Sanjay, Author at York Cardiology

The connection between atrial fibrillation and the stomach

By | Atrial Fibrillation, cardiology, heart disease | No Comments

Today I again wanted to write about atrial fibrillation (AF) and in particular explore the connection between AF and how gastric issues could be associated with an increased likelihood of AF

We know that gastric issues are extremely common in people these days and in particular many people suffer from hiatal hernia which means that part of the stomach can protrude through into the chest cavity and as this can actually mechanically compress on the left atrium and therefore increase likelihood of atrial heart rhythm disturbances.

There is an interesting study that I came across in the Journal of Afib from 2013 by Roy et al and what they wanted to find out whether people with a hiatus hernia have a much higher prevalence of atrial fibrillation. They looked at all patients who had a diagnosis of hiatus hernia and had been seen at the Mayo clinic in Rochester from Jan 1st 1976 to 31st dec 2006 and they also looked to see if they also had a diagnosis of AF. They then compared to this ti the reported prevalence of AF in patients of similar age and gender in the general population.

What they found was very intesting indeed. In younger men aged less than 55 years, AF was present in 3.5% of the population with hiatal hernia and only in 02% of the general population..I.e a 17.5 fold higher!

 

Men 55-59 years 7.8 fold increase
60-64 years 5.9 fold increase
65-69 years 4 fold increase
70-74 years 2.4 fold increase
75 – 85 years 1.2 fold increase

Similarly in women under the age of 55, there was a 19 fold higher incidence of AF compared to the general population.

Women 55-59 11.7 fold increase
60-64 years 5.9 fold increase
65-69 4 fold increase
70-74 2.4 fold increase
75-79 2 fold increase
80-84 1.6 fold increase

So it appears that in some way hiatus hernia is associated with increased prevalence of atrial fibrillation. However association does not automatically imply causation; and therefore I was keen to see if there was any evidence that treating the hiatus hernia can improve AF.

I found a few interesting case reports in the literature suggesting possible causation.
Schilling et al reported a case of patient who had atrial flutter and a large paraesophageal hernia and once the patient had an operation to repair the hernia he had no more atrial flutter.

There was another case of paroxysmal flutter that didn’t respond to an even ablation but once he was started on PPIs sinus rhythm was maintained at 1 year of follow-up

I also found another case where a patient with a large paraesophageal hiatus hernia regularly developed Afib after eating found that his symptoms disappeared after he had sugery

The mechanisms by which the hiatus hernia could cause AF are 3;
1. Mechanical compression
2. Inflammation
3. Increased vagal tone from the reflux could cause AF

So I hope this was useful for you. Here is a link to my video on this subject

 

 

 

The benefits of exercise in atrial fibrillation (AF)

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Today i wanted to do a blog post  on the benefits of exercise in patients with atrial fibrillation

We know that patients with Afib often have comorbidities such as diabetes high blood pressure, obesity etc.

We also know that exercise is beneficial because it helps reduce blood pressure, control diabetes and of course reduce obesity.

What we did not know is whether exercise helps reduce atrial fibrillation. Often people worry about exercising because they worry about bringing on epodes of Afib. Also there is a lot of evidence that high level of endurance training can paradoxically cause Afib and therefore there is a lot of confusion as to whether exercise is good or not, how much benefit it is associated with and most importantly exactly how much exercise is beneficial

So last year there was a very interesting study published in the Circulation journal by Malmo et al.

http://circ.ahajournals.org/content/133/5/466?ijkey=598cfc8c74b76e68f79bc84935e7ff2d6130eaf3&keytype2=tf_ipsecsha

This study was performed in Norway and these chaps took 51 patient with symptomatic paroxysmal or persistent Afib who had been referred for an ablation.

A loop recorder was inserted to record the time the patient was in Afib.
They collected baseline data for 4/52
Then subjects were randomly divided into 2 groups
26 were assigned to a 12 week Aerobic interval training and 25 wre assigned to a control group in which they were allowed to just do what they had always done
Now these guys were not hugely overnight..average height was 6 ft and weight 93kg and BMI of 28

At the end of the study they found the following:

Mean time in Afib increased from 10 to 14% in the control arm and decreased from 8.1% to 4.8% in patients who went through the exercise program

The exercise group had significant improvement in quality of life and reported less frequent AF episodes and less severe AF episodes

Their weight decreased and cholesterol levels went down

And their left atrial function improved!

And these were pretty symptomatic patients because they had been referred for an ablation!

This is a very important study which nicely shows how beneficial exercise is for fib

And so if you want to try it out for yourself, here is the regime to use:

walking or running on a treadmill 3 times a week for 12 weeks.

Each session started with a 10-minute warmup at 60% to 70% of maximal heart rate obtained at exercise testing (HRpeak),

followed by four 4-minute intervals at 85% to 95% of HRpeak

with 3 minutes of active recovery at 60% to 70% of HRpeak between intervals,

ending with a 5-minute cooldown period.

Here is a link to my video on this subject

Common triggers for atrial fibrillation

By | Atrial Fibrillation, cardiology | No Comments

Today’s blog is on Atrial fibrillation and this is particularly relevant to those of you who have paroxysmal Afib which means that the AF can come and goes of its own accord.

Most people with paroxysmal AFib seem to tolerate Afib very badly..they feel lethargic breathless, tires and get palpitations and they don’t know how long it is going to go on for.

What we do know is that there are often triggers which can increase the chances of an Afib attack happening and recognizing the triggers and avoiding them can make a big difference to the frequency of attacks.

So i found an interesting study where 100 people were asked what they felt were their major triggers: This is by Hansson et al in the BMC cardiovasc disorders in 2004

100 people were asked about their triggers. There were 72 men and 28 women
Paients ranged from as young as 22 years to 79 years
76 of the 100 were taking tablets (sotalol) and 24 were not taking any medications
72 patients felt that their symptoms starteed at around about the same time of the day and the majority occurred between 6-9 pm but also from midnight to 9 but the least number complained of symptoms starting from 9-3pm.
35% woke up with AF
31% occurred during rest and 22% occurred after physical exertion
for most patients 64% attacks typicaly lasted less tan 1 day, 17% said they lasted between 1-7 days and none had it for more than a week
The commonest triggers were mental stress (54%), physical effort (42%), tiredness (41%), alcohol 34%, certain foods (25%)
If you can identify and avoid your triggers, you will hopefully get less AF. Please do consider liking, commenting and sharing. Also please visit my Facebook page (yorkcardiology@gmail.com).

 

Here is a video on this subject.

Can stress cause atrial fibrillation?

By | Atrial Fibrillation | No Comments

My name is Sanjay Gupta and I am a cardiologist in York. One of the commonest questions i get asked by patients suffering from atrial fibrillation is:

Can stress cause atrial fibrillation?

Today’s blog is therefore on the subject of emotional stress and how it can trigger Afib.

This is a subject that is very close to my heart because whilst everyone believes that the reason there is so much illness about is because of an aging population, i have always maintained that it is more to do with lifestyle. And whenever lifestyle is mentioned people assume that lifestyle relates to exercise and diet. However to my mind perhaps the most important yet most neglected component of lifestyle is stress.

We live in a hugely stressful world and stress is everywhere and to my mind stress is perhaps the single biggest cause of morbidity and mortality and it is unfortunate that our politicians are happy to give millions of pounds to pharamceutical companies to bring wierd and wonderful drugs to treat medical illnesses, they don’t invest at all in strategies to help reduce stress and thereby prevent disease from happening in the first place. And the simple reason for this is that preventing disease is not as profitable as treating disease!

We know stress is hugely inflammatory to the body and most chronic western world illnesses arise from long term chronic inflammation.

This week, I found a very interesting study in the journal of American college of cardiology and this was published in Oct 2014. The lead author is Rachel Lambert and the study was called ‘triggering of symptomatic atrial fibrillation by negative emotion’

95 patients paroxysmal AF were studied.All were in sinus rhythm at the time of enrollment.
They were asked to keep an electronic diary summarising their emotions for the day at the end of each day for a whole year. They were asked to fill in if they had been happy, sad, angry, stressed, impatient, anxious or hungry.
They were given a loop recorder so that they could record their symptoms when they felt that they had gone into Afib and then they were also asked to fill in exactly what their emotions were just before theu developed their symptoms.
Once a month, they were also given a 24 hour tape and every 30 minutes they were asked to fill in how they were feeling.

So the researchers then used the result to compare 2 things:
Did emotional status influence whether you had an Afib attack on the same day?
Did emotional status on the day before impact on whether you had an Afib attack the next day?

The results were amazingly interesting!

Stress, Anxiety and sadness and anger all increased the likelihood of Afib
Happiness was incredibly protective
In fact the likelihood of AF events was 85% lower after reports of happiness!

They also found that if the patient had reported being stressed or angry the day before then this almost doubled the likelihood of AF on the following day. The more the stress the more likely an episode of AF!

So in summary this study very elegantly showed that negative emotion can trigger Afib.

And this is why i think that being mindful of the huge negative impact that stress can have on our health is so important and giving priority to those aspects of your life that genuinely give you happiness and destress you is a very worthwhile investment.

Here are some more videos on the subject of Afib

Also if you would like to speak with me please come and join me on my facebook page (yorkcardiology1), my website is www.yorkcardiology.co.uk and my twitter id is yorkcardiology.

Ectopic heart beats which happen on exercise

By | cardiology, Uncategorized | No Comments

One of the biggest anxieties in people with ectopic heart beats is if they notice them on exercise and this is because everywhere you read on the internet it says that if your ectopics go away on exercise then they are benign and therefore people worry that if their ectopics are actually noticeable on exercise then that is in some way more sinister and it is not uncommon for me to get people contacting me and saying look i have had ectopics for many years and they were only at rest and now i notice them on exercise and i am panicking and i have stopped exercising

So i thought id reassure you

it is true that ectopic heart beats generally get less with exercise and this is because when you increase your heart rate you are reducing the amount of time between each heart beat and therefore there is less chance of the ectopics creeping in but that doesn’t mean you can’t have ectopic heart beats on exercise as well. In fact in my job i often have to supervise treadmill tests and i see one or two ectopic heart beatss creep in during exercise in the majority of patients.

it is also true to say that most heart conditions become more noticeable on exercise because you are increasing the demands on the heart so if you have heart artery narrowings then the first time the heart will have a problem receiving the blood it needs is when it is working really hard and therefore needs a lot more of it. Similarly if the heart is anyway damaged or a heart valve is narrowed then the first time you will notice it is when the heart is working really hard and so if the heart is struggling because it is not able to keep up it could become more irritable and therefore misfire with more ectopics

So how do you know whether it is just the kind of incidental ectopics you are noticing or whether they really do reflect that the heart is more distressed and the answer is that there are two things to look for:

consistency
progression

Consistency means that if there is major heart problem you would usually expect the ectopics to happen everytime you do the same level of exercise. If you get them one day when you are walking briskly but then you can go and do a fast run without a problem then it makes it highly unlikely that the ectopics are sinister

Progression means that if your ectopics are happening because the heart is distressed and therefore more sinister then you will find that they will increase with increased exertion which means that if you continue to exercise your ectopics will continue to get worse and worse.

It is always good to have some baseline investigations if you haven’t had any and i would always recommend a stress echocardiogram because with a stress echocardiogram you can study the heart at rest, look for consistency and progression and also work out if all the heart muscle is getting all the blood at maximal physical stress.

If you have a normal stress echo then it is highly unlikely that you need to worry about your ectopics on exercise.

If you get a chance, do watch my Youtube video

Valentine’s day – a day to look after your and your loved one’s heart

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With Valentine’s Day approaching, it’s important that you look after things people love about you; your mind, your body and especially your heart.

Your heart keeps you alive by pumping blood around your body 24 hours a day for every day of your life so it makes sense to look after it. You can help reduce the risk of developing many types of heart disease by making some lifestyle changes. Here are a few tips:-

Diet
Eating an unhealthy diet high in fat can lead to hardening of the arteries and increase your risk of heart attacks. There are two types of fat-  saturated and unsaturated. Avoid foods containing high levels of saturated fat because they increase levels of bad cholesterol in your blood.

Foods high in saturated fat include:

  • meat pies
  • sausages and fatty cuts of meat
  • butter
  • ghee (a type of butter often used in Indian cooking)
  • lard
  • cream
  • hard cheese
  • cakes and biscuits
  • foods that contain coconut or palm oil

Eating a small amount of unsaturated fat will increase the level of good cholesterol and help reduce any blockage in your arteries. Foods high in unsaturated fat include:

  • oily fish
  • avocados
  • nuts and seeds
  • sunflower, rapeseed and olive oil

Smoking

Smoking is a major risk factor for heart attacks because it causes atherosclerosis and raises blood pressure. Everytime you smoke, you are adding a layer of tar in the your heart arteries and progressively this will cause further narrowing of the heart arteries.

Alcohol

If you drink alcohol, do not exceed the recommended daily limits (no more than three to four units a day for men, and two to three units a day for women). A unit of alcohol is roughly half a pint of normal strength lager, a small glass of wine, or a single measure (25ml) of spirits.

Regularly exceeding the recommended alcohol limits will raise your blood pressure and cholesterol level, increasing your risk of another heart attack.

Avoid binge drinking (drinking more than three alcoholic drinks in one to two hours). Binge drinking can cause a sudden and large rise in your blood pressure, which could be potentially dangerous.

Make sure you are a healthy weight.
If you are overweight or obese, it is recommended you lose weight and then maintain a healthy weight using a combination of exercise and a calorie-controlled diet.

Regular physical activity
Physical activity is activity that requires you to use more energy than when you are resting.  It can include activities such as walking or gardening. The aim is to reach a stage where you are slightly out of breath

Healthy adults should do at least 150 minutes (two and-a-half hours) of moderate-intensity aerobic activity (such as cycling or fast walking) every week.

The level of activity should be strenuous enough to leave you slightly breathless.

Hopefully you already take good care of your heart and if you don’t, its never to late to start. With very good care, you may even be able to reverse some of the damage that has already been done. If you ever have any concerns about the health of your heart and want to discuss further, drop me an email.

best wishes for a very happy (and healthy) Valentine’s day!

 

The Last Heart Attack

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Welcome to my blog.

Some of you may know that I have a very illustrious namesake in the USA. This other Dr Sanjay Gupta is a neurosurgeon but has spent a large part of his career addressing  the issue of whether heart attacks can be prevented and even abolished. I was recently fortunate enough to watch his highly illuminating documentary.

We know that heart disease is caused by a furring up of the heart arteries. It is also well known that the process of furring up (atherosclerosis) starts decades before any of us have any symptoms of heart disease. By the time, we develop symptoms of chest discomfort or breathlessness on exertion or even at rest, it is often too late to reverse this process. Even though people have stents implanted or bypass operations, we know that these procedures simply provide symptom relief rather than a cure. Heart artery disease, once it has developed can not be cured and will undoubtedly contribute to a reduction in the sufferer’s lifespan.  Dr Gupta has found through years of interviewing some of the greatest minds in medicine that the only way to avoid having heart disease is by being aware of its ubiquity and by proactively finding out whether you have any signs of furring up in your arteries. Fortunately we now have the technology in the UK by which people can find out exactly what is happening inside their heart arteries and take steps to prevent or abort the process of atherosclerosis.  The technology is called CT coronary angiography and a few minutes through a scanner can give you a fairly accurate assessment of whether or not you are likely to develop a problem with your heart in the future. If the heart arteries look clean then you can relax and get on with your life. If the heart arteries show signs of some furring up, then by taking cholesterol lowering medicines (statins), getting regular exercise, losing weight and generally adopting a healthy lifestyle, it is possible to significantly slow down or even abort the process of heart artery disease.

You can watch Dr Gupta’s documentary here.

I would strongly urge you all to  be proactive about your health and particularly your heart. Please go and see your GP about whether CT coronary angiography is available in your area. If you have any questions or need advice, please don’t hesitate to contact me.