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Our leading cardiologists at OneWelbeck Heart Health have...Learn More
Dr Malik says, "PFO (patent foremen ovale) related stroke...Learn More
Dr Boon Lim, Consultant Cardiologist at OneWelbeck Heart Health...Learn More
Dr Malik was recently asked by a patient whether Red Yeast...Learn More
Dr Malik pioneered a day-case pathway for TAVI (to treat aortic...Learn More
Aspirin is one of the most commonly-used drugs internationally, but what does it actually do and how effective is it? Dr Iqbal Malik investigates.
Can aspirin help people who have already had a stroke or heart attack?
We often use anti-platelet drugs to stop the blood clotting. They act to make platelets, the blood cells involved in forming a clot when you bleed, less sticky. In patients with proven heart attack or stroke, the the enemy is the clot. Aspirin in combination with other agents, such as Clopidogrel or Ticagrelor, is used after heart attack and coronary stents. After a stroke, aspirin is often seen as not strong enough, and Clopidogrel is used more often. However, if the stroke is related to atrial fibrillation, a common heart rhythm problem, then neither aspirin or Clopidogrel are strong enough, and agents such as Warfarin, Rivaroxaban, Edoxaban, Dabigatran, and Apixaban are used. The newer (non-Warfarin agents) have the advantage of not needing regular blood tests and having standard dose regimes, some of which are only once a day.
Instead of aspirin, what can you recommend to patients who want to prevent cardiovascular disease?
If a patient has had a heart attack or stroke, then they should take the recommended anti-platelet drug, which may be Aspirin, Clopidogrel, Ticagrelor or a combination of them.
If, however, they have not had a previous event, then I suggest that there is more benefit in reducing risk in other ways, such and losing weight, controlling blood pressure and diet, stopping smoking and of course considering lowering the cholesterol with a statin. Statins are well tolerated in the vast majority of people. The risk of bleeding goes up with aspirin and the risk of heart attack and stroke goes down. The net clinical benefit becomes small! There is some emerging data that you may try to find those patients who may gain some benefit from aspirin by assessing the bleeding risk in detail, the clotting risk in detail, and then add a CT coronary calcium score (done using a small dose of X-Rays) to see if the process of coronary disease has already begun. The trouble is that the calcium score is rarely above zero under age 50.
Do you have a question about having a heart ultrasound? Here at OneWelbeck Heart Health we can provide answers and advice on what happens during a typical ultrasound scan.
Heart Ultrasound Scans – What to Expect
When we want to understand what is going on inside the heart, imaging tests are essential. One of the most common tests carried is a heart ultrasound; known more commonly as an echocardiogram. When someone has an echocardiogram carried out, it helps doctors analyse how the heart is working and that everything is performing as expected.
You might feel slightly nervous about having a heart ultrasound scan carried out for the first time if you don’t know what to expect. Let’s discuss the test, what happens during the examination, and what information a doctor expects to get from a heart ultrasound.
What is a heart ultrasound (echocardiogram)?
Echocardiograms are ultrasound tests which scan the heart and provide accurate information about the heart’s structure and function. The test is attempting to understand how the heart is working while resting.
How is a heart ultrasound done?
A probe is used to send sound waves from your chest to the heart and back. It is entirely harmless, and patients won’t feel a thing when the probe is moved around the chest.
It is common for the doctor to move the probe around slightly while checking the heart as it helps build a complete picture of how different parts of the heart work. The pictures received come as an “echo”, hence the term.
What does a patient do during a heart ultrasound?
In most instances, a patient will be asked to remove clothes from the upper body and then lie on their left side.
Would you be expected to exercise during an echocardiogram?
Sometimes doctors will want to understand how the heart works with stress. To do this they might ask the patient to run on the treadmill or to cycle on a static bike. You can find more information on that procedure here.
How long does it take to have a heart ultrasound?
A patient would expect their appointment to last for 30 to 45 minutes, depending on how easy it is for doctors to get the images they need.
What does someone experience during a heart ultrasound?
The majority of patients won’t feel or notice anything while the ultrasound takes place. You will hear the sound of the flow of blood through the heart at times during the test when Doppler is used.
Do you need to take any specific medicine to have an echocardiogram carried out?
Usually, this test doesn’t need the patient to take any medicine. If the patient needs to have a bubble contrast echocardiogram, a saline injection will be needed.
Talk to echocardiogram specialists
If you have any questions about any of the tests carried out, or would like to speak with someone about visiting OneWelbeck for a test, please visit our contact page.
Dr Malik at CSI Live Conference!
Our OneWelbeck Consultant Cardiologist Dr Iqbal Malik chaired a session at CSI’s live Case Day run on zoom.
To see some of his own cases see:
The CSI live case conference covered all aspects of the disease with experts from around the world giving their opinion on complex cases.
Don't miss OneWelbeck's cardiologists at The Heart Rhythm Congress!
Our leading cardiologists at OneWelbeck Heart Health have been invited to deliver lectures both for patients, and physicians at the UK’s leading heart rhythm conference, the Heart Rhythm Congress in Sep 2020. This year, the conference will be held virtually, and be made freely accessibly to all patients and healthcare professionals.
To register click here https://www.heartrhythmalliance.org/aa/uk/a-a-heart-rhythm-congress-2020-registration
Our expert cardiologists will be speaking on varied topics as follows:
- ‘Pacemakers and other devices’ ‘How might Covid-19 affect people with a device such as an ICD S-ICD or pacemaker?’
- ‘How might Covid-19 affect people with a device such as an ICD, S-ICD or pacemaker?’
- ‘How does Covid-19 affect arrhythmia patients? How might Covid-19 interact with arrhythmia medication?’
- ‘How does Covid-19 affect AF patients?’
- ‘New Treatments on the horizon in the new decade’
- ‘PoTS in teenagers’
- ‘Treating AF in someone with heart failure: which options for which patient?’
- ‘Debate: (Pro) AF ablation is overused and expensive and should be restricted to patients with disabling symptoms as identified by PROMS’
- ‘Mapping Atrial Fibrillation-Where have we come from?’
Arrhythmia Alliance is launching the first Virtual Patients Day
On the 27th of September the Arrhythmia Alliance is launching the first ever online Patients Day. For only £10, patients can listen to talks by our amazing OneWelbeck Cardiologists Dr Boon Lim and Dr Mark Earley
Make sure you register for Patients Day here: bit.ly/PatientsDay2020
Dr Malik does live PFO closure
Dr Malik says:
PFO (patent foremen ovale) related stroke is not uncommon.
- PFO (patent foremen ovale) is present in 25% of all people.
- If you have had a stroke for no reason then a PFO may become relevant.
- I have performed 100s of PFOs closures over the last decade and have also taught many others to do so.
- We broadcast live to the USA for the PICS-AICS annual meeting.
The cases went well and my team was brilliant as ever. Working on a Saturday for the benefit of the patient.
Dr Malik on 'Managing the heart during COVID-19'
Dr Malik says:
“There have been significant changes in heart disease presentation and management during COVID-19. There was a drop in presentations for heart attacks. In addition, hospital beds were in short supply, and doctors were sick or sidelined with other duties.
“With the second wave coming, we need to prepare again. This article from my group at Imperial College Healthcare NHS Trust helps all of us try to cope better. We were ahead of many in the 1st wave, with PPE protocols, Patient pathways and more. We also began to source our own PPE and set up a fund to help staff in need, on top of the good work done by the national authorities.
Thus we could
- Look after patients without COVID-19 disease who have a heart attack
- Look after patients with COVID-19 disease who have a heart attack
- Look after patients with COVID-19 disease who had serious disease that was mimicking a heart attack
Read the full article here.
Find out more from Dr Iqbal about heart health in COVID times in these blog posts:
OneWelbeck Heart Health's Dr Boon Lim features on BBC's Diagnosis Detectives
Dr Boon Lim, Consultant Cardiologist at OneWelbeck Heart Health, recently featured on the BBC2 series Diagnosis Detectives, which was hosted by Dr Michael Moseley to investigate and treat patients with difficult unresolved diagnoses. Dr Lim was chosen to to be part of this series in which 12 of the leading experts in their fields were carefully chosen to give their opinion to help these patients.
You can catch up on Diagnosis Detectives on BBC iPlayer, with a 12-episode run.
Is Red Yeast Rice an alternative to statins? Dr Iqbal Malik investigates.
Dr Malik was recently asked by a patient whether Red Yeast Rice (RYR) can be used as an alternative to statins, so he undertook some research and found the below results.
After consulting this medical journal, published in 2018, Dr Malik surmised that Red Yeast Rice contains Monacolin K, which in some forms (lactone) is nearly identical to Lovastatin (at statin). RYR is made by fermentation of rice with yeasts, mainly Monascus Purpureus. RYR is traditionally used in China for culinary purposes as a food colouring or as a traditional remedy to promote digestion and blood circulation.
The main points to note are:
- RYR will lower cholesterol as it acts as a statin
- It may cause similar side effects to statins and have similar drug interactions
- It is not regulated as a medicine and therefore does not go through all the checks that statins have to go through
- It is hard to calculate what the correct dose is. Some formulations have 10mg of Monacolin K, which is probably equivalent to a pharmacological dose of Lovastatin, but the ratio between Monacolin K lactone and Monacolin K HA is variable in food supplements containing RYR. For example, a range of supplements showed Monacolin K levels of 0.05mg to 2.74mg per 600mg of RYR.
So to summarise: Is Red Yeast Rice safer than a statin? Dr Malik says probably not.
New data shows how Heart care has changed in COVID times.
Dr Malik pioneered a day-case pathway for TAVI (to treat aortic stenosis) when previously the stay was several days. Despite this, the national data shows that there was a 50% reduction in this essential procedure since lock-down. Less “essential” treatments such as most electrical ablations (over 90%) and a fair number of angioplasty in elective patients were also deferred.
Read the final report here.
Find out more from Dr Iqbal about heart health in COVID times in these blog posts: