What these conditions actually are.

Chest pain has many causes — acid reflux, muscle strain, anxiety and lung problems among them. But it is also the most common presenting symptom of coronary artery disease, and the only way to separate them reliably is to assess it properly.

Cardiac chest pain is classically a heaviness, pressure or tightness rather than a sharp stab. It often comes on with exertion and eases with rest. It may spread to the jaw, the left arm or the back, and can come with sweating, nausea or breathlessness. In people with diabetes, and often in women, it can be much subtler than this.

Hypertension rarely causes symptoms until it has already affected the heart, kidneys, eyes or brain. Most people who have it feel entirely well. That is the reason it is worth measuring even when nothing is wrong.

It is diagnosed on repeated readings, not a single high one at a clinic — a first raised reading is a reason to measure again properly, not to start treatment that afternoon. Where treatment is needed, it usually continues long term, and stopping tablets because the reading has normalised is one of the most common avoidable causes of a return to dangerous levels.

Cholesterol is not treated in isolation. The same LDL level means something quite different in a 35-year-old with no other risk factors and in a 60-year-old with diabetes and a family history of early heart disease. What is being managed is total cardiovascular risk, and the target moves with it.

Diet and exercise genuinely help, and for many people are enough. For others they are not, and no amount of dietary discipline substitutes for medication — which is a matter of inherited liver biology, not willpower.

The name frightens people more than the condition warrants. Heart failure means the heart is not pumping as effectively as it should, so fluid backs up and less blood reaches the body. It is a chronic condition that is managed, often well, for many years.

It shows up as breathlessness — first on exertion, later at rest or lying flat — swelling of the ankles and legs, fatigue, and sometimes a cough at night. An echocardiogram measures the pumping fraction directly, which is why it is central to both diagnosis and follow-up.

Most palpitations are benign — caffeine, stress, dehydration, thyroid problems and anaemia are all common causes. Some are not, and the distinction rests on the pattern, the associated symptoms, and what an ECG or Holter recording actually captures during an episode.

Atrial fibrillation deserves specific mention: it can be entirely asymptomatic, and it materially raises stroke risk, which is treatable once it is known about. It is one of the more valuable things a routine ECG picks up by accident.

Fatty deposits build up in the coronary arteries over years, narrowing them and limiting blood flow to the heart muscle. When the narrowing is significant, exertion produces chest discomfort. When a deposit ruptures and a clot forms, the result is a heart attack.

Assessment moves from the least to the most invasive: history and examination, ECG, echocardiogram, a stress test, and — where those raise a real question — a coronary angiogram, which shows the arteries directly and is what determines whether angioplasty, bypass surgery or medication alone is the right answer.