Staying heart healthy

1 July 2012

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.

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 checked annually?

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 properly?

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 happening?

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 genetic?

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 pressure)?

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 a doctor.

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 cessation clinic.

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 day.
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 your GP.

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 favour.

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 illness.

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 heart?

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 your GP.

GOODBOY7 asked: Dr Bell, I am 60 yrs old. Had a bypass surgery 15 years back. I am on blood pressure medication.

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 GP.

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 your GP.

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 second opinion?

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? Thank you.

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 breaks off.

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.

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