The aortic valve is the exit valve of the heart. When the heart contracts, it forces open this one-way valve to push the blood out into the main blood vessel, the aorta, from where the blood goes to the rest of the body. If there is a problem with this valve, then the heart may not be able to pump blood out as efficiently and this will impact on how much blood is delivered to the rest of the body. [...]
The heart is a muscle that needs an electrical current to make it contract. That electrical current is generated and conducted around the heart from an area at the top of the heart called the Sino-atrial node. The Sino-atrial node therefore is the heart’s pacemaker. The pacemaker’s job is to generate a heart rate commensurate with the physiological needs of the body at any given time. When this go [...]
The arrival of menopause can be particularly distressing both mentally and physically. A number of conditions are associated with menopause. These include hot flashes, an increase in incidence of osteoporosis, alzheimer’s, vaginal atrophy and cardiovascular disease. At the beginning of the 20th century, the FDA approved an estrogen replacement medication called Premearin for the treatment o [...]
AF is commonly seen in older patients with multiple comorbidities such as diabetes, high blood pressure, obesity, vascular disease and sleep apnoea. When those patients ask me why they developed AF, I tend to blame it on age, lifestyle and inflammation and say to them that maybe AF is a symptom of these underlying problems. However there is another group of patients that I see with AF. These are y [...]
Most chronic disease is caused by underlying low grade chronic inflammation. In cardiology, one of our biggest challenges in atherosclerosis (which refers to wear and tear of the blood vessels which supply our vital organs) and these blood vessels are also prone to increased wear and tear which results in progressive damage to the vessel walls and the devlopment of plaque within the vessels. This [...]
Testosterone is the principal male sex hormone and we know that in general, as men get above the age of 40, testosterone levels start dropping. We also know that as men get above the age of 40, their overall cardiac risk and overall risk of mortality starts increasing. So it appears that overall cardiac risk starts going up around about the same time as testosterone levels start falling. What we s [...]
One of the long term consequences of chronic conditions such as diabetes, high blood pressure and even severe obesity is the development of chronic kidney disease. In fact it is estimated that the number of patients with chronic kidney disease is more than doubling every decade. What is also a major concern is that as chronic kidney disease is an exceptionally inflammatory condition, it substantia [...]
Most of the AF we see occurs in older patients - usually those above the age of 60 and therefore much of what we know about AF comes from studies involving older patients. What we are however beginning to realise is that AF can occur in younger patients too and perhaps this group of patients represents a group that we do need to study and research a lot more because what we understand about the ca [...]
Patients can have AF without experiencing any symptoms whatsoever. This is termed silent AF. The problem here is that patients may be experiencing a heart rhythm disturbance which is associated with an increased risk of stroke without knowing anything about it. It is always difficult to be accurate about the prevalence of silent AF but it is estimated that 10-40% of all AF patients are asymptomati [...]
POTS is characterised by orthostatic intolerance. This means that patients feel significantly worse when they adopt an upright posture compared to when they are lying down. To try and find effective treatments, it is vital that we try and understand the physiology of what happens in the body when normal healthy people stand up. When we stand up, blood in our vessels tends to get sucked down into [...]
One of the most prominent and debilitating features of POTS is a very marked increase in heart rate upon adopting an upright posture. This causes the patient to experience very fast heart palpitations which are both scary and very uncomfortable. The patient therefore will try and sit down or lie down to feel better but this is at the cost of becoming increasingly deconditioned in the medium and lo [...]
Supraventricular tachycardia (SVT) is a common heart rhythm disturbance which may occur in all age groups including young and otherwise healthy patients. It is characterised by a sudden and unpredictable development of heart palpitations which to the patient feel very fast and regular. It can last between a few minutes to several hours and subside almost as quickly as it came on. Occasionally it d [...]
One of the most worrying things when we experience chest discomfort is the possibility that it can be due to heart disease and that it could be a warning for something really bad on the horizon such as a heart attack or even death. Chest pain can be due to so many different pathologies and not all forms of chest pain indicate a problem with the heart and therefore a lot of people ignore it [...]
As we find ourselves in the midst of the COVID-19 pandemic, we are realising that this particular virus is far more dangerous than we had initially thought and apart from largely supportive measures, we don’t really have any proven effective treatments. The truth is that whilst the lockdown and social distancing measures may control the spread of the illness they don’t have any impact on the dange [...]
Atrial fibrillation is a disorder both of heart rate and heart rhythm. By definition, the heart beats irregularly but also can beat excessively fast or excessively slow. When the heart beats excessively fast, there are 2 main consequences: The patient is generally more symptomatic with palpitations, breathlessness, fatigue and exercise intolerance There is a likelihood that as the heart is working [...]
As you all know we are in the midst of the COVID-19 pandemic and whilst we know the virus predominantly affects the lungs there have been several reports that it can also damage the heart and a lot of people have written to me to ask to try and clarify what i understand about the virus and its effects on the heart. The first thing to say that we only have limited data at the moment and our underst [...]
POTS is a hugely debilitating condition which is characterised by an abnormally high heart rate when the patient adopts an upright posture. A lot of medical research has focused on trying to reduce the heart rate and this does seem to make a beneficial difference in patients with POTS. However virtually every POTS patient that I have looked after will complain of lots of other symptoms which are n [...]
A lot of people have written to me asking about the safety of taking ACE inhibitors during the COVID-19 pandemic. I therefore thought I’d do a blog to clarify my understanding of this subject. It is important to note that given the very rapid and terrifying pace of growth of the pandemic, we have very limited data to make absolutely definitive conclusions and the advice may change as results from [...]
