Chest Pain
Definition
“Chest Pain” is itself a bit misleading. I recommend breaking it into its parts: think of “Chest” as the area below your jaw and above the diaphragm, and “Pain” as any unwanted sensation — dullness, heaviness, aching, tightness/squeezing, numbness, etc. Basically any new or unwanted sensation that occurs below the jaw and above the diaphragm.
Possible causes
Many diagnoses can present as chest pain, including (but not limited to):
- GERD (i.e. heartburn or reflux)
- Coronary artery disease
- Heart attacks
- Pericarditis
- Bronchitis
- Costochondritis
When to seek care
Be concerned if the chest pain is changing:
- Getting more frequent
- Getting more intense
- Lasting longer
- Occurring with less exertion
How chest pain is evaluated by a cardiologist
- ECG
- Echocardiogram
- Stress test
- Imaging (i.e. cardiac MRI)
Shortness of Breath
Definition
Shortness of breath is difficulty breathing in air. It can occur at rest or with exertion. Sometimes patients complain that they “can’t catch their breath” or “tire from walking” — both are different ways of describing shortness of breath.
Possible causes
Many diagnoses can present as shortness of breath, including (but not limited to):
- Coronary artery disease
- Congestive heart failure
- Pneumonia
- Bronchitis
- Valve diseases
When to seek care
Be concerned if the shortness of breath is worsening:
- Getting more frequent
- Getting more intense
- Lasting longer
- Occurring with less exertion or other eliciting factor
How shortness of breath is evaluated by a cardiologist
- ECG
- Echocardiogram
- Stress test
- Imaging (i.e. cardiac MRI)
Palpitations
Definition
Palpitations are usually described as a “fluttering” or “pounding” in the chest. They are usually caused by an electrical abnormality in the heart called an arrhythmia. Many are benign and not dangerous, but some can be life threatening.
Possible causes
Many diagnoses can present as palpitations, including (but not limited to):
- Atrial fibrillation (“A-Fib”)
- Other SVTs (supraventricular tachycardias)
- PVCs (premature ventricular contractions)
- Ventricular arrhythmias
When to seek care
Be concerned if the palpitations are worsening:
- Getting more frequent
- Getting more intense
- Lasting longer
- Becoming associated with other symptoms such as lightheadedness, chest pain, or loss of consciousness
How palpitations are evaluated by a cardiologist
- ECG
- Echocardiogram
- Holter monitoring
- Electrophysiology study
Passing Out / Syncope
Definition
The terms “passing out” and “syncope” refer to a loss of consciousness. Patients are often described as unresponsive — including falling, an inability to speak, or being unable to move. There may be many causes of these symptoms, but from a cardiovascular perspective the primary concern is an inability to receive blood from the heart.
Possible causes
Many diagnoses can present as syncope, including (but not limited to):
- Valve disorders
- Arrhythmias
When to seek care
Be concerned if the episodes are worsening:
- Getting more frequent
- Occurring during exertion or driving
- Lasting longer
- Becoming associated with other symptoms such as lightheadedness, chest pain, or loss of consciousness
How syncope is evaluated by a cardiologist
- ECG
- Echocardiogram
- Holter monitoring
- Electrophysiology study
Congestive Heart Failure
Definition
Congestive heart failure is usually defined as a reduction in the output of the heart. There are two main types: systolic and diastolic. Traditionally, when people use the term “heart failure” they refer to systolic heart failure, a weakening in the output of the heart with a reduction in the “ejection fraction” (EF). Diastolic heart failure refers to a reduction in the ability of the heart to relax and accept blood.
Possible causes
Systolic heart failure
- Often a lack of blood supply due to coronary heart disease
- Viral illnesses
- Toxicities, including excess alcohol intake
Diastolic heart failure
- High blood pressure
- Advanced age
- Obesity
- Kidney disease
When to seek care
You should be concerned about congestive heart failure if you have any of the following symptoms:
- Shortness of breath
- Swelling in your legs or abdomen
- An inability to do the activities you were previously able to do
- An inability to lie flat in bed
- Feeling the need to get up at night due to shortness of breath
How congestive heart failure is evaluated by a cardiologist
- ECG
- Echocardiogram
- Stress testing
- Cardiac catheterization
Atrial Fibrillation
Definition
Atrial fibrillation (A-Fib) is an irregular rhythm caused by an abnormality in the electrical conduction of the heart. The irregularity originates in the pulmonary veins in the left atrium (the upper left chamber) and spreads through both upper chambers, causing them to “quiver”. The electrical signal is then transmitted to the bottom chambers of the heart, which then beat very irregularly and rapidly.
Possible causes
Atrial fibrillation is often seen in the setting of infection, thyroid disease, and after surgery. It can also be triggered by excess alcohol intake. Most commonly, atrial fibrillation has no definitive cause and occurs with age.
When to seek care
You should be concerned about atrial fibrillation if you have any of the following symptoms:
- Palpitations
- An irregular heartbeat
- A high heart rate
- An EKG that reads “A-Fib”
How atrial fibrillation is evaluated by a cardiologist
- ECG
- Echocardiogram
- Electrophysiology testing
Coronary Artery Disease
Definition
Coronary artery disease refers to a blockage in the arteries that supply blood to the heart. If it occurs suddenly, this results in a heart attack. The blockages are usually a result of fat and fibrous materials that deposit on the inner surface of arteries.
Possible causes
Coronary artery disease normally occurs as a result of aging, but is accelerated by smoking, obesity, tobacco use, poor diet, lack of exercise, and a genetic predisposition.
When to seek care
You should be concerned about coronary artery disease if you have any of the following symptoms:
- Chest pain
- Shortness of breath
- An inability to perform the activities you were previously able to perform
- Fatigue
- “Atypical chest pain”, including shoulder pain, neck pain, back pain, etc.
How coronary artery disease is evaluated by a cardiologist
- ECG
- Echocardiogram
- Stress testing
- Coronary calcium score
- Cardiac catheterization
High Cholesterol
Definition
High cholesterol — also called “hyperlipidemia” or “dyslipidemia” — is a condition that results from elevated types of fat within the bloodstream. This condition can increase the risk of heart attack and stroke.
Possible causes
The most common causes of high cholesterol include a genetic predisposition, poor diet, and aging.
When to seek care
You should be concerned about high cholesterol if you have an elevated cholesterol reading on a lab test.
Hypertension
Definition
High blood pressure, or “hypertension”, is usually defined as a blood pressure of 130/80 in younger patients and 140/90 in older patients. Hypertension can result in an increased risk of heart attack, stroke, and death.
Possible causes
The most common causes of hypertension include a genetic predisposition, poor diet, tobacco use, and aging.
When to seek care
You should be concerned about hypertension when your blood pressure is shown to be elevated, or if you have:
- Headaches
- Vision changes
- Changes in urination