Chest discomfort, breathlessness, palpitations, dizziness and fainting can have more than one cause. An online guide cannot diagnose the cause or tell you which test you need. The safest next step depends on what is happening now, how the symptom has changed and your medical history.
Urgent symptoms: call 999 or go to A&E
Call 999 or go to A&E if you have tight or squeezing chest pain, chest pain spreading to an arm, neck or jaw, severe difficulty breathing, or you have passed out. Call 999 or go to A&E for palpitations that do not settle with chest pain, shortness of breath, feeling faint or fainting. Do not drive yourself.[1] [2]
Use NHS 111 if you need urgent advice
Contact NHS 111 if you need medical help now and are not sure where to go. For example, NHS guidance advises urgent advice for a sudden increase in breathlessness, chest pain with nausea, or chest pain with a racing, slow, skipped or fluttering heartbeat.[2] A routine appointment should not delay urgent care.
When a non-emergency assessment may be appropriate
If you feel well now but a symptom keeps returning, changes, or affects normal activity, start with a GP or clinically appropriate assessment. A clinician can decide whether a cardiology discussion is useful. They may also identify a different cause or a more suitable route.
Repeated palpitations
A GP may assess palpitations that keep returning, last longer than a few minutes, occur more often, or happen in the context of heart disease or family history. The test choice depends on the symptom pattern and clinical assessment.
Breathlessness or a change in activity tolerance
Breathlessness has many causes, including heart and lung conditions. Seek medical advice if it worsens with usual activity or when lying down, or if it occurs with ankle swelling.
Fainting or near-fainting
Fainting has several causes. You should seek medical assessment after fainting. Emergency care is needed in the circumstances set out below.
Family history or known risk factors
A first-degree family history of early cardiovascular disease, high blood pressure, high cholesterol or diabetes can justify a discussion about individual cardiovascular risk. It does not automatically mean that you need a scan or a specialist test.
Symptoms need a clinical context
Heart palpitations can feel racing, pounding, fluttering or irregular. They can relate to stress, sleep, medicines, alcohol, caffeine, nicotine, hormonal changes, anaemia, thyroid problems or a heart rhythm condition. NHS guidance advises seeing a GP if palpitations keep coming back, last longer than a few minutes, occur with heart disease or family history, or worry you.[1]
Shortness of breath also has a broad range of causes. See a GP if it worsens during normal activity or when lying down, or comes with swollen ankles. An assessment should consider both heart and non-heart causes.[6]
You should see a GP after fainting. Call 999 if someone has chest pain or a pounding, fluttering or irregular heartbeat with fainting, does not recover fully, faints during exercise or faints while lying down.[7]
Tests may support, not replace, assessment
An ECG records electrical signals from the heart. An echocardiogram uses ultrasound to assess heart structure and function. Longer rhythm monitoring or blood tests may also be considered. NICE guidance for recent chest pain includes ECG and other tests within a clinical assessment pathway.[3]
No test provides a complete answer in isolation. A clinician interprets results alongside your symptoms, timing, medicines, history and examination. The clinic confirms the appropriate appointment route, suitability, any referral requirements, availability, preparation, reporting and follow-up at booking.
Family history and cardiovascular risk
A first-degree relative with early cardiovascular disease may be relevant to your own risk assessment. NICE guidance on cardiovascular risk supports decisions that take account of individual needs and preferences. A family history does not by itself establish a diagnosis or make a specialist test necessary.[5]
Related information
Frequently asked questions
Can I see a cardiologist for palpitations?
Recurring palpitations may need medical assessment. A clinician may start with symptoms, medicines, health history and examination, then decide whether an ECG, longer rhythm monitoring, blood tests or another route is appropriate.
Will I need an ECG or an echocardiogram?
These tests answer different questions. An ECG records the heart's electrical activity. An echocardiogram uses ultrasound to look at heart structure and function. A clinician selects tests according to the clinical question, not as a routine bundle.
Do I need a referral?
The clinic confirms the appropriate appointment route, suitability, any referral requirements, availability, preparation, reporting and follow-up at booking.
Can a normal test rule out every heart problem?
No. Every test has limits. A result needs interpretation alongside your symptom pattern, history and examination. Seek further advice if symptoms persist, worsen or change.
Should I wait for a routine appointment if I feel unwell now?
No. Call 999 or go to A&E for emergency symptoms. Use NHS 111 for urgent advice if you are unsure where to seek care. A routine cardiology appointment is not an emergency service.