Cardiovascular conditions

Angina pectoris

Angina is a temporary discomfort or pain that occurs when part of your heart muscle is temporarily deprived of the blood and oxygen.  

It usually is triggered by physical activities and goes away after a few minutes of rest.  Angina is caused by plaque clogging your coronary arteries.  Angina is not a heart attack.  However, it does indicate the development of coronary artery disease and can lead to heart attack.  It can also be brought on by stress, heavy meals, alcohol, and caffeine.  If not treated appropriately angina can interfere with an active lifestyle.


The pain associated with angina usually feels tight, gripping or squeezing and can vary from mild to severe.  

Angina is usually felt in the centre of your chest.  It may spread to both of your shoulders, back, neck, jaw or arms.  It can even be felt in your hands. 

Many people do not even feel pain, and a just an unpleasant sensation of discomfort in the chest.  Angina may also be experienced as shortness of breath rather than pain.  If your symptoms do not go away within 10 minutes of rest and using your sublingual nitrate medicine, or gets worse quickly you may be having a heart attack.  Call 000 immediately and ask for the ambulance.


A cardiologist can diagnose angina based on symptoms and how they arise.

Tests may be needed such as: 

  1. Electrocardiogram, ECG at rest.  
    An ECG is a reading of your heart’s electrical impulses taken from electrical leads   placed on your chest and limbs.  
  1. Exercise stress testing
    A stress test is sometimes called treadmill or exercise test is a type of ECG that is done while you are exercising.  It helps the doctor to find how well your heart responds to physical activity.
  2. Nuclear cardiac stress test
    This type of test is sometimes called an exercise thallium scan or nuclear scan.  A radioactive substance called a tracer is used to produce an image of your heart muscles.  When combined with an exercise test, a nuclear cardiac stress helps determine if areas of your heart are not receiving enough blood during rest and exercise. 
  3. Stress echocardiogram
    This exercise test utilises the echocardiogram to study the function of your heart in combination with exercise stress testing.  
  4. Angiogram
    An x-ray examination of the coronary arteries known as angiogram is a proven means of assessing the presence and severity of coronary artery disease.  This procedure is explained in the patient education contents.

Unstable angina

Unstable angina occours if angina is severe, occurs at rest, occurs frequently or changes pattern, and is brought on by less exercise than in the past, and needs prompt medical attention.






























High Blood Pressure
















Heart Attack









































As we age,  cholesterol builds up in our arteries putting us at risk for heart attack, strokes and premature death.

What is Cholesterol?

Cholesterol is a fatty substance that circulates in the blood and is an important component of human cells. The body obtains cholesterol through two methods – via the liver which produces about 75% and through food which accounts for 25% of cholesterol. Cholesterol comes in several forms notably the good and bad cholesterol. A high level of low density protein “LDL” the so called bad cholesterols are associated with increased heart attack and stroke. By contrast increased level of high density lipoprotein “HDL cholesterol” or good cholesterol offers protection against heart attacks and stroke. Triglycerides are another form of circulating fatty substance when elevated is also associated with heart attack and strokes.

What Problems Can Cholesterol Cause?

The body requires some cholesterol to function, but increased level of cholesterols can lead to plaque deposition within the walls of the arteries and eventually atherosclerosis. These plaques grow over time and some of them can break open and trigger the formation of blood clots. This sudden clogging of an artery prevents oxygen from arriving at the heart muscle or brain causing permanent damage resulting in heart attacks or strokes.

How Do Cholesterol Levels Predict Risk?

Many studies have shown that people with elevated total cholesterols are at increased risk for future heart attacks. Everyone should know their LDL and HDL levels. For every one umol/L increase in LDL of blood, the risk of a heart attack increases by almost 20%.

Lifestyle Changes to Lower Cholesterol

You can reduce your Cholesterol through changes in your diet and exercise. The cholesterol intake should be less than 200mg per day and the total fat intake should be no more than 20%-25% of all calories. The saturated fats and trans fatty acids “a manufactured type of saturated fat found in hard margarine, shortening and many cooking oils” should be minimised or eliminated from your diet. Weight loss, exercise and sustained change in your diet will improve cholesterol levels. With optimal diet and exercise regimen you can lower your total and LDL cholesterol by 10-15%.

Drug Treatment of Cholesterol

Despite the lifestyle change the majority of people who require drug therapy to adequately reduce their LDL levels. The statins are the most commonly and powerful class of drugs. They reduce LDL cholesterol by blocking a key step in the process of manufacturing cholesterol in the liver. The average starting dose of statins will reduce LDL by approximately 25% to 40% and rise in HDL by 5-10%. The high dose of stronger statins can reduce LDL by 50-60%.

Side Effects

Cholesterol lowering drugs have been used in hundreds of millions of persons for the last 15 years. In 3-4% of people liver and muscle enzymes tests are elevated. The chance of most severe muscle inflammation is less than1:20,000.

How Low Should My Cholesterol Be

National guidelines strongly recommend that a person with a history of heart disease documented atherosclerosis or risk of diabetes should aim for LDL of less than 2.0 umol/L.  An additional goal of LDL level of less than 1.5 umol/L in a person at high risk which defined as patient with known heart disease, multiple risk factors, diabetes, multiple or poorly controlled risk factors, continued smoking is recommended


Blood pressure is the pressure of the blood in the arteries as the heart pumps it around the body.

Blood pressure doesn’t stay the same all the time; it is always changing to meet your body’s need.


A blood pressure reading of less than 120/80 mmHg is normal blood pressure and something equal to or more than 140/90 mmHg is high for different individuals.


If the blood pressure remains high it can cause serious problems such as heart attack, stroke, heart failure and kidney disease. You can have high blood pressure and feel perfectly well. The only way to find if your blood pressure is high is by having it checked regularly by your doctor.

The following increases the risk of serious problems associated with blood pressure.

  1. Smoking
  2. High blood cholesterol
  3. Being overweight
  4. Diabetes


A lifestyle change is very important in helping to control high blood pressure.

The following steps might help to get your blood pressure in control:

  1. Be a non-smoker
  2. Reduce salt intake
  3. Achieve and maintain a healthy body weight
  4. Daily physical activity

Each year millions of people experience heart attacks and half of them are fatal.

Who is at risk?

Many people think that heart attacks are a man’s problem however as a matter of fact this is a number one killer of both men and women. In men the risk for heart attack increases significantly after the age of 45. In women heart attacks are more likely to occur in the years after menopause usually after the age of 50.

Besides age these are the factors that increase risk of heart attack:

  1. A previous heart attack
  2. Family history of heart disease
    1. Father/brother diagnosed before the age of 55
    2. Mother/sister diagnosed before the age of 65
  3. Diabetes mellitus
  4. High blood cholesterol
  5. High blood pressure
  6. Cigarette smoking
  7. Being overweight
  8. Physical activity

During heart attack, a clot in the heart artery blocks the flow of the blood to the heart. The heart begins to die. This is technically called myocardial infarction meaning death of the heart muscle.

The more time that passes without treatment the greater the damage to the heart muscle. The part of the heart that dies during the heart attack cannot grow back or be repaired.

A clot bursting drugs called thrombolytics are used to open the blocked arteries and also in a tertiary institution a balloon angioplasty is used.

To be most effective these treatments should be given within one hour of heart attack symptoms. The benefit of opening the blocked artery decreases with each passing hour from symptom onset until treatment.

Heart attack warning signs

Many people think that the heart attack is a sudden incident like the Hollywood heart attack depicted in the movies; however, this is a myth.

The thought is that many heart attacks start as a mild discomfort in the centre of the chest.

The important warning signs

1. Chest discomfort

Most heart attacks involve discomfort in the centre of the chest that last for more than a few minutes or that goes away and comes back. The discomfort can feel like uncomfortable pressure squeezing or fullness.

2. Discomfort in the area of the upper body

Symptoms can include discomfort in one or both arms, or in the back, neck, jaw or stomach.

3. Shortness of breath

This symptom often accompanied chest discomfort; however, it can also occur before the chest discomfort.

4. Other signs

These may include breaking in a cold sweat, nausea or light-headedness. Some patients report a sense of impending doom.

What are the tests to see if you are having a heart attack

1. Electrocardiogram (ECG)

This is a graphic record of the electric activity of the heart as it contracts and rests. It can often show area of damage and inadequate blood flow, heart enlargement and abnormal heart beats.

2. Blood test

Blood tests are often used to check for biochemical markers that are released into the blood within the first few hours after the heart damage occurs. These are called troponin and CK.

3. Nuclear scan

This is sometimes used to show damage area of the heart muscle and reveal problems with a pumping action. A small amount of radioactive material injected into the vein. A scanning camera is positioned over the heart and records the nuclear activity delivered to the coronary arteries and either taken up by the heart muscle healthy area (or not taken up) damaged area.

4. Stress test/echocardiogram

Exercise stress testing is used to diagnosed coronary artery disease rhythm problems and heart condition. It is also used to test the effectiveness of the treatment. An echocardiogram can be incorporated into the stress testing to look at the pump function of the heart in real time while exercise is occurring.

5. Coronary angiography

The test is used to take detailed picture of the coronary arteries. A fine tube (catheter) is threaded through the artery of the arm or the groin into the heart. The fluid that shows in x-ray is then injected called contrast and the heart and blood vessels are filmed as the heart pumps. The picture is called angiogram. It can show problems such as blockages caused by the atherosclerosis.

Atrial fibrillation occurs when uncoordinated beating of both the left atrium and the right atrium of the heart. For the heart to pump blood effectively and efficiently from the atria into the ventricles, both atria must have a normal rhythm. 

Risks of atrial fibrillation
The heart will not stop during atrial fibrillation.  However, the risk of atrial fibrillation is disruption to the normal pumping of the blood can cause stagnation of the blood to form in the artery.  This can cause blood clots to form in the blood and some clots may adhere to the wall of the atria.  The clot can then be swept into the brain, kidney or other organs leading to stroke and other debilitating or life threatening conditions.   

Symptoms of atrial fibrillation
A person may have a rapid and irregular heartbeat, palpitation, dizziness, fatigue lethargy, shortness of breath and generally feeling unwell.

Causes of atrial fibrillation

  1. Excess alcohol or caffeine intake
  2. Physical or psychological stress
  3. Stimulation medications
  4. Coronary artery disease
  5. Valvular heart disease
  6. Heart muscle dysfunction
  7. Over active thyroid gland
  8. Pericarditis
  9. Atrial fibrillation becomes more common with increasing age. 

Over 40 – about 2/100, Over 65 – about 6/100, Over 80 – about 10/100

Diagnosis of atrial fibrillation

Test to investigate causes of atrial fibrillation

  1. An ECG including a 24 hour monitoring
  2. X-ray examination of the heart
  3. Echocardiogram
  4. Blood test
  5. Electrophysiological studies
  6. Coronary angiogram

Treatment of atrial fibrillation

1. Medications

To slow and control the heart rate
Digoxin, beta blocker or calcium channel blockers. 

2. Prevent clot formation

 Heparin, Warfarin or other blood thinning medications such as NOAC-Apixaban, Rivaroxiban and Debigatran

Treatment with cardioversion
If the arrhythmia persists one may undergo a procedure called cardioversion.  This is the application of an electric shock across the chest to revert the heart back into normal sinus rhythm under general anaesthtics.  

Treatment with pacemaker
To control atrial fibrillation some people may need a small electrical device known as a pacemaker to be implanted following the ablation of the AV node.

Surgical/invasive treatment
These days highly sophisticated complex radiofrequency ablation can be attempted with a cure. The success rate is about 70-80%.

Facts on atrial fibrillation

  1. Most common heart rhythm disturbance
  2. One in 4 people over 40 years or older will develop AF. 
  3. There are a quarter of a million people with AF in Australia. 
  4. Because of the ageing population the number is expected to double in 30 years. 
  5. There is fivefold increase in stroke in patients with AF.  
  6. Three million people worldwide suffer from stroke related atrial fibrillation. 
  7.  AF related strokes are severe and disabling.
  8. 75% of the strokes due to atrial fibrillation could be prevented with blood thinners. 
  9. Warfarin is the agent used to thin the blood and has been used for the last 70 years.  

Warfarin has several limitations. These includes bleeding, unpredictable response, food and antibiotic interactions, routine monitoring needed and dose adjustment.