Heart Clinic Online — specialist care for the heart and blood vessels

Typical age

Adults, more common with increasing age.

Background

One of the most common conditions in cardiovascular care, often without symptoms.

Common symptoms

Often no symptoms at all; sometimes headache or dizziness at very high readings.

What the doctor looks for

Repeated blood pressure measurements, often home readings over time.

Investigations

Blood pressure measurement, blood tests (kidney function, glucose, lipids), sometimes an ECG.

How the diagnosis is made

Through repeated measurements showing consistently raised readings.

Management

Lifestyle measures (diet, exercise, salt intake) and blood-pressure-lowering medication where needed.

Follow-up

Regular checks of blood pressure and any side effects of treatment.

Prognosis

Good with well-controlled blood pressure; untreated, it raises cardiovascular risk over time.

Risk factors to know

Heredity, overweight, high salt intake, physical inactivity, chronic stress, high alcohol intake.

Common misconception

That you can feel when your blood pressure is high. The vast majority of people with raised blood pressure notice nothing at all — which is precisely why regular measurement matters.

What you can do yourself

Measure at home morning and evening for at least three days — two readings each time after five minutes' rest. Discard the first day and average the rest.

When should you book?

When home readings repeatedly exceed 135/85, or if you have high blood pressure and have recently changed medication.

Typical age

More common after 65, but it occurs in younger people too.

Background

The most common form of irregular heart rhythm.

Common symptoms

Palpitations, fatigue, breathlessness; sometimes no symptoms at all.

What the doctor looks for

An irregular pulse on examination.

Investigations

An ECG is decisive; sometimes longer rhythm monitoring.

How the diagnosis is made

An ECG showing the absence of normal atrial rhythm.

Management

Depends on cause and risk level — may include medication for rhythm or rate control, plus blood-thinning treatment to reduce stroke risk.

Follow-up

Regular checks of rhythm, anticoagulation and any symptoms.

Prognosis

Manageable with the right treatment; untreated, it raises the risk of stroke.

Risk factors to know

Older age, high blood pressure, sleep apnoea, excessive alcohol intake, valvular heart disease, overactive thyroid.

Common misconception

That atrial fibrillation is always obvious. Many people live with it entirely without symptoms, which makes blood-thinning treatment particularly important even without complaints.

What you can do yourself

Feel your pulse at the wrist when you notice palpitations and note whether it is regular or not — that is valuable information for the doctor.

When should you book?

For a newly irregular pulse, or if you have known fibrillation and notice the episodes becoming more frequent or longer.

Typical age

More common in middle age and upwards.

Background

Occurs when the heart muscle gets too little oxygen, usually on exertion.

Common symptoms

Pressing chest pain on exertion that eases at rest.

What the doctor looks for

The symptom pattern in relation to exertion.

Investigations

ECG, exercise testing, sometimes cardiac imaging.

How the diagnosis is made

Through the symptom picture combined with examination findings.

Management

Lifestyle change, medication, and in some cases catheter-based or surgical treatment.

Follow-up

Regular assessment of symptom control and risk factors.

Prognosis

Good with the right treatment and risk factor control.

Risk factors to know

Smoking, diabetes, high cholesterol, high blood pressure, heredity, a sedentary lifestyle.

Common misconception

That angina and a heart attack are the same thing. Angina is a warning sign that eases at rest — pain that does NOT ease at rest requires emergency assessment.

What you can do yourself

Note exactly how much exertion triggers the symptoms and whether that threshold has changed — deterioration over time is important information.

When should you book?

If you get chest symptoms on less exertion than before. If the symptoms come at rest — seek emergency care, don't book.

Typical age

Varies, more common in middle age and upwards.

Background

After a heart attack, structured follow-up is needed for recovery and secondary prevention.

Symptoms at follow-up

Fatigue, worry, questions about returning to activity.

What the doctor looks for

How symptoms develop, adherence to medication, risk factors.

Investigations

Review of previous records, current test results, sometimes follow-up imaging.

How the assessment is made

Based on previous medical documentation and current status.

Management

Continued secondary preventive medication, lifestyle support, rehabilitation advice.

Follow-up

Regular checks according to an individual plan.

Prognosis

Substantially improved with good secondary prevention and adherence to medication.

Common questions patients ask

“When can I start exercising again?”, “Is it safe to have sex?”, “Will I be able to work as before?” — all legitimate questions that deserve straight answers, not evasion.

What you can do yourself

Bring your current medication list to every visit and note any side effects — adherence is the single most important factor for the prognosis.

When should you book?

For questions about returning to work or exercise, for suspected side effects, or when it's time for planned follow-up.

An ongoing or suspected acute heart attack is always an emergency — see the safety box above. This section covers follow-up after an earlier, already-treated event, not acute treatment.

Typical age

More common with increasing age.

Background

The heart can't pump efficiently enough for the body's needs.

Common symptoms

Breathlessness, swollen legs, fatigue, reduced exercise capacity.

What the doctor looks for

Fluid retention, breathing pattern, previous cardiac history.

Investigations

Blood tests, ECG, echocardiography.

How the diagnosis is made

A combination of symptoms, examination findings and imaging.

Management

Medication, fluid and salt restriction, monitoring of weight and symptoms.

Follow-up

Regular checks of symptoms, weight and medication dosing.

Prognosis

Varies with cause and severity; good symptom control is possible with the right treatment.

Common misconception

That heart failure means the heart is about to stop. The name is misleading — it is about reduced pumping capacity, not imminent cardiac arrest, and many people live well for many years with good treatment.

What you can do yourself

Weigh yourself at the same time every morning. A rapid gain of two to three kilos over a few days often indicates fluid retention and should prompt contact with care.

When should you book?

For increased breathlessness, increasing leg swelling, or rapid weight gain as above.

Typical age

More common with increasing age, but can be congenital.

Background

One or more heart valves aren't working as they should — narrowed or leaking.

Common symptoms

Breathlessness, fatigue, in some cases chest pain or feeling faint.

What the doctor looks for

A murmur on cardiac examination.

Investigations

Echocardiography is central to diagnosis and grading.

How the diagnosis is made

Through imaging that shows how the valve is functioning.

Management

Depends on type and severity — anything from monitoring to medication or surgical/catheter-based intervention.

Follow-up

Regular checks, often annual echocardiography with known valve disease.

Prognosis

Varies considerably with type and grade; many cases are stable for a long time.

A common question

Do I need surgery straight away? The answer is almost always no with mild to moderate valve disease — most cases are followed over time, and surgery is considered only when the grade and the symptoms justify it.

What you can do yourself

Keep track of whether your exercise capacity has gradually declined — that is often the first sign that valve disease has progressed.

When should you book?

For newly developed breathlessness, or when it's time for your planned annual check.

Typical age

All ages.

Background

Brief episodes of palpitations without underlying serious heart disease, often linked to stress, caffeine or lack of sleep.

Common symptoms

A brief sensation of the heart “skipping” or beating faster.

What the doctor looks for

The symptom pattern, triggers, and a normal cardiac examination.

Investigations

ECG to rule out an underlying rhythm disturbance; sometimes longer rhythm recording for recurring symptoms.

How the assessment is made

By ruling out more serious causes through examination.

Management

Often no specific treatment is needed; lifestyle advice on stress, caffeine and sleep.

Follow-up

As needed, if the symptoms change or increase.

Prognosis

Usually good, but it should always be assessed by a doctor to rule out another cause.

A common worry

Many people who experience this are afraid it is dangerous. Even though it is almost always benign, it is entirely reasonable and right to have it checked — particularly the first time.

What you can do yourself

Try cutting caffeine, alcohol and nicotine for two weeks and note whether the symptoms change — that often gives a clear answer.

When should you book?

For first-time symptoms, or if the palpitations come with dizziness, chest pain or feeling faint.

Typical age

Adults, increasing with age.

Background

Raised blood lipids increase the risk of arterial disease over time.

Common symptoms

Usually no symptoms.

What the doctor looks for

Blood test values in combination with the overall risk picture.

Investigations

Blood tests (total cholesterol, LDL, HDL, triglycerides).

How the diagnosis is made

Through blood test analysis.

Management

Dietary change, physical activity, and medication where needed.

Follow-up

Regular checks of blood lipids and treatment effect.

Prognosis

Good risk reduction is possible with treatment and lifestyle change.

Risk factors to know

Heredity plays a large part, and people of normal weight may well have raised values — it is not only a question of being overweight.

What you can do yourself

Replace saturated fat with unsaturated, increase fibre, and be physically active regularly — lifestyle change often gives a measurable effect within three months.

When should you book?

For newly found raised values, or for follow-up three to six months after starting treatment.

Typical age

All ages, with different underlying causes by age.

Background

A temporary loss of consciousness caused by a temporary drop in blood flow to the brain.

Common symptoms

Sudden fainting, often preceded by dizziness or visual disturbance.

What the doctor looks for

The circumstances around the event, previous cardiac history.

Investigations

ECG, blood pressure lying and standing, sometimes longer rhythm monitoring or echocardiography.

How the assessment is made

By mapping the pattern and ruling out a cardiac cause.

Management

Depends on the cause — anything from fluid and salt advice for a benign cause to specific cardiac treatment.

Follow-up

According to the established cause and risk level.

Prognosis

Varies greatly with the underlying cause — most cases are benign, but a cardiac cause always requires further investigation.

What you can do yourself

Note exactly what you were doing just before — were you standing up, exerting yourself, were you hot? That often decides the assessment.

When should you book?

After any faint that doesn't have an obvious benign explanation. For fainting during exertion — seek emergency care.

Fainting DURING physical exertion (not after) is always significant and should be assessed promptly, because it is more often linked to a cardiac cause.

Typical age

More common with increasing age.

Background

Swelling in the legs can have several causes, including cardiac ones.

Common symptoms

Swelling, a feeling of heaviness, in some cases skin changes.

What the doctor looks for

Whether the swelling is one-sided or affects both legs, and other cardiac symptoms.

Investigations

Clinical assessment, sometimes blood tests or referral for imaging.

How the assessment is made

By separating a cardiac cause from other causes (for example venous insufficiency or a medication side effect).

Management

Depends on the cause — may include compression stockings, medication adjustment or further cardiac investigation.

Follow-up

According to the established cause.

Prognosis

Good once the cause has been correctly identified and treated.

What you can do yourself

Raise your legs above heart level for twenty minutes a couple of times a day and note whether the swelling goes down — swelling that persists is more significant.

When should you book?

For new or increasing swelling, particularly alongside breathlessness.

Sudden, one-sided swelling with pain can in rare cases indicate a blood clot and should be assessed promptly; gradual swelling in both legs is more often benign but still deserves investigation.

Typical age

All adult ages, most common in young and middle-aged people.

Background

One of the most common reasons people seek care for cardiac symptoms. The body's stress response raises the pulse and makes the heartbeat more noticeable — which in turn creates worry, which increases the stress response further. A self-reinforcing circle that is unpleasant but fundamentally harmless when the heart is healthy.

Common symptoms

Fast pulse, a sense of the heart pounding, breathlessness without exertion, pressure in the chest, sometimes tingling in the hands.

What the doctor looks for

The link between symptoms and stressful situations, and that the heart is otherwise healthy.

Investigations

ECG to rule out a rhythm disturbance; sometimes thyroid blood tests.

How the assessment is made

By ruling out cardiac causes — the stress explanation only becomes reassuring once the heart has been confirmed healthy.

Management

Understanding the mechanism is often treatment in itself; beyond that, stress management, sleep, and talking support where needed.

Follow-up

If symptoms persist or the pattern changes.

Risk factors to know

Lack of sleep, high caffeine intake, acute life stress, previous panic disorder.

Common misconception

That “it's just stress” means you're imagining it. The symptoms are entirely real — it is the cause, not the experience, that is benign.

What you can do yourself

Slow breathing out (longer out than in) for a few minutes often breaks an acute episode.

When should you book?

For first-time symptoms, to have the heart assessed and be able to let go of the worry.

Prognosis

Very good once a cardiac cause has been ruled out.

Typical age

All ages, considerably more common in older people.

Background

Blood pressure falls on standing up, because the body's regulation doesn't compensate quickly enough. Common with dehydration, certain medications, and with increasing age.

Common symptoms

Dizziness or blacking out on standing, sometimes feeling faint, usually passing within seconds.

What the doctor looks for

The difference in blood pressure between lying and standing, plus a review of the medication list.

Investigations

Blood pressure measured both lying and standing, blood tests where dehydration or anaemia is suspected.

How the diagnosis is made

A documented drop in blood pressure on standing, combined with symptoms.

Management

Increased fluid and salt intake where appropriate, standing up more slowly, often an adjustment of blood pressure medication.

Follow-up

After medication adjustment, to check the effect.

Risk factors to know

Blood pressure medication, diuretics, dehydration, prolonged bed rest, diabetes.

Common misconception

That it is just “standing up too fast”. In older people it is often medication-related and entirely fixable.

What you can do yourself

Get up in two stages — sit up first, wait twenty seconds, then stand.

When should you book?

For recurring dizziness on standing, particularly if you take blood pressure medication.

Prognosis

Good, and often entirely fixable with simple adjustments.

Typical age

All adult ages; often younger people who have become worried after an event in the family.

Background

Heredity is one of the strongest risk factors for cardiovascular disease, particularly if a close relative fell ill early (men before 55, women before 65).

Common symptoms

Often none — it is the worry, not the symptoms, that leads to the visit.

What the doctor looks for

Which relatives, at what age they fell ill, and what kind of cardiac event it was.

Investigations

Blood tests (lipids, glucose), blood pressure, ECG; sometimes further investigation with strong heredity.

How the assessment is made

Through a combined risk evaluation where family history is weighed together with your own readings and lifestyle factors.

Management

Targeted risk reduction — often lifestyle, sometimes starting cholesterol treatment earlier than would otherwise be the case.

Follow-up

Regular risk evaluation, often every few years.

Risk factors to know

Early heart disease in a parent or sibling, familial hypercholesterolaemia, sudden unexplained death in a young relative.

Common misconception

That heredity means there is nothing you can do. The opposite — it is precisely with inherited risk that early measures make the biggest difference.

What you can do yourself

Map your family history before the visit — who, at what age, and what they were affected by.

When should you book?

When a close relative has been affected by heart disease before the age of 65, or if you have never had a risk assessment.

Prognosis

Very good risk reduction is possible with early identification.

Typical age

All ages, most common in young and middle-aged people.

Background

A large share of all chest pain comes not from the heart but from the chest wall, muscles, rib cartilage, the oesophagus or the pleura. The heart still has to be ruled out first, though.

Common symptoms

Pain that worsens on deep breathing, on pressing the chest, or with certain body movements — unlike cardiac pain, which more often depends on the level of exertion.

What the doctor looks for

Whether the pain can be reproduced by pressure or movement, and any link to meals.

Investigations

ECG and sometimes blood tests to rule out a cardiac cause; then clinical assessment of the chest wall and stomach.

How the assessment is made

By systematically ruling out a cardiac cause before other explanations are accepted.

Management

Depends on the cause — pain relief for a musculoskeletal cause, acid suppression for reflux-related pain.

Follow-up

If the pain persists or changes.

Risk factors to know

Heavy lifting or unaccustomed training, reflux, a long-standing cough.

Common misconception

That chest pain always means the heart. It doesn't — but it is the doctor's job, not the patient's, to decide that.

What you can do yourself

Press gently on the tender area — if the pain can be reproduced exactly, that points more often to the chest wall than to the heart. This does not replace an assessment.

When should you book?

For recurring chest pain you want explained. For pain at rest, with cold sweats or breathlessness — seek emergency care.

Prognosis

Good, particularly once a cardiac cause has been ruled out.

Typical age

All adult ages.

Background

Physical activity is one of the most effective treatments in cardiovascular disease — but many people don't dare exercise after a diagnosis, for fear of harming the heart. The result is often unnecessary inactivity, which itself worsens the prognosis.

Common symptoms

Uncertainty rather than symptoms; sometimes breathlessness or pressure that makes the patient afraid to continue.

What the doctor looks for

Current cardiac status, symptoms on exertion, and what kind of training is planned.

Investigations

Review of previous cardiac investigations; sometimes exercise testing where exercise tolerance is uncertain.

How the assessment is made

Individually, based on the diagnosis, the symptom picture and previous findings.

Management

A concrete, individually adapted recommendation on training intensity and which symptoms should make you stop.

Follow-up

If symptoms change or when the training level is to be increased.

Risk factors to know

Uncontrolled blood pressure, a recent cardiac event, pronounced valve disease.

Common misconception

That you should avoid exertion after a cardiac diagnosis. For the vast majority the opposite is true — adapted training improves the prognosis considerably.

What you can do yourself

Start low, increase gradually, and learn to recognise your own warning symptoms rather than avoiding all exertion.

When should you book?

Before you start new or more intensive training with a known cardiac diagnosis.

Prognosis

Very good — adapted physical activity is one of the strongest prognosis-improving measures there is.