News

What is a Congestive Heart Attack?

A congestive heart attack is a heart attack. A heart attack occurs when there is congestion in the heart, which stops the flow of blood.

Why was the Term “Congestive” Dropped?

It is simply a case of the word being used less and less over time. The terminology remains the same; it’s just the frequency has dropped.

Are there Other Types of Heart Attack?

Yes and no. While heart attacks all involve some form of congestion in the heart, there are different classifications a heart attack and pain around the heart can fall under. The most common include:

  • Angina
  • ST-segment elevation myocardial infarction (STEMI)
    • This is where the heart’s blood supply is congested to a point due to blockage in the coronary artery, resulting in damage to the heart.
  • Non-ST segment elevation myocardial infarction (NSTEMI)
    • This is where there is a partial block in blood supply which congests but it does not affect as large an area.

Knowing When You Have a Potential Heart Problem

You can see why an investigation is needed to know whether an individual has had a STEMI or if they have angina.

There is a broad range of symptoms that highlight if someone has a potential heart problem.  The most common of these are:

  • Fatigue
  • Breathlessness
  • Increased heart rate
  • Oedema
  • Palpitations

There are other less common symptoms like coughing, bloating and weight fluctuation, which are all indicators as well.

Symptoms like these can happen independently or build up over time without much notice.

Can Congestive Heart Failure Run in the Family?

There are some inherited genetic risk factors associated with heart failure. In most families, preventive measures can be taken through tests being carried out.

What are the Warning Signs to see a Doctor?

If you, or someone you know experiences the symptoms listed above, and they appear to be getting worse, it is best to see a doctor so tests can be carried out.

When symptoms come on quickly, and it is clear someone is having congestive heart failure, phone 999 or visit the closest A&E department.

How are Congestive Heart Problems Diagnosed?

Standard tests to diagnose heart failure include:

At OneWelbeck, we categorise tests under four main categories:

  • Non-invasive
  • Stress testing
  • Complex Imaging
  • Invasive investigation

You can find out more about the analyses we carry out here.

What Happens After Initial Tests Take Place?

Your doctor will take the information and give an idea of what your diagnosis should be. Someone found to have had heart failure will be diagnosed on a sliding scale from Stage 1 to Stage 4.

It may be the case that an individual has other underlying heart problems like Postural Tachycardia Syndrome (POTs), high blood pressure or Carotid Artery Stenosis.

These are all conditions we diagnose and you can get full information here.

Get in Touch

If you have any questions about heart-related issues, please get in touch with us, and we’ll be happy to discuss how the clinical care team at OneWelbeck Digestive Health can help.

What is Coronavirus?

The infection is a virus, similar to the flu virus. From the Chinese epidemic that in the vast majority (more than 80%) of cases however, the infection will be just like flu with a complete recovery. However it is more contagious and the risk of dying from infection is about 10 times greater than that associated with seasonal flu.

What are the symptoms?

The most common symptoms of COVID-19 are:

  • A persistent new cough, which is most often dry and does not produce sputum
  • Fever of  37.8o C or more
  • Breathlessness – usually develops at a later stage

Non-specific symptoms include:

  • Fatigue
  • Aching muscles and bones/joints

Less common symptoms include:

  • Sore Throat
  • Headaches
  • Chills

A runny or congested nose, sneezing, diarrhoea are much less common and would point towards a common cold or gastroenteritis.

Who is at risk?

We have learned that the risk of a serious illness is increased with any of the following risk factors, and more if you have more than one factor:

  1. Increasing age, especially over 70 yrs
  2. Cardiovascular conditions
  3. Hypertension
  4. Diabetes
  5. Respiratory disease

The published reports so far show that the main damage is to the lungs causing a type of viral pneumonia and inflammation. This is caused by a direct effect of the virus to the lungs and as well as acute inflammation stress which is also seen in other overwhelming infections. The impact on the heart is also to cause inflammation resulting in heart muscle weakness as well as serious rhythm disturbances. In addition, with the body under greater stress, the heart is in turn under greater stress causing further problems with acute cardiac failure, rhythm disturbances and also in some cases heart attacks.

This is obviously frightening to hear – So what should I do?

How you can help?

The advice, and there is plenty in the public domain, is to try and avoid infection at all costs.

The principles are logical and can be applied by all of us.

Clearly if you are in a high-risk group such as those over 70yrs or older, then it is even more important and the current thinking is to consider the isolation measures for up to 12 weeks.

Self-Isolation

  1. Avoid contact with anyone with suspected infection
  2. Avoid large gatherings with close proximity – weddings, funerals, parties, religious gatherings etc.
  3. Avoid all unnecessary travel particularly to Europe, Far East at present but probably in time anywhere even locally.
  4. Avoid public places such as pubs, restaurants, cinemas, theatres.
  5. Avoid travelling at peak hours on trains, tubes and buses etc.
  6. Work from home as much as you are able to.
  7. Avoid direct contact with people – hugs, kisses, handshakes even with close family.

Personal Hygiene

  1. Regularly wash your hands thoroughly for at least 20 seconds.
  2. Frequent hand washing when you go out, are in contact with anyone, and before each meals
  3. Avoid touching your face without hand-washing first as you may bring the virus nearer to your mouth and nose.
  4. Use a hand sanitiser whenever you cannot easily wash, but soap and water is even better.
  5. Turn off taps without touching using a tissue and then throw it in the bin
  6. Use paper tissues rather than handkerchiefs as the latter may harbour viruses for longer
  7. Mask usage is of limited value – it will protect others if you have symptoms but less likely to protect the mask wearer. Wearing a mask is uncomfortable and you will be more likely to touch your face to adjust it, paradoxically increasing risk. The medically approved FFP3 mask is for medical worker usage only and is in very short supply. You should NOT buy or hoard these masks.

 

If you develop symptoms do not go to your GP or hospital, but follow latest government advice.

This is currently to self-isolate for 14 days in your home and to only contact 111 if you become more seriously unwell.

Self-isolation applies for 14 days also applies to  all those who live in your household.

If you are asked to self-isolate, then sleep in a separate room from the rest of the family members and confine yourself as much as possible to your room. Clean surfaces in toilets etc vigorously to avoid cross-contamination.

FAQ

Answers to some specific questions raised by patients so far

Should I travel on holiday?

  • All non-essential travel should be avoided.
  • Though the air in-flight is safe, you will be in closer proximity to others and surface contact could cross-contaminate.
  • Travel insurance may not cover cancellations and you may also face difficulty in returning home

I have had tests undertaken or need to be seen for follow up.

  • In the NHS and privately tele-medicine protocols are being set up to reduce direct contact and unnecessary travel.
  • Please contact the OneWelbeck Heart Health team (0203 652 2005) or your doctor’s medical secretary to enable this. The private insurers have agreed to reimburse for such consultations.
  • Patients with worsening heart failure or serious valvular heart disease may need to be examined in person, but the team will be able to advise.

I am unwell with my heart condition – What should I do?

  • Please contact the OneWelbeck Heart Health team (0203 652 2005) or your doctor’s medical secretary to arrange an initial telephone consultation and then we can decide on further tests and review.
  • We will organise tests before reviewing, on the same day where possible, to minimise repeated journeys and in some instances can follow up with a tele-video consult afterwards. Please clear this with your insurers first.

Should I stop or replace Ramipril (ACEi, ending in -pril), or Losartan (the sartans) like drugs?

  • Whilst there is a recent article in the Lancet stating theoretical reasons for a potential link between these drugs and greater harm from COVID-19, there are also potential benefits in protecting the lungs with these drugs.
  • The cardiology community, in the absence of any clear evidence, has advised that you should not change your medication at the present moment.

The situation is likely to change rapidly and we will update this advice as required.

In the mean-time please follow gov.uk or other reputable websites for any changing advice.

As written by The Daily Mail

A team of experts including OneWelbeck Consultant Cardiologists Dr Richard Schilling and Dr Iqbal Malik reveal their tips to transform common health concerns including wearing ankle weights when watching TV, climbing the stairs on tiptoes, and skipping a meal or two.

 

Click here to read the full article.

 

Advice by Dr Iqbal Malik

This is the guidance for doctors from NHS England if Coronavirus is suspected. It is a worrying time, but there is no cause for alarm.
If you have these symptoms, which are of course common, concern is only if you have been to or been in contact with someone who has been to China, Wuhan Province in particular.
If worried please contact NHS direct on 111.

New Research by Barts NHS Trust and University College London

New research led by Barts NHS Trust and University College London found that running a marathon for the first time could have several health benefits including reducing blood pressure and arterial stiffness.

OneWelbeck Consultant Cardiologist Dr Charlotte Manisty who was part of this study said: “As clinicians are meeting with patients in the new year, making a goal-oriented exercise training recommendation—such as signing up for a marathon or fun-run—may be a good motivator for our patients to keep active. Our study highlights the importance of lifestyle modifications to slow the risks associated with aging, especially as it appears to never be too late as evidenced by our older, slower runners.”

To read the full article, please go to:

https://www.bartshealth.nhs.uk/news/first-time-marathon-runners-reduce-their-blood-pressure-and-arterial-stiffness-7113

You can also catch Dr Manisty talking on BBC Radio 4’s Today Programme on the 7th January 2020 available on BBC iPlayer (listen between 2:49:49 -2:56:12)

Written By Dr Iqbal Malik, Consultant Cardiologist

Cardiovascular risk reduction

NICE’s clinical guideline ‘Cardiovascular disease: risk assessment and reduction, including lipid modification’ (CG181 published 2014, last updated September 2016) includes:

Omega-3 fatty acid compounds for preventing CVD

1.3.48  Do not offer omega-3 fatty acid compounds for the prevention of CVD to any of the following:

  • people who are being treated for primary prevention
  • people who are being treated for secondary prevention
  • people with CKD
  • people with type 1 diabetes
  • people with type 2 diabetes.

1.3.49 Tell people that there is no evidence that omega-3 fatty acid compounds help to prevent CVD.

Combination therapy for preventing CVD

1.3.50 Do not offer the combination of a bile acid sequestrant (anion exchange resin), fibrate, nicotinic acid or omega-3 fatty acid compound with a statin for the primary or secondary prevention of CVD.

A Cochrane review ‘Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease ’https://doi.org/10.1002/14651858.CD003177.pub4 (version published 30 November 2018) concludes: “Moderate‐ and high‐quality evidence suggests that increasing EPA and DHA has little or no effect on mortality or cardiovascular health (evidence mainly from supplement trials). Previous suggestions of benefits from EPA and DHA supplements appear to spring from trials with higher risk of bias.”

REDUCE-IT trial

If icosapent ethyl, a highly purified eicosapentaenoic acid ethyl ester is licensed in the UK, the REDUCE-IT trial suggests it may have a role in cardiovascular risk reduction. Is it cost effective? The data is from one trial and not yet main stream in the UK.

In REDUCE-IT,  2g twice a day of  2g of icosapent ethyl was compared to placebo.

  • The risk of the primary composite end point of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or unstable angina (THAT IS  A LOT OF ENDPOINTS – some of which are hard to be certain about), lower, by 25%,(4.8% lower,  number needed to treat of 21)
  • The risk of the key secondary composite end point of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke was also significantly lower, by 26%, ( absolute between-group difference of 3.6 percentage points in the rate of the end point and a number needed to treat of 28)
  • AF rates were higher in the treatment group however
  • Cardiovascular death was reduced, but not total mortality.

Written by Dr Iqbal Malik

Reference: https://www.nejm.org/doi/full/10.1056/NEJMoa1812792

Newly initiated prescriptions: 

These  drugs should only be prescribed by, or on the recommendation of, lipid specialists, only for patients who meet all the following criteria:

  • Under the care of a lipid specialist and
  • Taking maximum fibrate and statin and
  • Fasting triglycerides remain >10mmol/l


Thus NOT for everybody- eat oily fish 2x per week instead!

Original source: The New England Journal of Medicine

Dr Malik says “alcohol is a potent driver for atrial fibrillation (AF) and cutting back reduces the risk of it coming back. This article in the NEJM provides more evidence for this”.

Excessive alcohol consumption is associated with atrial fibrillation. Patients with paroxysmal or persistent atrial fibrillation who were in sinus rhythm and who were consuming 10 or more standard drinks per week were randomly assigned to either abstinence from alcohol or continued drinking for 6 months. Recurrence of atrial fibrillation was less common in the abstinence group.

Dr Iqbal Malik. Consultant Cardiologist

Dr Malik recently performed a Paravalvular Leak closure.

The patient had a leak around the aortic valve replacement- a bright jet of colour seen on echocardiography.

(see upper panel)

After 3 plugs were placed around the metal frame of the valve, the leak vanished. The three plugs can be seen as black dots above and below the valve.

The echocardiogram looked much improved – the flame had gone! (see lower panel)

Dr Malik is a recognised world expert in this procedure.

Written By Dr Boon Lim. Consultant Cardiologist and Electrophysiologist

The field of Atrial Fibrillation (AF) is moving at a rapid pace, and at the same time, it’s moving right back to basics. The paradigm for AF ablation is pulmonary vein isolation, where the pulmonary veins, which drain blood back from the lungs into the left atrial chamber, are electrically isolated and therefore ectopic firing beats from the pulmonary veins can no longer trigger and sustain AF. Pulmonary veins can be isolated using either radio frequency energy, generating heat, or cryoablation, where tissue is frozen to create a line of scar around the pulmonary veins which isolates them.

Therapeutic strategies beyond pulmonary vein isolation, have been studied extensively, but as of mid-2020, there is no accepted “conventional” strategy across different centres beyond pulmonary vein isolation.

Top 5 Strategies For Getting AF Back Into Sinus Rhythm:

  1. Treat AF Early – Which means see your doctor as soon as you detect AF, this is important as “AF begets AF” – which means exactly what is says on the tin – the longer you have AF, the more difficult it is to get you out of it, whatever strategy is chosen? How long is long ? Well, most electrophysiologists feel that beyond 4 years of AF persistence is a threshold beyond which it would be difficult to restore normal (sinus) rhythm (<40% success rate).
  2. Stay Healthy- Live well – exercise and diet well. There is a large body of compelling data which now clearly show a link between sleep apnoea, obesity, the “metabolic syndrome” and AF. Staying healthy with lifestyle choices and losing weight is one of the most important ways to prevent and treat AF.
  3. Be Mindful Of Obvious Triggers And Avoid Them- Some common triggers for AF are extreme stress, fatigue, strong caffeine or alcohol intake – if there are repeated triggers for AF which are avoidable, its important to recognise what these are and obviously take precautions to avoid these triggers.
  4. Treat Medical Conditions Which Can Cause Predispose To AF-These include thyroid function abnormalities, electrolyte abnormalities, diabetes, hypertension, ischaemic heart disease, recurrent infections (typically chest infections), especially in patients with existing lung conditions such as COPD and sleep apnoea.
  5. Catheter Ablation With Pulmonary Vein Isolation- This remains a cornerstone and should be the baseline ablative treatment of choice whenever ablation is considered. Choose a cardiologist who has experience in ablation, and ideally in a high volume centre. The cardiac specialists (electrophysiologists) who have an active research profile usually have a good understanding of contemporary research in AF including the latest ablation techniques and use of state of the art technology to treat AF.

Written By Dr Boon Lim

 

Written By Dr Boon Lim. Consultant Cardiologist and Electrophysiologist

Sleep apnea is now recognized as a significant factor in both triggering and maintaining Atrial Fibrillation. This is because over time, the repeated apnoeic (cessation of for several seconds) episodes that occur repeatedly overnight, may lead to stress on the heart, which is known to trigger AF.

Sleep Apnea Risk Factors:

• heavy snoring
high blood pressure

Sleep Apnea Symptoms

• morning headaches
• fatigue throughout the day
• inability to get a good “rest” despite many hours of sleep

In this situation, management SOLELY of AF, for example with drugs or even catheter ablation may fail, with the ongoing primary trigger of sleep apnea which continue to drive repeated episodes of AF at night, which eventually lead to persistent symptoms even during the daytime.

There Are Other Problems With Sleep Apnea too:

There is a clear link between sleep apnea and cardiovascular problems. It’s possible that the constant fluctuation in blood oxygen levels caused by sleep apnea may contribute to arterial inflammation, blood flow obstruction, insulin resistance, and, increased hypertension and cardiovascular-related events.

Our team of electrophysiologist specialist will be able to deliver state of the art treatment of patients with both atrial fibrillation(AF) and sleep apnea. Your treatment from the beginning to the end, will comprise of comprehensive holistic approach addressing all risk factors for AF, including:

• Sleep apnea
• Diabetes
• Obesity
• Metabolic Profile
• Coronary artery disease
• Thyroid dysfunction

Sleep Apnea Detection Device

We will be able to fit an easy to use overnight wrist-based sleep apnea detection device (WATCHPAT ™) which will be able to make a diagnosis of obstructive sleep apnea, and to then initiate approach management to get you back to better health.

Sleep Apnea and Atrial Fibrillation

If you need a comprehensive assessment of AF with sleep apnea, and you are worried how to cure sleep apnea, please contact us to make an appointment with one of our cardiologists.

Written By Dr Boon Lim