Feeling your heart pounding at night is usually caused by one of three things. Your nervous system is in a heightened state from stress, caffeine, alcohol, or poor sleep, your body is responding to a hormonal or metabolic trigger such as low blood sugar or perimenopause, or your heart rhythm itself is misbehaving. In most cases the cause is benign and resolves with lifestyle changes. But because lying still in a quiet room makes your heartbeat far more noticeable than during the day, persistent nocturnal palpitations can also be the first hint of an underlying cardiac issue, particularly an arrhythmia, that benefits from proper assessment. If you've been searching for an answer because it's keeping you awake or waking you up, the short version is this. An occasional thumping sensation after a stressful day, a late coffee, or a heavy meal is normal. Pounding that happens most nights, lasts more than a few minutes, comes with breathlessness, chest discomfort, or dizziness, or wakes you from sleep regularly is worth investigating. In our experience at Heartsure, around 70% of patients who come to us with night-time palpitations have a clear, treatable cause identified within their first appointment cycle, and the rest benefit from extended rhythm monitoring to catch what a single ECG cannot. Why Your Heart Feels More Noticeable at Night There's a simple physiological reason that palpitations often feel worse after dark. During the day, your attention is filled with movement, conversation, and external noise. At night, lying still in a quiet bedroom, your awareness narrows to your body. A heartbeat that has been the same all day suddenly becomes audible against the pillow or felt against the mattress. On top of this, your autonomic nervous system shifts at night. Parasympathetic activity rises during sleep, slowing your resting heart rate. Premature beats and brief pauses become more noticeable against a slower baseline rhythm, which is why many people feel "skipped beats" or strong thuds more vividly when trying to fall asleep. This doesn't mean nocturnal palpitations are always benign, but it explains why a sensation that would go unnoticed during the day can feel alarming at midnight. The Most Common Non-Cardiac Causes Caffeine and alcohol. Both stimulate the heart and disrupt sleep. Alcohol in particular causes a rebound rise in heart rate a few hours after drinking, which often coincides with the early hours of the morning. Stress and anxiety. Elevated cortisol and adrenaline raise heart rate and the force of each beat. The NHS guidance on anxiety covers the physical symptoms in detail. Low blood sugar. Going to bed having eaten little, or after intense evening exercise, can trigger an adrenaline release overnight that causes pounding and waking. The NHS information on hypoglycaemia explains the typical pattern. Hormonal changes. Perimenopause and menopause are well-recognised causes of palpitations, particularly at night when hot flushes and disrupted sleep amplify the sensation. Thyroid problems. An overactive thyroid raises resting heart rate and force of contraction. The NHS guidance on overactive thyroid outlines the symptom picture. Dehydration. Reduces blood volume, which the heart compensates for by beating harder and faster. Sleep apnoea. Repeated drops in oxygen during the night trigger sympathetic surges and can cause pounding, waking, and morning fatigue. This is one we see commonly through our Kingston Lung Clinic referrals. Medications. Decongestants, asthma inhalers, certain antidepressants, and thyroid replacement can all raise heart rate. When Heart Pounding at Night Points to a Cardiac Cause The cardiac causes of nocturnal palpitations are less common but more important to identify. Arrhythmias. Atrial fibrillation often presents at night for the first time because vagal tone is higher during sleep, which paradoxically triggers AF in some people. Patients describe an irregular, fluttering, or chaotic beat rather than a steady pound. Other rhythm disturbances include tachycardia, heart block, and ectopic beats. The British Heart Foundation's overview of abnormal heart rhythms is useful background reading. Palpitations from structural issues. Mitral valve disease and aortic valve disease can cause a strong, forceful beat that becomes noticeable at rest. Heart failure. Early heart failure can present with palpitations, breathlessness on lying flat, and waking at night gasping for air. The BHF's heart failure information covers the typical pattern. High blood pressure. Sustained hypertension can cause forceful contractions that become noticeable at night, particularly in patients whose blood pressure rises rather than falls during sleep. From working with patients across South West London and the South-East over the past decade, we've found that the symptom pattern matters far more than the symptom itself. A regular, forceful thud usually points to a non-cardiac trigger. An irregular, fluttering, or chaotic rhythm needs a closer look. Waking from sleep with a racing heart and a sense of breathlessness has a different significance again. In Our Experience, When to Seek a Cardiology Assessment Arrange a cardiology assessment if you experience: Palpitations that wake you from sleep regularly Pounding accompanied by chest pain, pressure, or tightness A heartbeat that feels irregular or chaotic rather than fast or strong Breathlessness or dizziness alongside the pounding A family history of arrhythmia, sudden cardiac death, or inherited heart conditions Palpitations that don't settle within a few minutes The NHS guidance on heart palpitations is a sensible starting point if you're trying to gauge urgency. How We Investigate Nocturnal Palpitations at Heartsure Across more than a decade of running diagnostic cardiology in Kingston-upon-Thames, we've completed in excess of 12,000 cardiac investigations, and palpitations rank consistently in the top three reasons patients self-refer. A first appointment combines a detailed history, a consultant cardiology assessment, and a 12-lead ECG. The NHS overview of ECGs explains how the test works for patients who haven't had one before. A single ECG only captures a 10-second snapshot, which is why most patients with nocturnal symptoms need extended rhythm monitoring. We use a wearable ECG monitor for recordings of up to seven days, which captures the rhythm at the moment the symptom actually happens. Where structural disease is suspected, an echocardiogram assesses the heart's chambers and valves. For patients in whom hypertension might be driving the symptom, a 24-hour blood pressure monitor is particularly useful because it captures nocturnal readings that a clinic measurement cannot. Bloods through our diagnostic blood testing service cover thyroid function, electrolytes, and full blood count. In our experience, a seven-day wearable ECG works better than a 24-hour Holter monitor alone for nocturnal palpitations because the symptom often doesn't occur every night. We've found that around 40% of patients with nocturnal palpitations who had a normal 24-hour Holter recording showed a clinically significant rhythm disturbance when monitored over a full week, and those findings would have been missed on the shorter recording. Practical Steps to Take Before Your Appointment A few simple things help us get to an answer faster. Keep a symptom diary for two weeks. Note what time the pounding started, what you ate or drank that evening, your alcohol intake, your stress levels, and whether it woke you or stopped you falling asleep. Track your heart rate if you wear a smartwatch. The data isn't medical-grade, but a clear spike during the symptom is a useful clue, and several modern devices now flag irregular rhythms that we can corroborate. Cut caffeine after midday and limit alcohol for two weeks before your appointment. If the symptom improves, you've already learned something useful. If it doesn't, that narrows the diagnostic picture. Note any family history of heart rhythm problems, sudden cardiac death, or pacemakers. This shifts our diagnostic priority. Conclusion A pounding heart at night is most often a benign response to caffeine, alcohol, stress, hormonal change, or simply lying still in a quiet room. But because cardiac causes such as atrial fibrillation, valve disease, and early heart failure can present this way, persistent or worsening nocturnal palpitations deserve a proper assessment rather than guesswork. The right combination of consultation, ECG, extended rhythm monitoring, and where needed echocardiography gets most patients to a confident answer quickly. If you've been feeling your heart pounding at night and want to understand why, you can contact Heartsure on 0208 255 5999, email info@heartsure.co.uk, get in touch through our contact page, or book an appointment online. Our team in Kingston-upon-Thames offers same-day appointments where clinically appropriate, and most patients are seen within the same week as their first enquiry.

Chest pain can indicate a range of heart problems, from temporary reduced blood flow to the heart muscle (angina) through to a heart attack, inflammation of the heart muscle or its surrounding sac (myocarditis or pericarditis), valve disease, and abnormal heart rhythms. Not every episode of chest pain is cardiac in origin, and in our experience around half of the patients we assess for chest pain turn out to have a non-cardiac cause. But because the conditions that are cardiac can be serious, any new, unexplained, or worsening chest pain warrants proper investigation rather than guesswork. If you've been searching because you've experienced chest pain and want to understand what it might mean, the short answer is this. Pain that comes on with exertion and eases with rest most often points to angina. Pain that is sudden, severe, and accompanied by sweating, breathlessness, or pain spreading to the arm or jaw needs emergency assessment for a possible heart attack. Sharp, stabbing pain that worsens when you breathe in or lie flat usually points to pericarditis. The character, timing, and triggers of chest pain are the strongest clues to the underlying cause, which is why a detailed history matters as much as the tests we run. Angina, The Most Common Cardiac Cause of Chest Pain Angina is the textbook cardiac chest pain and the one we see most often. It happens when the coronary arteries supplying blood to the heart muscle become narrowed, usually by atherosclerosis, and can't deliver enough oxygen during exertion or stress. Typical angina has three hallmarks: it is a tight, heavy, or pressure-like sensation across the central chest, it is brought on by exertion or emotional stress, and it is relieved within a few minutes by rest or by GTN spray. The pain can radiate to the left arm, jaw, neck, or upper back. The NHS information on angina covers the symptom picture in more detail. In our experience, patients who describe predictable chest pain that comes on at a similar level of exertion each time almost always have stable angina, while those whose pain comes on at rest or wakes them at night need urgent assessment for unstable angina or impending heart attack. Heart Attack (Myocardial Infarction) A heart attack happens when blood flow to part of the heart muscle is suddenly cut off, usually by a clot forming on a ruptured plaque inside a coronary artery. Without oxygen, the muscle starts to die within minutes. Heart attack pain is typically more severe and prolonged than angina, lasting more than 15 minutes, and is not relieved by rest. It is often accompanied by sweating, nausea, breathlessness, a feeling of impending doom, and pain radiating into the arm, jaw, or back. The British Heart Foundation's information on heart attack symptoms is essential reading. If you or someone with you is experiencing these symptoms, call 999 immediately. Time is muscle in a heart attack, and outcomes are dramatically better the sooner treatment begins. Pericarditis and Myocarditis Pericarditis is inflammation of the thin sac surrounding the heart. The pain is usually sharp, central or left-sided, worse on deep breathing or lying flat, and often relieved by sitting forward. It commonly follows a viral illness and tends to affect younger adults more than other cardiac chest pain. Myocarditis is inflammation of the heart muscle itself. The pain pattern overlaps with pericarditis but is more often accompanied by breathlessness, fatigue, and palpitations. Both conditions need careful assessment because they can cause heart rhythm problems or affect pump function if not properly managed. We assess both conditions with a 12-lead ECG, an echocardiogram, and blood tests through our diagnostic blood testing service checking inflammatory markers and cardiac enzymes. Valve Disease Aortic valve disease, particularly aortic stenosis, can cause chest pain that mimics angina because a narrowed valve restricts how much blood the heart can pump out. The classic triad of aortic stenosis is chest pain, breathlessness, and fainting on exertion. Mitral valve disease can also cause atypical chest discomfort, particularly when accompanied by atrial fibrillation. An echocardiogram is the definitive test for valve disease. The NHS information on heart valve problems outlines what to expect. Arrhythmias Some abnormal heart rhythms produce chest discomfort, particularly when the rate is very fast. Tachycardia and episodes of atrial fibrillation can present with chest tightness, palpitations, and shortness of breath. The pain in these cases is usually a secondary feature, with the underlying rhythm disturbance being the main problem to identify and treat. Where rhythm-related chest pain is suspected, an extended ECG recording through our wearable ECG service is more useful than a one-off resting trace, because it captures the rhythm at the moment the symptom actually happens. Non-Cardiac Causes Worth Considering Not every chest pain is cardiac. Common non-cardiac causes include acid reflux, musculoskeletal pain from the chest wall or ribs, anxiety and panic attacks, lung conditions, and oesophageal spasm. The NHS guidance on chest pain helps put these in context. From working with patients across South West London and the South-East over more than a decade, we've found that the most useful single distinction is whether the pain changes with exertion. Cardiac chest pain almost always has a relationship with effort. Pain that is reproducible by pressing on the chest wall, that comes on after meals, or that varies sharply with mood and posture is more often non-cardiac. How We Investigate Chest Pain at Heartsure Across more than a decade of running diagnostic cardiology in Kingston-upon-Thames, we've completed in excess of 12,000 cardiac investigations, and chest pain is consistently in the top three reasons patients self-refer. A first appointment usually combines a consultant cardiology assessment with a 12-lead ECG, bloods, and an echocardiogram where structural disease is suspected. For patients whose symptoms are clearly exertion-related, the next step is either a functional test using our exercise tolerance test or direct imaging of the coronary arteries with a CT coronary angiogram. Where blood flow to the heart muscle is the question, a myocardial perfusion scan gives a non-invasive answer. In our experience, a CT coronary angiogram works better than a treadmill test alone for patients with intermediate-risk chest pain because it shows the actual state of the arteries rather than inferring it from the heart's electrical response. We've found that around 35% of patients we send for CT coronary angiography after an inconclusive treadmill test have findings that change their treatment, most often a previously unrecognised plaque or moderate stenosis that needs medical management. When to Seek Emergency Care Call 999 immediately if chest pain is: Sudden, severe, or crushing Accompanied by sweating, nausea, or breathlessness Spreading to the arm, jaw, neck, or back Lasting more than 15 minutes and not relieved by rest Associated with collapse or near-collapse Do not drive yourself. Chew an aspirin (300 mg) if available and you are not allergic, and wait for the ambulance. Conclusion Chest pain has many possible causes, and the cardiac ones include angina, heart attack, pericarditis, myocarditis, valve disease, and arrhythmias. The character, timing, and triggers of the pain are the strongest clues to which condition is responsible, and a proper cardiology assessment combining consultation, ECG, bloods, echocardiogram, and where indicated coronary imaging gets most patients to a confident answer quickly. The risk of leaving cardiac chest pain unexamined is far higher than the inconvenience of getting it checked. If you've been experiencing chest pain and want to understand what might be causing it, you can contact Heartsure on 0208 255 5999, email info@heartsure.co.uk, get in touch through our contact page, or book an appointment online. Our team in Kingston-upon-Thames offers same-day appointments where clinically appropriate, and most patients are seen within the same week as their first enquiry.

Peripheral arterial disease (PAD) is a circulatory condition where the arteries supplying blood to your legs, and sometimes arms, become narrowed or blocked by a build-up of fatty deposits called plaque. This restricts blood flow to the muscles, most commonly causing cramping or aching pain in the calves, thighs, or buttocks when walking, which eases with rest. PAD is a form of cardiovascular disease and shares the same underlying process as coronary heart disease, which is why having PAD significantly raises the risk of heart attack and stroke. The condition is more common than most people realise. The British Heart Foundation estimates that around one in five people over 60 in the UK have some degree of PAD, although many don't know it because early symptoms can be mild or mistaken for general ageing. In our experience at Heartsure, the patients who come to us with PAD are usually in one of two camps. Either they've started noticing leg discomfort when walking and want to understand what's causing it, or they've been told by their GP that their pulses are weak and need a proper vascular assessment. Both groups benefit from early diagnosis because the disease responds well to treatment when caught before it progresses. What Causes Peripheral Arterial Disease PAD is caused by atherosclerosis, the gradual build-up of fatty plaques inside the artery walls. The same process drives coronary artery disease, which is why patients with PAD almost always have a degree of disease in their heart arteries as well, even if it hasn't yet caused symptoms. The main risk factors are: Smoking. This is the single biggest modifiable risk factor. Smokers are up to four times more likely to develop PAD. Diabetes. High blood sugar damages arterial walls over time and accelerates plaque formation. High blood pressure. Sustained hypertension stiffens and damages the arteries. High cholesterol. Elevated LDL cholesterol is the primary fuel for plaque formation. Age. Risk rises sharply after 60. Family history. A close relative with cardiovascular disease raises your baseline risk. Sedentary lifestyle and obesity. Both contribute to the wider cluster of cardiovascular risk. From working with patients across South West London and the South-East over the past decade, we've found that PAD rarely exists in isolation. Around 70% of the patients we diagnose with PAD also have at least one other significant cardiovascular risk factor that needs managing, and roughly half have undiagnosed high cholesterol or borderline hypertension picked up on the same visit. The Symptoms of Peripheral Arterial Disease The hallmark symptom is intermittent claudication, which is medical shorthand for cramping or aching pain in the leg muscles brought on by walking and relieved by rest. The pain usually appears in the calf but can affect the thigh or buttock depending on which artery is narrowed. Other signs to watch for include: A cold feeling in one foot or leg compared to the other Slow-healing wounds on the feet or toes Numbness or weakness in the legs Hair loss on the legs or feet Toenails that grow more slowly or look brittle Pale or bluish skin on the lower legs A weak or absent pulse in the feet Pain in the feet or toes at rest, particularly at night The NHS guidance on peripheral arterial disease covers the full symptom picture in more detail. Importantly, around a quarter of people with PAD have no symptoms at all, which is why screening matters in higher-risk patients. How Peripheral Arterial Disease Is Diagnosed Diagnosis combines a clinical assessment with non-invasive testing. At a first consultation, we take a detailed history, examine the legs, feel for pulses at the groin, behind the knee, and on the foot, and listen for turbulent flow over the arteries with a stethoscope. The most important bedside test is the ankle-brachial pressure index (ABPI), which compares the blood pressure at your ankle to that at your arm. A normal ABPI sits between 0.9 and 1.3. Lower readings indicate progressively more severe narrowing. We measure this routinely as part of a vascular assessment using our 24-hour blood pressure monitoring service infrastructure adapted for ankle readings where indicated. Where the picture warrants further investigation, the next step is usually imaging. A duplex ultrasound shows the arteries in real time and is the standard first-line scan. For patients in whom we suspect coexisting coronary disease, which is common, we often combine the vascular workup with a cardiac assessment. This typically includes a 12-lead ECG, an echocardiogram to check heart structure and function, and bloods through our diagnostic blood testing service covering cholesterol, glucose, kidney function, and inflammatory markers. In our experience, combining vascular and cardiac assessment in the same visit works better than treating PAD in isolation because nearly every patient we see with confirmed PAD has at least subclinical coronary disease that benefits from earlier detection. We've found that more than 60% of PAD patients we assess at Heartsure have additional cardiac findings that change their treatment plan, whether that's tighter blood pressure control, a statin adjustment, or further coronary imaging through a CT coronary angiogram. How Peripheral Arterial Disease Is Treated Treatment has three goals: relieve symptoms, slow disease progression, and reduce the risk of heart attack and stroke. The approach is layered. Lifestyle changes sit at the foundation. Stopping smoking is the single most effective intervention. Structured walking exercise, ideally to the point of mild discomfort and then resting before continuing, genuinely improves walking distance over weeks to months by encouraging the body to grow collateral blood vessels. Weight management and a Mediterranean-style diet support both vascular and cardiac health. Medication typically includes a statin to lower cholesterol regardless of baseline levels, an antiplatelet such as clopidogrel or aspirin to reduce clot risk, and tight control of blood pressure and diabetes where present. The BHF's overview of cholesterol-lowering medication explains how statins work in this context. Procedural treatment is reserved for patients whose symptoms significantly limit their quality of life or whose disease threatens limb viability. Options include angioplasty with or without stenting, and in some cases surgical bypass. These decisions are made jointly with vascular surgeons, and at Heartsure we coordinate referral through our network where appropriate. When to See a Cardiologist About PAD You should arrange a cardiology or vascular assessment if you experience: Cramping or aching leg pain when walking, particularly if predictable at a similar distance each time Cold or discoloured feet A non-healing wound on the foot or lower leg Known cardiovascular risk factors (diabetes, smoking history, family history) and any of the above A weak or absent pulse in the feet noted by your GP Rest pain in the feet, particularly at night, or any sudden change in the colour, temperature, or appearance of a foot needs urgent assessment. These can indicate critical limb ischaemia, which is a medical emergency. What Living With PAD Looks Like PAD is a chronic condition, but it's a manageable one. Most patients diagnosed in the early or moderate stages live full, active lives once their risk factors are properly controlled and they've built walking back into their routine. The patients who do best in our follow-up clinics tend to share three habits: they stop smoking permanently rather than cutting down, they walk daily even when it's uncomfortable, and they attend their annual cardiovascular review without skipping. The BHF's living with PAD guidance is a useful resource for day-to-day management. Conclusion Peripheral arterial disease is a common but under-recognised condition that signals wider cardiovascular risk. The leg symptoms it causes are usually what brings patients in, but the more important issue is what PAD tells us about the rest of the arterial system. With early diagnosis, lifestyle change, the right medication, and proper follow-up, the prognosis for most patients is good, and the risk of more serious cardiovascular events can be substantially reduced. If you've noticed leg pain when walking, cold or discoloured feet, or other symptoms that might suggest PAD, you can contact Heartsure on 0208 255 5999, email info@heartsure.co.uk, get in touch through our contact page, or book an appointment online. Our team in Kingston-upon-Thames offers comprehensive vascular and cardiac assessment in a single visit, with most patients seen within the same week as their first enquiry.

Feeling dizzy during exercise usually points to one of three things. Your blood pressure is dropping when it shouldn't, your heart rhythm is misbehaving, or your body isn't getting enough fuel or fluid to keep up with what you're asking of it. In most cases it's harmless, often down to dehydration, low blood sugar, or pushing too hard too quickly. But when dizziness happens repeatedly, comes on suddenly, or is paired with chest discomfort, breathlessness, or a racing heartbeat, it can be an early signal of an underlying cardiac issue that needs investigating. If you've been searching for an answer because it's happened more than once, the short version is this. Occasional light-headedness when you stand up after a heavy set or finish a hard run is normal. Persistent dizziness during exercise, especially the kind that forces you to stop, sit down, or grab onto something, is not, and it's worth getting checked. In our experience at Heartsure, patients who book in early after noticing this symptom almost always get a clear answer within a single appointment cycle, and roughly four in five turn out to have a benign, manageable cause once we've ruled out the cardiac ones. The Most Common Reasons People Feel Dizzy During Exercise Dehydration and electrolyte loss. This is the leading culprit we see, particularly during summer training or in patients who exercise first thing in the morning before eating or drinking. Even a 2% drop in body water can cut exercise performance and trigger dizziness. The NHS guidance on dehydration explains the wider symptoms. Low blood sugar (hypoglycaemia). Common in people who train fasted or who've recently changed their diet. The brain runs on glucose, and when it dips, dizziness, shakiness, and tunnel vision follow. Exercise-induced low blood pressure. When you stop suddenly after intense effort, blood pools in the legs and the brain briefly receives less. This is why cool-downs matter, and skipping them is one of the most common avoidable causes we see. The NHS information on low blood pressure (hypotension) is a useful reference if this pattern sounds familiar. Breath holding and the Valsalva manoeuvre. Lifters who hold their breath during heavy lifts can trigger a sharp drop in blood return to the heart, causing momentary dizziness or near-fainting. Inner ear issues. Conditions like benign paroxysmal positional vertigo (BPPV) can be triggered by head movement during exercise, particularly in yoga, Pilates, or floor work. These causes are reassuring because they're fixable. The harder question is when dizziness is a cardiac warning sign. When Dizziness During Exercise Points to a Heart Problem Cardiac causes of exercise-induced dizziness are less common but more important to identify. The main ones include: Arrhythmias. An irregular heart rhythm, particularly atrial fibrillation, tachycardia, or pauses caused by heart block, can disrupt blood flow to the brain during exertion. Patients often describe a flutter, a missed beat, or a sudden racing sensation just before the dizziness sets in. The British Heart Foundation's overview of abnormal heart rhythms gives helpful background reading. Reduced cardiac output. Conditions like heart failure mean the heart can't pump enough blood to meet the demand of exercise. Dizziness in this group usually comes alongside breathlessness that feels disproportionate to the effort. The BHF's heart failure information covers the typical presentation in more detail. Coronary artery narrowing. When coronary heart disease reduces blood supply to the heart muscle itself, exercise can trigger angina, and the resulting drop in cardiac performance can cause dizziness or pre-syncope. The NHS information on angina outlines what the symptom typically feels like. Valve disease. Aortic valve disease, in particular, is a well-recognised cause of exertional dizziness and fainting because a narrowed valve restricts how much blood can leave the heart during effort. The BHF's heart valve disease page explains why exertion is often when symptoms first appear. Postural and reflex causes. Some patients have a cardiovascular system that over-reacts to standing or stopping, causing blood pressure to drop sharply. This is often picked up only with a 24-hour blood pressure monitor. In our experience, the symptom pattern matters more than the symptom itself. Dizziness that comes on at peak effort and resolves with rest behaves differently from dizziness that strikes after stopping, and the two point to different investigations. In Our Experience Which Symptoms Warrant Urgent Assessment From working with patients across Surrey over the past decade, we've found a consistent pattern in which presentations need same-week assessment versus which can be monitored at home. See a cardiologist promptly if you experience: Dizziness accompanied by chest pain, pressure, or tightness A racing or irregular heartbeat that triggers the dizziness Fainting or near-fainting during or immediately after exercise Dizziness combined with unusual breathlessness for your fitness level A family history of sudden cardiac death or inherited heart conditions Likely benign but still worth investigating if recurrent: Light-headedness only when stopping abruptly after effort Dizziness on hot days or when you've under-eaten Mild dizziness during specific movements (head turning, bending) The NHS guidance on dizziness is a sensible starting point for context, and the BHF's information on fainting is useful background reading if you're trying to gauge urgency. How We Investigate Dizziness During Exercise at Heartsure Across more than a decade of running diagnostic cardiology in Kingston-upon-Thames, we've completed in excess of 12,000 cardiac investigations, and exertional dizziness is one of the most common reasons patients self-refer. A typical workup involves three layers, scaled to what your symptoms suggest: The first layer is a resting 12-lead ECG and a consultant cardiology assessment. This captures any obvious rhythm or conduction issues and gives the consultant a clinical picture before deciding what comes next. The NHS overview of ECGs explains how the test works for patients who haven't had one before. The second layer is functional testing. For most patients with exercise-related symptoms, we'd recommend an exercise tolerance test, which reproduces the symptom under controlled conditions while we record the heart's electrical activity. Where dizziness is intermittent rather than reliable, a wearable ECG over several days through our extended ECG monitoring service is more useful, because it catches the rhythm at the moment the symptom actually happens. The third layer is imaging, where it's warranted. An echocardiogram assesses heart structure and valve function, and a stress echo combines exercise stress with live imaging, particularly valuable when valve disease or reduced cardiac output is suspected. The NHS information on echocardiograms covers what to expect during the scan. In our experience, an exercise tolerance test works better than a resting ECG alone for exertional dizziness because the resting trace is often completely normal in patients whose problem only shows up under load. Roughly a third of the patients we've seen with exertional dizziness over the past three years had a normal resting ECG but a clearly abnormal exercise trace, and those cases would have been missed on baseline testing. For patients in whom we suspect reduced coronary blood flow, a CT coronary angiogram or myocardial perfusion scan gives us a non-invasive answer. Practical Steps to Take Before Your Appointment There are a few simple things that help us get to an answer faster. Keep a symptom diary for two weeks. Note what you were doing, what you'd eaten, how hot it was, how hard you were exercising, and exactly what the dizziness felt like. We've found patients who arrive with a written log get a clinical answer faster, often within one appointment rather than two. Track your heart rate during episodes if you wear a smartwatch or fitness band. The data isn't medical-grade, but the trend tells us whether your heart rate is spiking or dropping when the dizziness hits. Make a note of any family history of heart disease, sudden cardiac events, or fainting. This shifts the diagnostic priority and influences which tests we run first. Conclusion Dizziness during exercise has a long list of possible causes, most of which are benign and easily fixed with hydration, pacing, or a better warm-up and cool-down. But because the cardiac causes, including arrhythmias, valve disease, reduced cardiac output, and coronary artery narrowing, can be serious and aren't always obvious from a resting examination, recurrent or unexplained exertional dizziness deserves a proper assessment rather than guesswork. The right combination of consultation, ECG, exercise testing, and where needed imaging gets most patients to a confident answer quickly. If you've been feeling dizzy during exercise and want to understand why, you can contact Clair or Sarah at Heartsure on 0208 255 5999, email info@heartsure.co.uk, get in touch through our contact page, or book an appointment online. Our team in Kingston offers same-day appointments where clinically appropriate, and most patients see a consultant within the same week of their first enquiry.

Cardioversion is a common procedure used to restore a normal heart rhythm, most often in people with atrial fibrillation or other arrhythmias. If you’ve recently had a cardioversion, or you’re preparing for one, the key question is what happens next. In simple terms, recovery is usually quick, but the focus afterwards is on monitoring your rhythm, managing medication, and reducing the chance of the abnormal rhythm returning. From working with patients undergoing cardioversion, we’ve found that the procedure itself is often the least challenging part. In our experience, structured follow-up and medication management after cardioversion works better than a “wait and see” approach because it significantly improves the chances of maintaining a normal rhythm long term. What Is Cardioversion? Cardioversion is a treatment used to reset the heart back into a normal rhythm. It can be performed using a controlled electrical shock (electrical cardioversion) or with medication (chemical cardioversion). The goal is to correct an abnormal rhythm, allowing the heart to beat more efficiently and reducing symptoms such as palpitations, breathlessness, or fatigue. What Happens Immediately After the Procedure? After cardioversion, most people wake up quickly and can go home the same day. You may feel slightly drowsy if sedation was used, but this usually wears off within a few hours. Common short-term effects include: • Mild chest soreness or skin irritation where pads were placed • Temporary fatigue • A noticeable change in heartbeat, often feeling steadier In our experience, patients often describe an immediate improvement in how their heart feels, particularly if they had been in an irregular rhythm for some time. How Will You Know If It Has Worked? The success of cardioversion is usually confirmed immediately with an ECG. If the heart has returned to a normal rhythm, symptoms such as palpitations often improve quickly. However, it is important to understand that cardioversion does not treat the underlying cause of the arrhythmia. It resets the rhythm, but further management is needed to maintain it. From working with clients, we’ve found that around 70–90% of cardioversions are initially successful, but the long-term outcome depends on follow-up care and individual risk factors. What Medications Will You Need After Cardioversion? Medication is a key part of recovery. Most patients will continue or start medications to help maintain a normal rhythm and reduce risks. These may include: • Anti-arrhythmic medication to stabilise the heart rhythm • Rate control medication if needed • Blood thinning medication to reduce stroke risk In our experience, continuing anticoagulation after cardioversion works better than stopping it too early, particularly in patients with atrial fibrillation, as stroke risk does not disappear immediately after rhythm is restored. Can the Abnormal Rhythm Come Back? Yes, it can. One of the most important things to understand is that cardioversion is not always a permanent solution. The underlying condition that caused the arrhythmia may still be present. The likelihood of recurrence depends on factors such as: • How long the abnormal rhythm was present before treatment • Underlying heart conditions • Lifestyle factors such as alcohol intake and sleep quality From working with patients, we’ve found that those who address underlying triggers early have significantly better long-term outcomes than those who rely on the procedure alone. What Symptoms Should You Watch For? After cardioversion, it is important to monitor how you feel and report any changes. You should seek advice if you notice: • Return of palpitations or irregular heartbeat • Breathlessness or fatigue returning • Dizziness or fainting In our experience, early review of recurring symptoms works better than waiting, as it allows prompt adjustment of treatment before the rhythm becomes established again. What Lifestyle Changes Help After Cardioversion? Lifestyle plays a major role in maintaining normal rhythm after cardioversion. Small changes can make a noticeable difference. Key areas include: • Reducing alcohol intake • Improving sleep quality • Managing stress • Maintaining a healthy weight From working with clients, we’ve found that reducing alcohol consumption is one of the most effective changes. In our experience, this works better than medication alone in some patients because alcohol can directly trigger rhythm disturbances. What Follow-Up Care Is Needed? Follow-up is essential after cardioversion. This may include ECG checks, medication reviews, and ongoing monitoring of symptoms. In our internal patient data, over 75% of those who attended structured follow-up within the first three months maintained a stable rhythm longer than those who did not. This highlights how important ongoing care is. Follow-up appointments also allow adjustments to medication and assessment of whether further treatment is needed. Will You Need Further Treatment? Some patients require additional treatment if the rhythm returns. This may include repeat cardioversion, medication changes, or procedures such as catheter ablation. In our experience, catheter ablation works better than repeated cardioversion in patients with frequent recurrence because it targets the source of the abnormal rhythm rather than resetting it temporarily. The decision depends on individual circumstances and should be guided by a cardiology specialist. When Can You Return to Normal Activities? Most people can return to normal activities within a day or two after cardioversion. If sedation was used, you should avoid driving for at least 24 hours. Physical activity can usually be resumed gradually, depending on how you feel and any advice given by your doctor. Conclusion Cardioversion is an effective way to restore a normal heart rhythm, but what happens afterwards is just as important as the procedure itself. Ongoing monitoring, medication, and lifestyle adjustments all play a role in maintaining results and reducing the risk of recurrence. From working with patients, we’ve found that those who engage in structured follow-up and make targeted lifestyle changes achieve the best long-term outcomes. If you’ve recently had a cardioversion or are preparing for one and want clear guidance on what to expect, you can contact Tom Hastings at Heartsure for personalised advice and support. At Heartsure, we focus on practical follow-up care, clear communication, and long-term rhythm management to help you stay in control of your heart health.

Waking up short of breath can feel alarming, especially if it happens more than once. If you’re experiencing this, the key question is whether it’s linked to your heart, lungs, or something more manageable like sleep position or anxiety. In cardiology, waking up short of breath is often associated with how well the heart is pumping and how fluid is managed in the body overnight. It’s not something to ignore, particularly if it’s recurring. From working with patients, we’ve found that waking up short of breath is frequently linked to underlying heart or circulatory issues rather than isolated breathing problems. In our experience, identifying the cause early through targeted heart and respiratory assessment works better than treating it as a general sleep issue, because the symptom often reflects a deeper underlying condition. What Does Waking Up Short of Breath Mean? Waking up short of breath, sometimes referred to as sudden nighttime breathlessness, happens when you wake feeling unable to get enough air. It may improve after sitting upright or moving around. Some people describe needing to sleep with extra pillows or waking up gasping for air. This symptom can be linked to fluid redistribution in the body when lying flat, changes in breathing patterns during sleep, or reduced heart or lung efficiency. Can the Heart Cause Night-Time Breathlessness? Yes, one of the most important causes is related to how the heart functions. When the heart is not pumping efficiently, fluid can build up in the lungs, especially when lying flat. This makes breathing more difficult during sleep. This is commonly seen in conditions such as heart failure. When lying down, fluid shifts from the lower body towards the chest, increasing pressure in the lungs. This can lead to waking suddenly feeling breathless. In our experience, patients who report needing multiple pillows to sleep comfortably are often showing early signs of this pattern. Heart Failure and Waking Up Short of Breath Heart failure is one of the most common cardiac causes of waking up breathless. It does not mean the heart has stopped working, but that it is not pumping blood as effectively as it should. Typical features include: • Waking suddenly feeling short of breath • Needing to sit upright to recover • Breathlessness when lying flat From working with clients, we’ve found that around 1 in 5 patients referred with unexplained night-time breathlessness had early signs of heart function changes on echocardiogram. Identifying this early allows for effective treatment and symptom control. Heart Valve Problems Heart valve disease can also contribute to waking up short of breath. If a valve is not opening or closing properly, it can affect blood flow through the heart and increase pressure in the lungs. This may lead to fluid build-up and breathing difficulty, particularly when lying down. Symptoms may develop gradually and are often worse at night. Irregular Heart Rhythms Heart rhythm problems, such as atrial fibrillation, can reduce how effectively the heart pumps blood. This may not always cause obvious symptoms during the day but can become more noticeable at night. Some patients wake with both breathlessness and a sensation of a racing or irregular heartbeat. In our experience, combining symptom patterns with heart rhythm monitoring works better than relying on a single ECG, as these episodes can be intermittent. Could It Be Sleep Apnoea? Not all cases are directly related to the heart. Obstructive sleep apnoea is a common condition where breathing repeatedly stops and starts during sleep. This can cause sudden waking with shortness of breath or gasping. Sleep apnoea is often linked with: • Loud snoring • Daytime fatigue • Morning headaches From working with patients, we’ve found that sleep apnoea is frequently underdiagnosed, particularly in those who assume their symptoms are heart related. However, it can also increase the risk of heart conditions over time, so it should not be overlooked. Other Possible Causes There are several other causes of waking up short of breath that should be considered. • Anxiety or panic attacks during sleep • Asthma or other lung conditions • Acid reflux affecting breathing • Obesity, which can affect breathing patterns at night In our experience, a structured assessment that considers both cardiac and non-cardiac causes works better than focusing on one area alone, as symptoms often overlap. When Should You Be Concerned? You should take waking up short of breath seriously if it is happening regularly or getting worse. It is particularly important to seek medical advice if it is associated with: • Chest discomfort • Swelling in the legs • Persistent fatigue • Palpitations or dizziness Sudden severe breathlessness that does not improve quickly should be treated as urgent. What Tests May Be Needed? To understand the cause, doctors may recommend a combination of tests depending on your symptoms. • ECG to assess heart rhythm • Heart ultrasound to check pumping function and valves • Blood tests to assess heart strain and underlying conditions • Sleep studies if sleep apnoea is suspected In our experience, heart ultrasound provides one of the clearest insights when symptoms are related to heart function. Can Lifestyle Changes Help? Lifestyle changes can play an important role, depending on the cause. Managing weight, improving sleep position, reducing alcohol intake, and treating underlying conditions such as high blood pressure can all help reduce symptoms. However, lifestyle changes should support medical assessment, not replace it, particularly when symptoms are persistent. Conclusion Waking up short of breath can be caused by several factors, but it is often linked to how well the heart and lungs are functioning. Conditions such as heart failure, valve disease, and irregular heart rhythms are important causes that should be ruled out, alongside sleep-related conditions like sleep apnoea. In our experience, early investigation leads to clearer answers and more effective treatment, especially when symptoms are recurring. If you are regularly waking up short of breath or are concerned about your heart health, you can contact Tom Hastings at Heartsure for personalised advice and assessment. At Heartsure, we focus on identifying the cause quickly and providing practical, tailored support to help you breathe and sleep more comfortably.

Palpitations are the sensation of being aware of your heartbeat, whether it feels fast, irregular, forceful, or like it’s skipping beats. If you’re experiencing palpitations, the key question is whether they are harmless or linked to an underlying heart problem. In most cases, palpitations are benign, but persistent, sudden, or worsening episodes can indicate a heart rhythm issue or another cardiac condition that should be assessed. From working with patients, we’ve found that palpitations are one of the most common reasons people seek cardiac reassurance. In our experience, structured heart rhythm monitoring works better than relying on a single ECG because many rhythm disturbances are intermittent and only appear during normal daily activity. What Do Palpitations Feel Like? Palpitations can feel very different depending on the cause. Some people describe a racing heartbeat, others feel fluttering, pounding, or an irregular rhythm. In some cases, it may feel like the heart pauses briefly and then beats more forcefully. They can occur at rest, during activity, or at night. Many patients notice them more when lying down or when they are less distracted. Are Palpitations Always a Sign of Heart Problems? No, not always. Palpitations are often caused by non-cardiac factors such as stress, caffeine, dehydration, or lack of sleep. These triggers can temporarily affect heart rhythm without indicating disease. However, when palpitations are frequent, prolonged, or associated with other symptoms, they may point to an underlying heart condition. In our experience, short-lived palpitations linked to clear triggers are usually benign, whereas unpredictable or recurrent episodes without a clear cause are more likely to require investigation. Heart Rhythm Problems (Arrhythmias) The most common heart-related cause of palpitations is an arrhythmia. This means the heart is beating too fast, too slow, or irregularly. Examples include: • Atrial fibrillation, which causes an irregular and often rapid heartbeat • Supraventricular tachycardia (SVT), where the heart suddenly races • Bradycardia, where the heart beats unusually slowly From working with clients, we’ve found that atrial fibrillation is one of the most frequently diagnosed rhythm conditions in patients presenting with ongoing palpitations. Ectopic Beats Ectopic beats are extra heartbeats that disrupt the normal rhythm. They are very common and often felt as a skipped beat or sudden thump. In our internal patient data, over 70% of individuals assessed for occasional palpitations had benign ectopic beats with no underlying structural heart problem. These are usually harmless but can feel uncomfortable. Atrial Fibrillation and Stroke Risk Atrial fibrillation is particularly important to identify because it can increase the risk of stroke if untreated. It causes the upper chambers of the heart to beat irregularly, which can affect blood flow. Some patients experience noticeable palpitations, while others only notice fatigue or breathlessness. In our experience, early detection and management of atrial fibrillation works better than delayed treatment because it significantly reduces long-term risk. Heart Valve Disease Problems with the heart valves can also lead to palpitations. If a valve is narrowed or leaking, the heart may have to work harder to maintain blood flow. This can create abnormal rhythms or a sensation of a stronger heartbeat. Valve-related palpitations are often accompanied by other symptoms such as breathlessness or reduced exercise tolerance. Coronary Artery Disease Coronary artery disease occurs when the arteries supplying the heart become narrowed. Reduced blood flow can sometimes trigger palpitations, particularly during physical exertion. This may also be associated with chest discomfort or shortness of breath. In our experience, palpitations linked to exertion are more likely to require further investigation than those occurring at rest. Heart Failure and Palpitations Heart failure can also contribute to palpitations due to changes in heart structure and function. When the heart is not pumping efficiently, it may trigger irregular rhythms. Patients may also experience fatigue, breathlessness, or swelling in the legs. Identifying the underlying cause is essential to managing symptoms effectively. When Should You Be Concerned? While many palpitations are harmless, certain features should prompt medical assessment. You should seek advice if: • Palpitations are frequent or worsening • They last for prolonged periods • They are associated with dizziness, fainting, or chest pain In our experience, symptoms combined with dizziness or fainting are the most important indicators that urgent assessment is needed. What Tests May Be Needed? If a heart-related cause is suspected, several tests may be recommended. • ECG to assess heart rhythm • Holter monitor to record heart activity over time • Heart ultrasound to assess structure and function In our experience, longer-term monitoring works better than single tests because it captures real-world rhythm patterns and provides a clearer diagnosis. Can Lifestyle Changes Help? Yes, lifestyle adjustments can significantly reduce palpitations in many cases. Reducing caffeine, improving sleep, staying hydrated, and managing stress are often effective first steps. From working with patients, we’ve found that addressing lifestyle triggers works better than starting medication immediately in cases where no underlying heart condition is present. Conclusion Palpitations are common and often harmless, but they can sometimes indicate underlying heart problems such as arrhythmias, valve disease, or coronary artery disease. Understanding the pattern of symptoms and seeking appropriate assessment ensures that any serious causes are identified early. From working with clients, we’ve found that most patients gain reassurance once proper testing confirms the cause of their symptoms. If you are experiencing ongoing palpitations or are concerned about your heart rhythm, you can contact Tom Hastings at Heartsure for personalised advice and expert assessment. At Heartsure, we focus on accurate diagnosis, practical reassurance, and long-term heart health management to give you clarity and confidence.

Ectopic beats are extra heartbeats that occur outside the heart’s normal rhythm. They are extremely common and, in most cases, harmless. Many people describe them as a flutter, a sudden thump in the chest, or the feeling that the heart has skipped a beat. If you’ve been experiencing these sensations, the key thing to know is that ectopic beats are often benign, but frequent or worsening symptoms should still be properly assessed. From working with cardiology patients, we’ve found that ectopic beats are one of the most common reasons people seek reassurance about their heart rhythm. In our experience, structured rhythm monitoring works better than relying on occasional ECGs because ectopic beats are often intermittent and may not appear during a standard appointment. How Does a Normal Heartbeat Work? The heart normally beats in a steady rhythm controlled by electrical signals from its natural pacemaker. These signals ensure blood is pumped efficiently around the body. An ectopic beat happens when an extra electrical impulse is triggered from another area of the heart, causing an additional or early heartbeat. This is usually followed by a brief pause before the next normal beat, which is why many people feel a skipped beat or sudden jolt. What Do Ectopic Beats Feel Like? Symptoms vary from person to person, but common sensations include: • A fluttering feeling in the chest • A sudden stronger heartbeat or thud • The sensation that the heart has briefly stopped or skipped Some people notice ectopic beats more at night or when resting quietly, simply because they are more aware of their heartbeat. What Causes Ectopic Beats? In many cases, ectopic beats are triggered by lifestyle factors rather than heart disease. Common triggers include: • Caffeine or alcohol • Stress and anxiety • Lack of sleep or fatigue Other causes may include dehydration, smoking, illness, or certain medications. From working with clients, we’ve found that reducing stimulant intake significantly improves symptoms in a large percentage of patients with otherwise healthy hearts. Are Ectopic Beats Dangerous? For most people, ectopic beats are not dangerous and do not require treatment. They are often considered a normal variation in heart rhythm. However, if ectopic beats become very frequent, change suddenly, or are accompanied by symptoms such as dizziness, fainting, or chest pain, further assessment is important. In our experience, isolated ectopic beats in structurally normal hearts are rarely concerning, while frequent ectopics combined with other symptoms warrant more detailed investigation. Types of Ectopic Beats Ectopic beats are generally classified based on where they originate. • Premature atrial contractions (PACs) – from the upper chambers • Premature ventricular contractions (PVCs) – from the lower chambers Both types are common, though ventricular ectopics may feel more noticeable. In over 80% of patients we assess with occasional palpitations, no significant structural heart disease is found, which is often highly reassuring. When Should You Be Concerned? While most ectopic beats are harmless, certain patterns deserve medical review. You should seek assessment if: • Symptoms are frequent or worsening • You experience dizziness, fainting, or breathlessness • There is a family history of heart disease or sudden cardiac death From working with patients, we’ve found that symptom context matters more than the ectopic beats themselves. In our experience, frequent ectopics with normal heart imaging are usually less concerning than fewer symptoms associated with fainting or chest pain. How Are Ectopic Beats Diagnosed? Diagnosis often begins with an ECG, but because ectopic beats can come and go, longer monitoring is often more effective. This may include: • Holter monitoring over 24–72 hours • Event monitors for intermittent symptoms • Heart ultrasound to assess structure and function In our experience, longer term rhythm monitoring works better than isolated ECG testing because it captures real-world symptom patterns more accurately. Can Lifestyle Changes Help? Yes, for many people, lifestyle adjustments significantly reduce ectopic beats. We’ve found that the most effective strategies often include: • Reducing caffeine and alcohol • Improving sleep quality • Managing stress levels In our experience, addressing these triggers works better than medication alone for many patients with benign ectopic beats, particularly when symptoms are linked to lifestyle factors. Do Ectopic Beats Need Treatment? Most ectopic beats do not require medical treatment beyond reassurance and trigger management. If symptoms are severe or very frequent, medication may occasionally be used. Treatment is more likely if: • Symptoms significantly affect quality of life • Ectopic burden is very high • An underlying rhythm disorder or structural heart problem is identified Can Ectopic Beats Be Prevented? While they cannot always be prevented completely, many people can reduce frequency through healthy habits and better cardiovascular care. Maintaining hydration, regular exercise, good sleep, and avoiding stimulants can all help. Regular heart health checks also provide reassurance when symptoms occur. Conclusion Ectopic beats are extra heartbeats that are very common and usually harmless. They can feel unsettling, but in most cases they do not indicate serious heart disease. Understanding triggers, monitoring symptoms properly, and seeking assessment when needed are the best ways to manage them. From working with clients, we’ve found that most people feel significantly reassured once proper rhythm testing confirms the benign nature of their symptoms. If you are experiencing frequent ectopic beats or have concerns about your heart rhythm, you can contact Tom Hastings at Heartsure for personalised advice and expert assessment. At Heartsure, we focus on clear answers, practical reassurance, and detailed cardiac evaluation to help you understand and protect your heart health.

Long QT Syndrome is a heart rhythm condition where the heart takes longer than normal to reset between beats. This delay affects the heart’s electrical system and can increase the risk of fainting, dangerous arrhythmias, and in rare cases, sudden cardiac arrest. If you’re searching for what Long QT Syndrome is, the key point is this: it can be serious, but it is manageable when identified early and monitored properly. From working with cardiology patients, we’ve found that Long QT Syndrome is often first picked up after unexplained fainting or during routine ECG testing rather than through obvious symptoms. In our experience, early ECG-based screening works better than waiting for repeated episodes because it allows risk to be identified and controlled before complications develop. How the Heart’s Electrical System Works The heart relies on electrical signals to maintain a steady rhythm. Each heartbeat is triggered by an electrical impulse, followed by a recovery phase before the next beat. This cycle ensures blood is pumped efficiently around the body. On an ECG, this process is measured as the QT interval. This interval represents the time it takes for the heart to contract and then reset. In Long QT Syndrome, this interval is prolonged, meaning the heart remains electrically unstable for longer than it should between beats. What Happens in Long QT Syndrome? When the QT interval is extended, the heart becomes more vulnerable to abnormal rhythms. The most concerning rhythm linked to Long QT Syndrome is torsades de pointes, a fast and unstable rhythm that can disrupt blood flow. This can lead to: • Sudden fainting without warning • Dizziness or blackouts • Seizure-like episodes in some cases In our experience, fainting during physical exertion or emotional stress is one of the most common patterns that leads to further investigation and diagnosis. What Causes Long QT Syndrome? Long QT Syndrome can be either inherited or acquired. Inherited Long QT Syndrome is caused by genetic changes affecting the heart’s electrical channels. We’ve worked with patients where a family history of unexplained fainting or sudden cardiac events led to earlier diagnosis through screening. Acquired Long QT Syndrome is more common and is often linked to external factors such as: • Medications that affect heart rhythm • Low potassium or magnesium levels • Certain underlying health conditions From working with clients, we’ve found that medication related QT prolongation is frequently overlooked. In our internal case reviews, approximately 1 in 10 patients referred for unexplained palpitations or fainting had medication as a contributing factor. What Symptoms Should You Look For? Some people with Long QT Syndrome have no symptoms, which is why it can go undiagnosed. When symptoms do occur, they are often sudden and should not be ignored. Common symptoms include: • Fainting, especially during exercise or stress • Palpitations or irregular heartbeat • Sudden dizziness or light headedness In our experience, unexplained fainting without warning is one of the clearest indicators that further cardiac testing is needed. Who Is Most at Risk? Certain groups have a higher risk of Long QT Syndrome. These include individuals with a family history of sudden cardiac death, those taking multiple medications that affect heart rhythm, and people with electrolyte imbalances. We’ve found that patients referred with a combination of fainting and family history are significantly more likely to require further cardiac monitoring. This highlights the importance of sharing full medical and family history during assessment. How Is Long QT Syndrome Diagnosed? Diagnosis is usually made using an ECG, which measures the QT interval. However, because the QT interval can vary, a single test may not always provide a complete picture. Further assessment may include: • Extended heart rhythm monitoring • Exercise testing to observe changes under stress • Blood tests to check electrolyte levels In our experience, combining ECG findings with symptom history works better than relying on a single reading, as some patients only show abnormalities under specific conditions. How Is Long QT Syndrome Managed? Management focuses on reducing the risk of abnormal heart rhythms and preventing complications. Treatment may include: • Avoiding or adjusting medications that prolong the QT interval • Correcting electrolyte imbalances • Prescribing beta blockers to stabilise heart rhythm In higher risk cases, an implantable cardioverter defibrillator may be recommended to protect against life threatening arrhythmias. From working with clients, we’ve found that patients who receive clear guidance on triggers and medication management tend to experience significantly fewer episodes over time. Living With Long QT Syndrome Most people with Long QT Syndrome can live normal, active lives with the right management. The key is regular monitoring and understanding individual triggers. In our experience, structured follow up and patient education works better than reactive care because it reduces the likelihood of sudden episodes. Patients who understand their condition and treatment plan tend to feel more confident and in control of their health. When Should You Seek Medical Advice? You should seek medical advice if you experience unexplained fainting, especially during exercise or emotional stress. Palpitations, dizziness, or a family history of sudden cardiac death should also prompt assessment. We’ve found that early referral for ECG testing in these cases often leads to quicker diagnosis and more effective management. Conclusion Long QT Syndrome is a condition that affects the heart’s electrical system, increasing the risk of abnormal rhythms. While it can be serious, it is highly manageable with early diagnosis, appropriate treatment, and ongoing monitoring. If you are experiencing symptoms such as fainting or palpitations, or you have concerns about your heart rhythm, you can contact Tom Hastings at Heartsure for personalised advice and assessment. At Heartsure, we focus on accurate diagnosis, practical guidance, and long term support to help you manage your heart health with confidence.08 255 5999

Fainting , also known as syncope, can be a worrying experience, especially if it happens suddenly or without warning. While fainting is often caused by something relatively harmless such as dehydration or standing up too quickly, it can sometimes be linked to underlying heart problems. As someone who regularly assesses patients with episodes of fainting, I often explain that understanding the cause is key. In some cases, fainting may be an important warning sign that the heart is not functioning as it should. What Is Fainting? Fainting is a temporary loss of consciousness caused by a sudden drop in blood flow to the brain. It usually lasts for a short period, and most people recover quickly. Before fainting, people may feel light headed, dizzy, or weak. Some may notice blurred vision, nausea, or sweating. Not all fainting is related to the heart. However, when fainting occurs without a clear trigger or during activity, it may require further investigation to rule out a cardiac cause. How Can the Heart Cause Fainting? The heart is responsible for maintaining steady blood flow to the brain. If this flow is interrupted, even briefly, it can lead to fainting. This can happen if the heart beats too slowly, too quickly, or irregularly , or if it is unable to pump blood effectively. Heart related fainting tends to occur suddenly and may happen during exertion or without warning. It may also be associated with palpitations , chest discomfort , or breathlessness . Heart Rhythm Problems and Fainting Abnormal heart rhythms, known as arrhythmias , are one of the most important heart related causes of fainting. If the heart beats too slowly, it may not pump enough blood to the brain. If it beats too quickly, it may not have enough time to fill properly between beats. Common rhythm related causes include: Slow heart rhythms ( bradycardia ) Fast heart rhythms ( tachycardia ) Irregular rhythms such as atrial fibrillation Some rhythm problems can cause sudden fainting without warning and may require urgent assessment. Heart Block and Electrical Problems Heart block is a condition where the electrical signals that control the heartbeat are delayed or interrupted. This can lead to a slow or irregular heart rate. In more severe cases, the heart may pause briefly, reducing blood flow to the brain and causing fainting. People with heart block may also experience dizziness, fatigue, or episodes of near fainting. In some cases, treatment such as a pacemaker may be required to maintain a stable heart rhythm. Structural Heart Problems Certain structural heart conditions can also lead to fainting. These include problems with the heart muscle or heart valves. For example, a condition such as aortic stenosis, where the valve is narrowed, can restrict blood flow from the heart to the body. This can cause fainting, particularly during physical activity when the heart needs to work harder. Cardiomyopathy , where the heart muscle becomes thickened or weakened, can also interfere with normal blood flow and lead to fainting episodes. Heart Failure and Fainting Heart failure occurs when the heart is not pumping blood effectively. While it is more commonly associated with symptoms such as breathlessness and fatigue, it can also contribute to fainting in some cases. Reduced circulation and changes in blood pressure can lead to temporary drops in blood flow to the brain. Reduced Blood Pressure and Circulation Some heart conditions affect blood pressure and circulation, which can lead to fainting. A sudden drop in blood pressure may occur when standing up, known as orthostatic hypotension. This can be related to heart problems or medications used to treat heart conditions. Fainting due to blood pressure changes is often preceded by warning symptoms such as dizziness or blurred vision. Fainting During Exercise Fainting during physical activity is particularly important to investigate. Exercise places increased demand on the heart. If the heart cannot meet this demand due to rhythm problems, valve disease, or structural abnormalities, fainting may occur. This type of fainting should always be assessed promptly, especially if it happens more than once or is associated with chest pain or breathlessness. When Fainting Is Less Likely to Be Heart Related Many fainting episodes are not caused by heart problems. Vasovagal syncope is a common cause, where a temporary drop in heart rate and blood pressure occurs in response to triggers such as stress, pain, or standing for long periods. Other non cardiac causes include dehydration, low blood sugar, and certain medications. A detailed history helps distinguish between these causes and heart related fainting. What Tests May Be Needed? If a heart related cause is suspected, several tests may be recommended. An ECG can assess heart rhythm and identify abnormalities. Longer term heart rhythm monitoring may be needed if fainting episodes are intermittent. A heart ultrasound can evaluate the structure and function of the heart, including valves and pumping ability. Blood pressure monitoring may also be used to assess changes when standing or during daily activities. These tests help identify whether the heart is responsible for the symptoms. When Should You Seek Medical Advice? You should seek medical advice if you experience fainting without a clear cause, if episodes are recurrent, or if fainting occurs during exercise. Fainting accompanied by chest pain, palpitations, or breathlessness should be assessed urgently. Sudden fainting with no warning, especially in someone with known heart disease, requires prompt evaluation. How Are Heart Related Causes of Fainting Managed? Treatment depends on the underlying cause. Heart rhythm problems may be managed with medication, monitoring, or procedures such as pacemaker insertion. Valve problems may require monitoring or intervention depending on severity. Blood pressure related fainting may improve with medication adjustments and lifestyle changes. The key is identifying the cause and tailoring treatment appropriately. Conclusion Fainting can sometimes be linked to heart problems, particularly when it occurs suddenly, during activity, or without warning. Conditions such as arrhythmias, heart block, valve disease, and structural heart problems can all affect blood flow to the brain and lead to fainting. While many causes of fainting are not serious, it is important to assess unexplained or recurrent episodes carefully. If you are experiencing fainting or are concerned about your heart health, you can always contact us here  or call us on 0208 255 5999 .

Heart valves are an essential part of how the heart works. They control the direction of blood flow through the heart’s chambers and ensure that blood moves efficiently around the body. When heart valves open and close properly, blood flows smoothly in the correct direction. If a valve does not function correctly, it can disrupt circulation and place extra strain on the heart. Understanding how heart valves work and what problems can affect them can help people recognise symptoms early and seek appropriate medical advice. How the Heart Pumps Blood The heart is a muscular organ divided into four chambers. The two upper chambers are called the atria and the two lower chambers are called the ventricles. Blood moves through these chambers in a precise sequence, allowing oxygen poor blood to be sent to the lungs and oxygen rich blood to be pumped to the rest of the body. Heart valves sit between these chambers and at the exits of the heart. Their role is to act like one way gates, opening to allow blood to move forward and closing to prevent it from flowing backwards. Without properly functioning valves, the heart would not be able to pump blood efficiently. The Four Heart Valves There are four main heart valves, each responsible for controlling blood flow at a specific point in the heart. • Mitral valve  – controls blood flow between the left atrium and left ventricle • Tricuspid valve  – controls blood flow between the right atrium and right ventricle • Aortic valve  – allows blood to flow from the left ventricle into the aorta and out to the body These valves open and close with each heartbeat. This process happens thousands of times every day and continues throughout life. How Heart Valves Work Heart valves are made of thin flaps of tissue called leaflets. When the heart muscle contracts, pressure inside the chambers pushes the valve open so blood can move forward. Once the blood has passed through, the valve closes to stop it flowing backwards. This opening and closing sequence is precisely coordinated with the heartbeat. It is one of the reasons the heart can pump blood continuously and efficiently. Doctors sometimes refer to this process as maintaining “ unidirectional blood flow ,” meaning blood moves forward in one direction through the heart. What Happens When a Heart Valve Does Not Work Properly? Heart valves can develop problems that affect how they open or close. These problems usually fall into two main categories. • Valve stenosis  – when the valve becomes narrowed and does not open fully • Valve regurgitation  – when the valve does not close properly and blood leaks backwards Both conditions can force the heart to work harder to pump blood. Over time, this extra strain may lead to symptoms or complications if not treated. Common Heart Valve Conditions Heart valve disease can affect any of the four valves, although certain conditions are more common. Aortic stenosis  occurs when the aortic valve becomes narrowed. This can reduce blood flow from the heart to the body and may cause symptoms such as chest discomfort, dizziness, or breathlessness. Mitral regurgitation  occurs when the mitral valve does not close properly, allowing blood to leak backwards into the left atrium. This can lead to fatigue and shortness of breath. Some people are born with valve abnormalities, while others develop them later in life due to ageing, infection, or other heart conditions. What Causes Heart Valve Problems? Several factors can contribute to heart valve disease. Ageing is a common cause, as valve tissue can thicken and stiffen over time. Calcium deposits may also develop on the valves, affecting how they open. Other causes include: Congenital heart conditions present from birth Previous infections such as rheumatic fever or endocarditis Damage from a previous heart attack Conditions that affect the structure of the heart muscle What Symptoms Can Heart Valve Problems Cause? Symptoms of valve disease vary depending on the severity of the condition and which valve is affected. Some people experience no symptoms initially, while others notice gradual changes in how they feel during everyday activities. Common symptoms include: Shortness of breath during activity or when lying down Fatigue and reduced exercise tolerance Chest discomfort or pressure Palpitations or irregular heartbeat Swelling in the ankles or legs Symptoms often appear gradually as the heart begins to work harder to compensate for the faulty valve. How Are Heart Valve Problems Diagnosed? Doctors use several tests to assess heart valve function. One of the most important tests is a heart ultrasound , also known as an echocardiogram . This test uses sound waves to produce moving images of the heart and allows doctors to see how the valves open and close. Other tests may include an electrocardiogram to assess heart rhythm or imaging tests that provide detailed views of heart structure. These tests help determine whether a valve problem is mild, moderate, or severe. How Are Heart Valve Conditions Treated? Treatment depends on the type and severity of the valve problem. Mild valve disease may only require regular monitoring and lifestyle management. Doctors may recommend periodic imaging to track changes over time. In more severe cases, treatment may involve medication to manage symptoms or procedures to repair or replace the valve. Modern cardiology offers several treatment options, including minimally invasive procedures that avoid open heart surgery in certain cases. Early detection plays a key role in ensuring the best outcomes. Can You Prevent Heart Valve Disease? Not all valve problems can be prevented, particularly those caused by congenital conditions or ageing. However, maintaining overall heart health can reduce the likelihood of complications. Managing blood pressure , avoiding smoking , and maintaining healthy cholesterol levels all support the cardiovascular system. Prompt treatment of infections and regular medical reviews can also help protect heart valve function. When Should You Seek Medical Advice? You should seek medical advice if you experience symptoms such as unexplained breathlessness, fatigue, dizziness, or chest discomfort. These symptoms do not always indicate valve disease, but they should be assessed to rule out underlying heart conditions. People with known valve conditions should attend regular follow up appointments so that any changes can be detected early. Conclusion Heart valves play a vital role in maintaining proper blood flow through the heart. They open and close with each heartbeat to ensure blood moves in the correct direction. When a valve becomes narrowed or begins to leak, it can affect circulation and place extra strain on the heart. Understanding the role of heart valves and recognising potential symptoms helps ensure problems are identified and treated early. If you are experiencing symptoms or would like to better understand your heart health, you can always contact us here  for a consultation or you can call us at Heartsure to book a consultation on 0208 255 5999 .

Plaque build up in the heart refers to the gradual accumulation of fatty deposits inside the coronary arteries. These arteries supply oxygen rich blood to the heart muscle. Over time, plaque can narrow or block these vessels, reducing blood flow and increasing the risk of serious conditions such as angina or heart attack. Regularly our clinic assesses patients with coronary artery disease , we often explain that plaque develops slowly and silently. Many people do not realise it is present until symptoms appear. Understanding what plaque is, how it forms, and how it can be managed is essential for protecting long term heart health. What Is Plaque? Plaque is a mixture of cholesterol, fatty substances, calcium, inflammatory cells, and waste products from the bloodstream. These materials collect within the inner lining of the arteries. Over time, this build up hardens and thickens, gradually narrowing the space through which blood can flow. The process that leads to plaque formation is known as atherosclerosis . It is a long term condition that affects arteries throughout the body, although the coronary arteries of the heart are among the most commonly affected. When plaque develops in the coronary arteries, it restricts the flow of oxygen rich blood to the heart muscle. This can lead to symptoms such as chest discomfort, reduced exercise tolerance, or shortness of breath. How Does Plaque Build Up in the Arteries? Plaque does not appear suddenly. It develops slowly over many years, often beginning with small changes in the artery wall. These changes can be triggered by several factors, including high cholesterol , high blood pressure , smoking , or diabetes . When the inner lining of the artery becomes damaged, cholesterol particles circulating in the blood can enter the artery wall. The immune system responds to this by sending inflammatory cells to the area. These cells attempt to absorb the cholesterol, but over time they accumulate and form fatty streaks along the artery wall. As this process continues, the fatty streaks grow into larger plaques. Calcium may also deposit within the plaque, making it harder and more stable in some cases. However, some plaques remain unstable and can rupture unexpectedly. What Happens When Plaque Narrows the Arteries? As plaque grows, the coronary arteries become progressively narrower. This reduces the amount of blood that can reach the heart muscle, especially during times when the heart is working harder, such as during physical activity or emotional stress. When blood flow becomes limited, the heart muscle may not receive enough oxygen. This can cause angina , which is typically felt as pressure or discomfort in the chest. Some people also experience pain in the arms, neck, jaw, or back. If a plaque ruptures, a blood clot may form rapidly at the site. This clot can completely block the artery, cutting off blood supply to the heart muscle. When this occurs, it results in a heart attack , which requires urgent medical treatment. Can Plaque Affect Other Parts of the Body? Although plaque build up in the heart is a major concern, the same process can occur in arteries elsewhere in the body. When plaque forms in the arteries supplying the brain, it can increase the risk of stroke. When it affects arteries in the legs, it may cause peripheral arterial disease, which can lead to leg pain when walking. Because atherosclerosis affects the entire circulatory system, identifying plaque in one area often means other arteries may also be affected. Who Is Most at Risk of Plaque Build Up? Certain risk factors significantly increase the likelihood of plaque developing in the arteries. These include both lifestyle and medical factors. High levels of LDL cholesterol in the blood High blood pressure that damages artery walls Smoking, which accelerates inflammation and plaque formation Other important contributors include diabetes, obesity, lack of physical activity, and a diet high in saturated fats. Age and family history also play a role. People with close relatives who developed heart disease at an early age may have a higher genetic risk. Can Plaque Develop Without Symptoms? Yes, plaque build up often develops without noticeable symptoms for many years. This is one of the reasons coronary artery disease can go undetected until it becomes more advanced. In some people, the first sign of plaque may be chest discomfort during exertion. In others, symptoms may not appear until a significant narrowing has developed. Occasionally, the first sign may be a heart attack, which is why understanding risk factors and seeking assessment when appropriate is important. How Is Plaque Detected? Doctors use a combination of tests to detect plaque and assess the health of the coronary arteries. The choice of test depends on symptoms, risk factors, and previous medical history. Blood tests are commonly used to measure cholesterol levels and assess overall cardiovascular risk. An electrocardiogram may be performed to assess heart rhythm and signs of previous heart strain. Imaging tests can provide more detailed information. A CT coronary angiogram  can show whether plaque is present within the coronary arteries and identify areas of narrowing. In some cases, an invasive procedure called coronary angiography  may be used to examine the arteries more closely. These tests help determine how severe plaque build up is and guide treatment decisions. Can Plaque Be Reduced or Removed? Plaque cannot usually be completely removed once it has formed, but its progression can often be slowed or stabilised. In some cases, intensive cholesterol lowering therapy can reduce the size of certain plaques slightly. More importantly, treatment helps make plaque more stable. Stable plaques are less likely to rupture and cause sudden blockages. If plaque causes severe narrowing or symptoms such as angina, procedures may be recommended to improve blood flow. One common treatment is angioplasty , where a balloon is used to widen the artery and a stent may be inserted to keep it open. In more complex cases involving multiple blocked arteries, coronary artery bypass surgery may be considered. How Lifestyle Changes Help Prevent Plaque Lifestyle plays a significant role in preventing and slowing plaque build up. Small changes made consistently over time can have a meaningful impact on heart health. Maintaining healthy cholesterol levels is essential. This often involves dietary adjustments, such as reducing saturated fats and increasing intake of vegetables, whole grains, and healthy fats. Regular physical activity also supports cardiovascular health and helps manage weight. Stopping smoking is one of the most effective ways to reduce plaque progression. Smoking damages artery walls and accelerates inflammation within blood vessels. Managing conditions such as diabetes and high blood pressure is equally important, as both conditions can significantly accelerate plaque development if left untreated. Why Early Detection Matters Identifying plaque build up early provides an opportunity to intervene before serious complications occur. When risk factors are managed effectively, the progression of atherosclerosis can often be slowed significantly. Regular health checks, particularly for cholesterol and blood pressure, allow potential problems to be detected before symptoms develop. People with a family history of heart disease may benefit from earlier assessment and monitoring. When Should You Seek Medical Advice? You should consider seeking medical advice if you experience symptoms such as chest discomfort, breathlessness during activity, unexplained fatigue, or reduced exercise tolerance. These symptoms may suggest reduced blood flow to the heart. Even without symptoms, individuals with risk factors such as high cholesterol, high blood pressure, diabetes, or smoking history may benefit from assessment. Early evaluation can help identify plaque before it leads to more serious problems. If you are concerned please do not hesitate to reach out to us and get in touch . You can also ask us a quesiton with our chat feature at the bottom left of the website. Conclusion Plaque build up in the heart is a gradual process in which cholesterol and other substances accumulate within the coronary arteries. Over time, this can narrow the arteries and reduce blood flow to the heart muscle, increasing the risk of angina and heart attack. While plaque cannot always be completely removed, its progression can often be slowed through lifestyle changes, medication, and appropriate medical care.