Adults
Fainting (syncope)
Syncope is a brief loss of consciousness from which you recover on your own. In most cases it is benign. It may be vasovagal syncope, a reflex triggered by heat, pain or prolonged standing, for example. It may also be caused by a drop in blood pressure when you stand up (orthostatic hypotension).
Sometimes, however, it is the sign of an arrhythmia, for example a heartbeat that is too slow (bradycardia) or too fast, or of a heart condition, especially if it happens during exertion, while lying down or without any warning, or if there have been cases of sudden death in the family. A consultation with an electrocardiogram and, when needed, an echocardiogram helps to identify the cause and to prevent further episodes and falls.
Palpitations and arrhythmias
Feeling your heart pound, suddenly race or “skip a beat” is common and often harmless: in most cases these are ectopic beats (extrasystoles), extra beats with no consequences. Sometimes, however, it is the sign of an arrhythmia that needs to be identified and treated, such as paroxysmal supraventricular tachycardia or atrial flutter, or of a heartbeat that is too slow (bradycardia).
To find out, we start with a consultation with ECG and, when needed, continue with the most appropriate tests. Sometimes reassurance and a few changes in habits are enough; other times treatment or specialist investigation is needed.
Chest pain and shortness of breath
Chest pain or a feeling of pressure, especially during exertion, and shortness of breath (dyspnoea) with activities that used to be easy should always be assessed. They may come from the heart, for example from disease of the coronary arteries or inflammation of the pericardium (pericarditis), but may also have musculoskeletal causes, gastrointestinal causes such as gastro-oesophageal reflux, or causes related to the lungs.
A consultation, an ECG and, if needed, an echocardiogram show whether the heart is involved and what to do next.
Emergencies: severe chest pain lasting more than a few minutes, or with sweating, nausea or shortness of breath, requires an immediate call to 112 rather than a scheduled appointment.
High blood pressure (hypertension)
High blood pressure is very common and often causes no symptoms, but over time it strains the heart, arteries, kidneys and brain. Treating it well is one of the most effective ways to prevent heart attack and stroke.
The first step is a correct diagnosis that also takes home readings into account: some people have high blood pressure only when it is measured by a doctor (white coat hypertension), while others have it only in everyday life (masked hypertension). An echocardiogram then shows whether blood pressure has already affected the heart, for example by thickening its walls (left ventricular hypertrophy), and we develop a personalised treatment plan and review it over time, alongside lifestyle changes.
Atrial fibrillation
It is the most common arrhythmia, especially after the age of 60. The heart beats irregularly and often fast; it can cause palpitations, breathlessness and tiredness or go completely unnoticed. It may come in episodes that stop on their own (paroxysmal atrial fibrillation) or persist over time (persistent atrial fibrillation).
The main risk is stroke, because small clots can form in the heart. Treatment has two aims: protecting against stroke, with oral anticoagulants when indicated, and controlling the heart’s rhythm or rate. I follow patients over time and, when needed, refer them for ablation procedures.
Coronary heart disease
Coronary (ischaemic) heart disease means that the heart muscle receives less blood than it needs, usually because the coronary arteries have narrowed. It can show up as angina, a pain or pressure in the chest during exertion, or as a heart attack. Some conditions, such as Takotsubo syndrome, often triggered by severe emotional stress, look like a heart attack but have a different cause and also need follow-up.
After a heart attack, angioplasty with a stent or coronary bypass surgery, regular cardiology follow-up is important: checking that treatment is right and well tolerated, keeping blood pressure, cholesterol and blood sugar under control and monitoring heart function over time with an electrocardiogram and an echocardiogram.
Heart valve disease
Heart valves can become narrowed (stenosis) or fail to close properly (regurgitation). Often the first clue is a murmur heard during a consultation; over time breathlessness, tiredness, chest pain or dizziness during exertion may appear. With age, aortic valve stenosis is particularly common; other examples are mitral regurgitation, mitral valve prolapse, aortic regurgitation and the bicuspid aortic valve, a variant present from birth that can be associated with a dilated aorta and needs monitoring over time.
An echocardiogram shows which valve is involved and how significant the problem is. Many valve conditions simply need regular check-ups, as do replacement valves after surgery or TAVI; when needed, I help choose the right time for a surgical or transcatheter intervention.
Heart failure
Heart failure means that the heart cannot pump blood as well as it should. Typical signs are breathlessness, tiredness and swollen ankles. It may be due to a heart muscle that contracts weakly, with a reduced ejection fraction, or to a stiff heart that does not fill properly; causes include cardiomyopathies, such as dilated and hypertrophic cardiomyopathy.
Today there are effective treatments that improve symptoms and prolong life, but they need to be introduced gradually and checked regularly. Consistent follow-up, with echocardiograms and blood tests, helps prevent deterioration and hospital admissions.
Cardiac amyloidosis
In amyloidosis, abnormal proteins build up in the body’s tissues; when they accumulate in the heart muscle they make it thicker and stiffer. The forms that most often affect the heart are transthyretin amyloidosis (ATTR), age-related or hereditary, and light-chain amyloidosis (AL).
It causes breathlessness, tiredness, swollen ankles or arrhythmias, and is therefore often mistaken for other conditions for a long time. Some signs, such as thickening of the heart muscle on an echocardiogram or carpal tunnel syndrome in both hands, may suggest this diagnosis. Recognising it early matters: today there are specific treatments that slow its progression.
Cholesterol and cardiovascular risk
Cholesterol, blood pressure, blood sugar, smoking, weight and family history all add up. LDL cholesterol, the “bad” cholesterol, matters most: in some families it is very high from a young age (familial hypercholesterolaemia), and lipoprotein(a), or Lp(a), also helps estimate risk. To decide whether and how to act, a single value is not enough: each person’s overall risk needs to be estimated.
With a consultation and blood tests we define your risk and the targets to aim for, with practical advice on diet, physical activity and, if needed, medicines such as statins.
Heart check-up
A check-up is useful even without symptoms, as part of cardiovascular prevention: if there has been heart disease or sudden death at a young age in your family, if you have risk factors, if you want to take up strenuous exercise, if you are over 40 or simply if you have never had your heart checked.
The check-up includes a consultation with ECG and, depending on age and history, an echocardiogram or other tests. At the end you receive a clear assessment and practical advice.
Follow-up after a sports medical examination
If your sports medical examination found something unusual, for example an abnormal ECG, ectopic beats or a murmur, or you were advised to see a cardiologist, you can book an assessment to understand what the findings mean.
Please bring the sports medical examination report and any tests. During the cardiology consultation I review the results together with your medical history, distinguish normal adaptations in an athlete’s heart from findings that need further investigation, and advise on any tests needed.
Women and pregnancy
High blood pressure in pregnancy
High blood pressure is one of the most common problems in pregnancy. It may already be present before conception (chronic hypertension) or appear during pregnancy, usually after the twentieth week (gestational hypertension); sometimes it progresses to pre-eclampsia, which needs careful monitoring.
Together with the obstetrician we review blood pressure readings, tests and the most suitable treatment, choosing medicines suitable for use during pregnancy and breastfeeding. A cardiology check-up after birth is useful: women who had high blood pressure in pregnancy have a higher cardiovascular risk in the following years.
Heart disease and pregnancy
During pregnancy the heart works harder: blood volume and heart rate increase. This is why women with a known heart condition, such as valve disease, congenital heart disease or an arrhythmia, need careful follow-up. It is also worth seeing a cardiologist when palpitations, breathlessness or fainting appear for the first time in pregnancy.
Ideally, an assessment should take place before conception, to estimate risks and adjust treatment. During pregnancy we plan regular check-ups, including echocardiograms, which use no radiation and are safe for mother and baby. More rarely, in the weeks around birth, a form of heart failure called peripartum cardiomyopathy can develop and needs to be recognised quickly.
Women’s heart health
Cardiovascular disease is the leading cause of death among women too, but symptoms can be different and less obvious: a heart attack in women more often presents with breathlessness, tiredness or nausea than with the classic chest pain.
Some stages of life deserve particular attention: with the menopause, for example, cardiovascular risk increases because blood pressure and cholesterol tend to rise. A cardiology assessment at this stage allows early action.
Children and teenagers
Heart murmur
The paediatrician hears a murmur: this is one of the most common reasons for a child’s first cardiology visit. In the vast majority of cases it is an “innocent” or functional murmur, simply the sound of blood flowing through a healthy heart.
A consultation and, when needed, an echocardiogram make it possible to tell an innocent murmur from one caused by a structural problem, such as a ventricular septal defect, a patent ductus arteriosus or a valve defect (aortic stenosis, mitral regurgitation, etc.), and to reassure the family.
Palpitations, fainting and chest pain
In children and teenagers these symptoms are very frightening, but they rarely come from the heart: more often they have benign causes, such as strong emotion, a harmless reflex triggered by heat or standing for a long time, or muscular pain in the chest wall.
A cardiology assessment with an electrocardiogram helps rule out cardiac causes, such as certain arrhythmias (for example ectopic beats or supraventricular tachycardia), and decide whether further tests are needed, including before starting sport.
Myocarditis and pericarditis
These are inflammatory conditions of the heart: myocarditis affects the heart muscle, while pericarditis affects the membrane around it. They often appear a few days after a viral infection, even a mild one, and can cause chest pain that changes with breathing or position, breathlessness, tiredness or palpitations.
Diagnosis is based on the consultation, the electrocardiogram, the echocardiogram and blood tests. In most cases the course is favourable, but a period of rest from sport and check-ups until full recovery are needed; a cardiology assessment is required before returning to sport.
Congenital heart disease
These are structural differences in the heart that are present from birth. Some need monitoring over time, while others require surgery or a procedure in the first years of life. The most common include septal defects, small holes in the wall separating the chambers of the heart (atrial septal defect, ASD, and ventricular septal defect, VSD), patent ductus arteriosus, coarctation of the aorta and the bicuspid aortic valve.
The patent foramen ovale (PFO) is different: a small opening between the atria that everyone has before birth and that stays open in about one person in four. It is not a disease, causes no murmur or symptoms and in the vast majority of cases needs no treatment or follow-up. It should only be looked for in specific situations, on a doctor’s advice.
