We’ve all seen those advertisements with fat oozing out of arteries. We all know that the way we live our lives — smoking and diet in particular — affects how healthy our heart and circulatory system are. Despite that, more and more people are living with conditions affecting the heart. About 1.2 million women and 1.5 million men in the UK are now living with coronary heart disease. The good news is that we’re more aware of the danger signs — high blood pressure and high cholesterol, for example — than ever before, and doctors are well geared up to intervene early. Death rates from coronary heart disease are falling.

So it’s best not only to do all we can to prevent heart disease through a healthy lifestyle but also to know how to access the best care if a problem does emerge.

If your doctor suspects a heart problem, he or she is likely to refer you to a cardiologist — a specialist in diagnosing and treating heart conditions. With some conditions that require surgery, you may also be referred to a cardiothoracic surgeon but you are likely to remain under the supervision of a cardiologist.

There has been very fast progress in cardiology in recent years. Increasingly, it has become difficult for cardiologists to keep fully up to date with all areas. So there is an increasing tendency for them to specialise in particular areas. That means that if your doctor refers you to a heart specialist, you should ensure that the person is an expert in your condition, or the test or treatment being recommended.

There are 688 cardiologists listed on the Dr Foster database, and 397 say they have a special interest in coronary heart disease — the subject of this article. Full details of consultant’s special interests can be found by clicking here.

Here is some guidance first on the questions to ask your GP if you experience the most common symptom of heart disease, angina. Then we look at the questions you should ask your GP or specialist when trying to ensure you are receiving the best diagnosis and treatment for heart disease.

ANGINA

Chest pain has many causes. It may be caused by inflammation in the lung lining, a rib problem, nerve compression or even anxiety. When it has been caused by a lack of oxygen reaching the heart muscle, it is called angina.

Angina is often accompanied by breathlessness, sweating, chest tightness or a choking feeling, and is usually worse during exercise, such as walking up hill. The pain can move to the neck, throat, jaw or arms.

Most angina is due to coronary heart disease, when the heart arteries become furred up with fatty deposits through a process called atherosclerosis. Angina affects about one in 50 people. It can often be controlled with a combination of medication and lifestyle change.

KEY QUESTIONS
Do I need an angiogram?
People with chest pain are often referred to a specialist for coronary angiography — a diagnostic technique which identifies whether there are any blockages in the heart’s blood vessels (see below for more details). It is not always necessary and the procedure carries some risks but, if there is a possibility that the cause of chest pain is angina, it is generally best to have an angiogram. The risk of serious complications following an angiogram is about one in 1,000. The risks of undiagnosed and untreated heart disease are many times higher.

What medication will I need?
Large clinical trials have demonstrated that patients who are proven to have coronary artery disease have a better prognosis if they take each of these four drugs: aspirin, a statin, an ACE (angiotensin-converting enzyme) inhibitor and a beta-blocker.

What is my cholesterol level?
High cholesterol levels are an important contributor to development of coronary artery disease. The most effective way to lower them is by taking a statin drug. There are other drugs that can also be used to lower cholesterol levels, as well as dietary measures.

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