General cardiology

Ischaemic Heart Disease

Risk factors for ischaemic heart disease include smoking, high blood pressure, diabetes, high cholesterol or family history of heart attacks at a young age. In women, additional risk factors include a history of pre-eclampsia, gestational diabetes or premature menopause.

If you are having symptoms of chest pain or severe breathlessness, call 000 for an ambulance.

It is well recognised that women more frequently experience the less typical symptoms of a heart attack or angina compared with men. Rather than classic, “crushing” pain in the middle of the chest, they may develop breathlessness, nausea or pain in the arms or jaw. This can sometimes lead to delays in women seeking medical advice or attending hospital for assessment. If you are experiencing such symptoms, you should also call 000 for an ambulance.

You may need further investigation if you have been evaluated for chest pain and discharged from an emergency department. Further tests may include stress testing, CT coronary angiography or, less commonly, invasive coronary angiography.

If you have already undergone any of these tests, you may also require further detailed explanation of the result. If you have been found to have ischaemic heart (coronary artery) disease, adjustment of your medications and pro-active management of your risk factors can help to reduce the risk of further cardiac issues in future.

Takotsubo cardiomyopathy

Thought to be a “stress-induced” cardiomyopathy (also commonly called “broken-heart syndrome”), Takotsubo cardiomyopathy is now recognised as a possible mimic of a classic heart attack. It is usually a temporary condition causing some parts of the main heart pump to become “stunned” but improving rapidly within days or weeks.

It is most common in post-menopausal women, and usually occurs following significant emotional or physical stress. The condition is thought to be due to the influence of the central nervous symptoms upon the heart, but the exact mechanism is not yet understood. Anxiety is common after an episode, and discussion with your doctor can help to better understand and manage your condition.

Spontaneous coronary artery dissection (SCAD)

SCAD is a rare cause of a heart attack, due to a tear within the coronary artery leading to a reduction or blockage of blood flow to the heart muscle. This condition is often treated with medication alone as spontaneous healing is very common.

Atrial Fibrillation/Flutter

These arrhythmias can cause significant symptoms and are also associated with an increase in stroke risk. A detailed evaluation can help in developing a management plan which may include medication for symptom control and a discussion around anticoagulant (blood thinner) medications to decrease your risk of stroke. Further evaluation for potential causes or triggers of atrial fibrillation may also be necessary. Lifestyle alterations such as weight loss, moderation of alcohol intake and treatment of obstructive sleep apnoea may assist in reducing recurrence of atrial fibrillation. If specialised procedures such as an AF ablation could be helpful, you will be referred on to a specialist with particular expertise in this area.