Dr Barakat - Heart live chat

5 March 2012

We were pleased to welcome Dr Khalid Barakat along to answer your questions on everything related to on heart health.

It was a busy session, with Dr Barakat fielding questions on a number of topics, from treating coronary heart disease to the durability of stents, this was a great Q&A with some great questions and detailed responses. Thanks to all who took part and to Dr Barakat.

Here are the live chat questions and answers in full:

AXAPPPhealthcare: Morning everyone, welcome to our live chat about the heart. We're pleased to welcome Dr Khalid Barakat from BMI. Looks like our first question has arrived...over to you

Walkingtrojan: Can you tell me if chelation works please ?

Dr_Khalid_Barakat: Good Morning Walkingtrojan. That is a great opening question. Chelation refers to the binding of metal ions and traditionally has been used in medicine for treatment of iron overload states where it has a definite proven role. Coronary artery disease is the process by which fat deposits in the lining of coronary arteries leading to their progressive narrowing and can lead to heart attacks and angina. It has been known for a very long time that calcium deposition is associated with coronary artery disease. There has therefore been a suggestion that chelation of calcium ions may lead to coronary artery disease regression. The state of the art at the moment suggests that there is no evidence that this is the case. Bigger trials may be needed but as things stands it is not a recognised mainstream treatment

Walkingtrojan: Thank you, if my arteries are 70% and 80% blocked would stents do the job in place of full blown bypass surgery ?

Dr_Khalid_Barakat: Treatment for coronary artery disease (blockages) falls into three main categories - medical, stents (angioplasty or stents) and bypass surgery. The mainstay of treatment and the thing that makes the biggest difference is medical therapy. Treatment beyond medication with stents or bypass has to be tailored to the individual and will depend on a number of factors including symptoms, other illnesses and most importantly the pattern of artery disease. So it is difficult to comment on an individual case without knowing all of these factors.

Walkingtrojan: Thank you Dr.

Nel: Female, age 55, weight 11stone 6lb, cholesterol 6.15, triglycerides 1.75, HDL 1.62, LDL 3.7, cholesterol/HDL 3.8 24 hour holter in January average 149/89.6, pulse 73.9 Started Ramipril 2.5mg on 10th Feb. Average of readings since then is 133/77 (based on waking & last thing at night). But still get home readings between 146 - 157 systolic just before going to bed and some dry cough has started in past week. Advice please.

Dr_Khalid_Barakat: The cough is most likely to be secondary to the Ramipril (an ACE inhibitor) and is seen in 15% of patients. This can be easily sorted by switching to an alternate medication. In your case the ACE inhibitor seems to be doing a good job at a low dose and I personally would consider a sister class of drugs called angiotensin II receptor blockers and you will need to report the cough to your GP first. Your BP seems to be getting under control but there is some room for improvement which will be achieved by titrating up the dose of the medication.

Nel: Sorry - are you suggesting angiotensin receptor blockers instead of Ramipril? Or angiotensin receptor blockers + up titrated Ramipril?

Dr_Khalid_Barakat:Ramipril is an ACE inhibitor. If you are experiencing a cough this may need to be stopped and replaced with an alternate such as an angiotensin II receptor blocker after discussion with your GP.

brianlondon: My BP this morning on rising was 130/75. It fluctuates at higher values (say 160/90) during the day, especially after meals. My age is 67.Should I have any concerns?

Dr_Khalid_Barakat: Good morning, brianlondon. There is a diurnal variation to blood pressure in that it tends to be lower first thing in the morning and rises during the day. It is lowest when we are asleep. The higher values during the day suggest that your blood pressure should be monitored and I would report this to your GP to monitor. It is often easily addressed with lifestyle and dietary modifications in the first instance.

Jane: I have high cholesterol 7.3 and 4.3 of the bad lipids so need to take statins, am very concerned about side effects such as muscle aches. I know some stains have a tendency to this side effect while others don't, any advice on which statin to take? Thanks. Btw, am 57 years old, high cholesterol is hereditary, but I am 9st 3 lbs and bp is 130/75 in morning, so no other heart indications, just this pesky cholesterol!

Dr_Khalid_Barakat: There are some differences with regards to the statins with regards to muscle aches but it is very difficult to predict if any individual will experience any problems with a specific one. In general about 7% of patients experience some degree of muscle aches with statins. I d try the statin that GP has suggested and hopefully you will be in the 93% not to experience muscle aches.

Jane: Thanks Doctor B.

Spud: Hi. I'm 34, male. Resting hr 42, sometimes less, sometimes more. Not athletic. No symptoms. Had 1 syncope episode last year but the A&E doctor said all ok. Do I need to have this investigated or just carry on as no problems?

Dr_Khalid_Barakat: I am less concerned about the heart rate per se in a young man like you and more interested to know if you are having any symptoms. In the absence of symptoms I would d not be concerned. However, if you experience any dizzy episodes or syncope you will need to be seen.

Spud: Ok thanks for that. I had one episode of syncope, went very grey apparently and hr went up to 130. A&E said ECG was ok and no murmur. Lowest rate ever was 32 but no symptoms. I tend to stick to 42-50 BPM and feel fine. So if A&E were happy do u suggest leaving things unless new symptoms

Dr_Khalid_Barakat: AE will have reviewed your ECG and provided that you are completely well I would stick to the advice that you have been given. If you have any light headedness, dizziness or syncope then you will need to be seen. Did they give you an explanation as to why you lost consciousness?

Spud: Dr said it could have been sat for too long watching a film then with sudden movement my hr went up and I went  to the floor. Only happened once.

Dr_Khalid_Barakat: Ok. Stick to plan A. Any further symptoms then seek some advice.

Spud: Thanks Dr B and AXA

CAB: Have a pacemaker as I needed a knee operation and the anaesthetist would not let the operation take place until I had had a pacemaker fitted. I hope this isn't a silly question but I lie on my left side at night but sometimes can't get to sleep because my heart is beating so loudly so have to turn over and things are then fine. Is his something everyone gets or is it a symptom of anything else. I am constantly tired but have been so for many years

Dr_Khalid_Barakat: Good morning, CAB. The symptom of a loud heart beat are not related to the pacemaker. There are many causes for breathlessness and you may want to discuss this with your GP

Julie Leach: Hi Dr. I was diagnosed with a congenital heart defect just 5 years ago when I was 35. It's mild / moderate aortic regurgitation but apart from a few palpitations I do not have not had many symptoms. However, I am now 5 months pregnant and feeling quite heavy palpitations at night particularly if I lay on my left side. Should I be concerned as this pregnancy progresses? I am having migraines / headaches which I know could be because of pregnancy in General but my blood pressure is good, if anything it can be low. Kind Regards. Julie

Dr_Khalid_Barakat: Hi Julie. Palpitations can mean different things to different people and it is not uncommon to have a feeling of a forceful but not very fast heart beat in pregnancy as a normal phenomenon since the heart's output increases to cope with the baby. if you are experiencing fast and or irregular heart beats then you should let your doctor know. However, from the condition that you describe I would not be worried that you will have any significant problems in pregnancy.

Karon: I have a condition called right bundle branch block and my father died aged 56 from a heart attack I'm overweight and worried that I might have a heart attack could I be in danger?

Dr_Khalid_Barakat: Right bundle branch block pattern (RBBB) is not a risk factor for heart attacks. It occurs in 1-3% of the population and increases with age. In the majority of patients it does not signify any significant underlying heart problems. In older patients who develop a RBBB there is a very small risk that that one day they may require a pacemaker.

Karon: Thank you.

Peter: How long do stents last, and do they need replacing?

Dr_Khalid_Barakat: Hello Peter. Stents are made of an alloy and last forever. They can re-narrow through the growth of natural tissue. The risk that this will happen with the latest generation of stents is around 55 for all comers but varies on the size of the artery and the length of disease.

Peter: Thanks Doc

Teasel: Background: -Am 64 year-old female, diabetic type 2 (diagnosed last June) - controlled by diet. Ex P.E. teacher with 2 knee and 1 hip replacement, so less high rate exercise then previously, and the weight crept on... but I have now cut out all sugar and on a low fat diet - has resulted in my being able to bring weight down and hoping to get back to 11 and half stone this year. Last June the diabetes was discovered when I had pains around my upper sternum, left shoulder and arm - this was investigated and the diabetes was diagnosed. I was then tested for angina at hospital and the angiogram came back clear, and have monitored blood pressure and that is good, as is cholesterol

My question is this... intermittently, I still have discomfort / pain in my left shoulder beneath my collar bone - usually when I lie back in the car or when I lie on my left side, but do not have any discomfort when I exercise. I have rationalised this by thinking it is a muscle pull taking a long time to heal, or arthritis appearing in shoulder joint... however could the pain / discomfort still be a problem such as a blocked artery in the shoulder region that didn't show up on the angiogram, and should I go back to the doctor? He seemed to not be worried about it when we had the follow-up to the angiogram last August.

Dr_Khalid_Barakat:  Hi Teasel. By clear angiogram I assume that no blockages were seen or indeed any narrowing in which case the angiogram is very reassuring. The symptoms that you describe do not sound like heart type pains which tend to occur on exertion. All of this will need to put into the context of the exact findings on your angiogram

Teasel: No blockages were found on the angiogram, but does this also indicate healthy arteries outside of the heart?

Dr_Khalid_Barakat: The coronary angiogram is specific for heart and will not give information about the state of the peripheral circulation

Martyn: I have recently had a heart attack (not massive). I also have MS and suffer from poor mobility, i.e. I walk with a stick over a limited distance . However we encouraged to exercise, a bit of a catch 22. What approach would you recommend? Martyn

Dr_Khalid_Barakat: Hi Martyn, sorry about the delay. It is difficult but you can only do what you can do. If your able to swim that would be a good form of exercise for you.

Martyn: Thank you Doctor. Martyn.

hilary77: Hi! Both my parents died with heart attacks, is heart disease hereditary? if so, what is the percentage of me having heart problems? I am a 61 year old female not in good health, I have mobility problems and the latest ailment to add to the list is Thyroid Graves Disease. All my problems seem to relate to my Immune System. I currently take Propranolol and Thyroid meds. One thing that is worrying me at the moment is my Mother just before her death always complained of a runny nose even though she did not have a cold and just recently my nose has started to run and I do not have cold? I was wondering if it is anything to do with heart problems? Any advice also welcome. thank you! kind regards Hilary

Dr_Khalid_Barakat: Good morning, Hilary although having a first degree relative with coronary artery disease is a risk factor for developing heart disease, heart disease is not hereditary like colour blindness but is multifactorial and depends a number of risk factors most important of which is smoking. Remember that families share many things in common (like diet) and not just genes. The runny nose is not a recognised symptom of heart disease.

Hilary: Thank You! so much for putting my mind at rest. I did not like to ask my doctor in case it was nothing (runny nose) which you have answered. Again thanks! for answering so quickly. kindest regards Hilary.

James B: I am 63 and generally fit (doctor says so); not overweight, take exercise, eat healthily, drink a bit of wine, cut out salt. BP has been high and was averaging 145/85 on 5 mg Amlodipine. He has now put me on 10 mg. Where do you think I should be aiming for in terms of BP readings at that level - it seems to take the Diastolic to 80 or below but the Systolic varies from 120's to early 150's.

Dr_Khalid_Barakat: Good morning James. I think you are close to target. I would be very happy with you averaging blood pressure readings of 140/80 or below. Individual higher values will occur during the course of the day.

JulieLeach: Hi Dr. I was diagnosed with a congenital heart defect just 5 years ago when I was 35. It's mild / moderate aortic regurgitation but apart from a few palpitations I do not have not had many symptoms. However, I am now 5 months pregnant and feeling quite heavy palpitations at night particularly if I lay on my left side. Should I be concerned as this pregnancy progresses? I am having migraines / headaches which I know could be because of pregnancy in General but my blood pressure is good, if anything it can be low. Kind Regards. Julie

Dr_Khalid_Barakat: Hi Julie. Palpitations can mean different things to different people and it is not uncommon to have a feeling of a forceful but not very fast heart beat in pregnancy as a normal phenomenon since the heart's output increases to cope with the baby. if you are experiencing fast and or irregular heart beats then you should let your doctor know. However, from the condition that you describe I would not be worried that you will have any significant problems in pregnancy.

Andy: Hi Doctor. Is it normal to have heart beat which seems to miss a beat ?

Dr_Khalid_Barakat: Good morning, Andy. Yes a missed heart beat (ectopics) is a normal and common phenomenon. They tend to occur at rest but if they start to occur with exercise then they are abnormal

Reg_Thomas: I was diagnosed with Atrial fibrillation in 2002. I am taking Warfarin, Bisoprolol 2.5mg, Bendroflumethiazide 2.5mg, Digoxin 250micrograms.(1) Is there any new treatment applicable to AF? (2) What is the best exercise for AF?

Dr_Khalid_Barakat: Good morning Reg_Thomas. This is a good question. The most important thing to address in atrial fibrillation is the risk of strokes which they have done in your case with Warfarin. Not everyone will need to be on Warfarin - this is determined by an individual's risk of stroke. The next question is to decide whether to accept atrial fibrillation or to restore normal rhythm. This is determined by one's symptoms - in the main. In the absence of symptoms then adopting a rate control strategy, as in your case is very reasonable. If someone is very symptomatic (shortness of breath) then one might try to restore normal rhythm with an electrical shock treatment and or powerful drugs. Newer minimally invasive treatments are available called ablation to try to restore normal rhythm in select cases.

Reg_Thomas: Thank you Dr. B.

Scorpio: Good morning Dr, I've had 6 months of multiple ECG's X-rays MRI on my heart, checking for what I know as a double beat? sometimes it leaves me having to breathe deeply to clear. after the time all I have been given is beta blockers 1.25, these don't last the day and now they have prescribed 2.5. It has been called a noisy heart. Will I have to take these pills all my life? I'm 66

Dr_Khalid_Barakat: Good morning, Scorpio. You have clearly seen a team that is very thorough. I presume the MRI was normal in which case they have excluded any sinister problems. The ectopic beats or extra heart beats are therefore more of an irritation than anything to worry about and the medication is designed to suppress them. Whether you take the medication or not will be determined by your symptoms.

Scorpio: Yes it was good news that nothing seemed wrong but no explanation was given as to what these ectopics were?

Dr_Khalid_Barakat: Hello again Scorpio. Ectopics are extra heart beats generated by the heart. Normally each heart beat is generated every second or so in sinus node. Occasionally other bits of the heart throw in their own heart beat which we sense as an extra or missed heart beats. Usually there is no explanation but sometimes they can be triggered by caffeine or Chinese meals.

vgibson41: When I lie down at night I am aware that my heart beat is irregular, sometimes doing a double beat. I am 70 years old, female with normal blood pressure and no heart troubles so far. Is this normal

Dr_Khalid_Barakat: Good morning vgibson. I am not concerned about the double heart beat but an irregular heart beat in someone with high blood pressure should be investigated to exclude atrial fibrillation. You should report this to your doctor.

Woodman: I'm a fifty year male, occasional angina since teens. It happens a few times a year when relaxed - not brought on by exertion. Goes away after 2 to 10 minutes of pain and restricted breathing (tiny breaths being the only kind possible) or in seconds with a borrowed GTN spray under the tongue. Never investigated, other than GP using stethoscope. Hasn't got worse. No other health issues, non-smoker, no family history, normal BP, cholesterol unknown. Should it be investigated? If so, what tests should one look for?

Dr_Khalid_Barakat: Good morning Woodman. I am intrigued that you were diagnosed with angina in your teens. It does make me want to question the diagnosis since angina is not a disease of the young and for that very reason I think you should be seen so that a definitive diagnosis be reached.

Woodman: The relief with GTN seems to confirm it?

Dr_Khalid_Barakat: Woodman. I am afraid that relief with GTN is not specific since other cause so pain such oesophageal spasm respond to SL GTN. I think that since you have had a diagnosis of angina since your teens and you are now at the age when a proportion of the population do develop angina you should be seen by a cardiologist to make a definitive diagnosis

Woodman: Thanks, what tests should I look to have?

Dr_Khalid_Barakat: Review with a cardiologist is the first port of call. Specific tests if needed can be determined thereafter

Woodman: Thanks. A final general query: I'm impressed with the weight of evidence for statins as a preventative measure against strokes and heart disease. Some say most over 50s should take them. Any views?

Dr_Khalid_Barakat: For primary prevention there are international and national guidelines which suggest working out the 10 year risk of an ischaemic event using a risk tool such as Framingham to determine the benefits vs. risks of taking the statins. The benefit for any therapy is greatest in those at highest risk.

c_h_summers: I am 69 years old and have an extra heart beat. I am on blood pressure tablets Perindopril) and diuretics because my readings can typically be over 40 up to 60 systolic and 90 diastolic when taken at the doctor's surgery and as low as 103/53 when taken at home. I have just read a book by Dr. John Sarno called the Divided Mind and his research has shown that emotional stress does not necessarily cause blood pressure and it is more likely to be repressed emotions that causes stimulation of the sympathetic nervous system that to be more hypertension prone. In this case the medication has little effect and suggests that Beta s may be more effective. This excluding factors such as hereditary, obesity and alcoholic abuse. Can you comment as I believe my medication is not working.

Dr_Khalid_Barakat: Good morning c_h_summers. I am not sure that the transcript has the correct BP readings when you are at the surgery. Would you mind resending them.

AXAPPPhealthcare: Hi Dr Barakat we're not sure c_h_summers is online - the question states these readings "can typically be over 40 up to 60 systolic and 90 diastolic when taken at the doctor's surgery and as low as 103/53 when taken at home" - not sure this is enough information?

Dr_Khalid_Barakat: c_h_summers - I cannot comment as the BP as posted suggests a lower systolic than diastolic pressure at the surgery which is not possible.

RichardG: Hi, my Doctor has diagnosed that I have high blood pressure and prescribed "Valsartan" 40mg daily. I monitor my own blood pressure and my average over the last 12 months is 145.7 / 87.7. It varies a lot at different times of day is this normal and should I increase the dose to 80mg? I am 62 years old. Thanks

Dr_Khalid_Barakat: Hi RichardG. Diurnal variation of blood pressure is normal - see above. You probably do need to increase the dose of the Valsartan but I would not do this without consulting your GP first.

RichardG: Thanks for your reply. I have one further question - since taking the medication (Valsartan) I seem to wake in the night with a very dry mouth and have to take a glass of water to bed every night - is this a side effect of the medication?

Dr_Khalid_Barakat: Yes it is.

Walkingtrojan: Hi Doc, how often is keyhole surgery performed rather than full blown opening?

Dr_Khalid_Barakat: Hi. Angioplasty rates vs. bypass rates depend on which country or patient population you are looking at. In some places the ratio is as high as 7:1 in favour of angioplasty and in others as low as 1:1 overall it is probably around 3:1. Over the last 10 years the number of bypass operations have remained constant but the number of angioplasties have increased dramatically mainly driven by improving device technology.

AXAPPPhealthcare: A question from John Reed next : "I had an ablation for Wolff-Parkinson-White 10 years ago. A month ago, I started to get minor palpitations (not fast)and mild pain in the same area with breathlessness now. Does WPW come back or could this be as a result of the ablation?"

Dr_Khalid_Barakat: WPW can sometimes be only partially or incompletely ablated and therefore appear to comeback. This is unlikely to be the case after 10 years. If you are experiencing palpitations again then I would suggest that you are reviewed by a cardiologist.

Walkingtrojan: Hi Doctor, is bypass always necessary ? or would stents be good enough ?

Dr_Khalid_Barakat: see above but the decision regarding bypass versus angioplasty is an individually tailored decision determined by a large number of factors including patient's other illnesses and the pattern and extent of arterial narrowings. Put it this way, I undertake angioplasties for a living but if I had heart disease which was best treated with bypass then I would have a bypass even if angioplasty was technically possible.

Walkingtrojan: Thank you very much Dr Barakat. I wish you well for the future and keep up the excellent work you and your colleagues provide.

Nel: Great Q&A session. Thank you

Dr_Khalid_Barakat: Pleasure, it has been hectic but great fun

AXAPPPhealthcare: Yes Dr Barakat it has been busy, we're all really grateful for the answers you've posted

Frank: I had a catheter ablation four years ago for SVT [supraventricular tachycardia] since then I have had a constant extrasystole, is this likely to affect me in the future?

Dr_Khalid_Barakat: If that has been the case ever since the ablation then it is unlikely to affect you.

Nel: Newly hypertensive and have seen GP so far. At what point should I take up my PPP membership and go and see a consultant?

Dr_Khalid_Barakat: High blood pressure is very well looked after by primary care. You would need to see someone if the blood pressure wasn't treated effectively or they suspect an underlying cause for hypertension which is particularly the case in very you patients (<35 years old).

AXAPPPhealthcare: Nel, its best to contact us if your doctor refers you to a consultant ..we can then go through making a claim, so you're ready to arrange treatment.

deseri.chandler: If your blood pressure is 137over82 and your pulse rate is 79 is this within the guidelines?

Dr_Khalid_Barakat: For the general population, yes.

Haggis: Apparently I have a slightly prominent ascending thoracic aorta but my GP hasn't explained what this is - I did ask but was told nothing to worry about !!. Should I be worried? Can you explain in simple language please.

Dr_Khalid_Baraklat: It is nothing to worry about. It is the shadow formed by the aorta as it bends on itself en route through the chest to the abdomen. It is that part of the aorta (the main blood vessel out of the heart) which is visible either side of the breast bone. It is common for this to become more prominent as we get older. This is because as the amount of elastic tissue in this tube changes so the way it bends in the chest also changes slightly, causing it to become more prominent.

Haggis: Thank you so much for your response - an excellent service.

AXA PPP healthcare: Dr Barakat we've got time for one question from a blog reader - you may have already answered a similar question in amongst this mornings, sorry if its repeating. It's from Edward Neville Can excess adrenalin cause high blood pressure and irregular heartbeat?

Dr_Khalid_Barakat: yes it can but causes of excess adrenaline are exceedingly rare.

joycebaddeley: Hi, just started to get a racing heart and when this happens it my heart jumps every few seconds what could this be?

Dr_Khalid_Barakat: this may turn out to be nothing but it would be worth discussing this with your GP with a view to a referral to a cardiologist. Extra or missed heart beats are very common and usually of no significance.

joycebaddely:  Could it be blood pressure tablets as I have been on then since July....saying that it's only been racing the last 3 weeks.

Dr_Khalid_Barakat: Unlikely given the timecourse you describe. A tablet like Amlodipine if you are on it can sometimes cause a racing heart beat

Sha2512: Hi have Ehlers-Danlos and mitral regurgitation, allergy and poss mast cell release + NMH [neurally mediated hypotension] + Pots. not treated successfully have read about Ivabradine being used for POTS [post orthostatic tachycardia syndrome] and NMH plus also to stop tachycardia caused by mast cell release. Have you any ideas on this? Also if spiro would help with fluid retention from Mitral Valve. Am getting fed up of symptoms and would appreciate any advice. Not many cardiologists bothered about probs caused by this but it is very tiring to have your heart banging away like this. Thanks

Dr_Khalid_Barakat: Hi, I am sorry that you are having such a difficult time. You do have a set of rare and very specific problems. Treatment for you will have to be carefully targeted by your physician/cardiologist. Having said that if the mitral valve is responsible for fluid retention then it would be only if it were leaking significantly in which case Spironolactone would not be the drug of choice. In the absence of a significant leak in the mitral valve there a many causes of fluid retention which are not secondary to the heart

Sha2512: My mitral regurgitation is mild. I think I get fluid from sympathetic withdrawal during vasovagal stuff. A good cardiologist is hard to find when its neuro related, especially in the area I live in, they have not got a clue. Any ideas of a good one in Nottinghamshire would be helpful but I would guess you can't do that.

AXAPPPhealthcare: Well as we have a spare few minutes until the end of our time with Dr Barakat, would you mind telling us a little about yourself, type of work you do and so on?

Dr_Khalid_Barakat: I am a Consultant Cardiologist working in East Berkshire and south Bucks. I have a particular interest in coronary artery disease and angioplasty. In a typical week I will undertake 2 outpatient clinics a week, one - two coronary care unit ward rounds a week and will work in the cardiac catheter lab 1.5 days a week where I perform diagnostic angiograms, coronary angioplasty and pacemaker implantations.

AXAPPPhealthcare: Thanks Dr Barakat

AXAPPPhealthcare: We have some questions from our blog readers - firstly, Mrs R Wheatly I have been taking anti-depressants, (mirtazapine for 9years) and (sertraline for 4months) and concerned if they would have an affect on the heart. Can you please advise.

Dr_Khalid_Barakat: Both drugs are well tolerated from a heart point of view. They have no direct adverse effects on the heart. They may occasionally be associated with palpitations.

AXAPPPhealthcare: Question from a blog reader, Nicola Carter - Hi, I'm 38 years old. For years now my heart will every now and then skip a beat or sometimes do a double/tripple beat. It's not after exercise or exertion, it is very random and probably happens no more than once a fortnight(ish). I'm normal height and weight, slightly high cholesterhol (no meds for this though) and "very good" blood pressure. Is this anything to worry about?

Dr_Khalid_Barakat: Sounds very much like ectopic or extra heart beats which are a normal phenomenon. Typically these occur at rest and not during exercise. If they occur with exertion or are associated with racing heart beats and or dizziness or chest pain then it would be worth getting seen by a Cardiologist.

AXAPPPhealthcare: Question from a blog reader, Lowry Stanage - I am a 65 year old male and was diagnosed with AF 4 years ago. It is asymptomatic and I have been on Warfarin for the past 4 years. DC cardioversion was tried soon after diagnosis, unsuccessfully. At that time my Consultant felt that given my lack of symptoms and age he would not recommend the next stage of treatment which would be ablation. However, another Consultant from whom I sought a second opinion recommended that I explore the ablation option. I have not progressed this and, of course, am now 4 years older but a friend of mine in her 70′s with a similar condition has had successful ablation treatment (albeit in the US). This has caused me to think again - should I be reconsidering the ablation option and, given my age,would it be offered?

Dr_Khalid_Barakat: You have got to ask yourself what you are aiming to get from your treatment. If you are symptomatic then a successful ablation will restore your quality of life by removing those symptoms attributable to AF. In the absence of symptoms there is little to be gained.

AXAPPPhealthcare: Question from a blog reader, louisa - I'm 39 and I have been having heart palpations recently. A week ago my left arm kept having a cold feeling down the forearm. Today I have been experiencing slight dizziness and my left forearm has a numb feeling. Could this be related to the heart?

Dr_Khalid_Barakat: If you are experiencing palpitations with dizziness then you should be seen by a Cardiologist or a GP with an interest in Cardiology.

AXAPPPhealthcare: Question from a blog reader,  John Levison - I'm 40 years old and had a triple heart bypass (CABG) operation six months ago. I'm very fit (always have been, triathlete/marathon runner), never smoked, good diet, don't drink much and bloods/BP all good. Cause seems to have been hereditary cholesterol issue (non technical understanding - body doesn't produce enough 'good' cholesterol).

Recovery, generally has been perfect. Did all the rehab, walked daily, gym, swimming et al and no pain/discomfort. Problem now is that my legs feel very weak when trying to run or cycle. I can swim very hard with no aerobic/heart problems at all, but my legs feel like they have no power when running/cycling - could this be due to a side effect from the drugs?

I take Ramipril, Bisoprolol, Amiodarone, Atorvastatin (40mg) and aspirin daily. Symptoms possibly, not 100%, got worse when I moved from 20mg to 40mg of statin.

A) Are these symptoms familiar, could they be a side effect?

Dr_Khalid_Barakat: The beta blocker or statin could be responsible. The former can patients feel tired or if you have impaired circulation in the legs then they may be exacerbating that tendency. The statins can be associated with muscle aches and cramps. This is something that you should speak to your doctor about.

The leg issue aside, I feel absolutely fine and so much better than previous - can I start to reduce any/all of the tablets I'm currently taking? CABG ops fix the blockages but don't cure the underlying disease process. It is vital that you continue on aspirin, statins and Ramipril for life since they have been shown to improve survival. Short term amiodarone post bypass is not uncommon but something that we often will consider stopping at 3 - 6 months depending on the reason it was initially started.You will need to see your doctor about this.

AXAPPPhealthcare: Question from a blog reader, Kate Johnson- Hi, I am 55 year women being treated for mild non-obstructive CAD (10% obstruction found by coronary angiogram) with bisoprolol fumarate 1.25mg, simvastatin 40mg and aspirin 75mg. After 6 months on these pills developed breathlessness. Went back to Cardiologist who did a holter test and EGC, checked heart rate etc all ok. Then he cut the bisoprolol fumarate from 5mg to present dosage 1.25mg. This seemed to work for one month then again developed breathlessness.

Breathlessness only comes on when I required to do some short exercise like cooking or cleaning. If I go for long walks no problem. Breathlessness is in the form of having to take a deep breath not panting or like when running breathlessness. My lungs have been checked X ray, Peak flow and spirometry tests are all normal.

My question what is this breathlessness and is it related to bisoprolol fumarate?or is there anything else I can explore or do. Would be very grateful for a view on the likely prognosis for my non-obstructive CAD eg - Is it likely to deteriorate? Can I do anything with my lifestyle to help? eg foods/exercise to do or to avoid.

Dr_Khalid_Barakat: The breathlessness you should consult the doctor about as the bisoprolol could be contributing to your breathlessness. Your prognosis, with lifestyle modifications and aspirin and statins should be excellent. You only have a minor issue and hopefully this will be kept in check by the excellent treatment that you have been prescribed.