And to help you stay informed, our online health clinic was open
for business on Friday 29 June - with Dr Martin Bell available live
to answer your questions on heart health.
Dr Bell was able to provide expert advice
on your queries. Here's what he had to say:
Fiona asked: 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?
Dr.Martin Bell: Hi Fiona. Good question. There
is no hard and fast rule. The very fact that you are doing regular
exercise already means that you are doing more than many people to
keep fit and look after your heart. Cardio exercises are a
relatively modern invention which are 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, if you were my patient, I would
suggest that any additional exercise should be different just to
make it more interesting and to use some other muscles. Pick
something you enjoy doing. I hope that helps.
Sarah Jane asked: How often should you get your
blood pressure checked? I am in my 20's, should i be having it
Dr.Martin Bell: Excellent question Sarah-Jane.
The guidelines tend to suggest that for someone of your age they
should have their blood pressure 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, it
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, 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.
TheLazyGirlBlog asked: 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 a generally healthy/ stress free, I'm
30 with no underlying health issues.
Dr.Martin Bell: Hi. Regarding the low blood
pressure problem you have. In some ways this is a good sign because
low blood pressure means that you are 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 perfuse 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.
TheLazyGirlBlog asked: Hi Dr Bell- yes it was a
Neurologist who suggested it may be blood pressure, there is a
history of blood pressure related issues in my family anyway, I'm
booked for an ECG next week, and my GP has been told to keep a
regular check on it.
Reuben asked:I've been told that I might have
an irregular heartbeat when having checkups in the past. How
dangerous can this be & should I get this looked into
Dr.Martin Bell:Hi Reuben. It is important that
you 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 Atrail Fibrillation 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. Get it checked.
user1 asked: I'm in my early 30's, what kind of
heat conditions (if any) should someone my age be aware of?
Dr.Martin Bell: Hi user 1. At the age of 30 it
is 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
very rare heart conditions which affect young people but they are
very rare and tend to run in families. I hope this helps.
lyou32 asked: Several members of my family have
suffered heart attacks - what can I do to prevent this
Dr.Martin Bell: Hi lyou, the answer to this
question is almost identical to the previous one. However, if you
have a family history of heart attacks it is even more important
that you have your blood pressure and cholesterol levels checked
and that you don't ever 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.
Manaccessories asked: Hi Dr Bell. 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?
Dr.Martin Bell: Hi manaccessories. Good
question. 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 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 is not good for your kidneys.
Dave asked: Hi Dr Bell, 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.
Dr.Martin Bell: 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 are 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.
Dave asked: Is there anything lifestyle wise
that can cause these palpitations to occur or is it something more
Dr.Martin Bell: Hi again Dave, 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 and doing regular
exercise can also help to keep your heart healthy. However, true
heart rhythm problems can run in families so it is best, as I said,
to get it checked out initially with your GP.
Joey asked: Both my parents have been linked to
having high bp - am I at high risk of getting it myself?
Dr.Martin Bell: Hi Joey, the short answer 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 is 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 subsequent ones being determined by the reading the
doctor or nurse measures.
Dave2012 asked: I am confused about salt intake
- to be honest I rarely add it to food but am aware it's in
processed food in large amounts. What I want to know is, 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?
Dr.Martin Bell: Hi Dave2012. It is best to
calculate or have some idea of your salt intake because it is 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 break have 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 is important for all of us to keep our salt intake
down. I hope that is helpful.
AXAPPP_healthcare asked: Hi Dr Bell, we have a
question from a blogger - Dil, from SCforM asks:
Are there any particular age milestones where you should start to
become more aware of men's health issues (like high blood
Dr.Martin Bell: Hi Dil, 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
barry_h asked: I'm afraid I am 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.
Dr.Martin Bell: Hi Barry, 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 saying is
less arsenic ok for me?'! Smoking has been proven to be far and
away the biggest risk for heart disease and that isn't even
mentioning the risk of 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 Barry and
perhaps have another go at giving up. Most surgeries have a smoking
Joe asked:Both my dad and my grandfather have
suffered from heart disease and so I am 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?
Dr.Martin Bell: Hi Joe, it sounds as if
you are doing all the right things already but basically the things
you can do are - not smoke, have a regular blood pressure check,
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 which increases your heart rate. If you're doing all those
things then you are 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.
Jess asked: What is the best exercise to do
that will keep my heart healthy? I must do more as I do not feel I
am doing as much as I should
Dr.Martin Bell: Hi Jess, basically if you
are doing 20-30 minutes of sustained exercise which increases your
heart rate 3-4 times a week you are doing very well and are doing
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 then you are more likely to exercise if you enjoy
it so take up squash, badminton, tennis, jogging, walking, swimming
or anything which keeps your muscle groups working and increases
your heart rate. I hope that helps.
Jess asked: Thanks Dr Bell, I just find
it so hard to fit it into my routine as I am working full time.
Should I try and exercise in the morning first thing?
Dr.Martin Bell: There is no rule at all
to this. Fit it 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 are crow-barring into your
Jendelwin asked: 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?
Dr.Martin Bell: This is a bit technical 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
Kkaur asked: Hi, can you reverse the damage
smoking does to your heart and if so, how? Thanks
Dr.Martin Bell: Hi Kkaur, basically no
you can't but firstly stopping smoking will stop any further damage
and secondly the body is very clever sometime in finding ways of
bypassing areas of artery narrowing if given a chance and regular
exercise. Therefore it is 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
shazzer1954 asked: 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?
Dr.Martin Bell: Hi Shazzer, 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
Ang asked:I have been on statins for 8 years
due to familial Hypercholesterolaemia.. I have a healthy diet and
exercise 6 x weekly despite this cholesterol levels only maintained
just below 5. Is there anything else I can do? 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 ? Thanks
Dr.Martin Bell: Hi Ang, it sounds like you are
doing everything you can for your cholesterol and less than 5 is a
good reading for cholesterol. 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.
Meff asked: Hi, 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? Thanks!
Dr.Martin Bell: Hi Meff, firstly remember 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 is 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.
Valerie asked: I have tricuspid regurgitation/
atrial fibrillation/under active thyroid/ borderline diabetic
(reading 7) and am wondering if you can let me know who would be
interested in insuring me for when I go overseas I am quite well
get a little swelling in my ankles when it's hot (oedema)
I have never smoked and am not an alcoholic drinker. Also is it
possible to have a valve replacement for Tricuspid regurgitation as
I understand that it is a problem with the right chamber of the
Dr.Martin Bell: Hi Valerie, regarding insurance
I'm afraid I can't help as I am a GP and therefore am not au fait
regarding insurance issues. However to answer one of your questions
it is possible to have a tricuspid valve replacement but only if
your specialist feels that it is necessary in your case. Mild
regurgitation may not cause you or your heart any problems.
James_Mc asked: 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 work and walking the dog. Is this an
adequate amount of exercise for heart health?
Dr.Martin Bell: Hi James, the walk 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 more exercise such as
sport or the gym. People often rely on the walk to work or the
station as their exercise quota but it usually isn't enough.
GOODBOY7 asked: I have swelling in my legs for
past few days? Is it a symptom for any illness?
Dr.Martin Bell: Hi Goodboy, there are so many
causes for leg swelling that it is hard to answer this question
without knowing more about you, particularly your age. It can
simply be a sign of being on your feet too much or even sitting in
one position for too long and some blood pressure medication can
cause leg swelling. Equally, particularly in the elderly in can be
a sign of the heart not working quite as well as it should. The
best thing is that if it continues I would get it checked out by
GOODBOY7 asked: Dr Bell, I am 60 yrs old. Had a
bypass surgery 15 years back. I am on blood pressure
Dr.Martin Bell: Hi again Goodboy, if you are on
a type of blood pressure medication called amlodipine or ending in
...dipine which means it is a calcium channel blocker then this may
be the cause of your ankle swelling because that is a common
side-effect. I still suggest you see your GP.
Amanda asked: How do you really tell the difference between
indigestion and a more serious chest problem?
Dr.Martin Bell: Hi Amanda, good question. This
is why I went into General Practice - because it can be a bit like
detective work. In essence I would have to know more about you such
as your age, the length of time of the symptoms etc. However
basically if you can relieve your symptoms easily with an
over-the-counter anti acid medicine or tablet it is unlikely to be
anything to worry about but if the symptoms won't go and are
persistent or there are any other symptoms such as weight-loss or
tiredness or loss of appetite I would check it over with your
Keith asked: 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. 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?
Dr.Martin Bell: Hi Keith, 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
Widdenfarm asked: 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!!
Dr.Martin Bell: 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 this is best checked over.
PeterB asked: I have quite high BP at 140 or so
over 85 -90 or so controlled by Ramipril etc. 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 Left kidney,
with some cysts. The stones are being removed by percutaneous means
shortly. The Kidney has signs of hydronephrosis. Could this
contribute to the raised BP (Usual internet search!!)
Dr.Martin Bell: 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 this renal system 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.
Aragorn asked: Hi Dr Bell I just wanted to ask
2 quick questions. Recently October 2011 I had an Left Atrial
Myxoma removed and a Single bypass carried out at the same time.
The op went well and scars have healed very well, unfortunately I
gained something called Atrial Fibrilation and am on beta blockers
to keep the heart speed down. I also take warfarin and asprin 75mg.
I take a few other items of which Targinact and oxynorm 5mg also
diazepam5mg and others. My question is I had DVT and lately my leg
the vein was removed from swells up quite considerably turning a
darker colour around the calf and foot. I have been experiencing
quite sharp scatterings of pain in my chest but not my left arm I
find at these times I hunt for a breath clammy sweats have returned
leaving me requiring to change as clothes get very damp. I have
been to the GP on number of occasions and been told I will
experience these things and that I have an irregular heartbeat. My
GP has asked me recently to try and cut down on the beta blocker
but every time I do I get awake.
Dr.Martin Bell: Hi Aragorn, You are obviously
quite complex and it sounds to me that you have had and are having
all the right treatment. The easy part of your question is that it
is not unusual to have changes of colour in the ankle or foot after
one of your veins has been removed particularly if you have had a
DVT because this affects the drainage of blood from the lower leg.
As for our other symptoms your GP may be right but in view of your
AF and your fairly complex history I would be tempted to ask if you
could have further investigations or see a cardiologist even if
just for reassurance.
Aragorn asked: Thank you for your speedy reply.
Would a GP take offence if I was to phone my cardiologist to get a
Dr.Martin Bell: Hi Aragon, again. Your GP is
unlikely to be offended but if you were my patient I would prefer
that you asked me first, partly out of politeness and partly in
case I could do something for you.
Emmo asked: Hi - 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?
Dr.Martin Bell: Hi Emmo, things like angina and
furring up of the arteries does have an inherited element to it
quite often but that is only one factor of many. The others are
things like smoking, smoking, smoking (yes i did mean to say it
three times!) and blood pressure and cholesterol levels, weight,
whether or not there is diabetes and whether or not you do
exercise. So it is not inevitable that you will have the same
condition- a great deal is up to you.
492418 asked: I have recently been diagnosed
with Postural Orthostatic Tachycardia Syndrome. I'm currently
taking Ivabradine 7.5mg a day, Fludrocortisone 300mcg a day,
Octreotide injections 25mcg twice a day. My heart rate is still
very high many times during the day despite being on these
medications. Even when I'm sat down my heart rate goes up to around
140-170 on a bad day (I have more frequent bad days on average 3
bad days a week). I honestly think I have something else going on
other than related to my POTS as my heart rate is always so high
especially when walking up stairs at home? I have a pulse oximeter
and my heart rate is around 180bpm every time I walk up the stairs
at home? What are your thoughts on my symptoms, fast heart rate? A
few times an ECG takings have shown AF, but the majority of times
my ECGs shown sinus tachycardia with extra ectopic beats. I also
feel very short of breath when walking up stairs at home. Any
help/advice would be appreciated. Thank you.
Dr.Martin Bell: Hi 492418. I hope I'm not going
to disappoint you when I say you need to go back to your GP. What
you have is complex and even the medication you are on is unusual
(albeit that it's probably the correct medication). If you were my
patient I wouldn't mind you asking me, politely of course!, to see
a cardiologist or even have further tests even if it's just for
reassurance that all the bases are being covered.
492418 asked:Thank you Dr Bell for your
response to my question. I'm due to see my GP next week, so I shall
request for a referral to see a cardiologist. I was recently
discharged from my local cardiologist who is based in London, so
I'm now looking to find another cardiologist local to me who has
knowledge of Postural Orthostatic Tachycardia Syndrome. I don't
suppose you know any cardiologists who specialise in treating
patients with my condition as it's proving very difficult to find a
specialist in London due to how rare my condition is in the UK?
Dr.Martin Bell:Hi 492418. I'm afraid I don't
know of a suitable specialist but these days it is much easier to
find one on the internet than it used to be. Sorry I can't help
with this one.
Trojan asked: Hi Dr Bell, I had a bypass operation on 11th April
and I have been discharged from the Hospital. The consultant said
that I have a blood clot in my leg which should go after about
three weeks; it has shrunk but not completely gone!! Should I
worry? I also go on three and five mile walks up hill and down dale
is this too much?
Dr.Martin Bell: Hi trojan, I'm assuming that
you are talking about a DVT (deep vein thrombosis or clot in the
leg) and that you are on appropriate blood thinning medication like
warfarin. if that's the case it should gradually disperse and
although remaining active is good I personally wouldn't want you
walking up hill and down dale in case what remains of the clot
Trojan asked: Thanks Doc, but if the clot is a
result of the consultant taking a vein for the graft does this not
mean the clot is outside rather than in a vein?
Dr.Martin Bell: Yes you might be right. If that's the case then
your walking would be no problem. Just make sure it's not within
the vein i.e. a DVT.
Bumble asked: I have recently been diagnosed
with atrial fibrillation 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?
Dr.Martin Bell: Hi Bumble. In short 'No'. I am
not aware of a strong correlation between the menopause and heart
disease and certainly none with AF.
nj2dbz asked: I have two questions if I may. My
son plays a lot of sport always has - he's 23 now. I would be happy
if he had an ultrasound given the recent events of footballers
having heart attacks. Is this something we can do on the NHS -
would all doctors be sympathetic or would we have to do it
privately. Also I'm 57 and have severe gum disease since I was 42.
I know there is a link with heart disease again can I turn up for a
heart scan - will the NHS agree to it? Anything else i can do or
take to help prevent heart disease. I don't smoke. Thank you.
Dr.Martin Bell: Hi nj, you can ask your GP on
both counts but he or she may legitimately refuse you an echo on
the NHS. For your son because if every parent asked for an
echocardiogram for their child then there would be no appointment
for anyone else and for you the solution is to treat the gum
disease even though you are right there is a connection between
this and heart disease but not a strong one. Hope this helps.
Got another question? Ask our panel of experts on The Heart Centre.
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