Heart health


30 September 2019

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Most of us know how important it is to look after our heart, but with heart and circulatory diseases being a leading cause of death in the UK, it's good to stay up to date on the best ways to take care of you and your family's heart health.

To help you stay informed, we've brought together a selection of your questions on heart health, answered by our clinical experts.

Q: I go to the gym 3 times a week, but never know how much cardio I should be doing? And is cardio the only exercise that can benefit the heart?

There is no hard and fast rule. The very fact that you're doing regular exercise already means that you're doing more than many people to keep fit and look after your heart. Cardio exercises are a relatively modern invention, specifically tailored to strengthen the heart muscles and increase the heart rate to keep it strong, in the same way as using any muscle regularly will make it stronger. However, although they are particularly good for this, any exercise is better than none. Three cardio sessions a week sounds about right to me and we would suggest that any additional exercise should be different just to make it more interesting and to use some other muscles. Most importantly, pick something you enjoy doing!

Q: How often should you get your blood pressure checked? I'm in my 20's, should i be having it checked annually?

The guidelines suggest that for someone of your age, blood pressure should be checked every 3-5 years. However, I think that annually is better because, although blood pressure levels rarely increase dramatically from one year to the next, raised blood pressure hardly ever causes symptoms so, unless you have it checked, you won't know it's increasing. Further intervals will be decided by what blood pressure reading you record. If it's normal you can wait another year. It's worth mentioning that these days cheap, accurate blood pressure monitors can be bought in most chemists and online, not so that you become obsessed but more to avoid the necessity of seeing your GP or nurse. Most will come with some information about when to seek further advice. Our article How to lower high blood pressure contains more information on which monitors to buy and how to obtain an accurate reading at home.

Q: I've been told I may have low blood pressure as I've been experiencing sudden dizziness and numbness, which lasts no more than a minute, so how can I prevent that happening? I'm 30, generally healthy/stress free, with no underlying health issues.

In some ways, low blood pressure is a good sign because it means that you're far less likely to suffer in future from a heart attack, stroke or 'furred up' arteries. However, the down side is that you are more prone to fainting. The interval you describe when you feel dizzy is the bit where your body is adjusting the blood pressure upwards to supply your brain adequately. You probably don't need to do anything but just to be sure I would get your blood pressure professionally checked by your GP or nurse.

Q: I've been told that I might have an irregular heartbeat when having checkups in the past. How dangerous can this be and should I get it looked into properly?

It would be advisable to have this professionally checked. The reason is that, although we all have extra and missed beats every day and probably every hour, there is a common condition called atrial fibrillation (AF) which, although not necessarily dangerous in itself, makes it more likely to develop blood clots, which can travel to the brain, resulting in strokes. To avoid this, doctors thin the blood of people who have AF. An appointment with your GP and possibly an ECG will answer whether or not you have this condition.

Q: I'm in my early 30's. What kind of heart conditions (if any) should someone my age be aware of?

At the age of 30 it's very unusual to have any heart conditions. However, there is no age too young to do things to prevent heart disease when you are older. This includes not smoking, keeping your weight down to the correct level for your height, having your blood pressure checked to make sure it's not too high and ditto your cholesterol. These last two may be abnormal without you knowing. There are some heart conditions which affect young people but they are very rare and tend to run in families.

Q: Several members of my family have suffered heart attacks - what can I do to prevent this happening?

The answer to this question is almost identical to the previous one. However, if you have a family history of heart attacks it's even more important that you have your blood pressure and cholesterol levels checked and that you don't smoke. It would also be worth having a fasting blood sugar check done because high blood pressure, high cholesterol and type 2 diabetes often go together. Also I should mention that taking regular exercise at least 3 times a week can help to keep your heart healthy.

Q: Do you have any advice on how much takeaway should be eaten within a week/month? For example is having fish and chips or a pizza once a week ok?

As so often it comes down to that phrase 'everything in moderation' and also depends on the rest of your health. If you're otherwise well, not diabetic and of normal weight for your height, a pizza or fish and chips once a week would be fine. However, if you wanted to be more scientific about it you could ask for a check with your practice nurse, including having some fasting blood tests done to make sure that your cholesterol is not too high. Also beware takeaways with high levels of salt which can cause an increase in your blood pressure and can be harmful to your kidneys.

Q: When it comes to heart palpitations, should you have these checked out immediately or is it only in certain circumstances that it should be something to worry about? e.g. regularity.

Heart palpitations are a good subject. In summary you should get them checked out sooner rather than later even though most will not be anything to worry about. The reason for this is that almost all of us get missed and extra beats most days and sometimes we may get a few seconds of missed or extra beats which feel like palpitations, but when they're checked out they are found to be so infrequent as to be unimportant. However, they can sometimes indicate a true alteration in the heart's rhythm, which may need treating. Usually a simple ECG or a 24 hour ECG can resolve the problem of whether or not the palpitations are anything to worry about.

Q: Is there anything lifestyle wise that can cause palpitations to occur or is it something more genetic?

Lifestyle can help with palpitations. For instance reducing caffeine intake can help reduce the natural extra beats we all get and make you less likely to develop true heart rhythm problems. Doing regular exercise can also help to keep your heart healthy. However, true heart rhythm problems can run in families so it's best to get it checked out initially with your GP.

Q: Both my parents have high blood pressure - am I at high risk of getting it myself?

The short answer here is yes, you are at risk of getting it yourself. Hypertension (high blood pressure) is not fully understood but what we do know is that it's often inherited, so if you have two parents with it then you are at increased risk yourself. I suggest an annual blood pressure check with the need and frequency of subsequent ones being determined by the reading the doctor or nurse measures. In the meantime there are plenty of things you can do to help lower or maintain a healthy blood pressure. Click on the link to find out more.

Q: I'm confused about salt intake - I rarely add it to food but am aware it's in processed food in large amounts. If my diet's generally healthy, should I still be calculating my intake? Also - does high salt intake have dangers for all of us or are only certain people at risk of high blood pressure because of it?

It's a good idea to calculate or have some idea of your salt intake because it's very easy to exceed the recommended amount, which is 6 grams a day or less. A lot of processed food and takeaways have added salt and even simple things like butter and breakfast cereals can contain added salt. Although salt intake is particularly important for people with high blood pressure or a family history of high blood pressure or kidney problems, it's important for all of us to keep our salt intake down. Our article Getting your salt intake right provides more information.

Q: Are there any particular age milestones where you should start to become more aware of men's health issues (like high blood pressure)?

It's interesting that a few things seem to roughly follow age. For instance it's roughly true that 30% of 30 year-olds get high blood pressure and 50% of 50 year olds etc. In general, important male health problems are unusual under the age of 40 and then gradually increase. I'm thinking of things like high blood pressure, type 2 diabetes, prostate problems, stomach acid problems, etc. However, testicular cancer doesn't follow this pattern and is more common in younger men, so regular testicular self-examination is a must for all men from an early age, i.e. teenage onwards. Bowel cancer is more common in older people but can sometimes be found in men and women under the age of 40, so any persistent alteration in bowel habit (for 4-6 weeks or more) or persistent rectal bleeding should be reported to a doctor.

Q: I'm afraid I'm a smoker - although having said that I don't smoke every day and not heavily when I do. Can you tell me is my heart disease risk the same as that of a heavy smoker? I've tried to give up smoking in the past but am unsure I will ever do so successfully.

Your heart disease risk will be less than a heavy smoker because basically you will be poisoning yourself a bit less(!). But I guess you won't be surprised to hear me say that - it's a bit like someone asking 'Is less arsenic ok for me?'! Smoking has been proven to be far and away the biggest risk for heart disease, not to mention lung cancer, chronic bronchitis/emphysema (now called COPD) and lots of other problems. Sorry if I'm being a bit too full on but I sometimes ask my patients if they want to smoke or see their grandchildren grow up? Do your best and perhaps have another go at giving up. Most surgeries have a smoking cessation clinic.

Q: Both my dad and my grandfather have suffered from heart disease and so I'm nervous this may affect me as well. I exercise regularly and try to eat as healthily as possible but is there anything else I can that would help?

It sounds as if you're doing some of the right things already. Other preventative steps would be to: not smoke, have a regular blood pressure checks, keep your cholesterol down once you've had it checked, keep your weight within normal limits - for lot of reasons including avoiding type 2 diabetes which is linked strongly to obesity - and do regular exercise that increases your heart rate. If you're doing all those things then you are more likely to avoid heart disease. To reassure yourself, think of all the differences between you and your father and grandfather i.e whether they smoke, are overweight etc.

Q: What's the best exercise to do that will keep my heart healthy? I must do more as I don't feel I'm doing as much as I should.

Basically, if you're doing 20-30 minutes of sustained exercise, which increases your heart rate, 3-4 times a week you're doing very well and more than most of the population. I remind my patients that the gym is not the only way to exercise. If you like the gym then that's fine, but if not you're more likely to exercise if you enjoy it, so take up squash, badminton, tennis, jogging, walking, swimming, or anything that keeps your muscle groups working and increases your heart rate. If you need any help you'll find lots of tips, information and inspiration to help you get moving more and stay motivated in our exercise and fitness hub.

Q: Is it most beneficial to exercise first thing in the morning?

There is no rule at all to this. Fit exercise in wherever you can in your busy day. I sometimes suggest that people make it a regular date so that Wednesday night is swimming and Friday morning is half an hour at the gym or an exercise DVD at home. Then it becomes as routine as cleaning your teeth instead of being something you're crow-barring into your day.

Q: I've recently had a routine pre-operation ECG, which showed up T-wave inversion. Should I be concerned? Will it affect me and exercising in any way?

This is a bit technical and I hope you won't be surprised if I say that really you should ask your GP, because without my seeing the whole ECG for myself it's very hard to answer this question. T-wave inversion in some of what are called the 'leads' of an ECG is so-called 'allowed', i.e. it means nothing and can be totally normal. However, in other leads of the ECG it can sometimes indicate an old heart attack or reduced blood supply to an area of the heart. Therefore discuss it with your GP.

Q: Can you reverse the damage smoking does to your heart and if so, how?

Basically no you can't, but firstly, stopping smoking will stop any further damage and secondly, the body is very clever sometimes at finding ways of bypassing areas of artery narrowing if given a chance and with regular exercise. So it's true to say that it is almost never too late to give up smoking. Remember too that smoking is bad for so many areas of your body, so you won't just be doing your heart a favour if you can stop.

Q: I read an article in the AXA PPP heart centre about broken heart syndrome, which is triggered by intense grief. What's your view on this? We all experience grief at some stage in our lives, so should we now worry about this?

It's certainly the case that for reasons which are not fully understood and which are probably due to a collection of things, the death and illness rate in spouses left behind increases in the year or so after the death of the spouse. Sometimes just being aware of this can help the surviving spouse look after themselves and look out for signs of illness.

Q: I have been on statins for 8 years due to familial hypercholesterolaemia. I have a healthy diet and exercise 6 times a week yet despite this my cholesterol levels remain just below 5. Is there anything else I can do? I'm also curious to know when advised not to take grapefruit on statins, is that only at the time of ingestion or to be excluded from the diet forever? What does it do to the statins?

It sounds like you're doing everything you can for your cholesterol and less than 5 is a good reading. Assuming you are of normal weight for your height you could try using some of the lowering cholesterol spreads on your bread. As for the problem with grapefruit and statins, this is because of a rare but important interaction between the two which could result in heart rhythm problems so grapefruit is best avoided for as long as you are on statins.

Q: As an aspiring sportsperson cases such as that of footballer Patrice Muamba, collapsing at such an early age, are quite distressing. Do you think that more should be done to screen younger people for any potential heart conditions before they can cause any damage?

Firstly it's worth remembering that incidences such as the Patrice Muamba situation, although very distressing, are also rare. Screening would probably involve doing an echocardiogram on every young person for a very low pick-up rate. However, if there is a family history of heart rhythm problems or heart problems at an early age then it's worth considering that person being screened. Finally I have heard of a charity which organises echocardiograms on young active people to avoid this problem from occurring.

Q: I'm not a member of a gym and I rarely exert myself - but on an average day I walk between 50- 80 minutes between walking to and from work and exercising the dog. Is this an adequate amount of exercise for heart health?

The walking to work and with the dog sound very good and will certainly go a long way towards fulfilling your exercise needs for your heart. However, I can't help feeling that you should build into your week some resistance or strength exercises. People often rely on the walk to work or the station as their exercise quota but it usually isn't enough. Our article on exercises to reduce blood pressure offers some suggestions for heart-friendly activities to try.

Q: I have had swelling in my legs for past few days. Is it a symptom for any illness? I am 60 yrs old, had bypass surgery 15 years back and am on blood pressure medication.

There are so many causes for leg swelling that it's impossible to answer this question with any certainty without more information or a physical examination, so it's always worth getting checked out by your GP. Swelling in the legs can simply be a sign of being on your feet too much or even sitting in one position for too long. Equally, particularly in older adults, in can be a sign of the heart not working quite as well as it should. Certain blood pressure medications can also cause swelling in the lower limbs. If you're taking something called amlodipine, or ending in ...dipine, which means it's a calcium channel blocker, this may be the cause of the swelling in your case because that's a common side-effect. As mentioned above I would recommend seeing your doctor to find out the true cause and discuss possible treatment, if applicable.

Q: How do you really tell the difference between indigestion and a more serious chest problem?

This is why I went into General Practice - because it can be a bit like detective work. In essence I'd have to know more about you, such as your age, how long you've been experiencing symptoms, etc. to make a proper diagnosis, but basically, if you can relieve your symptoms easily with an over-the-counter antacid medicine or tablet, it's unlikely to be anything to worry about. However, if the discomfort persists or there are any other symptoms, such as weight-loss, tiredness or loss of appetite, I would get it checked out by your GP.

Q: Last year I had a scare with chest pains, ultimately leading to an angiogram. This showed everything was OK and eventually the symptoms were put down to stress, which I controlled by a mindfulness course. I've not had any problems for 18 months but then last week at the gym I got a pain in the chest, which has persisted on and off since. Pains are not severe and very similar to what I experienced last time around. I'm putting this down to stress again and trying to manage in the same way as before - I don't want to cry wolf after last time - is this a safe bet?

Good question! The fact that not long ago you were checked over means that these similar pains are most likely to be for the same reason, i.e. stress. However, chest pain particularly on exertion is not something to be ignored so I'm sorry but I would just run it past your GP.

Q: My husband has remarked that my breathing is extremely heavy when I'm sleeping. I have had aortic valve replacement surgery and I wonder if this is something to do with it? I also wake up tired!!

Your heavy breathing at night may be nothing to do with your aortic valve, however it just might be connected. Some heart problems can lead to the build up of fluid in the lungs overnight resulting in breathlessness at night. In view of your history, it would be best to get this checked out by your GP.

Q: I have quite high BP at around 140 over 85 -90, controlled by Ramipril. Last year I had some haematuria, and the cause was not diagnosed for a long time - it appears I have a 13mm stone plus 6 smaller friends in my left kidney, together with some cysts. The stones are being removed by percutaneous means shortly. The kidney has signs of hydronephrosis and an internet search suggests this could contribute to the raised BP. Is this true?

Peter, your internet search may have some truth to it. Very few people know that your kidneys are intimately involved with blood pressure levels and control. In fact your Ramipril works on the renal system (kidneys) to control your blood pressure. Between your kidney specialist and your GP they should resolve your kidney stone problems and your hydronephrosis and this may result in your blood pressure being a bit easier to control, although that doesn't always happen. Make sure your treatment of your stone and your blood pressure continues.

Q: My mother who is 86 has angina and has also had a heart bypass about 12 years ago. I am 6 months short of 60, and was wondering if my mother's condition was in any way hereditary?

Things like angina and furring up of the arteries do have an inherited element to them quite often, but that is only one factor of many. The others are things like smoking, blood pressure and cholesterol levels, weight, whether or not you have diabetes and whether or not you do exercise. So it's not inevitable that you will have the same condition- a great deal is up to you.

Q: I have recently been diagnosed with atrial fibrillation (AF) and read today in the paper that an early menopause can contribute to heart disease. I had a hysterectomy and both ovaries removed at age 38 so could this be a contributory feature to this current problem?In short 'No'. I'm not aware of a strong correlation between the menopause and heart disease and certainly none with AF.

Visit our heart centre for more information and tips to help you keep heart healthy. Or if you have a question of your own on this topic, or any other aspect of your, or your family’s health, you can contact our Health at Hand team at any time of the day or night via our Ask the Expert service. Simply submit your query online and our team of nurses, pharmacists and midwives will get back to you with an answer.

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