Sanjay's Blog

12 Lifestyle Modifications which work in POTS

POTS (postural orthostatic tachycardia syndrome) is commoner than we think. 1 in 3 people with a diagnosis of Chronic Fatigue Syndrome(CFS) or ME also have POTS. Similarly a large number of patients with Fibromyalgia probably also have POTS. In my practice, I have the privilege of managing the treatment of about 150 patients with POTS . I have found that lifestyle and behaviour change recommendati [...]

SINUS ARRHYTHMIA and the drummer par excellence

SINUS ARRHYTHMIA   Sinus rhythm means that the electrical impulses which regulate the heart rhythm are being produced in the pacemaker that god gives us all when we are born. This ‘pacemaker’ is otherwise called the Sino-atrial node and this is why this rhythm that is generated from the sinus node is called sinus rhythm. A nice analogy is to think of the sinus node as a drummer who beats th [...]

I have atrial fibrillation (Afib) but I don’t want to take blood thinners

Patients with a diagnosis of atrial fibrillation (Afib) who are above the age of 65 or who have co-morbidities such as heart failure, diabetes, high blood pressure, vascular disease or previous strokes are believed to be at a higher risk of future strokes. There is overwhelming evidence that such patients should be started on lifelong stroke prevention medications. All currently prescribed stroke- [...]

Cocaine and the Heart

Cocaine is purported to be the most potent stimulant of natural origin and is extracted from the leaves of the coca plant which is indigineous to the andean highlands of south america. It is a highly addictive and once someone uses it, it causes an irresistable craving in the user to use it again. Despite the ecstacy and euphoria, it never gives a feeling of satisfaction. Pure cocaine was first is [...]

By |September 28th, 2019|1 Comment

E-cigarettes, Vaping and the Heart: What we know so far

Vaping and the heart - e-cigarettes Very recently, there have been a large number of news reports alerting the public about possible dangers of vaping after 5 deaths and 450 possible causes of vape-related lung illnesses were reported across 33 states in the USA. Whilst it is unclear what the exact cause is, it is believed that chemicals like Vitamin-E acetate which are used to emulsify THC (tet [...]

By |September 12th, 2019|1 Comment

BNP: The blood test that detects heart failure

Today I am going to talk about a really interesting blood test that detects weakness of the heart muscle (heart failure). This test is called BNP.  BNP stands for brain natriuretic peptide and this test is already being used commonly in medical practice. Before I talk about this BNP, I wanted to start off by talking about heart failure.  In heart failure, the fundamental problem is that the heart [...]

The 3 important questions to ask if you have been diagnosed with high blood pressure

If there is one thing that causes a tonne of anxiety, it is the mention of high blood pressure. A common scenario, for example is that the patient goes to see his doctor for a routine visit or a completely unrelated complaint and the first thing the doctor or the practice nurse will do is measure the patient’s blood pressure.  Then the doctor will shake his head, and say the words “your blood pres [...]

The 2 most important (and rational) questions to ask and answer if you have ectopic heart beats

A lot of my work involves talking to and reassuring people who suffer from ectopic heart beats which seem to cause a great deal of anxiety and really seem to have a negative impact on quality of life. Most patients I have spoken to have already seen a doctor for their symptoms of ectopic beats and the doctor has told them that they are not dangerous but for many this reassurance is seldom enough. [...]

Afib, strokes and bleeding: Enter the Watchman

Introduction Patients with AF who are above the age of 65, or have co-morbidities such as diabetes, high blood pressure, vascular disease or heart failure are at an increased risk of stroke. It is understood that these patients are at a higher risk of stagnation of blood within the heart; the stagnant blood can form clots within the heart and these clots can get dislodged, travel to the brain, and [...]

Why everyone with Afib should have an echocardiogram

An echocardiogram is an ultrasound-based assessment of the heart.  It is painless, harmless, readily available in most hospitals and can give a large amount of very useful information about the structure and function of the heart.  As atrial fibrillation can be caused by a structural problem with the heart such as heart valve disease or heart muscle weakness, the echo can help to elucidate the und [...]

Patent Foramen Ovale: The door within out hearts

A patent foramen ovale (PFO) is best thought of as a communication at the level of the atrial septum between the left heart and the right heart.  It is found in 25-30% of a normal healthy population and usually does not cause any symptoms, impact on quality of life or lifespan. Many people refer to it as a ‘hole in the heart’ although strictly speaking, a PFO is more like a flap or a partially ope [...]

Mestinon: A glimmer of hope for POTs patients

Introduction: Medical care for patients who have a diagnosis of POTS remains hugely unsatisfactory. POTS or rather dysautonomia is a very heterogenous condition. No two people are exactly the same. There is no one single aetiology that can even sometimes be identified. Often the patient who is really suffering looks alright from the outside. Many doctors, largely out of ignorance or perhaps arroga [...]

Pulmonary Hypertension

Today I wanted to discuss an interesting but also potentially very dangerous condition called pulmonary hypertension. I refer to it as interesting for 3 reasons: Most heart disease tends to affect older people but pulmonary hypertension can affect young people as well. The symptoms in the early stages can be non-specific and not dramatic and therefore may not get taken as seriously by the patient [...]

Spontaneous Coronary Artery Dissection (SCAD): An important cause of heart attacks in young women

What is it? SCAD is an uncommon but potentially dangerous cause for heart attacks in young patients and especially young women (less than 50 years of age). Most heart attacks occur because of a blockage in the lumen of a coronary artery. This is usually because of build-up of atherosclerotic plaque over a number of years and this is why heart attacks are more common in the elderly. In SCAD however [...]

Wolff-Parkinson-White Syndrome

Wolff Parkinson White syndrome is an unusual heart rhythm condition in which patients can develop sudden onset of fast heart palpitations. These can be associated with light-headedness/dizziness, blackouts, chest pain and in very rare cases, sudden death. However the good news is that this is a completely curable condition. Wolff –Parkinson-White syndrome was first described by 3 physicians – Loui [...]

Peripartum Cardiomyopathy (PPCM)

What is peripartum cardiomyopathy? This is also known as pregnancy associated cardiomyopathy and is a relatively uncommon condition which affects women either late during pregnancy or within 5 months of giving birth and is characterised by the development of heart muscle weakness (also called heart failure) To be diagnosed with peripartum cardiomyopathy, 3 criteria need to be met 1) Development of [...]

Atrial Flutter?

What is atrial flutter? Atrial flutter is an abnormal heart rhythm. In atrial flutter, the atria contract at 300 beats per minute and every other impulse goes down into the ventricles and therefore the ventricles beat at 150 beats per minute. In patients who are taking medications such as beta blockers or calcium blockers the impulses reaching the ventricles may be reduced even more so the heart r [...]

A ‘pill in the pocket’ for patient with POTS

One of the subjects I have become very interested in POTS. For those who don’t know POTS, it stands for postural orthostatic tachycardia syndrome and is characterised by an excessive increase in heart rate when the patient is upright and this can be extremely unsettling. Along with the racing heart beat, the patient may feel tremulous and dizzy. In addition, patients with POTS have many other symp [...]

Understanding anticoagulation in AF

Anticoagulants act by delaying the ability of blood to form clots. Doctors commonly refer to them as ‘blood thinners’ however strictly speaking they don't thin the blood but merely reduce the ability for the blood to clot. Commonly used anticoagulants which can be taken orally include Warfarin and the NOACs. There is an anticoagulant which can be used as an injection called Heparin but it is impra [...]

By |August 20th, 2018|1 Comment

Understanding Angina

Angina is a fancy term for a symptom of chest discomfort (rather than necessarily pain) which comes from the heart. This means that if a patient has no symptoms then they don’t have angina. In its severest form angina can lead to a heart attack. Angina is caused because the supply of blood does not quite meet the requirements of the heart muscle and therefore the heart muscle does not get as much [...]

How to tell if your breathlessness is being caused by a heart problem

Breathlessness is a very common symptom and may be caused by underlying heart disease. Apart from heart disease, breathlessness can be caused by several other conditions. These include being unfit, being overweight, and even just getting older. Other important causes include anemia and lung disease. In this article, I will discuss how you can work out if the breathlessness could be caused by unde [...]

Why Magnesium is so good for us…and yet we have so little of it 

My most viewed video on youtube to date has been on the benefits of Magnesium on our overall health. In this blog, I summarise the most useful points from that video. 1) The majority of chronic illnesses are driven by chronic inflammation. With regards to  the heart, atherosclerosis (hardening of our blood vessels) is the process that  eventually leads to heart attacks and this is caused by chron [...]

Understanding Anticoagulation in Atrial Fibrillation

Patients who have been diagnosed with atrial fibrillation (AF) and who are above the age of 65 or have co-morbidities such as high blood pressure, Diabetes, heart failure or vascular disease have a 5-fold higher risk of suffering strokes. A significant proportion of the strokes are believed to be as a consequence of blood clots which have formed within the heart and then been dislodged and travell [...]

How to convince your GP to prescribe you a NOAC instead of Warfarin for your AF

Introduction Patients who suffer from AF and who are above the age of 65 years or have additional comorbidities such as diabetes, high blood pressure, heart failure and vascular disease have a much higher risk of suffering a stroke and it is for this reason they are prescribed anticoagulants. For several years, the only available oral anticoagulant which was proven to reduce strokes in such patien [...]