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Shortness of Breath

Patients may feel short of breath when they have a problem either with their lungs, their heart,  their gastrointestinal system, or their blood chemistry in addition to some other possible causes. Almost any type of heart disease may present with shortness of breath and it can manifest either during activity or even at rest. Some of the causes are extremely important and need to be treated urgently. So, it is best not to delay assessment when new symptoms appear. Your physician is trained to identify the exact cause of this problem 


Chest Pain

Patients may feel chest pain when they have a problem either with their lungs, their heart, their gastrointestinal system, their musculoskeletal system, in addition to some other possible causes. The pattern and character of the pain and the context in which it occurs can be helpful to the doctor in sorting out the actual cause. Some of the causes are extremely important and need to be treated urgently. So, it is best not to delay assessment when new symptoms appear. Your physician is trained to identify the exact cause of this problem.

Heart disease isn't really an all or none phenomenon. There may be graded amounts of any defect which may be present ranging anywhere from trivial-mild-moderate-severe disease.

Patients usually  start off in a health condition. Some go on to develop the beginning of a problem, and ultimately it may worsen with time. Often patients don't come in to be seen by their doctor until they already have advanced forms of an illness. Fortunately, for some patients the problem is discovered early on and there is ample opportunity for it  to be corrected. Other patients may not be  not so fortunate, and may end up requiring interventions such as angioplasty or bypass  or other therapies. It is through a pro-active philosophy that we all strive to prevent illness and to identify it as early on as possible.


Cardiac Risk factors are  important to recognize and may bear a direct influence on whether or not the patient may go on to develop heart disease. Quite frankly, if everybody were to adopt a policy of living a healthy lifestyle, then the prevalence of bad lifestyle factors* would probably drop, and the likelihood of developing  heart disease would probably drop significantly. Unfortunately, this is not the case. It appears that a large proportion of North Americans are overweight and at risk of manifesting cardiovascular disease in the near future. What's even worse, is that many of our children are less active now then previous generations  were. As a result, doctors anticipate that the next generation of adults will probably be more likely to have have cardiovascular  disease than the present generation.

* Bad Lifestyle factors:  I am referring to issues  like hypertension, high cholesterol, diabetes, metabolic syndrome, smoking, lack of exercise, poor nutrition, stress, etc.    


Vascular disease occurs when fatty plaque builds up along the inner wall of  the blood vessels. As time passes, the plaque may accumulate and cause progressive narrowing of some of the vessels. Ultimately, the narrowing may become significant  enough to impair the function of the organ which is depending on the blood flow from that vessel. This may manifest either with clinical symptoms , with abnormal physical findings, or with abnormal investigations which may  be ordered if your doctor has a high index of suspicion for this disease. In addition, sometimes the plaque may even spontaneously rupture and cause an abrupt blockage of a blood vessel with serious and potentially emergent consequences. When the plaque involves the coronary arteries, it interferes with the oxygen supply of the heart muscle. If the disease is mild, it may be too early to be recognized. But, as the plaque accumulates,  ultimately it may interfere with the supply of oxygenated and nutrient rich blood to such a degree so that whenever the heart needs to do more ( ex running, exercising, etc), the heart will simply not be able to receive enough blood flow to get its work done. That is when the patient begins to notice that he may  feel unwell during an  activity or even at rest.

Vascular disease may occur anywhere in the body and affect any organ system. When it involves the brain, it may cause a stroke. When it involves the heart, it may cause a heart attack or angina. When it involves the legs, it may cause leg cramps.



Abnormal rhythm may be present when patients experience a sensation of fluttering or racing or skipping in their chest. These symptoms are often nonspecific and usually require further testing for clarification. This is often accomplished by doing  a holter monitor or a loop recorder either of which may allow the physician to record a tracing of the heart rhythm during the time of the symptoms. There are several different types of abnormal heart rhythm which may present, and each one needs to be addresses and managed in a different fashion. Each abnormal rhythm carries with it a unique prognosis, some of which are benign and some of which may have serious consequences.  


Heart Murmurs can be noticed in normal patients under virtually any condition. Often they are the finding of a doctor with "good ears". However, murmurs can also be due to significant valvular heart disease. There are usually clinical clues which may help your doctor to determine whether or not a heart murmur is normal or not. When the doctor is uncertain of the nature of the murmur, or when evidence suggests that it is clearly abnormal, then an echo doppler study will be extremely useful in helping to sort things out. One example of an abnormal heart murmur may occur when there is  a valvular abnormality. Abnormal valve disease may be managed either medically or by intervention, depending on how severe it is and whether or not there are symptoms present.



Heart Failure happens when the heart cannot meet its obligations to pump blood forwards in an efficient manner so as to meet the demands that the body expects of it.  On a simple level, it may occur when  the demand is uncharacteristically high or more commonly, when the heart's mechanism is comprimized. There are many potential causes of heart failure due to a compromised mechanism. Examples of this include a problem with the heart muscle ( a thickened or a weakened heart chamber),  the heart valves, the coronary arteries, the heart rhythm (too fast or too slow), or the perciardial lining which surrounds the heart. Often, outside influences (like sleep apnea, anemia, thyroid disease, among other possible causes) may interfere with the heart's ability to do what is expected of it and render the patient susceptible to heart failure.

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