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Private Cardiology

Improving your heart health

Dr Alamgir Kabir

MBBS BSc(Hons) FRCP PhD

Consultant Cardiologist

GMC No 4308173

email:[email protected]

Telephone 07518 082 240 outside the UK 00447518 082 240

My Blog

Blog

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Four rules for exercise

Posted on February 21, 2014 at 1:05 PM Comments comments (60)
1. Gradually build up the intensity to avoid injury.
2. Vary what you do to avoid boredom-- walking, sitting up, bowls it does not matter.
3. Like a medicine take exercise regularly.
4. Start now and make it part of your daily routine.
 
 
Forming a habit of exercising is a lifelong gift. If I could prescribe it I would. Make exercise your medicine before you need to start taking medicine.
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Diabetes and extra virgin olive oil

Posted on January 7, 2014 at 4:53 PM Comments comments (95)
A recent trial in the Annals of Internal Medicine looked at the role of a Mediterranean diet in reducing the onset of type 2 diabetes. It seems to suggest that eating this type of diet which is especially high in extra virgin olive oil  (50ml/day) in some way prevents the onset of diabetes. The benefit was a 30% risk reduction in developing diabetes compared to controls who were on a low fat diet. The diet was relatively low in dairy products and low in carbohydrate content.
Although the mechanism of how the Mediterranean diet reduces the onset of diabetes is not completely understood it may be related to the relatively low carbohydrate content and the prevention of insulin resistance.
This is not conclusive evidence but it does suggest that a Mediterranean diet is better for us and in particular reducing the carbohydrate content in our diets is a good thing.
 
Reference
Ann Intern Med January 6 2014 http://annals.org
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New Year's resolutions

Posted on December 24, 2013 at 4:06 PM Comments comments (270)
Christmas is a great time to be with friends and family. Following on from this is new years and the inevitable drive to make a new year's resolution. Many of us will make a resolution to lose weight and get fitter.
A lot of us will keep the resolution for about a month and then slip back into our old habits. The secret is to make the resolution now and test yourself over Christmas. If your resolution survives the next few days then is may be strong enough to last well into the new year. Most diets work, but a year on we are back to our original weight. With weight loss keep it simple. Try four simple rules,
1. eat a proper breakfast, lunch and dinner
2. No snacks in between
3. allow yourself to feel hungry before you eat, don't eat just because it is time
4. do 20 minutes of any exercise you like a day
 
Don't tell anyone about the resolution JUST DO IT.
Good luck
Merry Christmas and have a wonderful new year!
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Mitral valve disease

Posted on October 22, 2013 at 3:38 PM Comments comments (480)
The mitral valve separates the left ventricle from the left atrium. It acts like all valves in the heart-- as a one way valve. This allows the blood to flow forward when the heart contracts and prevents leaking back into the left atrium as the heart relaxes between each contraction. The valve is composed of two leaflets which look, with the eye of faith, like the mitre the Pope wears-- hence the mitral valve.
The valve can become leaky (mitral regurgitation or MR) and this can cause the blood to leak into the left atrium. Patients can become more breathless as a result. In some patients it can cause the heart rhythm to become irregular. Breathlessness and palpitations are the main symptoms. Some patients can have mild to moderate degrees of leakiness of the valve and have no symptoms at all. The reasons for the leaking valve are several. The left ventricle can enlarge in conditions such as heart failure and this can lead to valve stretching and thus not closing tightly enough. The leaflets can become more floppy and prolapse back. In more dramatic cases the valve can become leaky after a heart attack or after an infection affecting the valve itself (endocarditis).
The valve can become narrowed (mitral stenosis or MS). This can be related to rhematic fever as a child. Some patients are born with a narrowed valve. Patients can present with breathlessness and palpitations. It can be undiagnosed for years and present when the heart is having to work harder, such as in pregnancy.
The treatment for a leaky valve if the degree is severe enough usually involves open heart  surgery. There are many patients with varying degrees of MR that simply need to be monitored for a period of time and can be managed well on medication for many years. In assessing the degree of leakiness a patient may require and angiogram which also focusses of the right heart pressures. They may also require a special type of echocardiogram called a transoesophageal echo. Recently there has been some cases of a mitral valve clip that can be used to reduce the leakiness which can be done via a procedure through an artery in the leg.
A narrowed valve may also require a surgical operation depending on the degree of narrowing. A balloon procedure that is performed from the leg is also possible in some patients.
With mitral valve disease monitoring of the valve with serial echocardiograms (ultrasounds of the heart) is important. The timing of heart surgery is important especially in mitral regurgitation.
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Aortic valve disease

Posted on September 29, 2013 at 2:29 PM Comments comments (524)
The heart normally has four valves in it. They all act as one way valves--opening fully allowing the heart to push blood forward when the heart contracts and -- closing completely stopping the blood from leaking backwards when the heart relaxes.
 
The Aortic valve
This valve separates the left ventricle (the main pump chamber of the heart) from the aorta (the main blood vessel-- supplying blood to the rest of the body).
 
The aortic valve can become narrowed (aortic stenosis). This restricts the blood flow out of the heart. Patients may have- no symptoms, or chest pain, shortness of breath and even dizziness and collapse. An echocardiogram can usually distinguish the degree of narrowing. In some patients the degree of narrowing is monitored and it does not require any intervention such as a surgical valve replacement. However if the degree of narrowing becomes severe and the patient has symptoms then an operation on the heart valve may be deemed necessary.
 
The aortic valve can become leaky (aortic regurgitation or incompetence). This means that when the heart contracts only a portion of the blood goes forward. The rest leaks backwards. Patients may have no symptoms or have increasing shortness of breath when they exercise or difficulty in breathing even at rest. If the degree of leakiness is sufficiently bad the valve may need to be surgically replaced.
 
Traditionally the replacement of the valve is done by surgery however when the risk of surgery is very high some patients have had the procedure done via a tube inserted in the leg (a percutaneous procedure). The reason for not offering this to everyone is that the long term results of this are not certain.
 
If you are being worked up for an aortic valve replacement you may need an coronary angiogram to look at the blood vessels of the heart (the coronary arteries). Please previous blog on coronary angiograms.
 
If you have any questions about your case please drop me an email.
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So, you are having an angiogram?

Posted on September 22, 2013 at 4:58 PM Comments comments (477)
A coronary angiogram is the procedure that is the gold standard for assessing the degree of a possible narrowing of the arteries of the heart. The procedure takes about 30 minutes to do and is performed in a cardiac catheter lab. Usually you are awake for the procedure, but you can ask for sedation if you are very anxious.
The procedure is performed either from the top of the leg or from the wrist. Local anaesthetic is given to numb the skin, then a small tube called a catheter is passed up towards the arteries to the heart. There are no nerves inside the arteries so generally this is painless. Sometimes with the radial approach (from the wrist) there can be a little spasm of the artery, which can be uncomfortable. This can usually be dealt with by using smaller sizes of the catheter or giving medication to dilate the arteries.
The reason for choosing either a radial (wrist) or femoral (top of the leg) approach is based on a number of factors including the consultants preference, the risk of bleeding and the presence of peripheral vascular disease (furring up the arteries in the legs).
The catheter is directed to the opening of the coronary arteries and then dye is injected in. An x-ray machine shows real time pictures of the artery filling with dye which demonstrate the presence of a narrowing. Several sets of pictures are taken to ensure nothing is missed.
Afterwards, the wrist approach requires the wearing of a small tight wrist band for about 1 hour. If the approach used was from the top of the leg then either manual pressure is required at the access site for about 10 to 15mins or a small closure device is used to block off the hole made by the catheter. However the patient will need to lie flat for up to 4 hours.
It is advisable to take a few days off  after the procedure before returning to heavy manual work.
Angiograms are quite routine procedures but we can all get quite anxious at times. I would be happy to answer any questions you have.
 
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Atrial fibrillation (AF)

Posted on September 15, 2013 at 3:24 PM Comments comments (95)
Atrial fibrillation or AF is a common condition that can affect upto 10% of the population above the age of 80. It is more common with age. Patients can present with a wide range of symptoms from --no symptoms to shortness of breath and chest pain with or without palpitations.
There are two important things to consider when someone is in AF.
 
1.Should you try to convert the rhythm back to a normal rhythm--or simply control the rate of the heart beat?
 
In patients who have recently gone into AF conversion back to a normal rhythm may be appropriate especially when they have symptoms associated with AF. This can either be done with electrical DC cardioversion or with medication such as sotalol, amiodarone or flecainide.
In selected patients who are particularly symptomatic a procedure called AF ablation may be appropriate.
 
2. Does the patient need to be on blood thinners (anticoagulation) to reduce the risk of stroke?
 
Stroke prevention is a major consideration as being in AF is a risk factor for strokes in some patients. This can either be with simply aspirin, or warfarin or in some suitable patients, newer oral anticoagulants such as Dabigatran.
 
AF is a common condition and the treatment involves both short term symptom control and the risk assessment of strokes.
 
 
 
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high blood pressure

Posted on September 9, 2013 at 5:58 PM Comments comments (342)
High blood pressure is a major risk factor for heart disease and strokes. As we age blood pressure can become more likely. The major problem with blood pressure is that we can have it without feeling any ill effects and therefore be undiagnosed for years. So it is really important to get is checked if you think you could be at risk-- a simple check by your family doctor or practice nurse or even at the local pharmacy is a start.
Blood pressure readings above 140/90 mmHg indicate some degree of high blood pressure. Blood pressure can be labile and subject to large swings so it is important to get it checked a number of times before confirming the diagnosis.
Above the age of 40 we usually consider that it is related to essential hypertension, in other words it has no underlying cause. Below this age there could be a secondary cause that may need investigation by a specialist.
Things that you can do to bring your blood pressure down
1. Worry less. Anxiety and stress does almost certainly have an effect on your blood pressure. Try simple relaxation techniques.
2. Exercise more. Gentle exercise can lower blood pressure by reducing what is known as peripheral vascular resistance.
3. Reduce your weight. This again has an effect on peripheral vascular resistance which in term can reduce blood pressure.
4. Reduce your salt intake. There is good evidence that even modest reduction in salt intake can help to reduce blood pressure.
5. Stop smoking and drink less alcohol as both of these factors increase blood pressure.
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Diabetes and heart disease

Posted on August 31, 2013 at 4:57 PM Comments comments (635)
The number of people with diabetes is growing. The likelihood of developing in particular type II diabetes goes up if you have relatives with the condition. It is also associated with having a higher body mass index (BMI) (greater than 27). If you have a family history, it is better to keep your BMI low as you get older. The lower the better, some have argued that between 23 and 25 is better.
The reason that diabetes affects the heart is that it makes the blood vessels, the coronary arteries more likely to develop atheroma (fatty deposits blocking up the arteries). This can lead to angina and is some cases an increased risk of heart attacks.
Prevention is better than cure. It is worth checking with your family doctor if you have diabetes by doing a simple blood test. It can also pick up impaired glucose tolerance which may be a forerunner of developing diabetes. If you have impaired glucose tolerance and are in the diet controlled diabetic group it is more important to keep your weight down. There is good evidence that reducing your weight can reduce the likelihood of developing diabetes or at least delay the onset.
1.Check your BMI.  BMI calculator
2.If you think you may be at risk of diabetes get it checked
3.Consider reducing your BMI by diet and exercise if you are at risk
 
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Minimally invasive cardiac surgery

Posted on August 30, 2013 at 5:25 AM Comments comments (103)
The field of cardiology is changing rapidly. The treatment of heart valve problems may involved open heart surgery in some patients, where the chest is opened via a wound at the front. 
There is pioneering work that has allowed the procedure to be performed via a much smaller incision, so called minimally invasive surgery. This reduces the recovery time after surgery and reduces the amount of discomfort for patients.
 
One the leading surgeons in this field is Mr Inderpaul Birdi. He and his team at the Keyhole Heart Clinic have done some truly ground breaking work. If you would like to find out more about this please visit http://www.thekeyholeheartclinic.com.
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