Sanjay's Blog

Testosterone and the Heart

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 [...]

AFib and bad kidneys: A toxic combo

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 [...]

AF in the Young

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 [...]

AF: The Silent Enemy

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 [...]

Midodrine for POTS/dysautonomia

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 [...]

Melatonin for POTS

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 [...]

Etripamil: A new hope for SVT sufferers

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 [...]

Chest Pain: Calculating my risk

  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 [...]

COVID-19, Chloroquine, hydroxychloroquine and risks to the heart

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 [...]

Pace and Ablate

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 [...]

Can COVID-19 damage the heart?

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 [...]

Brain Fog and Fatigue in POTS – Hope on the horizon?

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 [...]

ACE-Inhibitors and COVID

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 [...]

New Hope For Heart Failure Patients A Game-Changer Arrives!

  Any form of heart disease, if progressive, will lead to the heart gradually failing in its role as an effective pump. This condition is called heart failure and it is typified by an impairment in quality of life and a substantial reduction in lifespan for the sufferer. The good news Is that we now have some very good medications which can substantially improve prognosis in such patients. Th [...]

By |January 31st, 2020|5 Comments

Is there a way of treating blood pressure when tablets don’t work?

High blood pressure is a major health problem and affects about 30% of the adult population worldwide When the blood pressure is high and causing the patient damage then lowering the blood pressure can significantly reduce the risks of long term complications such as heart attacks and strokes. Currently the main strategies to control blood pressure are lifestyle management and medications. The pro [...]

Troponin: The blood test that detects heart attacks

Cardiac troponins are proteins that are found in heart muscle and play a role in the contraction of the heart muscle. If heart muscle is in someway damaged or injured, then cardiac troponins are leaked into the blood and can therefore be measured in the blood stream. They have therefore become exceptionally useful markers of cardiac cell injury and this is why anyone who presents to hospital with [...]

By |January 27th, 2020|0 Comments

Myocardial Bridges

  The heart is a muscle and any living muscle needs a blood supply. The blood is supplied by arteries that are known as coronary ateries. Usually these arteries sit on the surface of the heart. However sometimes a portion of the artery may run an intramuscular course for a portion of its length. This is termed a myocardial bridge.  The problem with a bridge is that there is a possibility that [...]

By |January 27th, 2020|1 Comment

Chest pain: Why it is not ok to wait and see

Chest pain is both common and very scary. It can also be the first symptom of a heart attack which in itself can be a fatal event. The universal advice for anyone who experiences chest discomfort especially if it a persistent sensation of heaviness, tightness or constriction, is to call an ambulance and get to a hospital as soon as possible. Despite this heavily publicised recommendation, I am sti [...]

By |January 27th, 2020|1 Comment

Hypothyroidism and the Heart

Hypothyrodism is a very common condition characterised by reduction in effective levels of a hormone called thyroxine. It is usually seen in women between the ages of 40-50 (but can be seen at any age) and is almost 10 x commoner in women than in men. It is estimated that about 1 in every 50 people you meet is overtly hypothyroid and it is estimated that there are many more people who are probably [...]

By |December 24th, 2019|6 Comments

Implantable cardioverter defibrillators

  When the heart is significantly damaged for any reason, there is an increased risk that it can become irritable and go into a fast abnormal rhythm (ventricular tachycardia) which may make the heart so inefficient that it can no longer effectively function as a pump. This may happen out of the blue with no real warning even if the patient has been well. If left unchecked for even a few minut [...]

By |December 3rd, 2019|0 Comments

Hypertrophic Cardiomyopathy

In simplistic terms, this is an inherited condition which is diagnosed by finding an abnormally muscular heart (ventricular hypertrophy) without an obvious cause to explain the increased muscularity. It is caused by mutations in the genes that encode components of the contractile apparatus of the heart and therefore the heart muscle itself is abnormal and this is why it looks thicker. One thing to [...]

By |December 3rd, 2019|2 Comments

The effects of Ecstasy on the heart

Ecstasy or MDMA is a psychoactive stimulant which is used as an illicit recreational drug. It shares properties of both amphetamines and hallucinogens. It typically causes wakefulness, feelings of euphoria, emotional intimacy and empathic communication, sexual arousal and disinhibition. This is because it increases the amount of noradrenaline, serotonin and dopamine in the body. Its half life of a [...]

By |November 11th, 2019|0 Comments

Ventricular Septal Defect (VSD)

This is a common type of ‘hole in the heart’ where there is a communication between the left and the right ventricle through the ventricular septum. VSDs may be congenital (meaning that the patient is born with it) or acquired (meaning that the patient develops it later on in life due to some damage to the heart) VSDs can be of various sizes and may be present in different locations within the v [...]

By |November 11th, 2019|0 Comments

Caffeine and the heart: The low-down

There is a perception within the public and many healthcare professionals that ingestion of caffeine may contribute to the development of heart rhythm disturbances and this leads to an almost universal recommendation in patients with heart palpitations to abstain from caffeine. In this blog, I wanted to explore the evidence or lack of to support this proposition. Caffeine is a stimulant and is fou [...]

By |November 4th, 2019|Tags: |3 Comments