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[INLINE] Heart Disease Chat - edited transcript
Transcript from the Heart disease chat session held on the 16th June with Hilary Jones and Belinda Linden, Cardiac Nurse Advisor and Manager of the medical information department at the British Heart Foundation.
Dr_Hilary says
Hello and welcome to today's chatroom on heart related problems. Heart disease remains Britain's biggest killer overall with a third of all men and a quarter of all women eventually dying from it. That's 1 person every 2 minutes having a heart attack or the equivalent of a jumbo jet crashing with the loss of all it's passengers every day. So many of these deaths however are preventable and avoidable. Simple lifestyle changes can make a huge difference, and modern treatment can give people back the quality of life they have lost. Joining me today is Belinda Linden, who is cardiac nurse advisor and manager of the medical information department at the British Heart Foundation, and we look forward to any questions you have ever wanted answered.
Moderator says
Gillian's question is: I understand that the patch form of HRT (Estracombi TTS) protects me from osteoporosis etc, but does it also protect me from heart disease as I have read somewhere that there was some doubt? I am a non-smoker, have a low fat diet, exercise regularly and am not overweight and will be 46 this August.
Dr_Hilary says
Long term studies in the use of HRT suggest that there is indeed a degree of protection against heart disease from which patients can benefit, especially if they have a family history of heart disease, and especially if they smoke. So much so that women who have had a heart attack and who are already on HRT are encouraged to continue with it to reduce the risk of further attacks.
Moderator says
Wendy asks: I have never had my heart rate checked. I have Turner's syndrome and understand that this can cause heart problems but could you tell me what sort?
B_Linden says
Thank you for this interesting question. Turner's Syndrome is a chromosomal disorder in which the child is of unusually short stature. The child often may have a variety of abnormalities of the heart although I am unable to specify one particular abnormality. Two thirds of children with Turner Syndrome lack one "X" chromosome.
Moderator says
Charlie's question relates to missed heart beats and he apologises in advance for his long question but feels that because many people suffer from the problem they will find the response invaluable. Charlie says: I have suffered for a number of years from what has been diagnosed as Premature Ventricluar Contractions - 'missed beats'. I have had a whole battery of tests: echocardiogram (3 years ago) 24 ECG x 2, all have come back normal although the palpitations continue on a day-to-day basis. Recently after going to A & E with mutiple missed beats I was kept in because I had an inverted T Wave on my ECG and slightly raised cardiac enzymes - eventually after 8 hours I was allowed home with no explanation of why I had been kept in. Once more my GP referred me to a cardiologist for assessment. Following another 24-hour holter (during which I went on a long run) the cardioloigst said that he could find nothing unusual. I fully accept his assessment and also that I undoubtably
have an element of neurosis about my heart, however, no one could give me a explanation of why I was kept in at hospital which was extremely distressing or how I might learn to cope with this irregular heart beat. I exercise 5 times a week but get the missed beats immediately after finishing so this has started to put me off. The last thing I want to do is allow anxiety related to this condition to start interfering with my life but they really are unbelievably annoying. Do you have any idea why I would have been kept in - did it mean I had some kind of heart attack (unlikely I hope)? Are there any support groups for people who have this condition?
Dr_Hilary says
These missed beats are extremely common, in fact I have them myself. Provided investigations are normal, they are considered benign. I expect you were kept in hospital on that one occasion to exclude any possible heart attack, and to make sure your blood tests and ECG results were compatible with normal. Anxiety always makes palpitations worse, so keep exercising and try to stop worrying.
Moderator says
Chris is 17 years old and aks: I lead a healthy and active life but I have been diagnosed with Wolf Parkinson White. I have had palpitation's but they are very infrequent. I have been offered the ablation but I feel fine. Is my life in any danger? What do you suggest I do?
B_Linden says
Wolffe Parkinson White Syndrome is an abnormality of heart rhythm which involves an extra abnormal electrical pathway. This can trigger irregularities of heart beat which may or may not cause symptoms. Sometimes these only need to be controlled with drugs but ablation therapy can be very effective if the abnormal rhythm persists and causes symptoms. Ablation is a catheter procedure which detects the abnormality with x-ray vision and uses radio frequency waves to ablate or wipe out the abnormal pathway.
Moderator says
Jane explains: I am more than 19 weeks pregnant and suffering from frequent palpitations and breathlessness. My doctor has prescribed beta-blockers which I have been advised to take but am reluctant to. My doctor has referred me to see a cardiologist for a 24-hour box to be fitted - but I am very concerned about the effect these palpitations could have on my baby. Will it cause breathing or heart problems, or complications in labour?
Dr_Hilary says
Both your symptoms are common in pregnancy due to normal changes in your circulation. Your 24 hour ambulatory ECG test will confirm your palpitations are purely physiological (benign) and they will have no effect at all on your baby's development and growth. This is because they will have no appreciable effect on your blood pressure and the circulation through the placenta to your baby. So relax.
Moderator says
Jim is aware of skipped heart beats, sometimes 3 or 4 times a day, other days as many as 30 or 40 times a day. He says: I recall Dr Jones writing about this a couple of years ago when he mentioned something about electrical impulses just above the stomach area and I think he said this was nothing to do with your heart.
B_Linden says
Thank you for your interesting question that affects many people. These are quite harmless for 90% of the population, but for the other 10% investigations may be needed particularly if the missed beats cause symptoms. An electrocardiogram (ECG) can clarify the abnormality and probably reassure you that it is not harmful. Extra or missed beats can often result from anxiety due to increased adrenaline circulating in the system.
Moderator says
Sarah asks: My husband (who is 31) has a 'regular' 'irregular' heart-beat! He has 8 'normal' beats, then appears to miss a beat before starting the pattern again. He is reluctant to see his GP - should I force him to go?
Dr_Hilary says
Again, these regular missed beats are extremely common. He should have an ECG and a full examination, but as long as he is generally fit and well, and has adopted a healthy lifestyle there is probably nothing to worry about, especially if his family history is clear of heart disease. But any fluctuation in heart rhythms should really be brought to the attention of his doctor.
Moderator says
Emma explains: My husband has been recently diagnosed with heart valve disease which an echocardigram showed as being mild, but which could be due to his tricuspid valve only being bicuspid. More worrying was that an electrocardiogram showed 'unusual' changes for a man of his age. My husband is 30-years-old and is very physically fit. He runs & plays football on a regular basis, & earlier this year, prior to this diagnosis, he ran a half marathon in his best time. The consultant that we saw about this heart problem suggested that the changes in the ECG could be due to having an 'Athlete's heart'. I cannot find any information about 'Athlete's heart', and hope that you can give me some more information.
Dr_Hilary says
You are asking two seperate questions. One concerns bicuspid valves and another concerns the athlete's heart. Firstly, a bicuspid valve has unusually two cusps rather than three and this may, in some cases, cause the valve to be less efficient, however, many patients have no problem with bicuspid valves. This can be checked with an echocardiogram. Athletes exercise intensively and this can cause the heart muscle to become thicker. Inevitably, this can lead to changes in the electrocardiogram or ECG. These changes are generally of little concern, but of course doctors need to be aware of whether you are an athlete so that they can accurately interpret the ECG.
Moderator says
Ruth asks: Should I be concerned at painful palpitations at night that disturb my sleep? My doctor prescribes lots of analgesia and hypnotics which I am very reluctant to use regularly as I hate pill-popping. I am trying an osteopath currently, to free up the Titze's, however with three children at university and being a lone parent cost is an inhibiting factor!
Dr_Hilary says
Palpitations are often uncomfortable and noticeable, but if they are actually painful, as you say they are, they should certainly be investigated in more depth. It is highly unlikely that you are experiencing angina, but to reassure you, you should see your doctor and inform him about your symptoms. It may be that you simply need a higher dose of HRT to help with insomnia and palpitations, but only specific tests can tell you.
Moderator says
Kym explains: Recently, I have experienced the feeling of my heart skipping a beat when just sitting at work, on the tube or taking a breath. Is this common or could it be related to anything. I am a stable asthmatic and excercise regularly, however, I do like to rave and drink regularly. Could this be related to my lifestyle?
Dr_Hilary says
Most palpitations of a benign nature are experienced at rest and not when exercising. They may be triggered by asthma medication and by other stimulants including caffeine in tea or coffee, cola drinks and chocolate, cigarettes, alcohol and any form of stress. So yes, your symptoms could well be related to your lifestyle.
Moderator says
Annie asks: A cardiologist has informed me that my heart misses a beat. I am to have an echocardiogram. I have tried looking this arrythmia up on the internet with no luck. Can you give me some information please?
B_Linden says
Generally, missed beats are not of real concern, but for some patients they may indicate underlying heart disease. They are also often called extrasystoles or ectopic beats. However, an ECG will be able to confirm whether this is the abnormality and an echocardiogram will be able to outline the heart and assess its efficiency.
Moderator says
Karen asks a question about her mother who is aged 72: My mother has a diagnosed enlarged heart, high blood pressure, both untreated. She has been excessively breathless (walking a few steps, climbing more than 4/5 steps) recently. Her parents had artheriosclerosis and high blood pressure/strokes. Should she be asking for preventive medicine? She has a reasonably healthy diet and doesn't drink so lifestyle changes aren't the solution.
Dr_Hilary says
Your mother must be tested regarding her breathlessness, as this could well be an early sign of coronary heart disease or mild heart failure. Preventative treatment can be wonderfully effective and could potentially give her a new lease of life, including more energy and exercise tolerance. Why not make an appointment with her GP and go along with her?
Moderator says
Trish explains: I am a 25 year old non-smoker, non-drinker. I have suffered from high blood pressure for the past 6 years, which has been kept under control with beta-blockers. However, 7 months ago I had my first baby and my blood pressure increased further still. My medication has more than doubled to Monocor 10 and water tablets. I am now concerned that my blood pressure will never decrease naturally and I will be on medication for life. It worries me what damage high blood pressure causes over a long period of time and also what effect the medication has on my long-term health, what side effects can it cause? I would also like to have another baby in a few years time, but will I be well enough to do so without risk to a baby or myself? I am not over weight, eat a balanced diet, but recently I have been told that I also have high cholesterol. Are the two problems connected in some way? I suffered from E coli when I was very young which meant I had to go on kidney dialysis
for a few weeks. Could this possibly be causing my high blood pressure and high cholesterol now?
B_Linden says
Thank you Trish for your questions. It is important that blood pressure is controlled, particularly if you have high blood pressure at such a young age. For many people the cause is unknown but for some people kidney disease can be a cause. Your GP can reassure you here. Although tablets are annoying to take they reduce the risk of stroke, heart attack or heart failure which can occur after long term high blood pressure. I understand that beta-blockers can be taken while pregnant, but each individual case needs the advice of their doctor. Ways in which you can help reduce your blood pressure are to increase activity, cut down on salt and find time for relaxation.
Moderator says
David asks: I am very concerned about some unusual symptoms I have been suffering. For many years I have been having irregular heartbeats which were diagnosed as ectopic beats and I was told they were benign. However, for the last few months I have been getting a very heavy beating which comes on suddenly and goes suddenly. This can be felt in my throat. When I take my pulse it is about 85 beats per minute. My normal pulse rate is about 60. Could this be an arrythmia? My doctor seems undisturbed by my symptoms and tells me, on examination, that my heart is normal. By the way, when this happens I feel that each heartbeat almost hurts because of the heavy beat. I was wondering whether this could be anything to do with flatulence?
Dr_Hilary says
You could be having episodic arrythmias (irregular heart beats) and if you are experiencing this feeling in your throat ( tracheal tug) and the symptoms are fairly common, I would say the time has come to have a 24 hour ECG recording to confirm that they are indeed benign and do not require treatment. Flatulence does seem to trigger such arrythmias in some people anecdotally, and dietary adjustment to eat little and often, and cut out stimulants, may be beneficial.
Moderator says
Ann explains: Three years ago I had electrical tests on my legs because of numb sensation in my feet. Although I explained to the doctor at the time that I had had this feeling in both feet, also the side of my left leg and once in my fingers, he said that I must have hurt my ankle in the past and damaged a nerve. For a few months now I have had this feeling in my right foot covering a larger area than usual and it covers the toes on my left foot, once it goes from one spot I notice it in another. Until now I have had no pain with it, but this time on my right foot I get sharp twinges and it itches a lot, although I cannot relieve this because its as if I cannot get to the itch because of the numbness. I am 43, 5ft 5in, 11 stones 6 pounds, I do not smoke and I have a drink occasionally. I have recently been to the doctors because of a slight chest pain I have been getting, the doctor at the time told me I have a slight heart murmur and I have had a echocardiogram and
exercise tests and will get the results of these test on the 26th of this month. The results of a blood test I had when I went to the doctors with the chest pain have shown that I have a slight under active thyroid. I am not having any treatment for this but will have a blood test ever three months. I had a MRI scan because of back pain three years ago which showed I have a slightly worn disk. I have had tests for diabetes which show I am not (my 24 year old son is diabetic). I have asked the doctor again about this numb feeling but was told to ask the specialist when I go for the results of the echocardiogram, will this be something connected to the heart pains?
B_Linden says
Unfortunately, I am unable to explain the numbness in your feet and do hope the specialist can help you here. The heart murmur is an unusual sound of the blood passing through the heart valves. The echocardiogram will be able to detect whether there is any valve abnormality. Sometimes people develop chest pains that are totally unrelated to heart conditions, but of course it's important to exclude this possibility.
Moderator says
John asks: Do you have any idea of the percentage of deaths from first-time heart attacks in terms of the overall number of deaths by heart attack? The reason I ask is because my father died from his first attack, which even 2 years on leaves me bewildered.
Dr_Hilary says
Nearly 50% of first time heart attacks are fatal. This means that more than 150,000 people every year are never given the chance to alter their lifestyle by stopping smoking, cutting down on fatty food, taking more exercise and avoiding stress that might prolong their life and improve it's quality. If everybody accepted appointments offered at well person clinics, many people without symptoms yet at risk of heart disease would benefit. Thanks for your letter.
Moderator says
Rob explains: I am a 35 year old male, weight: 14st 12, height: 5 ft 10. I was born with a heart murmur and have always been told that it was an 'innocent systolic' murmur - something to do with the shape of my chest cavity. Last year, however, after performing a routine check up for new patients, my new GP referred me to a cardiac consultant who carried out various tests. I am now told that I have a 'bicuspid aortic valve'. I understand what this is and that it should, I think, be tricuspid? But I'd like to know more about it. What should I look out for? Is it dangerous? Is surgery a common solution? I was not worried about my murmur before - being extremely active in sports in my youth and early adulthood and suffering no side effects. Now I am changing my perception on learning the murmur is not so 'innocent' any more and because my lifestyle has changed significantly - I have a stressful job, little time for sports activities and virtually the only exercise I get is
walking and gardening. Also, no matter what diet I follow - and I eat very sensibly and not to excess - I find it impossible to lose weight. How can it be that the fact the valve is bicuspid was not picked up when I was examined at length as a child? Can the valve have fused two cusps together since the original diagnosis? I cannot get to see my consultant until this time next year.
B_Linden says
A bicuspid aortic valve as you say has two cusps instead of its usual three. This abnormality affects about 1% of the population. Generally this may cause no real problem, but with some people the valve may become less efficient and lead to valve incompetence. This may be reflected in a heart murmur which the doctor can detect with a stethoscope. Although it is important to have a healthy diet, this should not affect the way your valve works.
Moderator says
Robert asks: Can you please tell me if there is any risk to health from prolonged use of pagers? We constantly hear of the possible risks to health from extensive use of mobile phones but I wonder if there has been any medical research into the use of pagers.
Dr_Hilary says
We are not aware of any risk from pagers although precautionary current advice based on theoretical risks of radio frquency signals suggests that mobile phones should not be clipped to breast pockets but secreted elsewhere about your body as far away from your heart and brain as is practically possible.
Moderator says
Lou asks: Following a routine ECG test (because I suffer with Essential hypertension) my GP, following advice from the hospital, prescribed one junior Aspirin perday. The ECG revealed I have a T wave. I am worried by this prognosis as it seems to suggest my heart is damaged. Can you please advise the long term effect of such a diagnosis.
B_Linden says
Thank you for your query. T waves are a normal finding on an ECG, but I presume that you have an abnormal T wave, possibly resulting from your hypertension. However, these abnormalities really do need to be interpreted by a specialist to guide your treatment.
Moderator says
Kate explains: My pulse rate is usually about 60 bpm. I occasionally get a tight sensation in my throat and chest and my heart will suddenly beat very hard and heavily. I feel this in my throat. When I take my pulse at this time it is about 90 bpm. It will then suddenly change from 90 back to 60 and the tightness goes at the same time. Could this be a tachycardia or arrythmia? I have been to my doctor but she says it is nothing to worry about.
Dr_Hilary says
Your doctor is likely to be correct, but I know how difficult it can be not to worry when you experience these alarming and recurrent symptoms. The problem is anticipating the palpitations usually serves to bring them back again. An ECG recorded at a time when you are having symptoms would be helpful and reassuring, and so would some simple advice about what to do to prevent symptoms and deal with them yourself when you have them.
Moderator says
Stuart explains: I have atrial fibrillation but I am only 28. I have tried every drug including amiodarone; I have had 3 cardioversions and an ablation but am still in AF. Do you think I should try the open heart procedure - the maze? The nearest place is Utrecht with 95% success rate. My heart has been as high as 300 bpm.
B_Linden says
Thank you for your enquiry Stuart. I sympathise with the frustration of persistent atrial fibrillation (AF) despite ablation therapy. The maze procedure has offered some success, but obviously you may not wish to undergo a large operation unnecessarily. There is a new catheter procedure being trialed called microcatheter ablation where small linear scars are formed inside the heart wall, and this has helped some patients control the AF.
Moderator says
Dereck asks: The French appear to have a much lower rate of heart disease than the British, is this anything to do with drinking wine?
Dr_Hilary says
Partly. The French also have a higer rate of alcoholic cirrhosis than we do, so drinking wine is not the only answer! Genetic factors and a healthy mediterranean style diet certainly contribute to their healthier history of heart disease, but red wine with it's antioxidant content has been shown to be helpful in preventing heart disease in a dose of 2 glasses a day. In fact people who drink moderately like this may have healthier hearts than tee-totallers.
Dr_Hilary says
Thanks everybody for participating in our chatroom today. As we thought, we had an enormous response and calls are still coming in. Remember that you can call up other questions and answers in our archives and find the names and addresses of support groups on our dedicated support group page. Belinda and her colleagues may be contacted at the British Heart Foundation's helpline on 0990 200 656 (recorded information) or at 14 Fitzharding Street, London W1H 4DH.
Have a great weekend, don't forget to apply the sunscreen, and why not join us next week in our chatroom devoted to the subject of homeopathy with Bob Leckridge.
16th June 2000
[INLINE] Want to know more?
[INLINE] Relevant chapters in NetDoctor.co.uk
* Facts about Angina
* Facts about Atherosclerosis
* Facts about High cholesterol (hypercholesterolaemia)
* Facts about Coronary thrombosis (heart attack)
* Facts about Factor V Leiden
* Facts about Familial hypercholesterolaemia
* Facts about Hypertension
* Facts about Pulmonary thrombosis
* Facts about Stroke
* Facts about Vascular diseases
* Health Advice: Heart Attack - First Aid
* Health Advice: How to lose weight the healthy way
* Health Advice: Smoking - cutting down or quitting
* Health Advice: Smoking - health risks
* Sex and Relationships: Sex and heart disease
* Topic Overview: Heart blood and circulation
* Topic Overview: Smoker's diseases
[INLINE] Support Groups
* British Cardiac Patients Association, (The Zipper Club)
* British Heart Foundation
* Cardiomyopathy Association
* The Haemophilia Society
* National Heart Research Fund
* Children's Heart Federation
[INLINE] Newsgroups
* alt.support.diet
* bionet.biology.cardiology
* sci.med.cardiology
* sci.med.pharmacy
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