The aim of a modern cardiology unit is to find the cause of your symptoms. Most of the time, in angina, this will be atheroma, affecting one, two, or all three of your coronary arteries. The tests to be performed in the clinic should identify the problem in sharp detail, so that any corrective treatment is planned for your own individual needs.

You will be asked to undergo exercise testing, special EKG tests, and X-ray investigations, including perhaps a radioisotope heart scan, an echocardiography, and finally a coronary angiogram.

The thought of all those tests, especially after you have been told you may have an at-risk heart, is daunting and frightening. Please do not let it worry you. In modern cardiology units, everything is done to make sure you are relaxed and calm. The staff are highly specialized, having concentrated on heart investigations for years, and know very well what entering such a unit means for their patients.

I have visited many such units, all of them staffed by cheerful, kind, and dedicated nurses and doctors, who can make even the most apprehensive patient feel relaxed. The atmosphere is never somber—there is no “gloom and doom.” The feeling is more of a professionalism dedicated to helping people back to a normal life, with much to look forward to. They have every reason to be cheerful, because they succeed in their aims with the vast majority of their patients, and since the development of coronary care units, the death rate from ischemic heart disease has dropped dramatically.

The first investigations aim to find the underlying cause of the symptoms. They will rule out such problems as heart valve disease (one clue being a heart murmur heard through the stethoscope), high blood pressure, an overactive thyroid, or anemia. If patients are found to have one of these problems, they will be given treatment and their angina should recede. Sometimes the heart clinic finds evidence of esophageal spasm (a form of cramp), and will refer you to a gastrointestinal specialist for treatment.

Most of the rest of the patients seen with angina in the cardiology unit have atheroma affecting the coronary arteries. The next aim is to find out how serious they are, and to estimate the risks of a fullblown heart attack in the near future. That means getting as many details as possible of how the heart is performing at the time of an angina attack. The two ways of doing this, initially, are to use a stress test or a Holter monitor.


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