THIS week I have chosen two questions sent in by readers, both regarding heart related issues.

As always, I am delighted to answer any queries in my capacity as a full time NHS GP. However, this must not be a substitute for consulting with your own doctor.

Question – my GP noticed a murmur when examining me and sent me for an echocardiogram. I was surprised as I don’t have any symptoms and have always considered myself to be fit and well. I’ve been told that I have aortic stenosis, but that they are just going to follow it up with a yearly scan. Please can you explain; John. 71

Answer – With age, the valve cusps in the heart become worn and do not open as easily, hence narrowing this outlet. As the coronary arteries, which supply the heart muscle itself, come off the aorta just above this valve, the amount of blood flowing through these may also be reduced. Typical symptoms are chest pain and/or shortness of breath, more noticeable when you are active, but if the narrowing is severe, they can occur at rest. Some individuals report only a sense of fatigue. If the narrowing is mild you may not have any symptoms.

A cardiologist will monitor you with periodic echocardiograms (jelly scan of the heart), as many will progress at such a pace as to not require treatment. However, if you develop symptoms or a worsening of your symptoms between scans, please alert your GP as you may need your next echo at a shorter interval.

Symptoms of blackout or collapse, especially if precipitated by exercise, must never be ignored.

Question – I went to my GP because I would really like an angiogram. I get chest pains and I’m worried it’s my heart. He has sent me for a chest x-ray and an ECG. He said that I wasn’t likely to have heart disease at my age, but I’ve read you can get it at any age – Simon, 25

Answer – There are several causes of chest pain, not all of which are heart related. Cardiac chest pain is less common in younger individuals, as the majority of heart disease is acquired over several decades, unless you have a strong family history.

Symptoms of angina, the main indicator of coronary artery disease, are chest pain and/ or shortness of breath, worsened by exercise and relieved by rest.

If your doctor suspects you have cardiac chest pain, the first investigations are an ECG to look for abnormality in your heart rhythm or signs of heart strain.