Pain in the chest is a pain in the front part of the chest, located between the neck and the upper part of the abdomen, which can be a symptom of various cardiac, respiratory, infectious, nervous pathologies, and osteoarticular or muscular injuries. Sometimes, chest pain may spread to the neck, abdomen or back.
It is a very common pain and may cause different intensities depending on its cause or origin.
Chest pain may be due, in severe cases, to serious and urgent medical conditions as heart attack or heart failure, which are life threatening conditions.
Despite the feeling of strong chest pain, most of the time the causes are not dangerous. But since there are many possible causes of chest pain, it is essential to visit a cardiologist or pulmonologist quickly, to receive immediate treatment if necessary.
The most common symptoms of chest pain are a stabbing pain and compressed feeling, although they usually vary depending on the affected organs or tissues:
Due to the multiple causes that can cause chest pain, it is sometimes a challenge for the specialist to establish a diagnosis. For this reason, the clinical history of the patient will be essential, to be able to understand their symptoms, previous illnesses and family medical records.
Once the patient's medical history is analysed, and if there is no clear traumatic cause, a chest x-ray and an electrocardiogram will be required to rule out other serious diseases which could lead to risks such as a heart attack.
Depending on the results of these tests, more investigations may be required, such as a coronary CT scan, pulmonary scintigraphy, a Holter monitor or digestive study.
There are multiple causes of chest pain, depending on the organs affected:
Chest pain can be prevented if the underlying cause is treated. This is why a visit to a medical specialist is important – making the correct diagnosis of the problem is the first step to effective treatment and future prevention.
Treatment for chest pain depends on the original cause:
As chest pain is susceptible to several causes, the treatment of chest pain may be handled by a number of specialists, such as a cardiologist, pulmonologist, gastroenterologist or psychologist.
At first, when the onset of symptoms that cause pain are unknown, it is best to visit your GP, who will study your medical history and symptoms then refer you to the right specialist to treat your particular case.
A heart murmur is a whistling, rasping sound that is heard during a heartbeat cycle. The heart murmur is an extra sound made during a heartbeat cycle. Heart murmurs can be harmless, but they may also indicate a faulty valve, for example. Heart murmurs can be heard using a stethoscope. There are two main types of heart murmur; innocent murmurs and abnormal murmurs.
Innocent murmurs present when blood flows more quickly than usual through the heart. This can result from pregnancy, exercise, illness or growth spurts (e.g. puberty). Abnormal murmurs are common in cases of congenital heart defects in babies, such as valve problems or holes in the heart.
Often a heart murmur will not be accompanied by other symptoms, however, if they murmur is a result of an underlying heart condition, the following symptoms may also be present:
Whilst people with a healthy heart can have heart murmurs, they can also result from other problems, such as:
In general, heart murmurs do not need any treatment. If the murmur is associated with an underlying heart problem, such as high blood pressure, it will be necessary to treat this. When the heart murmur is due to valvular disease, a pharmacological treatment or surgical intervention may be necessary.
Palpitations are heartbeats that feel either too fast or too hard, and sometimes they can feel like your heart is skipping a beat. These are felt in your chest, throat or neck. Often these are not harmful and can result from stress, caffeine, nicotine or anxiety. Pregnancy can also cause heart palpitations at times. Sometimes, heart palpitations can indicate more serious heart conditions, particularly if they happen frequently. If palpitations are experienced alongside dizziness, chest pain or shortness of breath, seek medical attention.
Heart palpitations are usually not severe, but if they occur frequently, a medical examination will be needed to rule out underlying heart problems, such as arrhythmia.
Heart palpitations can feel unpleasant and feel as though the heart is beating too strong and too fast. If palpitations are experienced alongside dizziness, chest pain or shortness of breath, seek medical attention.
To rule out possible underlying heart conditions, you may need an ECG, a blood pressure test or an echocardiogram.
Heart palpitations are usually a result of anxiety, stress or panic attacks; caffeine intake or nicotine; consumption of illegal drugs; exercise and fever, among others. In addition, there are conditions that can increase the probability of having an abnormal heart rhythm, such as:
It is possible to prevent palpitations by doing the following:
Treatment will depend on the underlying cause of the palpitations. If it caused by anxiety or stress, then these can be managed better. If they are caused by a stimulant, then these can be avoided. If there is an underlying heart condition, then this will have to be treated accordingly.
Cardiologists would diagnose and treat heart palpitations.
Syncope, also known as fainting, is the sudden loss of consciousness for a brief period. This is usually caused by insufficient blood flow to the brain, and is often associated with low blood pressure (hypotension).
Before fainting, you may feel weakness or nausea. The following are also warning signs experienced just before fainting:
After fainting, you normally regain consciousness within 20 seconds, and you may feel weak for a short period afterwards. You may also not remember what you were doing just before you fainted.
Fainting (syncope) is caused by a reduction in blood flow to the brain. This can be disrupted by several factors:
There is no specific treatment that prevents the onset of syncope, but if a person is prone to fainting, you can either avoid known triggers, or if you feel an episode coming on, lie down and lift your legs or sit down and put your head between your knees. This keeps blood flowing to your brain.
Treatment depends on the cause of the syncope. If there is an underlying health condition, then tests will need to confirm this and treated accordingly. The tests that the doctor can order can include:
Often, after fainting, no further treatment is needed, but measures to avoid future episodes can be taken, such as avoiding triggers.
An echocardiogram is a non-invasive, painless ultrasound scan carried out to create an image of the heart. The exam uses ultrasound waves to view the structure and examine the functionality of the heart, including the chambers, valves, cardiac muscle and adjoining blood vessels.
An echocardiogram is a non-invasive diagnostic tool that allows the doctor to examine the chambers of the heart and connecting blood vessels, providing useful information on your heart’s general state of health and on any potential cardiopathies.
It usually lasts 10-15 minutes, during which you’ll need to be very still. You will have to take your shirt off and lie down on a flat bed. A special gel will be applied on your skin and then some electrodes will be placed on your chest. A probe or transducer will be then placed on your chest and, thanks to the ultrasound waves the probe emits, the doctor will have a clear picture of your heart and surrounding structures.
An echocardiogram is done to get more information about your heart’s pumping strength, the condition of the valves and the blood flow to the heart’s cavities. It can be carried out in several different ways:
You may have to do an echocardiogram if:
You won’t feel any pain or discomfort, since the procedure is completely painless and safe.
A congenital heart disease happens when there is a malformation of the heart or nearby vessels of the newborn or foetus. Some of these heart diseases don’t develop until months or years later.
In these cases we speak of a congenital heart defect, such as an underdeveloped heart, narrow blood vessels, leaking heart valves, or holes in the septa.
There are different types of heart defects, some are mild and only pose a mild health risk to the child’s health, and others may require urgent surgery.
Heart disease can be classed as:
These heart diseases are all linked to sudden death syndrome.
Most congenital heart diseases can be detected by ultrasound before birth. These ultrasounds are routine procedures that monitor pregnancy progress as well as the mother and foetus health status.
There are some heart diseases that can only be detected after birth. If the heart disease is serious, this will be identified in the medical check-ups after birth.
As mentioned, there are different types of congenital heart diseases with varying seriousness. Some may be mild and spontaneously solve themselves while others may require immediate hospitalisation and surgery.
The causes for congenital heart disease remain unknown, although some risk factors have been identified:
There are primary preventive measures that can reduce the risk of heart diseases developing:
Babies and children with congenital heart issues are diagnosed and treated by a paediatric cardiologist. If surgery is needed, this will be performed by a cardiac or cardiovascular surgeon.
Dr Alessandro Giardini is a top cardiologist based at Great Ormond Street Hospital (GOSH) in London, specialising in paediatric cardiology. An expert on congenital heart disease, Dr Giardini is Director of Inpatient Services at GOSH, and also provides outpatient consultations for all manner of heart problems in children, including palpitations, heart murmurs, chest pain, and heart valve issues.
Graduating from the University of Bologna in his native Italy, Dr Giardini went on to undergo extensive training in paediatric cardiology both in Bologna and in San Francisco, USA. He is actively involved in research, having published over 120 articles in peer-reviewed journals. His unit at GOSH is a world leader in cardiac care. His philosophy is a patient-centric approach, delivering treatment with compassion and understanding, and personalising his consultations and treatment to each child and their family.
Aortopathy describes a disease of the aorta (the largest artery in the body, which carries blood from the heart).
An arrhythmia is also known as a heart rhythm problem, causing the heart to either beat too fast (tachycardia), too slow (bradycardia) or that it has an irregular pattern. This results when the electrical pulses that coordinate the heartbeats do not work properly.
People with an arrhythmia may not experience any symptoms, but a prominent arrhythmia may result in the following symptoms:
Arrhythmias are caused by problems in the electrical conduction system of the heart. Among the main causes are:
There are certain risk factors that can increase the chances of developing an arrhythmia, detailed above, so the following measures can help to reduce this risk:
Mild arrhythmias often won’t require treatment, but when an arrhythmia is serious treatment will be required. Treatment can consist of:
Atrial septal defect is a type of heart defect wherein blood flows between the atria, which are normally separated by a dividing wall (the interatrial septum). While in the womb, and just after birth, it is normal for blood to flow between the atria through the foramen ovale, a small passageway between the two.
There are different types of ASD, and they can form at various stages in foetal development, or on occasion, after birth (e.g in patent foramen ovale, where the foramen ovale does not close as it should).
The types can be broadly categorised into:
Atrial septal defect is congenital. If the dividing wall (the septum) is absent or defective, then oxygen-rich blood in the left side of the heart can mix with the blood in the right side of the heart, which has depleted levels of oxygen. As a result, the blood which is found in the arteries and which supplies the brain, other organs, and tissues of the body, has lower levels of oxygen in it than is usual. The heart then pumps extra blood into the lung arteries, meaning the heart and lungs have to work harder, damaging the lung arteries in the process.
If the defect is very small, then symptoms may not be present, and there may not be any medical complications related to the defect. Symptoms may present when the child has grown up to be an adult, and can occur around age 30 in some cases. Signs to watch for include:
As ASD is congenital, in most cases it cannot be prevented. However, certain factors increase the risk of its development, including drug use, smoking, and substance abuse during pregnancy, obesity, having diabetes, and having rubella during the first few months of pregnancy.
If the defect is small, then treatment may not be necessary. Monitoring to see how the defect progresses will be advised, to see if the hole closes on its own – which can happen. However, treatment may be necessary, and this may be recommended in the form of medication or surgery. Medication can be used to control or reduce symptoms which occur along with the defect, while surgery aims to repair the defect itself.
A cardiologist, or paediatric cardiologist generally monitors and treats atrial septal defect.
Pain in the chest is a pain in the front part of the chest, located between the neck and the upper part of the abdomen, which can be a symptom of various cardiac, respiratory, infectious, nervous pathologies, and osteoarticular or muscular injuries. Sometimes, chest pain may spread to the neck, abdomen or back.
It is a very common pain and may cause different intensities depending on its cause or origin.
Chest pain may be due, in severe cases, to serious and urgent medical conditions as heart attack or heart failure, which are life threatening conditions.
Despite the feeling of strong chest pain, most of the time the causes are not dangerous. But since there are many possible causes of chest pain, it is essential to visit a cardiologist or pulmonologist quickly, to receive immediate treatment if necessary.
The most common symptoms of chest pain are a stabbing pain and compressed feeling, although they usually vary depending on the affected organs or tissues:
Due to the multiple causes that can cause chest pain, it is sometimes a challenge for the specialist to establish a diagnosis. For this reason, the clinical history of the patient will be essential, to be able to understand their symptoms, previous illnesses and family medical records.
Once the patient's medical history is analysed, and if there is no clear traumatic cause, a chest x-ray and an electrocardiogram will be required to rule out other serious diseases which could lead to risks such as a heart attack.
Depending on the results of these tests, more investigations may be required, such as a coronary CT scan, pulmonary scintigraphy, a Holter monitor or digestive study.
There are multiple causes of chest pain, depending on the organs affected:
Chest pain can be prevented if the underlying cause is treated. This is why a visit to a medical specialist is important – making the correct diagnosis of the problem is the first step to effective treatment and future prevention.
Treatment for chest pain depends on the original cause:
As chest pain is susceptible to several causes, the treatment of chest pain may be handled by a number of specialists, such as a cardiologist, pulmonologist, gastroenterologist or psychologist.
At first, when the onset of symptoms that cause pain are unknown, it is best to visit your GP, who will study your medical history and symptoms then refer you to the right specialist to treat your particular case.
In children and teenagers, chest pain may be brought on by a number of things, including infection or injury to the chest wall (ribs, sternum and other bones, muscles and joints in the chest area), colds, acid reflux (heartburn), stress or anxiety, and asthma. In rare cases, it may be caused by a heart condition, though this is unusual.
A congenital heart disease happens when there is a malformation of the heart or nearby vessels of the newborn or foetus. Some of these heart diseases don’t develop until months or years later.
In these cases we speak of a congenital heart defect, such as an underdeveloped heart, narrow blood vessels, leaking heart valves, or holes in the septa.
There are different types of heart defects, some are mild and only pose a mild health risk to the child’s health, and others may require urgent surgery.
Heart disease can be classed as:
These heart diseases are all linked to sudden death syndrome.
Most congenital heart diseases can be detected by ultrasound before birth. These ultrasounds are routine procedures that monitor pregnancy progress as well as the mother and foetus health status.
There are some heart diseases that can only be detected after birth. If the heart disease is serious, this will be identified in the medical check-ups after birth.
As mentioned, there are different types of congenital heart diseases with varying seriousness. Some may be mild and spontaneously solve themselves while others may require immediate hospitalisation and surgery.
The causes for congenital heart disease remain unknown, although some risk factors have been identified:
There are primary preventive measures that can reduce the risk of heart diseases developing:
Babies and children with congenital heart issues are diagnosed and treated by a paediatric cardiologist. If surgery is needed, this will be performed by a cardiac or cardiovascular surgeon.
An echocardiogram is a non-invasive, painless ultrasound scan carried out to create an image of the heart. The exam uses ultrasound waves to view the structure and examine the functionality of the heart, including the chambers, valves, cardiac muscle and adjoining blood vessels.
An echocardiogram is a non-invasive diagnostic tool that allows the doctor to examine the chambers of the heart and connecting blood vessels, providing useful information on your heart’s general state of health and on any potential cardiopathies.
It usually lasts 10-15 minutes, during which you’ll need to be very still. You will have to take your shirt off and lie down on a flat bed. A special gel will be applied on your skin and then some electrodes will be placed on your chest. A probe or transducer will be then placed on your chest and, thanks to the ultrasound waves the probe emits, the doctor will have a clear picture of your heart and surrounding structures.
An echocardiogram is done to get more information about your heart’s pumping strength, the condition of the valves and the blood flow to the heart’s cavities. It can be carried out in several different ways:
You may have to do an echocardiogram if:
You won’t feel any pain or discomfort, since the procedure is completely painless and safe.
Fainting is a temporary loss of conciousness which can come on suddenly, often resulting in a fall. The medical term for fainting is syncope (pronounced sin-co-pee). Fainting is relatively common and is usually harmless. However, in some instances it can be an indication of a serious problem, such as a heart problem, or a neurological condition.
The general reason behind why people faint is a temporary drop in blood pressure. This can happen for numerous reasons, including dehydration, going without food for a long period, standing for long periods of time, or simply being unwell. Fainting may occur as the result of passing a bowel movement, urination, breath holding, or even coughing. Children can also faint if they are frightened or as a reaction to severe pain.
However, fainting can also be caused by conditions such as:
Before fainting, sometimes symptoms will present. These can include feeling dizzy or lightheaded, nausea, some changes in vision, and cold or clammy skin. If these symptoms present, it may be enough for you to notice your child should sit down or lie down before fainting happens.
If your child faints, follow these steps to ensure their safety:
If your child faints, you should make an appointment with their doctor to tell them what happened.
You should also take your child to the GP or visit a specialist if your child again experiences fainting, even after preventive measures have been taken, if there is no clear cause, or there is a family history of fainting. You may be referred to a specialist depending on the cause of fainting: you may need to see a paediatric cardiologist if your child faints during sport, for example.
Call 999 right away if your child is not breathing, they do not become alert almost immediately, or if you note a change in their vision, movements, or speech after fainting.
Your child may be referred to a paediatric cardiologist if they experience regular or sporadic fainting (i.e it is not a one-off occasion). This cardiologist can check for some of the more serious heart problems which can cause syncope. They will ask about your child’s medical history, family medical history, and ask you to explain what happens when your child faints.
They may order tests such as an ECG (electrocardiogram) to check the heart’s electrical activity, a Holter monitor (where the heart’s electrical activity is monitored over a 24-48 hour period), or a stress test (allowing the doctor to see how your child’s heart responds when under more stress, e.g during exercise).
If fainting does not frequently occur, avoiding the circumstances that can lead to syncope or taking certain steps before losing consciousness can prevent fainting, such as keeping hydrated, avoiding stuffy closed-off rooms with little air, and not standing for long periods of time.
However, if fainting occurs because of an underlying condition, the condition itself must be treated or monitored in order to prevent or treat syncope.
A heart murmur is a whistling, rasping sound that is heard during a heartbeat cycle. The heart murmur is an extra sound made during a heartbeat cycle. Heart murmurs can be harmless, but they may also indicate a faulty valve, for example. Heart murmurs can be heard using a stethoscope. There are two main types of heart murmur; innocent murmurs and abnormal murmurs.
Innocent murmurs present when blood flows more quickly than usual through the heart. This can result from pregnancy, exercise, illness or growth spurts (e.g. puberty). Abnormal murmurs are common in cases of congenital heart defects in babies, such as valve problems or holes in the heart.
Often a heart murmur will not be accompanied by other symptoms, however, if they murmur is a result of an underlying heart condition, the following symptoms may also be present:
Whilst people with a healthy heart can have heart murmurs, they can also result from other problems, such as:
In general, heart murmurs do not need any treatment. If the murmur is associated with an underlying heart problem, such as high blood pressure, it will be necessary to treat this. When the heart murmur is due to valvular disease, a pharmacological treatment or surgical intervention may be necessary.
A heart murmur is an extra noise made by the heart, heard with a stethoscope. The noise may be completely natural and not indicative of any underlying problem (innocent murmur), but sometimes a murmur may be due to a problem with the heart, such as narrow or leaking heart valves or holes in the heart (pathological heart murmurs).
Hypertrophic cardiomyopathy is primarily a disease of the heart muscle characterised by increased wall thickness due to internal causes of the muscle itself. This thickening of the heart wall is known as hypertrophy, which can make it difficult for the heart to pump blood.
Hypertrophic cardiomyopathy is a disease that can cause very serious complications. Some of these are:
The symptoms of hypertrophic cardiomyopathy include the following:
A series of medical tests can be performed to help diagnose the disease:
Cardiomyopathy often goes undiagnosed because there are very few symptoms.
Most hypertrophic cardiomyopathies are caused by genetic mutations that thicken the heart muscle. The disease cannot be attributed to a specific cause, although in a large number of cases it is hereditary.
Individuals with cardiomyopathy also have an abnormal arrangement of heart muscle cells which can cause arrhythmia.
The severity of the disease varies, but it most commonly enlarges the heart and limits blood flow out of the myocardium.
Sometimes the flow is only slightly blocked, but the heart has lost its pumping capacity.
As mentioned above, the main cause of hypertrophic cardiomyopathy is heredity, so there is no way to prevent the disease, although early diagnosis is important to avoid complications.
The prevention of sudden death is especially important. It has been shown that a defibrillator can stop and prevent a sudden death from heart attack.
However, since many people are not aware that they have the disease, sudden death from a heart attack may be the only sign that they have the disease, and it can occur in apparently healthy, young people.
As a preventive measure, people with the disease are often advised to avoid playing certain competitive sports in order to avoid sudden death.
The aim of treatment is to relieve symptoms as well as to prevent sudden death from a heart attack. Ways of doing this include:
The specialists in charge of treating and diagnosing hypertrophic cardiomyopathy and associated problems are cardiologists and cardiac surgeons.
Kawasaki disease is a rare childhood condition mainly affecting children under the age of five. It causes inflammation in the walls of the blood vessels, which leads to a number of symptoms, including a rash, swelling, fever, and swelling and inflammation of the mouth and tongue (which is dubbed a “strawberry tongue” due to the red, swollen appearance).
Kawasaki disease affects around 8 in 100,000 children in the UK and is more prevalent in boys than girls.
Most children recover within six to eight weeks if the Kawasaki disease is diagnosed and treated properly. The sooner the treatment begins, the quicker the recovery and the lower the chance of complications.
Complications can arise if Kawasaki disease affects the coronary arteries (the blood vessels supplying blood to the heart). Inflammation occurring here can cause an aneurysm, which can lead to blood clots, and in turn, heart disease or even heart attacks. Complications like these can be fatal, but this is rare. However, children who experience heart-related complications of Kawasaki disease may be left with permanent heart damage or left at a higher risk of developing heart conditions later in life.
The first symptom of Kawasaki disease is usually a fever that does not respond to the usual remedies. Further typical symptoms include:
During the second phase of the disease, there may be skin peeling and a number of other symptoms, such as abdominal pain, vomiting, diarrhoea, fatigue, joint pain, and headache.
Symptoms begin to improve and disappear in the third stage, although the child may still get tired easily until fully recovered.
A diagnosis of Kawasaki disease is usually based on the presence of at least four key symptoms (rash, swollen lymph nodes, changes (e.g. swelling) to the mouth or throat, changes to the hands or feet, and conjunctival infection in both eyes), coupled with a fever lasting longer than five days. There is no one test to diagnose the condition, but several tests may be performed to rule out other conditions like scarlet fever, measles, glandular fever, and lupus.
Kawasaki disease cannot be prevented. It is unclear exactly what causes it, but there are several theories:
Kawasaki disease is usually treated in hospital due to the age of the patients and the severity of the possible complications.
Treatment involves two key components:
Paediatricians and paediatric cardiologists treat Kawasaki disease.
Marfan syndrome is a disorder which causes a disruption in the growth of connective tissue, a group of tissues which strengthen the body structures and support internal organs. It mainly affects the skeletal system, eyes, skin and the cardiovascular system. It can also affect the lungs and the heart where it can cause stretching or weakening of the aorta, which is known as aneurysm or aortic dilation.
Typical characteristics of those with Marfan syndrome include being tall, with abnormally long legs, arms, fingers, and toes. Heart defects and lens dislocation are also typical in those with Marfan syndrome. Marfan syndrome can also cause the spine to become abnormally curved, i.e scoliosis. Other spinal problems can occur in those with the syndrome, including spondylolisthesis (one of the vertebra slipping over another) and dural ectasia (the membrane lining your spinal cord and brain weakening and expanding).
Other symptoms include:
In most cases, Marfan syndrome is hereditary and is transmitted from parents to children. It is caused by defects in a gene called fibrillin-1, which is a fundamental gene for connective tissue in the body. However, up to 30% of patients do not have a family history.
Gene mutations that cause Marfan syndrome cannot be prevented.
There is no cure for Marfan syndrome at this time, but the associated problems it causes can be managed, such as visual problems and scoliosis. Medication can decrease the heart rate to help prevent stress in the aorta (the main artery in the body). Some people may need surgery to replace the valve and the aortic root.
Palpitations are heartbeats that feel either too fast or too hard, and sometimes they can feel like your heart is skipping a beat. These are felt in your chest, throat or neck. Often these are not harmful and can result from stress, caffeine, nicotine or anxiety. Pregnancy can also cause heart palpitations at times. Sometimes, heart palpitations can indicate more serious heart conditions, particularly if they happen frequently. If palpitations are experienced alongside dizziness, chest pain or shortness of breath, seek medical attention.
Heart palpitations are usually not severe, but if they occur frequently, a medical examination will be needed to rule out underlying heart problems, such as arrhythmia.
Heart palpitations can feel unpleasant and feel as though the heart is beating too strong and too fast. If palpitations are experienced alongside dizziness, chest pain or shortness of breath, seek medical attention.
To rule out possible underlying heart conditions, you may need an ECG, a blood pressure test or an echocardiogram.
Heart palpitations are usually a result of anxiety, stress or panic attacks; caffeine intake or nicotine; consumption of illegal drugs; exercise and fever, among others. In addition, there are conditions that can increase the probability of having an abnormal heart rhythm, such as:
It is possible to prevent palpitations by doing the following:
Treatment will depend on the underlying cause of the palpitations. If it caused by anxiety or stress, then these can be managed better. If they are caused by a stimulant, then these can be avoided. If there is an underlying heart condition, then this will have to be treated accordingly.
Cardiologists would diagnose and treat heart palpitations.
The patent foramen ovale (PFO), also known by its colloquial name of “hole in the heart”, is a cardiac defect consisting in a small hole in the cardiac muscle, located between the right and left upper chamber (atria) of the heart. PFO is normal in babies when they are still in the womb, because a baby’s lungs are not working yet and that small hole allows blood to circulate between the heart’s atria. It is also fundamental for blood oxygenation and for the correct functioning of the circulatory system. However, after birth or during the baby’s first year, the small hole should close.
This condition is quite widespread - 30% of the adult population is affected from it. PFO can potentially become a severe condition, because it does not cause any immediate symptoms. There is a higher risk of complications for people who suffer from both cardiac and neurological disorders and for people who engage in underwater sports.
It’s not clear yet what causes PFO, although it may be possible for this condition to be associated with a genetic mutation. However, this theory has not been conclusively confirmed yet.
Currently, the condition is mostly diagnosed by doing a transcranial ecodoppler. PFO can be treated with surgery, which may be recommended if there are also other cardiac conditions (especially in children) or in case another concurrent cardiac disorder arises, if the blood stops flowing to the lungs or in case of recurring strokes (especially for adults).
There are two types of procedures to close the PFO:
Finally, people suffering from PFO and with a predisposition to blood clots formation also need to get started on medication to prevent or reduce the possibility of stroke.
The healthcare professionals who treat PFO are cardiologists and heart surgeons.
Sports cardiology is a sub-specialty of cardiology that diagnoses and treats heart conditions in athletes and assesses if the patients are fit to participate in sports. It encompasses a series of tests aimed at identifying heart muscle diseases that may pose a risk when playing sport. These tests allow doctors to analyse the health of the heart and how well it copes with intense physical exercise.
The patient may require a number of tests depending on their needs, medical history and the sport they practice. Common tests used in sports cardiology include:
This series of tests is aimed at both professional and amateur athletes and people who are starting a new sporting activity.
Sport can push our body and heart to the limit, so it is essential to know how far we can go without damaging our health.
These tests are therefore aimed at preventing serious heart problems such as heart attacks, Brugada Syndrome or sudden death syndrome, and for monitoring people who have had heart surgery, or who suffer from heart failure, arrhythmias or congenital heart disease.
Thus, the aim of sports cardiology is to provide athletes with the necessary tests and advice to avoid health risks when practicing sport, as well as to assure people with illnesses such as heart disease that it is safe to continue to practice sport.
An annual sports cardiology check-up is recommended for all athletes, especially those with heart problems.
People with a heart condition who are planning to start a new sporting activity should also have a check up to find out in advance if it could harm their health.
Anybody who has symptoms such as arrhythmias, chest pain, dizziness, or shortness of breath during sports should see a sports cardiologist find out the cause.
These tests are minimally invasive and require no special preparation.
The cardiologist may advise you on what clothes to wear or what food and drink you can have before the tests, as drinks such as coffee and tea, which contain stimulants are often discouraged so as not to affect the results.
Sports cardiology tests are minimally invasive procedures and are not painful.
In the case of stress tests, however, you will have to exert yourself physically, so you may feel tired or even dizzy and have difficulty breathing.
Abnormal results from sports cardiology tests may mean that you have a heart condition and can no longer play certain sports, or at least not at high intensity.
The cardiologist will evaluate the results and may ask that you repeat a test or have further tests to confirm the diagnosis.
Supraventricular tachycardia (SVT) is a heart condition where the heart suddenly beats much faster than normal. This type of tachycardia originates from faulty electrical impulses in the upper part of the heart, rather than from the ventricles (the lower chambers of the heart). It is less dangerous than ventricular tachycardia. SVT then refers to any non-ventricular tachycardia, such as:
However, the term “supraventricular tachycardia” usually refers to AVNRT or PSVT. Supraventricular tachycardia can affect individuals who don’t have any other heart disease.
For healthy people, SVT is usually a non-life-threatening condition. They usually won’t need any treatment, as the episodes will come on and go on their own.
During an episode, you may experience the following symptoms:
This type of tachycardia usually causes a regular, accelerated heartbeat which changes suddenly, going from 75 to more than 200 bpm. The episodes can last from a few minutes to 48 hours. Medical treatment may be necessary to make them stop.
If you happen to have an episode during an examination, the cardiologist will check the patient’s heartbeat and then order some other tests, such as an electrocardiogram (ECG), which may require the patient to wear a Holter monitor for 24 hours.
Supraventricular tachycardia is mainly caused by a malfunctioning of the electrical signals between the ventricles and the atria. The atria accelerate, causing a faster heartbeat. When the heartbeats are too close to one another, they are less efficient: the amount of blood pumped around the body is less than what is needed. This ends up lowering your blood pressure.
An episode of SVT can arise after a fairly intense exercising session. As a consequence, athletes - especially those at a competitive level - have to keep their heart under control.
There are several options for treating supraventricular tachycardia:
Medications may also be prescribed when vagal manoeuvres don't seem to be working or in case of frequent tachycardia episodes.
If you’re having frequent supraventricular tachycardia episodes, you should see a cardiologist.
Syncope, also known as fainting, is the sudden loss of consciousness for a brief period. This is usually caused by insufficient blood flow to the brain, and is often associated with low blood pressure (hypotension).
Before fainting, you may feel weakness or nausea. The following are also warning signs experienced just before fainting:
After fainting, you normally regain consciousness within 20 seconds, and you may feel weak for a short period afterwards. You may also not remember what you were doing just before you fainted.
Fainting (syncope) is caused by a reduction in blood flow to the brain. This can be disrupted by several factors:
There is no specific treatment that prevents the onset of syncope, but if a person is prone to fainting, you can either avoid known triggers, or if you feel an episode coming on, lie down and lift your legs or sit down and put your head between your knees. This keeps blood flowing to your brain.
Treatment depends on the cause of the syncope. If there is an underlying health condition, then tests will need to confirm this and treated accordingly. The tests that the doctor can order can include:
Often, after fainting, no further treatment is needed, but measures to avoid future episodes can be taken, such as avoiding triggers.
The tilt test or tilt table test is an examination carried out to find out the causes of syncope (collapse) without any specific cause, and that is accompanied by other symptoms such as instability or vertigo. Mainly, the test is based on the evaluation of the heart rate and blood pressure while lying down, standing almost upright, and being in an erect position.
The test involves lying on a tilt table, where you are tightly fastened with straps and with your feet lying on a foot support at the base of the table in order to help you stand in an upright position. While in this position, the first registration of your blood pressure and heart rate is done. Then you are laid flat and more registrations will be taken at the following minute intervals: 1, 5 and 10. Once 10 minutes have passed, you will be tilted to an almost upright position, between 60° and 80° for 20-30 minutes until you experience the same symptoms as when you suffer a syncope. If symptoms don´t show they will be artificially provoked using medication. The test is considered positive if it induces an episode of syncope, such as a drop in blood pressure and heart rate. These symptoms disappear when you are laid flat.
This test allows the doctor to find out the relation between blood pressure and the appearance of specific symptoms, which in many cases, makesdetecting the correct origin of the syncope possible, as it can sometimes be erroneously diagnosed as epilepsy. The test can also determine the origin of orthostatic hypotension and autonomic dysfunction.
The test lasts for around 40 minutes, and the only preparation you need is not to eat or drink for at least 3 hours before the test. It is advisable to bring someone along to your appointment as you may feel light-headed at the end of the test. For those suffering from ischaemic heart disease, diabetes mellitus, glaucoma, carotid artery stenosis, prostate enlargement and serious valvular heart disease, this test is not recommended. It is advised that you visit a specialist for advice.
The tilt test is not considered invasive, although the induced faint can feel uncomfortable.
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