Conditions We Investigate & Manage

Common Symptoms

• Tightness, pressure, or heaviness in the chest
• Pain radiating to the jaw, neck, shoulder, or left arm
• Chest discomfort during exercise or physical activity
• Shortness of breath accompanying chest pain
• Nausea or sweating with chest discomfort
• Pain that worsens with exertion and eases with rest (typical angina)

When to See a Cardiologist

If you experience recurrent, exertional, or unexplained chest pain, ask your GP for a referral to a cardiologist. Chest pain that occurs during exercise, at rest, or is accompanied by breathlessness, sweating, or nausea warrants prompt investigation. If you are experiencing sudden or severe chest pain, call 000 immediately.

How We Investigate

Dr Grewal may recommend an echocardiogram to assess heart structure and function, a stress echocardiogram to evaluate how the heart performs under physical stress, or a CT coronary angiogram including calcium score to visualise the coronary arteries and detect blockages. The choice of test depends on the nature of your symptoms, risk factors, and clinical assessment. All tests are fully bulk billed through Medicare.

Common Symptoms

• Feeling your heart racing or pounding
• Sensation of skipped or missed heartbeats
• Fluttering feeling in the chest or throat
• Heart beating irregularly or erratically
• Episodes lasting seconds, minutes, or longer
• Palpitations that worsen at night or when lying down

When to See a Cardiologist

If palpitations are frequent, prolonged, accompanied by dizziness, fainting, or chest pain, or if they affect your daily life, your GP should refer you to a cardiologist for further investigation. Palpitations that occur during exercise or cause you to feel faint require prompt assessment.

How We Investigate

A 24 Hour Holter Monitor is the primary test for investigating palpitations. This portable device records every heartbeat over a full day during your normal activities, capturing intermittent rhythm problems that may not occur during a brief clinic visit. Dr Grewal may also recommend an echocardiogram to check the heart structure and rule out underlying causes.

Common Symptoms

• Often no noticeable symptoms (silent condition)
• Persistent headaches in severe cases
• Shortness of breath with exertion
• Chest discomfort
• Visual changes in severe hypertension
• Nosebleeds in some cases of severely elevated blood pressure

When to See a Cardiologist

If your blood pressure is consistently elevated despite medication (resistant hypertension), or if your GP suspects it has affected your heart, a referral to a cardiologist is recommended for specialist assessment. Patients with hypertension and additional risk factors such as diabetes, high cholesterol, or a family history of heart disease should also consider a cardiac evaluation.

How We Investigate

Dr Grewal will assess the effect of high blood pressure on your heart using an echocardiogram, which shows whether the heart muscle has thickened (left ventricular hypertrophy) or the pumping function has been affected. She may also recommend a CT coronary angiogram including calcium score to assess your coronary arteries and overall cardiovascular risk profile.

Common Symptoms

• Shortness of breath, especially when lying down or during activity
• Persistent fatigue and reduced exercise tolerance
• Swelling in the legs, ankles, or abdomen (oedema)
• Rapid or irregular heartbeat
• Persistent cough or wheezing
• Sudden weight gain from fluid retention

When to See a Cardiologist

If you experience worsening breathlessness, unexpected weight gain from fluid retention, or persistent fatigue that limits your daily activities, ask your GP for a referral to a cardiologist. If you have been previously diagnosed with heart failure, regular specialist follow-up is essential to optimise your treatment.

How We Investigate

An echocardiogram is the key test for diagnosing heart failure. It shows how well the heart is pumping (ejection fraction), the size of the heart chambers, and whether the valves are functioning properly. Dr Grewal may also recommend a Holter monitor to check for arrhythmias that can worsen heart failure. Dr Grewal has a special interest in the management of cardiac failure.

Common Symptoms

• Chest pain or tightness, particularly during exertion (angina)
• Shortness of breath with physical activity
• Pain in the neck, jaw, or arms
• Fatigue and reduced exercise capacity
• May have no symptoms until a heart attack occurs (silent CAD)

When to See a Cardiologist

If you have risk factors for heart disease such as high cholesterol, diabetes, high blood pressure, smoking history, or a family history of heart disease, or if you experience exertional chest pain, a cardiologist assessment is recommended. Screening with a CT coronary angiogram including calcium score can detect coronary artery disease before symptoms develop.

How We Investigate

Dr Grewal may recommend a stress echocardiogram to see how the heart responds to exercise, or a CT coronary angiogram including calcium score to produce detailed images of the coronary arteries and detect any plaque or blockages. The calcium score quantifies calcified plaque and is a strong predictor of future heart events. Dr Grewal holds Grade A accreditation in CT coronary angiography — the highest level available.

Common Symptoms

• Chest pain, pressure, or heaviness — often triggered by physical exertion, emotional stress, or cold weather
• Pain that may radiate to the left arm, neck, jaw, back, or stomach
• Shortness of breath during activity or at rest in advanced cases
• Nausea, sweating, or light-headedness accompanying chest discomfort
• Fatigue and reduced ability to exercise compared to previously
• Some people — particularly women and people with diabetes — may experience atypical symptoms such as unusual tiredness, indigestion, or breathlessness without chest pain

When to See a Cardiologist

If you experience recurrent chest pain or tightness, particularly with exertion or stress, ask your GP for a referral to a cardiologist. If you have significant risk factors — such as high cholesterol, high blood pressure, diabetes, smoking, obesity, or a family history of heart disease — a specialist assessment can help determine your risk and whether further investigation is needed. If you experience sudden, severe chest pain that does not resolve within a few minutes, call 000 immediately as this may be a heart attack.

How We Investigate

Dr Grewal uses several tests to diagnose and assess ischaemic heart disease. A stress echocardiogram evaluates how the heart muscle performs under physical stress — areas of the heart that are not receiving adequate blood flow will show reduced movement during exercise. A CT coronary angiogram including calcium score produces detailed 3D images of the coronary arteries to directly visualise any narrowing, plaque build-up, or blockages. The coronary artery calcium score provides a numerical measure of calcified plaque burden, which is a strong predictor of future heart events. An echocardiogram assesses overall heart function and can detect areas of heart muscle damage from a previous heart attack. Dr Grewal holds Grade A accreditation in CT coronary angiography — the highest level available — and will recommend the most appropriate investigation based on your symptoms and risk profile. All consultations and in-clinic tests are fully bulk billed through Medicare.

Common Symptoms

• Irregular or rapid heartbeat
• Heart palpitations or fluttering sensation
• Dizziness or light-headedness
• Fatigue and reduced exercise tolerance
• Shortness of breath
• Some people with AF have no symptoms and it is detected incidentally

When to See a Cardiologist

If you have been diagnosed with AF by your GP, or if you experience episodes of irregular heartbeat, dizziness, or unexplained fatigue, a cardiologist can provide specialist management and assess your stroke risk. A cardiologist will determine whether you need blood-thinning medication and optimise your heart rate or rhythm control.

How We Investigate

A 24 Hour Holter Monitor is particularly valuable for detecting intermittent episodes of AF that may not be present during a clinic visit. It records every heartbeat over a full day to capture paroxysmal episodes. An echocardiogram assesses the impact of AF on heart structure and function, including the size of the atria and the heart's pumping ability.

Common Symptoms

• Shortness of breath, especially during activity or lying down
• Heart murmur detected by your GP
• Chest pain or tightness
• Fatigue and reduced exercise capacity
• Swelling in the ankles or feet
• Dizziness or fainting, particularly with aortic stenosis

When to See a Cardiologist

If your GP has detected a heart murmur, or if you experience worsening breathlessness, chest pain, or exercise intolerance, a cardiologist can assess your heart valves using imaging. Regular monitoring is important for known valve conditions to determine the right time for intervention if needed.

How We Investigate

An echocardiogram is the primary test for diagnosing and monitoring valve disease. It provides detailed images of all four heart valves, showing their structure, movement, and blood flow patterns in real time. A stress echocardiogram may be used to assess how valve disease affects heart function during exercise, which helps guide decisions about the need for intervention.

Common Symptoms

• Breathlessness during activity or at rest
• Swelling in the legs, ankles, and feet
• Fatigue and weakness
• Dizziness or fainting
• Irregular heartbeat or palpitations
• Family history of sudden cardiac death (in hypertrophic cardiomyopathy)

When to See a Cardiologist

If you have a family history of cardiomyopathy or sudden cardiac death, or if you experience unexplained breathlessness, fatigue, or heart rhythm disturbances, a specialist assessment is recommended. Family screening is particularly important for hypertrophic cardiomyopathy, which is the most common inherited heart condition.

How We Investigate

An echocardiogram is essential for diagnosing cardiomyopathy. It shows the size and thickness of the heart chambers, how well the heart muscle is contracting, and can identify the specific type of cardiomyopathy. A Holter monitor may be recommended to check for associated arrhythmias. Dr Grewal will develop a personalised management plan based on the type and severity of cardiomyopathy.

Common Symptoms

• Difficulty breathing during normal activities
• Breathlessness when lying flat (needing extra pillows)
• Waking at night short of breath
• Reduced ability to exercise compared to previously
• Feeling winded with minimal exertion
• Breathlessness accompanied by chest pain or swelling in the legs

When to See a Cardiologist

If shortness of breath is new, worsening, or cannot be explained by other causes such as asthma or lung disease, your GP may refer you to a cardiologist to rule out cardiac causes. Breathlessness that occurs when lying flat, wakes you at night, or is accompanied by chest pain, palpitations, or leg swelling warrants prompt cardiac assessment.

How We Investigate

An echocardiogram is the first-line test to assess heart function, valve integrity, and fluid around the heart. It can identify heart failure, valve disease, and cardiomyopathy as causes of breathlessness. A stress echocardiogram may be recommended to evaluate how the heart performs during exercise and detect conditions that only become apparent with physical exertion.

Common Symptoms

• Feeling light-headed or faint
• Sudden loss of consciousness (fainting)
• Dizziness with standing or exertion
• Near-fainting episodes (pre-syncope)
• Blackouts or unexplained falls
• Fainting during or after exercise

When to See a Cardiologist

If you have experienced fainting, recurrent dizziness, or blackouts, particularly during exercise or without warning, a cardiologist should assess whether a heart condition is the cause. Fainting that occurs during physical activity, while seated, or without any prodromal symptoms (warning signs) is considered high-risk and requires urgent investigation.

How We Investigate

A 24 Hour Holter Monitor records your heart rhythm continuously to detect arrhythmias that may cause dizziness or fainting. An echocardiogram can identify structural problems such as valve disease, cardiomyopathy, or reduced pumping function that may be responsible for syncope.

Common Symptoms

• Usually no symptoms (detected by GP during examination)
• Shortness of breath if caused by significant valve disease
• Fatigue or reduced exercise tolerance
• Chest pain in some cases
• Swelling in legs or feet if valve disease is advanced
• Dizziness or fainting if caused by aortic stenosis

When to See a Cardiologist

If your GP has heard a heart murmur during a physical examination, they may refer you to a cardiologist to determine whether it is innocent or caused by a valve abnormality. Even if you have no symptoms, an echocardiogram is recommended to characterise the murmur and guide future management.

How We Investigate

An echocardiogram is the definitive test for evaluating a heart murmur. It shows the structure and function of all four heart valves and can determine whether the murmur is harmless or requires treatment or monitoring. The test is painless, takes 30-45 minutes, and is fully bulk billed through Medicare.

Common Symptoms

• Usually no symptoms (detected through blood tests)
• May be associated with family history of early heart disease or premature heart attack
• Xanthomas (fatty deposits under the skin) in severe or familial cases
• Arcus senilis (white or grey ring around the cornea) in younger patients with familial hypercholesterolaemia

When to See a Cardiologist

If you have high cholesterol combined with other risk factors such as high blood pressure, diabetes, or smoking, or a strong family history of heart disease or premature heart attacks, your GP may refer you to a cardiologist for a comprehensive cardiovascular risk assessment. A cardiologist can determine whether imaging of your coronary arteries is needed.

How We Investigate

Dr Grewal may recommend a CT coronary angiogram including a coronary artery calcium score. The calcium score is a powerful screening tool that measures calcified plaque in the coronary arteries and provides a numerical risk score. A score of zero indicates no detectable calcified plaque. An echocardiogram may also be performed to assess heart function. Dr Grewal holds Grade A accreditation in CT coronary angiography — the highest level available.