.......................................thanks to Tim Grove
I have recently returned from the beautiful city of Vienna in Austria, where I attended the European Society of Cardiology's World Congress. This is an annual event, which is held in different European cities each year. I was amazed how big this event was with an attendance of over 22,000 doctors who had travelled from all over the world. However, you might be wondering why I attended such an event because in fact my background is in exercise rehabilitation. Well back in January of this year my University tutor recommended that I submit an abstract of my study to European Society of Cardiology to be presented as a poster presentation at their world congress. The study I submitted was the one that I presented at the THROB annual general meeting.
To my amazement my abstract was selected from over 10,000 entries to be presented as a poster presentation and was published in a journal supplement entitled the European Heart Journal. The congress went on for five days, which started on the 1st and finished on the 5th of September. I decided to make my way to Vienna on the Saturday and I presented my poster on the Tuesday and returned home on the Thursday. During my time at the congress I attended very interesting lectures on exercise testing, cardiac rehabilitation and the effects of exercise on longevity. The only thing I wish I had learnt about Austria much sooner, was that the beer is 12.5% in Alcohol and comes in litre glasses!
Tim Grove
THE BIT IN THE MIDDLE
In an increasingly obese society we are rapidly reaching the stage where to have a normal healthy weight is in fact abnormal - in other words more people have an unhealthy than a healthy weight. For those of you attending regular yearly cardiac or diabetes checks at your surgery you will be well aware of the recording of your Body Mass Index (BMI) a ratio of your height to weight that gives a number which will indicate your "risk". To have an ideal BMI your result needs to be between 20-25, then from 26-29 you would be considered overweight and from 30 - 39 the label becomes obese and from 40+ it changes to morbidly obese.
Whilst this is still an important measurement as a general guideline the flaws within it have been highlighted, for instance a muscular rugby player in his twenties could have a BMI that labels him obese so health professionals need to look at the patient holistically to assess actual risk and not rely too much on the BMI numbers. In an increasing climate of accurate risk prediction there have been many research studies that have investigated the significance of waist circumference and these have shown that increased waist measurement in both males and females is an accurate predictor of the risk of developing heart disease and diabetes. The reason for the increased risk associated with waist circumference is that it is a different kind of fat known as visceral fat. Unlike normal subcutaneous fat that is found elsewhere in the body, visceral fat inextricably surrounds internal organs, and it effectively becomes an organ in itself, secreting hormones and active molecules, called cytokines, which are bad for your health. Now a study from the Washington University School of medicine in St.Louis, has shown that these secreted hormones and molecules lead to system-wide inflammation that significantly increases the risk of developing type II diabetes and the biggest health risk to diabetics is heart disease.
There is some good news amongst all the doom and gloom and that is that even a small weight loss of 5% of body weight results in a reduction in waist circumference. By losing as little as 10 to 20 pounds you can dramatically improve your overall health status, whilst significantly diminishing your risk of disease. Therefore small successes result in big gains health-wise. Anyone changing their lifestyle to lose weight should be aiming at losing no more than 2 lbs a week. So as you all start rummaging in the junk draw for your tape measure you will need to know what range is normal and what number means a new look at your eating habits and exercise levels!! You need to measure at the mid-point of your tummy, halfway between your lower rib and your hip bone- which is usually around the level of your naval. Breathe OUT normally so do not attempt to pull your tummy in artificially.
Women: waist circumference greater than 80cm (32 inches) indicates risk
Men: waist circumference greater than 94 cm (37 inches) indicates risk
Additional information can be found at:
http://www.bbc.co.uk/health/healthy_living/your_weight/whatis_bmi.shtml
Lesley Richards
And also...........
We can add a rider to the above article on body fat. Prof. Stefan Anker of the Royal Brompton has been reported as saying that once the damage has been done and you've had the heart attack, you shouldn't try to lose weight as the extra fat helps to protect the body, the fat being an energy reserve. There is no evidence from epidemiological data that after the onset of heart disease in old and ill people that you improve hospitalisation rates or improve survival when patients lose weight. I don't know about you, but personally I lost almost two stones in a week or so from the sheer worry about my condition!
David Read
THE LOCAL CARDIAC SERVICE
Heatherwood and Wexham Park NHS Trust Cardiac services have come a very long way in a short space of time. It is remarkable to consider that as recently as the year 2000 the Trust did not have a dedicated Coronary Care Unit (CCU). The most significant change in recent years of course is the opening of the Cardiac Catheter Lab (Angiogram Suite) which was purpose-built and started operating in August 2004. We all call it the 'cath lab!' The facility is on the Wexham Park site, is ultra-modern and consists of the lab itself along with a day case 7-bedded unit and an in-patient unit immediately next to the CCU itself.
Initially the unit was only in operation on 3 days of the week and was used only to perform angiograms - a diagnostic test to look directly at the arteries of the heart to assess the need for angioplasty or bypass surgery in patients with angina. Of course since this time the unit has continued to grow and develop and now runs 8am-6pm Monday to Friday with extra work and private patient cases being performed at weekends and out of hours. Indeed such is the demand and workload that at present a mobile angiogram facility visits Wexham Park once a week to increase our angiogram capacity!
In 2005 the permanent pacemaker service commenced. This involves the fitting of tiny highly specialised devices (pacemakers) attached to small electrical wires fed directly into the heart itself to treat and correct dangerously slow heart rhythms. A modern pacemaker is about the size of two old 50 pence pieces glued together (but a little more expensive!) and pacemaker procedures, performed under local anaesthetic, typically take about an hour. 98% of our planned pacemaker procedures are done as a day case procedure- avoiding the need to stay in hospital overnight.
Since August 2006 the Trust has commenced coronary angioplasty and stenting. This procedure uses balloons and metal coils to treat narrowed arteries in the heart, which cause angina and heart attacks. Both planned and emergency work is now performed. Since August this year the Trust has also commenced the implantation of defibrillators (often known as ICDs). These are extremely sophisticated pacemaker type devices, which are actually able to correct dangerous, fast, abnormal heartbeats, if necessary, with an internal 'shock' to the heart.
We are also very proud of our weekly multi-disciplinary team (MDT) meeting. Much is said about poor communication between medical professionals and patients but at this meeting (held at 7am every Thursday) four consultants, one or two Cardiac Surgeons from the Brompton (how things have changed!), six junior doctors, nurses, cardiac rehabilitation specialist nurses meet up. The details of each and every single patient who requires angioplasty, bypass or valve surgery or any other specialist treatment is formally presented and discussed in detail. In this way we believe we are ensuring that all patients are getting the very best, individualised and responsive treatment and that our work is to the very highest standards. I believe that in medicine, the value of openness and discussion with colleagues cannot be underestimated.
Now for some Number Crunching!
When commending a department it is often too easy to focus on the high profile leaders but we all know that strong departments rely on a real team effort. The following people are the team that make the cath lab the success it is:
4 Consultants
5 Registrar Grade doctors
7 Nurses
3 Physiologists- specialist cardiac technicians
2 Radiographers- x-ray specialists
3 Admin Staff
2 Cleaners!
..............and more numbers….....
Since the cath lab opened and at the last count we had done the following number of procedures:
3100 Angiograms
365 Angioplasty procedures
560 pacemaker procedures including
72 defibrillator procedures
That is a lot of saved trips to the Brompton! So we are even reducing the cardiac carbon footprint of East Berkshire!
It is great to see a local service go from strength to strength.
Dr. Stephen Rex
(Cardiologist, and President of THROB)
MORE TRAVEL INSURANCE TIPS
A very useful item was found in the paper recently which was trying to deal with the problems of a couple in their seventies. It seemed to me that there were a number of items of use in the article and I have reproduced it in full below. (Ed.)
Global (www, globaltravelinsurance.co.uk Tel:01903 203933) offers a very good value annual policy for a flat rate of £110 per year, but only if you are 75 or under. It is underwritten by one of Britain's largest companies, AXA, but uses a different business model to other travel insurers. Instead of increasing premiums with risk, it charges a higher excess on claims: double for holiday cancellation and £750 for over-65s if pre-existing condition flares up and you have to make a medical claim.
Readers also recommended Bradford & Bingley (0800 169 4078, www.bradford-bingley.co.uk/insurance/travel), which offers annual policies for travellers up to the age of 79. A worldwide multi-trip policy costs £137 if aged 70-74, rising to £164 when 75-79, excluding baggage cover. Trip limit is the usual 31 days but this can be extended to 90 days for an extra premium.
Help the Aged (0800 022 3192) has no upper age limit for it's annual worldwide travel policy, which costs just £155 per year (£193 to include NorthAmerica) with a 31-day limit per trip. Pre-existing conditions, even if past and stable, do incur higher premiums. For someone who has had a hip replacement, suffers from type 2 diabetes and takes tablets to control cholesterol and low thyroid function this would be an extra £37 per year; £47 to include North America. All travellers should be aware that an annual multi-trip policy is really just a succession of single-trip insurances. This means that if you develop a medical condition during the policy year, see a consultant, have any kind of operation or are undergoing tests you must tell the insurer as soon as the problem arises, or subsequent claims will not be covered. Many readers recommended the travel insurance that is provided by banks to premium account customers. Lloyds TSB appears to offer the most generous terms, covering Platinum account customers up to the age of 80. One reader who had trouble finding annual insurance due to her hypertension found her condition is covered as standard by Lloyds TSB. But it is important to check the small print on these policies as past health problems are often excluded and there are other restrictions for older travellers.
A useful web sitefor over-65s seeking advice on travel insurance, immunisation and medical equipment is www.myholidayinsurance.com. Set up by a doctor and his brother as a public service, it says it takes no commission from insurance companies it recommends.
HEALTH SCREENING
A report from the University of Glasgow says that thousands of lives might be saved every year if relatives of premature heart attack victims were routinely screened by the NHS. It is estimated that up to 6500 premature heart attacks could be prevented annually if those in high risk groups were given statins. About 40,000 people would need to be screened to achieve this. Apparently a similar approach has been used for cancer patients and has been credited with saving thousands of lives. THROB members might do well to think about their nearest and dearest.........wives, husbands and offspring. THROB has taken a lead here and has just approved the purchase of portable blood testing equipment capable of measuring both high density and low density cholesterol. The service to be provided will probably be available at Sport and Leisure Centres and offered to the general public at a reasonable cost - certainly less that having a check at a private hospital. Once the system is set up THROB members' dependants, who probably do not qualify for a blood test through their GP, will be offered the service at a discounted rate. THROB members themselves should of course be given regular blood tests through their GP surgeries under the provision of the National Service Framework for Cardiovascular Disease.
David Read
TAKE A NAP !
An afternoon nap can help drive down your blood pressure and stave off heart attacks. A team at the John Moores University in Liverpool have been doing preliminary experiments to discover if Britons should be following in the footsteps of "siesta takers". The team took the blood pressure of nine men and women in three situations - while they had an afternoon nap, rested in bed and stood up relaxing. They found a significant drop in blood pressure during sleep, but not while resting or standing. This drop in blood pressure occurred mostIy after "lights out", but before the volunteer fell asleep. Lowering of blood pressure during a nap may take pressure off the heart and may be one explanation for the lower, cardiovascular mortality found among people who habitually take siestas.
David Read
IS PREVENTION BETTER THAN CURE?
Another major study to examine if daily aspirin can prevent heart attack is about to begin and will determine whether five million Britons should take a daily aspirin to prevent them from having their first heart attack or stroke. It will involve more than 12,000 people in five countries, including Britain, considered as being at moderate risk of heart attack or stroke. Men over the age 50 with two or more risk factors - such as elevated cholesterol, being a smoker, high blood pressure and a family history of heart disease - and women over 60 with three or more risk factors will be included. Results from other trials suggest that the risk of a heart attack or stroke could be cut by one third and the risk of a fatal attack cut by 15 per cent by taking aspirin. Patients who have had a heart attack or those at high risk are often put on aspirin to prevent a recurrence. Those in the study will be randomly assigned to take 100mg of aspirin or a dummy pill and neither they nor their doctor will know what they are taking. They will be monitored for at least five years. Data on cancer rates will also be noted as recent research has suggested that aspirin can protect against certain forms of the disease. This study is expected to significantly expand the existing strong body of evidence supporting use of aspirin for primary prevention of cardiovascular disease events - this time in a moderate-risk population.
WHAT THE PAPERS SAY......
Since the European Society of Cardiology has recently held its World Conference (that's the one Tim Grove went to) the papers have been full of heart related problems so I've not been short of press cuttings this quarter. Some of the more interesting ones are set out below. (Ed.)
TEN YEARS PROTECTION
Statins, the drugs that lower cholesterol, can prevent heart attacks for at least a decade after people stop taking them, a major study reveals today. New research into the world's biggest-selling medication has found that it has the ability to halt and even reverse the progress of heart disease. A study published today in the New England Journal of Medicine found that those who took statins were still showing the benefits of the drugs 10 years after they had stopped taking the medication.The scientists from the Uniiversity of Glasgow found that the chances of the patients suffering from a fatal heart attack had dropped by 25 percent. Prof Stuart Cobbe, who was involved in the research, said: "The benefit appeared to extend to at least 10 years after the original trial." He added that people should be encouraged to continue taking the drugs, but even those who give up would still enjoy the benefits. At present more than three million patients at risk of developing heart disease because they have elevated levels of cholesterol are prescribed statins.
The results were based on a study of 6,595 middle-aged men in the west of Scotland whose progress was monitored for 10 years after most stopped taking the drugs. That group was compared with a group of men who were given dummy pills during the initial five-year study launched in 1991. The scientists found there was a 25 per cent lower risk of heart attack or death from heart disease among those in the statins group. The researchers say that the statins' protective effect was probably because existing plaque in the blood was stabilised, reducing the chance of developing coronary artery disease. Statins, which can cost as little as 60p per tablet, have been the subject of much recent praise in the medical world. Earlier this year the drugs were found to reduce the risk of developing Alzheimer's by 80 per cent. The drugs work by
reducing LDL-type of cholesterol in the blood which can clog vessels.
(So when you think you've got only ten years to go you could give up the statin to get away from the side effects! Great! Ed.)
BEWARE IMITATIONS!!
The Government's drive to switch patients to cheaper cholesterol lowering drugs could put them at greater risk of heart attacks and strokes. Patients transferred from a branded statin to a cheaper generic drug have a 30% increase in risk of cardiovascular problems. Researchers are unclear why this happened but think that the branded statins are either more potent or moving to a different drug disrupts the control of their cholesterol level. The Government estimate that they could save £85 million out of £600 million spent on statins annually. It is interesting to note that 83% of drugs prescribed in the UK are generic medications - the highest percentage in Europe.
(Don't tell the Government about the ten year benefit! Ed.
A DELICATE MATTER
I remember being advised by my cardiologist following my heart attack that I should avoid "straining at stool". Dr. James LeFanu writing in the Daily Telegraph recalls a Medical Officer in the forces who recommended that anyone with such a problem should sit bolt upright with the arms straight up into the air pushing upwards with the hands. What it does and how it does it, I have no idea - but it certainly helps...
ARE YOU GETTING ENOUGH?
This might come as a nasty shock - the thirty minutes of moderate exercise each day as recommended by the Government guidelines is not enough to ward off heart disease, diabetes or certain cancers, according to a study carried out at Exeter University. Most people are under the impression that a brisk walk or half an hour of gardening or housework is better that vigorous exercise, but we THROB members know that short bursts of intense activity is more beneficial - you have to get the heart rate up! Thirty minutes of moderate exercise should be regarded as an absolute minimum requirement - certainly not an optimum - not enough to even combat weight gain and all the problems that can bring.
JOINTS
KNEES AND HIPS
These joints get exercised simply by walking which is undeniably good exercise but the movement of the joints is quite limited. Moving the joints over their complete range of movement requires specific exercises. All the exercises given below need to done by alternating from side to side. Knee raises, in which the knee is brought up until the thigh is horizontal, partially cover the range of movement of the hinged knee joint and moves the ball-and-socket hip joint in one plane and is a useful starter. Cross over knee raises provides some extra rotation of the hip. Hold the hands at waist height about two feet apart and raise the knee to touch the hand. A better range of movement of the knee joint can be achieved by back leg lifts. Hold your hands straight down behind you and make fists. Now gently bend your knees aiming to touch your fists with your heels (some may find this difficult to perform so always bend your knees in a comfortable range of movement. Another good exercise to work both hip and knee joints is the sit and stand from a chair. One should also include hip abductions - simply stand on one leg out to the side and back again. Be careful not to tilt the trunk and you may wish to hold on to a chair for support. Finally, a few backward lunges are also good for both hips and knees - bring one leg back and at the same time bend the knee in front. All exercises should be repeated 8 -12 times. If you have replacement hip or knee joints, modify the above in accordance with the advice you were given by your Consultant or Physiotherapist.
Tim Grove & David Read