Coronary artery chronic total occlusion

If you have coronary heart disease, including CTO, you may not have any symptoms. The most common symptom is chest pain or angina, which is a heaviness, tightness or dull pain in the chest, usually related to exercise.

The feeling can radiate through your left arm, back or neck. Other symptoms may include palpitations, shortness of breath, feeling very tired and nausea.

If your GP or consultant thinks you may be at risk of cardiovascular disease, including CTO, they will speak to you about any symptoms you have and ask about your medical background, lifestyle and family history of heart disease. They may do a blood test to check your cholesterol levels. Other tests for CTO may include:

• an electrocardiogram (ECG) to measure the electrical activity of your heart
• an echocardiogram to visualise the valves and chambers of your heart
• a myocardial perfusion scan to look at your heart's blood flow pattern
• an invasive or non-invasive coronary angiogram to examine the heart arteries and the extent of any narrowing or blockage

Traditionally, patients with symptoms related to a CTO would have open heart coronary artery bypass graft surgery. Now, CTO can often be treated with minimally invasive techniques.

Many of our experienced cardiac consultants specialise in angioplasty, which involves accessing the coronary arteries by threading a thin, flexible tube (catheter) into the heart through a vein in your wrist or groin, and using tiny surgical instruments to remove blockages or widen a narrowed artery with a stent. Your consultant will let you know your treatment options and help to determine the best approach for you.