heart monitor
  • Implantable ECG recorder (Reveal monitor)
  • Tilt Testing
  • Referral to a Consultant Neurologist

Treatment options

  • Lifestyle modification
  • Medical treatment (ie tablets)
  • Pacemaker implantation
  • Defibrillator implantation
  • Heart valve surgery
  • Neurological treatment

Heart murmurs and heart valve problems

A heart murmur is an abnormal sound that is identified when a doctor listens to your heart. A large proportion of the UK population have heart murmurs, many of which they may have been born with and of which they may well be unaware. The majority of heart murmurs are benign (ie safe, not likely to cause any problems and not requiring any treatment). However heart murmurs need to be investigated as, in some patients, they can be a sign of valvular heart disease or other structural cardiac problems which will need to be investigated. Valve disease may need to monitored over time and where appropriate treated with heart valve surgery. Patients with significant valve disease may experience symptoms including breathlessness, chest pain, periods of dizziness or palpitations and abnormal heart beats.

Key investigations

  • ECG
  • Blood tests
  • Echocardiogram
  • Chest x-ray

Depending on the results of these initial investigations your Cardiologist may suggest that you proceed to more specialist investigation which may include:

  • Trans-oesophageal echocardiogram (TOE)
  • Coronary angiogram

Treatment options

  • No treatment needed (if the murmur is benign)
  • Medical management (ie tablets)
  • Echocardiogram monitoring
  • Surgical replacement or repair of diseased valves

Heart failure

Heart failure occurs when the heart fails to pump enough blood to maintain an adequate circulation, usually due to a weakness of the pumping action of the heart. Causes of heart failure include coronary artery disease, high blood pressure, heart valve disease or diseases affecting the heart muscle itself (‘cardiomyopathies’). Heart failure can result in patients feeling breathless, tired and suffering from fluid retention (often swollen ankles). With prompt diagnosis treatment can be given to relieve symptoms and rectify the cause of the problem.

Key investigations

  • ECG
  • Blood tests
  • Echocardiogram
  • Chest x-ray

Depending on the results of these investigations the cause of the heart failure may need to be investigated in more depth with more specialized investigations which may include:

  • Trans-oesophageal echocardiogram (TOE)
  • Myocardial perfusion scan
  • Cardiac MRI scan
  • Coronary angiogram

Treatment options

  • Medical therapy (ie tablets)
  • Heart valve surgery
  • Coronary artery bypass graft surgery
  • Cardiac resynchronisation therapy

High blood pressure (Hypertension)

Your General Practitioner may choose to refer you to one of our Cardiologists if your blood pressure is consistently high and especially if it is proving difficult to control using standard medications. Patients suffering from high blood pressure are at increased risk of angina (caused by a ‘furring up’ of the coronary arteries), heart attacks, strokes, heart failure, aortic aneurysms, kidney failure and dementia. It is important therefore to recognise and treat this problem as promptly and effectively as possible. Our Consultant Cardiologists will be able to offer expert advice on treating your high blood pressure but will also arrange investigations designed to determine whether there is an underlying cause.

Key investigations

  • ECG
  • Blood and urine tests
  • Echocardiogram
  • 24 hour ECG recording
  • Renal ultrasound scan

Treatment options

  • Treatment of any underlying cause
  • Medical management (ie tablets) usually involving a combination of medications
  • Ongoing monitoring of blood pressure in conjunction with your GP

High coronary calcium score

Patients are often referred to West Kent Cardiology Partnership if they have proven to have a high coronary calcium score as part of a health screening program. Coronary calcium scoring is a relatively new screening investigation which identifies the extent of any ‘furring up’ in the coronary arteries. This is indicated in a calcium score which is interpreted according to your age and gender. Narrowed coronary arteries can lead to angina and heart attacks.

For patients referred with a high coronary calcium score our Cardiologists aim to:

  1. Identify if there are any obstructive narrowings in the major coronary arteries that may need interventional treatment
  2. To assess the individual’s risk factor profile for coronary disease (risk factors include smoking, family history of coronary disease, diabetes, high blood pressure and high cholesterol levels)
  3. To recommend a treatment and monitoring program to ensure that the patient’s risk of future coronary disease is minimised.

Key investigations

  • ECG
  • Echocardiogram
  • Blood tests
  • Exercise test

Depending on the results of these initial investigations the following further tests may be recommended:

  • Myocardial perfusion scanning
  • Coronary angiogram

Treatment options

  • Regular risk factor management with medical therapy (ie tablets) to control blood pressure and cholesterol levels
  • Coronary angioplasty or bypass graft surgery (rarely required)