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Heart health: answers at your fingertips - Graham Jackson


Year 2009

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AcknowledgementsForewordPreface to the fourth editionIntroduction1. How your heart worksANATOMY OF THE HEARTWhat is the heart?Can you tell me what the coronary arteries are?What happens when things go wrong with the coronary arteries?What is the aorta?What are the valves?What keeps the right and left heart apart?HOW YOUR HEART WORKSWhen I asked my doctor how my heart works, he said that it would take too long to explain! Can you tell me simply how the normal heart works?The nurse at our practice runs a clinic to test blood pressures. What is blood pressure exactly and why is it so important?I know that the heart beats automatically, but what, if anything, keeps it going?WHAT CAN GO WRONG WITH MY HEART?I am 46 and sometimes feel odd sensations in my chest. Are these to do with my heart? How will I know if I have a heart problem?What is the commonest heart problem for me to watch out for?What is the pericardium?2. Coronary heart diseaseAre there any risk factors that I can't change?RISKS OF SMOKINGI have smoked since my teens just as my father and grandfather did. My father is still alive and my grandfather lived until he was 65. What are my risks of heart disease?There is a lot of talk about the harmful effects of passive smoking. Can other people's smoke really harm me?The government gives us dire warnings about smoking but I know many people who smoke who are in their seventies or eighties. Are the statistics regarding the harmful effects of smoking really as bad as the press makes out?I have changed to a low-tar brand of cigarettes, with a filter. Why will smoking be so harmful to me now?I have tried again and again to give up smoking. Are there any 'safe' cigarettes?I cannot stop smoking. Would it help if I just cut down on my smoking?Both my husband and I smoke one pack of cigarettes a day. I have recently read that women are as much at risk as men. Is this true?If I could stop smoking, would this do any real good?I am 58 and have been smoking for many years. Is it ever too late to stop?My girlfriend has suggested that I change to a pipe as she is convinced that pipes and cigars are safer than cigarettes. Is this true?I have tried to stop smoking but always lapse. What can I do to quit smoking and avoid the temptations?I've given up smoking but I am afraid that I might begin again. Will it put me back to square one if I start again?I have heard that meditation can help people to stop smoking. Do you think it works and is it worth the effort?A friend of mine went to an acupuncturist to help her stop smoking and she has not smoked now for some months. I have also read that hypnosis can help. Do you think that any of these methods is any good?I don't do much exercise. Would exercise help me to give up smoking?I know people who have given up smoking, but then put on weight. How can I avoid this?I've not yet tried quitting as I am frankly unable to cope with going 'cold turkey'. What can I expect as withdrawal symptoms when I stop smoking?I have seen adverts for nicotine gum and patches. I smoke about 20 a day. Would nicotine replacement help me?Are there any side effects to the nicotine preparations?Can I become addicted to the nicotine patches?How much do these products cost?I have been trying to find a support group - can they help me?Are herbal cigarettes or dummy cigarettes worth trying?Would it be better if I used a filter?Why do some people smoke like chimneys but live a long life all the same?I have heard a lot about Zyban. Does it help stop smoking and how does it work?One of my friends is taking Champix - does it work?I had a heart attack a year ago when I was 61. Is it too late to stop smoking?What is a smoking cessation clinic - is it worth a try?Can you tell me more about blood pressure? Why is it serious if it becomes high?RISKS OF HIGH BLOOD PRESSUREFacts and figuresWhat causes high blood pressure?What tests can I expect to have if my blood pressure is found to be raised?I am not too sure what the adrenal glands are for. Can you explain their purpose?My wife and I went to the doctor's to get our blood pressures checked. Hers was different to mine. Why?When I went to the clinic to have my blood pressure checked, I was told that I had white coat hypertension. What is this?When I was 16, my blood pressure was lower than it is now that I am 45. Is this OK?What are the dangers if I can't get my high blood pressure down?Are there any specific risk factors for high blood pressure that might apply to me?I have read about the rule of halves, but did not understand it. Could you explain?How would I know if my blood pressure was raised?Measurement of blood pressureI have often seen home blood pressure monitoring machines in high street chemists, but they are pricey. Are they any good?How is blood pressure measured in the clinic?How often should my blood pressure be checked?My doctor tells me that my systolic pressure is very high, although the diastolic pressure is normal. Does this matter?Self-helpMy mother had high blood pressure and she suffered a stroke when she was 65. Can I avoid having hypertension myself?I'm 62 and my doctor is making me cut down on salt as she says that I am getting more sensitive to salt. What does this mean?My husband has been told that he has a high blood pressure. The doctor gave him a diet sheet. How can a better diet help him?TreatmentI am bitterly disappointed because I have lost weight and reduced my salt intake, but I have been told that my blood pressure is still raised. What should I do?There seem to be a lot of different medications on the market for raised blood pressure. Why have I been given one and not another?I read in the newspaper and saw a report on TV that calcium antagonists can be dangerous - is this true?Someone told me that one particular medication for blood pressure makes your hair grow - is this true?You have not mentioned Aldomet. I am pregnant and my doctor prescribed this medication for my blood pressure. Why did she choose this rather than the others that you have talked about?I've read about a new medication called Physiotens which was called a breakthrough for blood pressure treatment in my newspaper. Should I get my doctor to put me on it?When I went to see my doctor, he measured my blood pressure and put me on tablets straight away. Why was this?I have been feeling tired and lethargic lately. Do you think my tablets are causing the problem?I am on treatment for high blood pressure. I know that some medications cause side effects. What should I look for?I have heard that blood pressure pills can affect your sex life - is this true?While I am taking my tablets, can I lead a normal life or is there anything I should avoid doing?I am told that I have high blood pressure and need treatment, but I don't seem to have any symptoms. If I do not feel unwell, why should I need it?Now that I have been prescribed tablets, how long will my treatment last?I don't mind taking one tablet a day, but one of my friends has so many that she rattles. Will these tablets be all that I need to take?My blood pressure seems to be resistant to many drugs and I have now been put on spironalactone. How is this different?What should I do if I forget to take my tablets?RISKS OF HIGH CHOLESTEROL LEVELSFacts and figuresThere is a lot of talk these days about lipids and cholesterol and now I've seen something about triglycerides! I am rather muddled about it all. Can you tell me what all these words mean?I was told that all cholesterol is bad for you. Now I read that there is a 'good' cholesterol and 'bad' cholesterol. What's the difference?I'm going to have a complete check-up next month. When I have my cholesterol profile checked, what levels should all these different fats be?When I had a lipid profile done on my blood, the doctor told me I had hypercholesterolemia. What does this mean?When I look at a food label, there are different types of fats listed, such as saturated and unsaturated fats. Can you explain more about the differences between the types of fats?The media has also talked about the harmful effects of trans fatty acids. How can I avoid them?The article that I read also mentioned vitamin E as being beneficial. Why is it important?You have talked about vitamin E. What about vitamin C - isn't this an antioxidant as well?I have always believed taking vitamin supplements would protect me - are you saying this is not true?I know of people taking beta carotene supplements and our health food shop is always marketing it. What is beta carotene, and should I be taking it?I thought that people supplementing their diet with extra beta carotene from the health food shops had a lower chance of developing heart disease or cancer. You say that there may be risk of developing these conditions - which view is right?There is so much advice about fat intake that I really don't know what to believe. How much fat should we eat a day?My father had a high cholesterol level and died aged 55. My wife is concerned that I may be like him -1 am now 52. Can this be inherited?Self-helpShould I know my cholesterol and other test level numbers? Will it do any good?How well will a healthy diet lower my cholesterol?Which is more important - to avoid foods high in cholesterol or saturated fats?I am told that I have a high cholesterol level. If I manage to lower this level, will this really prevent heart disease?What should I get my cholesterol levels down to in order to see a benefit to my heart?I have reduced my cholesterol level so that the tests are now normal. Can I go back to smoking?I have seen cholesterol self-testing kits in the chemists. Are these any good?Do I need to starve for the blood test?My doctor has only measured my total cholesterol level. Is this enough, or should I ask for all the different levels to be measured?When should I have a repeat cholesterol level test?TreatmentWhat happens if my second cholesterol level test is still raised?What medications are there to treat high cholesterol levels and are there any side effects?I have been prescribed cholesterol-lowering medication, although I am only 50. Will I always need medication?When I have finally got my cholesterol level under control, how often should I have it checked?I have been on cholesterol-lowering medication for some time now. When I go for a check-up, my doctor checks my liver. Why?Can lowering cholesterol levels be harmful, as I have read that lowering cholesterol increases the chances of suffering a violent death or suicide?I have had a heart attack and even though my cholesterol was only 4.51 have been put on a statin - why is this?I have read about a new cholesterol drug called Ezetrol - when is this used?OTHER RISK FACTORS FOR CORONARY HEART DISEASEBeing overweight - obesityI don't feel overweight but the doctor says I am. Have I got more chance of developing heart disease because of this?StressI have a very stressful job. Am I more likely to get heart problems?Will I be able to recognize the symptoms of dangerous levels of stress?Is there any way I can reduce my stress levels?Why is so much emphasis placed on stress in the media?I have read about type A' and 'B' personalities having an effect on the heart. What is the difference between them?Do different emotions affect the heart adversely?I feel that I am stressed at the end of the day. What can I do?DiabetesI have had diabetes for 30 years. What is the effect of diabetes on heart disease?I have diabetes and have now been told that I have insulin resistance and am at risk of heart disease - what is insulin resistance?Illegal drugsI worry that my teenage daughter might have access to drugs. Do illegal drugs affect young people's chances of heart problems?WOMEN AND CORONARY HEART DISEASEI am a mother aged 53. I am concerned to read that coronary heart disease is a major risk for me. Isn't this a man's disease?My father had heart disease and I am concerned that my daughter might develop heart disease also. I know that she smokes. How can I help her avoid heart disease?I have read that women's natural hormones protect us from heart disease. Is this true?I have been taking the pill on and off since I was 18. I have just been through the menopause. Am I at any greater risk of heart disease because I have been using oral contraceptives?I have felt well since being on HRT but I am worried about its effect on my heart and the risk of breast cancer - what should I do?I have read in the paper about a new drug called raloxifene -what advantage does this have?Does HRT have any side effects?Does HRT raise blood pressure?I have breast cancer which is now controlled, and I have also had a heart attack - will HRT help me?What sort of HRT therapy is available?I have been advised to go on HRT but I am resisting as I have read that it doubles your chances of getting blood clots in the legs - is this true?I'm fit and active with no risk factors for heart disease - will I benefit from HRT?From the point of view of heart health, who will benefit most from taking HRT? I have been taking HRT for 7 years and I think that it is wonderful -1 now feel a new woman! However, my doctor says that I should stop it soon. How long should I continue taking HRT?I'm on HRT at the moment. Do I need regular check-ups?I have been on oral HRT for some months and my doctor has arranged for me to have a lipid test. Why?I do find the advice on HRT confusing - can you clarify it for me?I'm concerned that my wife is at risk of heart disease and I want her to take it seriously; she smokes and is rather well padded! However, her doctor does not seem to be bothering either. What should I tell her?3. AnginaSYMPTOMSMy husband has got angina. He is obviously in pain but cannot describe it easily. What does it feel like?Can my husband's chest pain be from causes other than heart disease?What is the difference between angina and a heart attack?I have been diagnosed as having unstable angina. What is this?I am on medicine for angina and I still often get pains. If I get an attack of angina, it is difficult to know when I should bother the doctor. What should I do?When should I dial 999 rather than just call a doctor?I have angina, but I want to live an active life. Is there any activity that is likely to bring my angina on?I sometimes get a pain after eating. The doctor told me this was 'post-prandial angina'. What exactly is this?Sometimes when I drive, for instance in the rush hour, I get angina symptoms - am I wise to carry on?TESTSWhat tests might I have to undergo for angina?ECGMy doctor is sending me for an ECG next week. I am not sure what this involves - will it mean time in hospital for an operation?What does an exercise ECG involve?I have an appointment for an exercise ECG. How should I prepare for it?My ECG last week was absolutely normal. However, because the doctor still thinks that I have angina, I have got to go for more tests. Why?What makes the exercise test abnormal?My doctor says the exercise test is equivocal, so he can't be sure if there is or isn't a problem, and is sending me for a nuclear scan. Will I be radioactive?AngiogramI have been told to go to the hospital for an angiogram. What is this and what does it involve?I am told I need an angiogram but I saw on TV a new kind of angiogram using CT scanning. What's this?MRI does not involve X-rays so can I have an MRI instead of an angiogram?Is there any difference between an angiogram from the arm or the leg?I have been on warfarin tablets for some time now, to prevent blood clots. Do I need to stop or reduce my warfarin before the angiogram?I'm taking aspirin every day - do I need to stop this for the angiogram?Is the angiogram at all painful?Is the angiogram procedure dangerous?What happens after I have had my angiogram?How long after my angiogram will I get my results?What happens after I have been discharged from hospital, following the angiogram?I always thought that angina was a man's problem. Do women get angina?I have had my angiogram and my arteries are clear, but I still have angina. My doctor says that I have Syndrome X - what does this mean?TREATMENTWhat is there, apart from medication, to treat angina?The use of aspirin as a preventative drug has been discussed a lot in the media recently. What does aspirin do?I get indigestion on aspirin - is there an alternative?MedicationWhat relieves the pain of angina? Do I have to take medication?NitratesBeta-blockersCalcium antagonistsPotassium channel activatorsTaking your medicationSurgeryAngioplastyBypass surgeryOTHER TREATMENTS FOR ANGINAI am not too sure what the 'placebo factor' means. Can you explain this to me?Could alternative medicine with acupuncture, homeopathy or herbal therapy just be a placebo effect?What types of alternative therapy are available for people with heart problems?I have heard that herbs can be helpful in heart disease and angina. Can you give me some advice?You keep emphasizing the importance of going to reputable shops to buy herbal medicine. Isn't all the information we need on the label?Are Chinese herbs the same as our herbal medicines and can they help?Are you in favour or against alternative methods of treatment?I thought alternative medicine practitioners were all trained. Isn't this so?Why are doctors so sceptical about alternative medicine?Do you think there is place then for alternative medicine or should I ignore it?Can complementary therapies do any harm?I have read in the paper about laser surgery. This sounds exciting - is it being used everywhere?What drugs should I be on to help stop my angina problems coming back?Drugs are much cheaper on the Internet - is it safe to buy them?4. Heart attacksWill I be able to avoid a heart attack?Can you tell me what causes a heart attack?I have recently heard that heart attacks can be caused by exhaust pollution. Is this true?SYMPTOMSWhat are the symptoms of a heart attack?Are there any warning signs that might point to an impending heart attack?I know that I get angina and have learnt to recognise the symptoms. How will I recognise the difference between the pain of angina and that of a heart attack?My brother has had a heart attack - according to the hospital. He says that he did not feel it happening. I thought a heart attack was painful.HEART ATTACK - THE EVENTMy mother has been told that she is 'at high risk' of a heart attack. I am her carer and am worried about her. What should I do if I think she is having a heart attack?Why do we have to say 'heart attack' when calling an ambulance?We live in the country and fortunately have a very good local hospital. However, it does not have a coronary care unit like the general hospital 40 minutes away. Our doctor has advised us to go to the coronary care unit in the event of my husband having a heart attack. Why?My partner is very stubborn and simply refuses to go to hospital. He is getting on now and not strong. He has been a life-long smoker. I do not want to upset him by making him go to hospital if he had a heart attack. Would he be able to stay at home?Going to hospitalMy husband has heart problems and I am told that he is 'at risk'. If he had a heart attack, what actually happens after hospital admission?My husband went straight for an angioplasty even in his outdoor clothes - why did they rush?My husband has gone into a Coronary Care Unit. What will happen when he returns to the general ward?What drugs should a heart attack patient be taking on leaving hospital?RECOVERY PERIODI always thought that having a heart attack was the end of the story. Now you give me the good news that nearly everyone recovers nowadays. Is this true?A friend of mine had a heart attack recently and is still in hospital. She rang me to say that she was coming out soon. Will she be completely dependent and unable to look after herself? What can she do for herself after leaving hospital?I had a heart attack over a month ago and I now feel completely better. I am frustrated that my doctor wants me to vegetate at home! When will I be allowed to lead a normal life again after my heart attack?What should I do to help my recovery after my heart attack?I am on the mend after a heart attack - a nasty shock! How will I feel in myself when I return home?Am I likely to get more chest pain after I have recovered from my heart attack?I am home from hospital after having had a heart attack. Will I need surgery or angioplasty in the future?EMOTIONAL PROBLEMS AFTER A HEART ATTACKWill I be able to resume a normal sex life after a heart attack?Why do I feel so angry about what has happened to me?I still feel very moody at times after my heart attack. Why is this?I am the one who has had a heart attack, but I now feel fine, perhaps a bit low sometimes; but my children really blame themselves over what happened. Why do they feel guilty?I'm really depressed after my heart attack, which is unusual for me as I am usually 'bubbly'. My doctor tells me that this is normal after a heart attack. How will I know if I am 'medically' depressed rather than just 'down'?TREATMENTWhat treatment will I be given when I leave hospital following my heart attack?My husband has angina and I am worried that he may not survive a heart attack. What can I do if he has one suddenly -and what should I tell his friends to do?Is there an alternative to 'clot buster' drugs for heart attacks?We were so grateful that my brother did not die from his heart attack. Why do some but not others die from a heart attack?HELPING YOURSELFExerciseI have always hated exercise. Now that I have had a heart attack, and presumably should take things easy, my doctor tells me that I need to take more exercise. What exercise should I be doing?How I should begin my exercises?You hear horror stories about the dangers of exercise, from slipping a disk to straining muscles, or even dropping dead! Are there any 'commandments' that I should be following?I am recuperating from a severe heart attack. How can I tell when I am overdoing things?Is it really necessary to know my heart rate?I can honestly say that I have never taken any exercise, but my doctor tells me that I need to do so if I do not want more heart problems. For how long should I exercise?How will exercise help me?DietShould I be doing anything about what I eat?I am absolutely miserable when I go on a slimming diet - it never works anyway. What is so wrong with being fat?Would it help if I saw a dietitian?My cholesterol was checked 2 weeks after my heart attack. It had gone right down, but my hospital doctor did not seem as pleased as I was. Why not?I have read a lot about what I should do, now that I am home after my heart attack, but there seems to be too much to do at once.5. Heart failureCAUSESAre the causes of heart failure known?My daughter has been diagnosed as having cardiomyopathy -what is this condition?I have read of footballers and other sports people dropping dead from HOCM - what is this?How often do sports players collapse and die?My husband has heart failure but the doctor says his heart is OK, he's just anaemic. How can this be?If the heart valves are to blame for weakened muscle, can they be replaced?I have been told that I have heart failure. Is heart failure dangerous?SYMPTOMSWhat are the symptoms of heart failure?My partner has been diagnosed with heart failure but no one would guess on meeting her. However, she does get breathless at night. Why is this?I have heart failure. Am I right to be worried that I will not be able to lead an active life?I had a heart attack recently. My cardiologist tells me that my heart has weakened and that I have now got heart failure. Will the symptoms be noticeable?My doctor says I have a hibernating myocardium. What does he mean?Should I discuss the diagnosis of heart failure with my family?TESTSThe doctor at the hospital told me that I have heart failure. For some reason, he told me to report back for a chest X-ray. Why do I need a chest X-ray for heart failure?Why do I need blood tests for heart failure?My sister is very concerned that she has been given an appointment to have an echocardiogram. What is this?How is an echocardiogram performed?My doctor wants a special echocardiogram to see if I might benefit from a pacemaker. What is this about?I have heard that some echocardiograms are done by the patient swallowing a tube. Is this true and, if so, what is happening here?I have an appointment at the hospital for a nuclear scan. This sounds rather dangerous to me. Is it harmful and how is a nuclear scan done?The hospital has written to me and told me that I need a test called a SPECT. What is this?I have had test after test until I feel that I could not be tested further. I now have been summoned for a nuclear scan. When is nuclear scanning specifically helpful?My wife was told that she is going to have a PET scan. How is PET different from SPECT?TREATMENTI have been told that I have heart failure but was also informed that I will not need treatment for some time; why not? And, if I have to have treatment in the future, what might it consist of?I have had an unpleasant jolt, having a heart attack. I suppose that I ignored the advice and warnings. Now I am determined not to lose control again. My doctor says it's heart failure. What can I do to help myself with my heart problem?Medication I have been prescribed diuretics. What are these?How will I know if the diuretics are working?My doctor tells me that I need digoxin to help my heart. Why?My doctor has taken me off water tablets and put me on ACE inhibitors, which don't agree with me at all - they just make me cough all the time. Why?My wife has heart failure and gets very breathless. She was prescribed nitrates at her last visit to the doctor. What are these for?I have been prescribed warfarin. I thought this was rat poison! Why am I taking it?Should I be taking aspirin? I have heard a lot about it in the media recently.Can I take other medicines while I am on any of these heart failure tablets?Should I be taking beta-blockers?I have heart failure - can you tell me which drugs I should be taking and why?I recently read about spironolactone. Will this be given to me?My doctor placed me on eplerenone because I developed heart failure after a heart attack. How does it work?Can I help monitor my heart failure at home?SurgeryI have been diagnosed as having heart failure. Will I be able to have a heart transplant?What does a heart transplant involve?I've heard about an operation to reduce the size of the heart by cutting out a piece of heart muscle. It is claimed to help heart failure. Should I consider this before a transplant?My doctor has mentioned cardiomyoplasty but was not very enthusiastic about it. What is this operation?Is an artificial heart another option for me?Can pacemakers be used to treat heart failure?My cardiologist has advised a defibrillator as well as a pacemaker. Why both?6. PalpitationsTYPES OF PALPITATIONSI often feel that my heart has missed a beat. Is this serious?I drink rather a lot of coffee. I have heard that caffeine is bad for the heart and I must admit that sometimes I feel that my heart has missed a beat. Am I about to have a heart attack?When I was at work the other day, I suddenly felt my heart was working overtime -1 hadn't even been rushing up the stairs! What was happening?I've been very worried when I had two attacks of rapid heartbeats recently. Are there any types of palpitations that are dangerous?I am in my twenties and am getting rapid heartbeats every so often. I work in the type of job where results are all important. My husband has just lost his job as well, so sometimes I feel really stressed. Should I go to the doctor?SELF-HELPI occasionally get palpitations. Now that I am approaching 50 are they going to get worse?I have just had three attacks of palpitations in a week, which made me very worried. By the time I got to see my doctor, they had gone away. What should I do if I get another attack?I have heart disease and am finding that I occasionally get attacks of palpitations. Is this serious?There was something in the media about a problem with grapefruit juice interacting in some way with medications. Should I avoid the fruit or juice completely?I am in my sixties and have developed rapid heartbeats in the last few weeks. I like to drink with friends most evenings. Do you think I am drinking too much?I have tried all sorts of self-help methods but I keep getting palpitation attacks; when should I see the doctor?TESTSI have been to the doctor because I was so worried about these rapid heartbeats that occurred. He has given me a little machine to record any attacks that I get in future. Can you tell me more about this please?I think the machine that I am to be given is called an event recorder. Is this different to the 'Walkman'-type recorder?An appointment has been made for me to go to hospital for electrophysiological (EPS) tests. What are these?TREATMENTI have a very stressful job and find that I get really nervous. My heart seems to miss a beat when I am stressed or anxious. Is there anything that can help me?I am going for tests at the hospital next week for palpitations. Will I be offered any medication to treat irregular heartbeats?ATRIAL FIBRILLATIONI have just had a test for irregular heartbeats and been told that I have atrial fibrillation. What is this?I have been diagnosed as having atrial fibrillation. What could have caused this?How will I know that the palpitations are due to atrial fibrillation?My husband has just been told that he has atrial fibrillation. Is this dangerous and can anything be done to help him?Tests for atrial fibrillationMy doctor has told me that I have will have to undergo some tests to check to see whether I have atrial fibrillation. What will this involve?Treatment of atrial fibrillationWhat sort of treatment is there available for me now that I have been diagnosed with atrial fibrillation? Can I just be treated with medication?What medication will I be offered to treat my atrial fibrillation?I have been told that I am going to have shock treatment for atrial fibrillation. What will this involve and is it dangerous?My cardiologist has mentioned cardiac ablation. What will this involve? Is it safe?OTHER ABNORMAL HEARTBEATSTwo or three of my friends now have a pacemaker. Although I have 'funny' heartbeats, I have not been offered one. When are they used?There seem to be a lot of different methods of helping abnormal heartbeats. Why was I offered electric shock treatment and not a pacemaker?I am going to have a pacemaker fitted next month - are there different types?I am rather nervous about having a pacemaker fitted. What will it involve?Before my heart started to play up, I was very active. Will I be able to go back to that sort of activity when I have had my pacemaker inserted?Can pacemakers be troublesome?When I went to see the cardiologist, he was very frank with me and said that the type of heart rhythm that I had was rather dangerous. He wants to insert an implantable defibrillator. Is this a type of pacemaker?A friend of mine has a defibrillator for atrial fibrillation - is this a new treatment?BLACKOUTSMy wife has suffered from blackouts recently. Can you tell me what these are and what causes them?My wife has been ignoring these blackouts because they don't happen too often. Should I get her to go to the doctor and have them investigated?How does a faint differ from a blackout?If my wife feels faint, what should I do to help?7. Valve diseaseCAUSESI have been diagnosed with valve disease. What do you think is likely to have caused it?SYMPTOMSHow will I recognise valvular disease?Does the fact that I have valve disease mean that there is a greater strain on my heart?TESTSI have been asked to go for tests to see if I have valve disease. What will these involve?TREATMENTI have had tests for valve disease and have been put on a waiting list for a new valve. It all sounds rather frightening -what will this involve?What are artificial heart valves like?How long do these different types of valve last?It sounds like a big operation. What are my chances of pulling through?What happens if something goes wrong later? Can valve operations be repeated?Do all diseased valves need an operation?Are there any other types of surgery for valve disease? I have been told there is something called 'balloon surgery'. What is this?If you can balloon a narrow valve without heart surgery, can you replace valves also?INFECTIONI am about to undergo valve surgery. Are there any problems associated with valve replacement?I had a valve replacement some months ago. How will I know if I have developed an infection?When I was in hospital for a valve replacement, one of the patients there had developed an infection. Is infection common? Is it likely that I shall develop an infection too?8. Sex and the heartQUESTIONS YOU MAY FIND DIFFICULT TO ASK YOUR DOCTORWhat happens to my heart when I am making love?If the heart rate is increasing, is sex stressful to the heart?Is casual sex more stressful to the heart than with a partner in a long-term relationship?You sometimes hear horror stories of people dying while they are making love. Are these stories true?I had a heart attack recently. How soon can I start making love again?I am in my early fifties and have had a heart attack. Am I too old for sex?I had heart surgery 3 weeks ago. My husband is keen to make love again. Can I resume lovemaking safely?My partner has recently had heart surgery but has been given the all clear. Are some positions during lovemaking dangerous?Since I came back from hospital following a heart attack, I've had no interest in making love. It upsets my partner and frustrates him. What should I say to him?I have been diagnosed with angina. Will heart disease affect my sex drive?My wife and I have always had a vigorous and adventurous love life. Now I am worried that I may get angina while I am making love. Is this likely?To be honest, our love life wasn't up to much before the heart attack. Will it get worse?I have heart failure and find that sex is too much effort. What can I do?I am taking medication for my heart problem. Can medication affect my sex life?Since being on blood pressure pills, my husband is having a problem getting an erection. Is there a connection?Everyone has heard about Viagra. My husband has a poor erection: will it help him?A friend of mine had a heart attack after taking Viagra: it seems dangerous to me. What do media reports say?Does the effect of Viagra wear off the more you use it?What happens if I get angina during sex after taking Viagra?Are there other heart drugs that may react with Viagra?Nitrates help my angina but I would like to try Viagra - what should I do?I have tried Viagra but it only partly works - how can I improve things?I have heard of newer Viagra-like drugs - are they any different?If tablets don't work do I have any other choices?Can I mix medications?All I hear about is men's problems - do women get sexual difficulties and can they be helped, with Viagra for example?Can you give me some advice in preparing for sex since my heart attack?I have heard that K-Y jelly can be useful if lovemaking is a problem or painful. How safe is it to use?Does oral or anal sex stress the heart?I have resumed sex after my bypass and there are no problems, but I'm afraid that it might do some damage to the operation site. Is this possible?I read in the newspaper that ED could be a marker for silent coronary disease. Is this true?My husband has lost all interest in sex even though he has made a good recovery from his small heart attack. Is it my fault?9. DietFOOD TYPES AND EATING HEALTHILYFatsI have read that fish oil is very good for you. Can you tell me about this?If I eat fish twice a week, will it allow me to eat what I like for the rest of the week?I'm not keen on fish - can I have fish oil capsules instead?What is the difference between white fish and oily fish?I quite like fish but it can be expensive. How much is it recommended that I eat each week?How do I know if the fish is fresh? I would hate to get food poisoning.Isn't it possible to keep fresh fish in the fridge for a week?What types of food have low or high levels of fat and cholesterol in them?What sort of foods should I eat to cut down on my fat intake?According to the TV ads, some margarines seems to be a good way of lowering cholesterol - do they really work?My friend in America is taking nicotinic acid (niacin) for her cholesterol - is it available here?Someone told me that nuts were good for reducing coronary disease - should I eat them regularly?Are there better ways of cooking I could try?FibreThe doctor often recommends that I should eat more fibre. Is fibre important in my diet?What is the difference between soluble and insoluble fibre? Should I eat both?When I am in the supermarket, I get confused as to which foods are best for fibre content. Can you tell me more about which contain more fibre?I know that vegetables are good for me because they contain fibre and vitamins. I have heard that boiling vegetables loses the vitamins. How should I prepare fruit and vegetables to get the maximum benefits from them?SugarI have rather a sweet tooth. Is sugar really that bad for you?I've read that poor dental health can cause coronary heart disease - is this true?Have you any tips for cutting down on sugar?SaltI have raised blood pressure and my doctor tells me that I must cut down on my salt. Why is this?So how much salt do we actually need in our diet?I know that I eat too much salt and my blood pressure is on the high side. What foods should I try to limit?I have heard that bananas are very good for you. Why is this?How do I read food labels and what do the figures mean for me?GarlicI have read that garlic is very good for high blood pressure. Is this true?DrinksI drink quite a few cups of coffee a day. Is coffee bad for the heart?I like to have a drink now and again. How does alcohol affect my heart?I have heard a lot about the benefits of wine. Is wine better than beer or spirits?SnacksBesides fruit can you suggest some healthy snacks?LOSING WEIGHTI know I have to lose some weight. Have you any general tips?How quickly should I lose weight?My friend has taken so-called diet tablets. Do these work?I have been on a slimming diet and managed to lose some weight. How can I keep the weight off now?I have seen two different charts for an ideal weight. What should my target weight be?I find the whole business of BMI confusing - can it be made simpler?I have heard the nurse talk about a waist/hip ratio. What is this? Does it apply to my husband as well as me?I've tried all sorts of slimming diets and nothing seems to work -what can I do now?Is it safe for heart patients to try the Atkins diet?We have a local Weightwatchers group in our area. Are slimming groups any good?You have mentioned before that Asians have a higher incidence of coronary disease and diabetes - what dietary changes can they make?We have a full social life and I am often out during the week at business lunches. How can I avoid fatty foods when I am out?There are times when I really fancy a steak. Should I never eat this?What should my intake of fats be?Can you give some simple guidelines regarding calories? How many should I need on a daily basis?I know I should eat more vegetables and fruit in my diet to lose weight. Which ones have the least calories?What exactly is a 'portion'?I know there is a good deal of fibre in breads and cereals. What about their calorie value?How many calories are there in alcohol?I want to be healthy and not overweight - can you summarise for me the most important ways of achieving this?If I miss a meal because I am travelling or I am on business, what can you suggest as an alternative?10. ExerciseWHY BOTHER?Why will exercise do me good?What types of exercise are good for the heart? I have been doing weight lifting for years - is it of any help to my heart?I've read about exercise and there is often a mention of METs -what are they?If I'm fit why should I quit smoking as well?I am now 51 and made a resolution on my 50th birthday to take exercise regularly. I found that my good intentions fell away after 3 months when I was ill for a week with flu. What do you suggest might help now?I'm over 60 and have never really taken exercise properly, though I live an outdoor life. Am I too old to exercise now?I am going to start an exercise routine. How will I be able to work out how many calories I use up?HOW MUCH?I have a busy life and am not sure that I can set aside half an hour every day for exercising. Is my effort wasted if I do not take exercise every day?I am put off exercising because, in my exercise class, everyone else seems much fitter than me. Why is this?SAFETYYou mention talking to my doctor before I start exercising. Do I really need a medical check first?I'm worried that I might overdo things. Should I take any special precautions before exercising?Last time I tried jogging, I tore a calf muscle and was off work for 2 weeks. How can I avoid this happening again?CHOOSING YOUR EXERCISEMy local recreation centre offers 40 different sports from judo to meditation. What is the best form of exercise to do?I lead a very busy life and just do not have time to exercise. Is there anything I can do?I am in my forties and have always hated competitive sport but enjoy walking. Is there a simple walking programme I could start?A friend of mine was told to judge his exercise by the talking test. What is this?I should like to go walking but I'm afraid to walk alone - I'm always reading in the local paper of women being attacked. Isn't it rather dangerous to walk on my own?I've tried walking 1 mile a day and I find that I get bored after a month. What else can I do besides walking?There is a heart testing machine at my local gym, but frankly I do not understand what the figures mean. What should my maximum heart rate be?I've got a tracksuit and trainers. Do I need any other special clothing to exercise in?Does regular exercise help prevent me from getting a heart attack during sex?What is 'exercise with a purpose'?Glossary
 
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