Uncategorized Archives - York Cardiology

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.


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

Ectopic heart beats which happen on exercise

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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 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

Cardiac Syndrome

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Obesity-heart-diseaseAffected dogs die of sudden cardiac death or congestive heart failure. In some cases there is sudden death from the arrhythmia that occurs.

The dose should be adjusted to heart rate and rhythm. The pacemaker is a small battery-powered unit usually implanted under the skin and wired to the heart to control its rate and rhythm of contraction.

A large number of studies have provided clear evidence for a link between the risk of coronary heart disease and psychological risk factors. The major risk factors for heart disease and stroke are also the most important risk factors for PAD. People with a family history, who smoke, and who are obese have a higher risk of developing heart disease.

You cannot change some risk factors for heart disease, but others you can change. Educating Canadians about modifying existing risk factors for heart disease has been shown to be an important aspect of prevention. Even though the risk of heart disease increases with age, it does not mean you can not do anything about it.

Coronary heart disease is the most common type of heart disease and can lead to sudden death from a heart attack. Exercise does not prevent heart disease and does not reverse heart disease as claimed. Coronary artery disease, one type of heart disease, is the leading cause of heart attacks. Coronary Heart Disease Coronary heart disease is the most common form of heart disease.

The Links Between Diet and Coronary Heart Disease Coronary heart disease is a disease of the arteries that causes damage to, or malfunction of, the heart. Coronary artery disease is the most common type of heart disease and the leading cause of death worldwide.

A heart attack occurs when blood flow to an area of your heart muscle is completely blocked. When your coronary arteries are narrowed or blocked, oxygen-rich blood can not reach your heart muscle. A heart attack happens when a blood clot suddenly and completely blocks one of the heart arteries, starving part of the heart muscle of oxygen.

Cigarettes-tied-with-rope-and-wick-isolateed-on-whiteA heart attack occurs if the flow of oxygen-rich blood to a section of heart muscle is cut off. When the blood supply is completely cut off, the result is a heart attack, and the heart muscle begins to die. The goals of treatment are to restore blood flow to the heart muscle and prevent another heart attack.

The symptoms of heart disease vary depending on the type of heart disease. Types of cardiovascular disease affecting the heart include syncope, rheumatic heart disease, and heart attack. Although the signs of heart disease may appear mild at first, and may be mistaken for signs of aging, heart failure is a serious, progressive problem and can be life-threatening.

The symptoms of rheumatic heart disease vary and damage to the heart often is not readily noticeable. Many different types of heart disease can result in heart failure. Rheumatic heart disease is a complication of rheumatic fever in which the heart valves are damaged.

High cholesterol and high blood pressure are almost certainly among the causes of microvascular disease. You may be asked to take one or more medicines to treat blood pressure, diabetes, or high cholesterol levels. When you have your blood pressure measured, the systolic pressure is the first, higher number to be recorded.

High blood pressure is defined as a systolic pressure of 140mmHg or more, or a diastolic pressure of 90mmHg or more. As someone with diabetes, you should have your blood pressure and cholesterol levels checked at least once a year. You will most often see blood pressure numbers written with the systolic number above or before the diastolic number, such as 120/80 mmHg.

AngioplasticYour heart is a muscle and if you weigh more it makes the heart work overtime to pump blood to all parts of the body. Because the heart is not pumping effectively, blood may back up in the heart, lungs, or other organs. When you have heart failure, your heart can not pump enough blood throughout your body.

A dilated heart chamber leads to dilated cardiomyopathy, which is a heart muscle too weak to beat with enough force to supply the cells with blood. The lack of blood flow to your heart may damage to your heart muscle. When the heart muscle is relaxing in between systoles, and filling up with blood in readiness for the next contraction, it is called diastole.

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:-

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 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.


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.