Sanjay's Blog

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|0 Comments

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|2 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|1 Comment

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

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

The More Muscular Looking Heart

The heart is a muscle and as with any muscle, when it has to work against a higher pressure over a prolonged period of time, it becomes more muscular. This increased muscle mass is seen as an increased thickness in the walls of the heart and is known as hypertrophy. Doctors sometimes erroneously refer to this as an enlarged heart. This is not true - the heart is not bigger but it is heavier; the w [...]

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|2 Comments

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 [...]