Dr Tom Cahill
Conditions
Dr Cahill routinely see patients with the following conditions:
Aortic stenosis
Aortic stenosis occurs when the aortic valve in your heart becomes narrowed, making it harder for blood to flow from your heart to the rest of your body. This condition typically develops gradually over many years, often due to age-related calcium buildup or a congenital heart defect.
Symptoms
Symptoms may include chest pain, shortness of breath (especially during activity), fatigue, dizziness, or fainting spells. Some people may not experience symptoms until the condition becomes severe.
Diagnosis
Diagnosis involves an echocardiogram (ultrasound of the heart), and sometimes additional tests like cardiac catheterisation or a CT scan.
Treatment
Treatment depends on severity. Mild and moderate cases may only require monitoring, while severe cases typically need valve replacement. Options include traditional open-heart surgery or TAVI (Transcatheter Aortic Valve Implantation), a minimally invasive procedure where a new valve is inserted through a small incision, often in the leg. Medications can help manage symptoms but don't cure the underlying valve problem.
Coronary artery disease – angina, heart attack
Coronary artery disease occurs when the blood vessels that supply your heart muscle become narrowed or blocked by fatty deposits called plaque. This reduces blood flow to your heart muscle, causing angina (chest pain) or potentially a heart attack if blood flow is completely blocked.
Symptoms
Symptoms of angina include chest pain, pressure, or tightness, often triggered by physical activity or stress. Heart attack symptoms may include severe chest pain, shortness of breath, nausea, sweating, and pain radiating to your arm, jaw, or back.
Diagnosis
Diagnosis involves blood tests, electrocardiograms (ECG), stress tests, and a CT scan or coronary angiogram to visualise your coronary arteries.
Treatment
Treatment includes lifestyle changes (diet, exercise, smoking cessation), medications (blood thinners, cholesterol-lowering drugs, blood pressure medications). Coronary angioplasty with stent implantation is a routine treatment to improve symptoms of angina. Coronary bypass surgery may be required for severe or extensive blockages.
High blood pressure
High blood pressure (hypertension) occurs when the force of blood against your artery walls is consistently too high. This condition is often called the "silent killer" because it usually has no symptoms but can lead to serious complications like heart disease, stroke, and kidney problems if left untreated.
Symptoms
Symptoms are rare, but some people may experience headaches, shortness of breath, or nosebleeds with severely elevated blood pressure. Most people feel completely normal despite having high blood pressure.
Diagnosis
Diagnosis is made through regular blood pressure measurements taken on multiple occasions. Your doctor may recommend home monitoring or 24-hour ambulatory monitoring to confirm the diagnosis and assess how well your blood pressure is controlled.
Treatment
Treatment typically begins with lifestyle modifications including a healthy diet (low sodium, rich in fruits and vegetables), regular exercise, weight management, limiting alcohol, and stress reduction. If lifestyle changes aren't sufficient, various medications are available to effectively lower blood pressure and protect your organs from damage.
High cholesterol
High cholesterol occurs when there are elevated levels of fatty substances (cholesterol and triglycerides) in your blood. While your body needs some cholesterol to function properly, too much can build up in your artery walls, increasing your risk of heart disease and stroke.
Symptoms
Symptoms are typically absent until complications develop. High cholesterol itself doesn't cause noticeable symptoms, which is why regular screening is important. Rarely, very high levels may cause yellowish deposits around the eyes or tendons.
Diagnosis
Diagnosis requires a simple blood test called a lipid panel, which measures total cholesterol, LDL ("bad" cholesterol), HDL ("good" cholesterol), and triglycerides. This test is typically done after fasting for 9-12 hours.
Treatment
Treatment starts with lifestyle changes including a heart-healthy diet low in saturated and trans fats, regular physical activity, weight management, and avoiding tobacco. If lifestyle modifications aren't enough, medications like statins, fibrates, or other cholesterol-lowering drugs may be prescribed to reduce your cardiovascular risk.
Mitral regurgitation
Mitral regurgitation occurs when your heart's mitral valve doesn't close properly, allowing blood to leak backward into the left atrium when the heart pumps. This can happen due to valve degeneration, infection, or heart failure. The heart is forced to work harder to pump blood effectively.
Symptoms
Symptoms may develop gradually and include fatigue, shortness of breath (especially when lying flat or during activity), heart palpitations, swollen feet or ankles, and reduced exercise tolerance. Some people may have no symptoms initially.
Diagnosis
Diagnosis involves echocardiography to visualise valve function and assess severity of the leak, and sometimes additional tests like stress echocardiography or cardiac MRI.
Treatment
Treatment depends on severity and symptoms. Mild cases may only require regular monitoring, while moderate to severe cases may need medications to reduce heart strain and manage symptoms. Severe cases often require intervention such as surgical valve repair or replacement, or transcatheter edge-to-edge repair (a minimally invasive procedure using clips to improve valve function). Early intervention typically provides better outcomes than waiting until symptoms become severe.
Mitral stenosis
Mitral stenosis occurs when the mitral valve becomes narrowed, restricting blood flow from the left atrium to the left ventricle. This condition is most commonly caused by rheumatic heart disease but can also result from age-related calcium deposition or congenital abnormalities.
Symptoms
Symptoms typically develop gradually and include shortness of breath (especially during activity or when lying flat), fatigue, heart palpitations, chest discomfort, and swollen feet or ankles. Some people may cough up blood or experience frequent respiratory infections.
Diagnosis
Diagnosis involves echocardiography to measure valve area and assess severity, and sometimes cardiac catheterisation for detailed evaluation. Additional tests may include a CT scan.
Treatment
Treatment options include medications to manage symptoms and prevent complications (such as blood thinners if atrial fibrillation develops), balloon valvuloplasty (a minimally invasive procedure to stretch the valve open), or surgical valve replacement for severe cases. The choice depends on valve anatomy, overall health, and symptom severity.
Patent foramen ovale
Patent foramen ovale (PFO) is a small opening between the two upper chambers of your heart that didn't close after birth as it normally should. This opening exists in all babies before birth but typically seals within the first year of life. About 25% of adults have a PFO that remained open.
Symptoms
Symptoms are usually absent, and most people with PFO never know they have it. However, some people may experience migraine headaches, and rarely, PFO can contribute to stroke in young adults if blood clots pass through the opening. Divers can experience decompression sickness due to bubbles passing across a PFO.
Diagnosis
Diagnosis is typically made through echocardiography with a bubble study, where saline bubbles are injected while ultrasound images are taken to detect the passage of bubbles between heart chambers. Sometimes transesophageal echocardiography provides clearer images.
Treatment
Treatment is usually not necessary for most people with PFO. However, if you've had a stroke related to PFO, or decompression sickness, PFO closure may be recommended using a small plug device inserted into the heart via a catheter tube at the top of the leg.
Tricuspid regurgitation
Tricuspid regurgitation occurs when the tricuspid valve (between the right atrium and right ventricle) doesn't close properly, allowing blood to leak backward. This can occur due to enlargement of the right side of the heart, valve damage, or high pressure in the lungs.
Symptoms
Symptoms may include fatigue, shortness of breath during activity, swelling in your legs, ankles, or abdomen, and a feeling of fullness in your neck. Some people may notice their abdomen becoming enlarged due to fluid accumulation.
Diagnosis
Diagnosis involves echocardiography (heart ultrasound) to assess valve function and measure regurgitation severity, and sometimes right heart catheterisation to measure pressures. Additional tests may evaluate underlying lung conditions.
Treatment
Treatment focuses on addressing underlying causes and managing symptoms. This may include medications to reduce fluid retention (diuretics), treat heart failure, or manage underlying lung disease. Severe cases may require surgical valve repair or replacement. Minimally invasive treatment options include transcatheter edge-to-edge repair and transcatheter tricuspid valve replacement.