heart attack

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7 signs of heart problems

Most of us know that a tightening sensation in the chest accompanied by pain down the arms can be a tell-tale sign of a heart attack, and that action should be taken immediately. Fewer of us are aware, however, of earlier signs and symptoms that can alert us to heart problems before they get out of hand.

Dr Gigi Taguri has prepared a simple guide to the warning signs to look out for – and what to do about them (short version: see your doctor!). For example, did you know that swollen feet can indicate a back-up of blood due to under-efficiency of the heart? Likewise, memory loss or the sudden onset of dizziness for no apparent reason can be connected with impaired blood flow to the brain. And erectile dysfunction may seem an embarrassing issue that you would rather keep to yourself in the hope that things will get better – but it is often a symptom of deeper issues, and can be one of the first signs of a heart problem.

These are just some of the symptoms to be aware of, and they may well be indicative of a completely different issue – but regardless, as Dr Taguri advises, it is best to see a doctor as soon as possible and get the treatment you need to prevent the problem escalating.


Hidden Signs of heart problems

Hidden Signs of heart problems from 

: onlinedoctor.lloydspharmacy.com/uk/info/mens-health-information/signs-of-heart-problems

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European Heart Failure Awareness Day – How one hospital is promoting awareness!


European Heart Failure Awareness Day

European Heart Failure Awareness Day

As you many have heard on the radio this morning today is European Heart Failure Awareness Day.

So the Heart Failure team at Glenfield Hospital in Leicester is showing its support for the event with an stall in the reception area of the hospital and nursing staff on hand to talk to people about heart failure and heart health in general.

Please feel free to share the picture associated with this blog. When enlarged (you can do so by clicking on it) the poster turns into an informational poster which is easy to share online.

The Europe-wide initiative is designed to raise awareness of heart failure, including spotting possible symptoms, the importance of an early and accurate diagnosis and the need for optimal treatment.


Heart failure affects about 900,000 people in the UK. The condition can affect people of all ages, but it is more common in older people. In fact, more than 50% of all people with heart failure are over the age of 75. It is also associated with a number of other serious health problems, including coronary heart disease, heart attack and high blood pressure (hypertension).

Louise Clayton who is Senior Heart Failure Specialist Nurse for Leicester’s Hospitals told us : “We are supporting this awareness day as heart failure is becoming more common. There are lots of things we can do to improve heart failure but it is important to diagnose it early. If you or someone you know has unexplained shortness of breath or ankle swelling please encourage them to speak to their GP or consultant.”

To find out more about the European Heart Failure Awareness Day, please visit http://www.bsh.org.uk/resources/heart-failure-awareness/

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Heart Valve Disease – Professor Ben Bridgewater tells us about signs, symptoms and treatments of heart valve disease. And why more needs to be done for the million plus people who receive inadequate treatment.


Professor Ben Bridgewate

Professor Ben Bridgewate

  • What is Heart valve disease?
  • What are the symptoms of Heart valve disease? Are their early signs for us to look out for?
  • What treatments are available?
  • Why do some of us not get the treatment we need?

PatientTalk.Org were luck enough to catch up with Professor Ben Bridgewater for an overview of the subject. Professor Bridgewater is the Heart Valve Voice Chair and Consultant Cardiac Surgeon at University Hospital of South Manchester and one of the planets leading experts on the topic of Heart valve disease.

PATIENTTALK.ORG -Professor Bridgewater,  what is Heart valve disease?

PROFESSOR BRIDGEWATER – So heart valve disease is a disorder in the valves of the heart, there’s four valves in the heart and they ensure that the blood flows one way and one way only around the body, a lot of people think that heart disease is about heart muscles and having heart attacks but also valves are really important to make sure that it functions well and those valves can become narrowed which means the heart has to work hard to pump blood through the narrowing or they can become leaky which means every time the heart pumps it pumps the blood round the wrong way of the body or it falls back into the heart and has to do it all over again, so either way it means that the heart struggles.

PATIENTTALK.ORG -What causes Heart valve disease?

PROFESSOR BRIDGEWATER – Well there’s different causes, the most common cause is just wear and tear, if people are around for a long time their heart valves are opening sixty to eighty times a minute all through their life the heart valves start to deteriorate so its unusual for people under the age of fifty its becomes more common and its really quite common for people when they get over their eighty’s but after the age of sixty it really starts to ramp up and become more common.


PATIENTTALK.ORG -So what is the main treatment for heart valve disease?

PROFESSOR BRIDGEWATER – Well the symptoms of heart valve disease is usually shortness of breath, chest tightness and feeling tired and often people put their symptoms down to the ageing process rather than heart valve disease parse but actually if there is a significant narrowing or a significant leaking of the valve there’s nothing that can be done with medications the only real treatments are valve procedures so those would usually be replacements of the aortic valve or repair or replacement of the mitral valve and both of those treatments are very effective.

PATIENTTALK.ORG -So the next question on this one was can you describe Heart Valve surgery, I don’t suppose you could answer that briefly?

PROFESSOR BRIDGEWATER – Heart valve surgery is typically open heart surgery where you use a bypass machine to isolate the heart from the rest of the body, the machine takes over the work from the heart and the lungs for a short period of time, you then isolate the heart and then have a look at valves and you remove them and replace them with a mechanical valve or a valve which is made of pig and cow tissues or occasionally with a Mitral valve you can repair it by keeping the body’s own tissues but putting a few stitches in to stop the valves leaking, That’s the classical treatments and those are very effective, there are new treatments which are coming in now which are either similar to the old treatments but through smaller incisions but now there are new treatments which are coming though catheter based approaches where rather than having open heart surgery at all you just have a catheter put in through the groin and those treatments can be very effective in some situations.

PATIENTTALK.ORG -Tell us what the prognosis is after the diagnoses?

PROFESSOR BRIDGEWATER – The prognosis after diagnoses is very good if the diseases is picked up early enough and treated appropriately but if its missed and people are referred to late into the disease  process the prognosis is not so good at all and unfortunately if its missed the heart can deteriorate such that these treatments aren’t appropriate, but if its picked up the early the procedures will return people back to an age matched healthy population the lifestyle will be the same an aged much healthy population and their life expectancy will be very good.

PATIENTTALK.ORG -Heart valve always is calling for a better diagnosis, why do you think it’s so poor at the moment?

PROFESSOR BRIDGEWATER – Heart Valve Voice is calling for better awareness about Heart valve disease, we know that in the UK about half of the number of procedures for aortic surgery’s as there are in France and France has a similar size population so we know it’s being under diagnosed and untreated in this country. We also know that there are big regional variations so there’s a postcode lottery of care, so we know those things and so we are calling for greater awareness, were calling for better diagnosis and earlier treatment for patients who are unlucky enough to suffer from heart valve disease.

PATIENTTALK.ORG -Do the rates of diagnosis differ for people with private health care?

PROFESSOR BRIDGEWATER – We have no information that the rates of diagnosis and treatments differ for people with private health care and it’s not something we would look to specifically but we have no evidence on that case at the moment.

PATIENTTALK.ORG -What other things can be done to improve the rates of diagnosis and treatments?

PROFESSOR BRIDGEWATER – For patients to get effective treatment they need to have the diagnosis made early and they need to be referred to people that have expertise in treating the disease, so that starts off with patients being aware particularly as they get older, if they are not feeling as well as they were, they need to see their GP and their GP should have a low index of suspicion for diagnosing heart valve disease, you can usually pick up a murmur by listening with a stethoscope , which I think is very important that the GPS do that. If they pick up a murmur they should be referring on for more detailed investigations which will often be an echo study, which is done in a quick study with a little bit of gel on the chest and a machine has a look at how they valves are working and that will give you a clear diagnosis, if that shows significant valve disease people need to be referred onto a specialist to see what treatment is best for them.

PATIENTTALK.ORG -What else Heart Valve Voice is calling for? You’ve released this white paper and there’s some other things in there that you would like to see happen?

PROFESSOR BRIDGEWATER – Heart Valve Voice is a group of patients, primary care doctors, secondary care doctors and surgeons and cardiologists like myself who treat the disease have come together and we launched the white paper yesterday at the houses of parliament. We think that it’s important that heart valve disease has a greater level of awareness right throughout the community, in patients and across health care professionals so that the diagnoses are made earlier and people are referred across. We think it’s very important that the elderly get more time with the GP’s so we are calling for longer consultations, 15 minute consultations for people over the age of seventy five, it can be quite often be difficult to unpick different symptoms in people as they become more elderly if they have multiple problems we are also asking for longer consultations for those types of patients, were asking for appropriate referrals pathways right through the disease so that people get the treatments effective and that decision should be made by multidisciplinary groups of  expertise in all of the various different treatment options and were asking for the same level of surgical treatments in the UK as we see in our European neighbours and if we can achieve those things we will do very well for the patients .

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Heart attack (myocardial infarction) patients still at high risk of another cardiovascular event four years after initial attack – a new study shows


Prof Harry Hemmingway

Prof Harry Hemmingway

  • APOLLO study, which looked at data from over 10,000 UK heart attack patients, presented at the European Society of Cardiology congress1
  • Study shows the risk of repeat cardiovascular (CV) events remains high for four years after a patient’s initial heart attack, despite use of secondary prevention interventions, including medication and surgery1
  • Expert says UK has some way to go to prevent patients having repeat attacks or dying from CV disease
  • CV is the UK’s biggest killer with around 180,000 deaths a year, while the British Heart Foundation (BHF) estimates that there are approximately 1 million men and 500,000 women who have had a heart attack, and almost 600,000 men and 600,000 women who have had a stroke.2

PatientTalk.Org were delighted to have the opportunity to interview Professor Harry Hemingway of the Farr Institute of Health Informatics Research and National Institute for Cardiovascular Outcomes Research, University College London about the research and its findings. He was one of the investigators on a this study of major event rates of people who have survived heart attack.

Patient Talk: This is a study of over ten thousand UK patients over a period of 5 years. Is that a particularly large sample for a study of this kind?

HH: So yes and no is the simple answer there. It would have been a large study if you had to individually contact each of these patients and invite them to take part in that study. That not’s all we did. What we did here was exploit the advantages of the high quality NHS patient records so this is anonymised data here to look at. This kind of sample size is needed to get good estimates of these risks.


PT: Would you mind just giving us an overview of the methodology that you touched on briefly there?

HH: We used NHS patient records for this study and that’s a real advantage because we have a country with one health system and it’s got electronic health records in primary care and it’s got data in hospitalisation and course specific death data. So we link those up and that gives us a complete picture of the people, the heart attack and their subsequent risk re heart attack, stroke and death.

PT: My understanding is that the first year is considered the most important to think about how people are reacting after the event but what the study implied here is that you need to start thinking that four years is the period that is going to be when events are going to take place.

HH: I think you are absolutely right –that historically our focus has been really on that acute phase. So somebody comes with a life threating condition of heart attack to hospital that’s where the clinical care is focused and that’s where the research is focused. Let’s face it we in the NHS and in other countries have been having been dramatic improvements in early survival and other outcomes but what this new research shows is that one year after a heart attack risks continue to be high and that’s really important and that suggests a new focus on these heart attack survivors.

PT: Do you think it will be fair to say that it starts to redefine what is high risk?

HH: It’s not about redefining. We don’t actually have a definition to start off with. One of the things that surprised us here is we actually don’t have previous good studies to say in exactly in this population people who have survived a year after their heart attacks what kind of risks can we expect. This study shows that those risks are high and it allows us to then re-orientate the guidelines to say what do we need to do to bring those risks down.

PT: You seem to be saying that this laying the groundwork.

HH: That’s right. This is new. It is laying the ground work. We can compare with some other studies. For example we’ve got, one study looked at people with so called stable coronary disease ie.people who are some months after a heart attack or they’ve got angina and we show that our risks that we see are three times higher in that particular study.

PT: How do your account for such a high level of repeat heart attacks?

HH: I think there a number of factors here. One is that the lifestyle factors so patients continue to smoke, may not exercise, diet may be a factor. Secondly we know that patients and their GPs are maybe not be prescribing or taking the secondary prevention medications that are required long term. Statins to lower bad cholesterol, aspirins to thin the blood, beta blockers. Thirdly I think these patients represent a chronic phase of disease and one may want to look after them in a chronic disease management framework. Often people with heart attack who have survived have other conditions; diabetes, heart failure and so on.

PT: These are the UK results. You have mentioned the NHS information has been quite helpful for this study. How do you see the results stacking up? I know you mentioned Sweden and France in the report. How did you see the NHS stacking up against those health systems and the UK results in the same fashion?

HH: In a sense this is a good news story for the NHS because although the risks are high they are high in all these country’s so this is not a problem about one health care system. This is a problem about how as a system we haven’t given enough focus to these patients. So in the US, in Sweden, in France, in the UK in total we studied 140,000 patients again drawn from records as part of usual clinical care and administrative data. And we showed that about 1 in 5 of these heart attack survivors went onto have a subsequent heart attack, stroke or death over the following three years.

PT: How can a person who has had a cardiac event best prevent recurrence?

HH: It’s really important to pay attention to lifestyle. If you smoke stop smoking. If you’re not taking any exercise then that needs to be looked at. It’s really important to take the right secondary prevention medication the statins, the aspirin, beta blockers and so on. And in addition I think it’s wise to check your heart health with your GP

PT: You mentioned briefly exercise there. Any sort of best practice of exercise that people should be taking into account of?

HH: That wasn’t the focus of this particular study and the recommendations for exercise after heart attack and rehabilitation after heart attack predominantly focus on that early phase after a heart attack. So by twelve months out of a heart attack there would be very few if any patients who were in structured exercise programs or cardiac rehabilitation.

PT: Finally what one piece of advice would you give somebody who has just had a cardiac event?

HH: I think for somebody who has survived twelve months after a heart attack, I would say keep on top of your risk. Be in consultation with your general practitioner. Make sure you are doing everything to keep that risk low.

HARRY HEMINGWAY is Professor of Clinical Epidemiology at University College London. He is the Director of the Farr Institute of Health Informatics Research, London, one of four national centres funded by the MRC and nine other funders, representing a £39M investment in health informatics research, a member of the UCL Partners Informatics Board, Co-Investigator on the Administrative Data Research Centre, England, (£8m ESRC investment), and informatics lead for several Biomedical Research Centre initiatives.

Postscript

AstraZeneca today announced the UK results from the observational APOLLO study, which demonstrates that the risk of repeat CV events remains high for four years after a patient’s initial heart attack, despite use of secondary prevention measures.1 The APOLLO study looked at data from over 10,000 (n=10,854) UK heart attack patients, between April 2005 and March 2010 and found that whilst two thirds of these patients (n=7,238) remained event free in the first year following their heart attack, approximately 17% (17.2%, CI 16.0-18.5) of these went on to suffer another event including heart attack, stroke or fatal cardiovascular disease (CVD) in the subsequent 3 years.1

The study also showed that the proportion of patients remaining on medication for up to 3 years after their first event was high. However, there were some variances with only 65% of patients taking a statin after three years.1

“These important data tell doctors, patients and policy makers in the UK that while we’ve made great strides in reducing cardiovascular risk in the general population, we still have some way to go in preventing people who have already had a heart attack, going on to have further events or dying from cardiovascular disease. This is especially true if we compare ourselves with our neighbours in Sweden and France,” said Harry Hemingway, Professor of Clinical Epidemiology and Director of the Farr Institute of Health Informatics Research, London, at University College London. “For doctors, these data tell us that all patients who have had a heart attack should be considered and treated as ‘high risk’ of subsequent events, regardless of their previous history; for patients, this study highlights that your risk doesn’t disappear after the first year and attention on maintaining good heart health should continue indefinitely.”

CVD (the term for all diseases affecting the heart and circulatory system) is the UK’s biggest killer and, despite the decline in death rates in recent years , it caused 180,000 deaths in 2010.2 The cost of CVD to the UK health care system was £8.7 billion in 2009 and there were approximately 292 million prescriptions issued to patients in England with CVD in 2011.2 In the UK, the British Heart Foundation estimates that there are approximately 1 million men and 500,000 women who have had a heart attack, and almost 600,000 men and 600,000 women who have had a stroke.2
APOLLO was an observational cohort study designed to estimate the event rates of MI, stroke and fatal CVD in patients who have experienced a heart attack and are being managed under usual clinical care.1 It also examined the rates of bleeding events and medication use in this population of patients.1 Similar data were collected from France (n=1,757), Sweden (n=77,976) and the US (n=53,909) and the findings show that the unadjusted risk of a subsequent hospitalisation for another heart attack or a stroke or death within 3 years of the first event is different across the 4 countries and was approximately: 1 in 4 in Sweden and the UK; 1 in 5 in France; and 1 in 3 in the US.3 However, when these risks are adjusted for differences between countries in the demographics and baseline health of the study populations, the rates are similar with about one in five going on to have a subsequent event in each of the four countries.3
References
1 Rapsomaniki E. et al. Health outcomes in patients with stable coronary artery disease following myocardial infarction; construction of a PEGASUS-TIMI-54 like population in UK linked electronic health records. Poster presented at ESC 2014; 31 August 2014
2 Townsend N. et al. (2012). Coronary heart disease statistics 2012 edition. British Heart Foundation: London. Available here. [Last accessed August 2014]
3 Rapsomaniki E, et al et al. International comparison of outcomes among 140,880 patients stable after acute MI; real world evidence from electronic health and administrative records; Abstract presented at ESC 2014; 31 August 2014