Cardiology: Ask the experts

Blog Health News 6th March 2023 Enquiries & appointments
KIMS Hospital logo on 3d heart for an 'Ask the Experts' Cardiology Q&A feature.

To help support National Heart Month in February, we assembled a panel of two Cardiologists together with our Cardiology Services Manager, to help answer any questions you might have about the symptoms, prevention and treatment of cardiovascular disease (CVD).

Thank you to those who have submitted questions. The video of our experts answering can be seen by visiting: HERE

or clicking here:

I’m Dr Naveen Mudalagiri, and I’m a consultant cardiologist with a specialist interest in coronary intervention and I practise here at KIMS Hospital.

I’m Dr Peter Kabunga, I’m a consultant cardiologist with specialist training in heart rhythm disorders. I implant pacemakers, defibrillators and conduct electrical physiology or electrical studies of the heart and ablation where appropriate, and I work at KIMS Hospital.

My name’s Anne Hatswell. I’m the cardiology services manager at KIMS Hospital.

Question: After a lifetime of having a heart rate of 56, my rate is now 90 to 130. This is despite taking beta blockers. Can you explain?

The heart rate is a number that’s going to be affected by a number of things:

  • Other medical history we need to consider.
  • Level of fitness will affect your heart rate, is it possible that you’re less fit than you were before.
  • Is it possible that your blood count has changed.
  • Could you be anaemic?
  • Are you taking medications that perhaps would affect your heart rate? We know that some medications will artificially increase your heart rate.

The main message to take from this is that the number is not nearly as important as the symptoms and what else is going on with your health. So a heart rate of 90 beats per minute can be normal but also can be abnormal, 56 is normal but can also be abnormal.

If you have no symptoms whatsoever, I would probably ignore the heart rate because it’s not as important as how you feel as a person.

Question: What are the best methods of managing suspected angina?

A very common symptom is chest pain but that could be as a result of a lot of different issues, but it’s very important that if it is suspected angina then this is investigated as it could potentially be quite dangerous.
It’s very important to make a diagnosis where an extensive review is taken on symptoms. This will then be directed down a series of investigations to try and determine what is the cause of their chest pain.

If angina is suspected, there are lots of tests that the patient may have to go through. The most basic tests would be an electrocardiogram which is an ECG, followed by an ultrasound scan of your heart to have a look at the structure and function of your heart and see if any obvious abnormalities are present.

To make a firm diagnosis, other tests will need to be done to look at the arteries or the blood flow to the heart which we offer here at KIMS. Other tests could be either a CT Cory angiogram, or a gold standard Connery angiogram by the wrist.

Question: A patient had a pacemaker fitted recently and wants to know what changes they have to do?

Many years ago, when pacemakers were first introduced, patients with pacemakers needed to avoid magnets. The magnet is a key component of the pacemaker so we know that if you in theory disrupt the functioning of that magnet you may disrupt the functioning of the pacemaker.

Now increasingly most of the pacemaker manufacturers recognise that pacemakers are so robust, that you’d have to have an industrial level magnet to disrupt its function. Some of our patients having MRI scans or other such investigations with a pacemaker can still have the MRI scan despite having a pacemaker, but obviously every manufacturer will have specific steps that must happen before the scan.

The general advice with induction hobs is that if you’re going to be working near one, you should keep a distance of at least two feet but if you were to accidentally be closer then there’s no need to panic. The pacemaker would more than likely reset to its user function and the general advice would be to contact your pacemaker Clinic. We certainly have a good pacemaker Clinic here in KIMS Hospital.

Question: I’ve had a few stressful years and I’m getting very stressed. Sometimes I wake up with my heart beating really fast. It slows down if I deep breathe and it passes after a few minutes. I don’t want to take medication. I’m practising yoga. Is this sensible?

Your heart rate does vary during the day and the night and it’s not unusual for that to happen. The majority of heart rhythms are not particularly dangerous but if you are having a problem with your heart rhythm it’s very important that we establish what that problem is.

Once we’ve determined what the problem is then we can give you a treatment plan on how to manage and treat the problem, if there is a problem in the first place. I’d advise you to see a healthcare professional, to then have heart tests. These may include monitoring the heart rate and rhythm for 24-72 hours in order for us to be able to catch what is going on and determine if there is or isn’t a problem here.

Question: I have hypermobility syndrome. Tests including an echocardiogram and a heart MRI show that I have a mildly leaky aortic valve, reduced LV function about 49% and the arrhythmia. I am waiting to see the arrhythmia team but do I need an ablation?

So the first thing that’s not clear from the question is what sort of arrhythmia you have. Arrhythmia means a heart rhythm disorder and my suspicion is that you’re referring to atrial fibrillation which is an irregular heart rhythm which we can’t treat with or manage with an ablation procedure.

The ablation for atrial fibrillation is the most effective treatment that we have. We have medication for oral arrhythmias or heart rhythm disorders, including atrial fibrillation, but specifically with regards to atrial fibrillation and ablation procedure of the most effective treatment. The earlier you perform the ablation the better.

What’s important to know is that in some patients the arrhythmia itself can have an impact on the overall function of the heart muscle. In other words, your left ventricular function is below what would be expected. 55% would be classified as normal.

I would recommend that you have an ablation soon because we know that the longer you have heart rhythm problems, the more difficult it becomes to treat them. So I would encourage you to have a conversation with your Rhythmia team with regards to exactly what it is you have, so they can explain what is better for you.

Question: I’ve recently been diagnosed with pulmonary hypertension and I’m waiting on an appointment to see a cardiologist but I’d like to fly to Canada. Is that okay for me to do so?

Pulmonary Hypertension is a specific problem where the blood pressure of the lungs has increased. There are many causes of pulmonary hypertension – it may be a problem with the lungs themselves and the vascular tubes in the lungs It could also be as a result of a secondary occurrence to some other disease processes, such as some people who’ve had lots of blood clots in their lungs or have got a problem with the little air sacs in their lungs which become very stiff and what we call fibrotic.

It’s important to diagnose and establish how severe it is which would determine whether or not you require any particular management plan like medication or treatments. The treatment for pulmonary hypertension would very much focus on establishing the cause and treat the cause to try and reduce further issues.

It is advisable to have this checked out before you travel as it’s unclear from the question how symptomatic you are as a result of this problem and problems can change in pressure and oxygen concentrations so it’d be probably better for you to have that checked out before you travel.

Question: This patient has a paroxysmal atrial fibrillation and wants to get an opinion on the best exercises they can do and should they consider an ablation?

The exercises that we will recommend for atrial fibrillation or any heartbreaking disorders are not really dissimilar to any exercise we recommend in general for anyone who has or hasn’t got a heart problem.
Any exercise that increases your heart rate to 70-80 is generally recommended for good General heart health. Exercising at least four to five times a week, around 30 to 60 minutes at a time. Combining aerobic exercising and strength exercising – swimming, running or walking and combining it with something that’s going to build your muscle mass. It doesn’t have to be a gym, it can just be hovering around the house or carrying your shopping for as long as possible. This exercise regime is not specific for atrial fibrillation, it can be applied across all kinds of heart problems.

Ablation is the most effective treatment for atrial fibrillation. For many many years we used to advise our patients to try medications first and if the medications fail then we can go for an ablation procedure. Evidence over the last five years shows that the earlier you perform an ablation the more effective.

Question: I frequently get fluttering in my chest. I’m also mainly in the morning when I do have a feeling of Doom and I get tightness in the chest. Is there something to do with my heart?

There are a number of symptoms that this patient’s experiencing. Fluttering in the chest which we need to determine what is the cause – it may well be benign but it may not be so it is best to diagnose and treat.
The feeling of doom and tightness in your chest is a symptom that gives me cause of concern. It will depend on the character of the pain; where the pain comes on, how it spreads, how it radiates, are there any associated symptoms with that. It’s also marrying your symptoms along with cardiovascular risk;

  • Do they smoke?
  • Do you have diabetes?
  • Do you have high blood pressure?
  • Do you have a family history of heart disease?
  • Have you yourself had a previous history of heart disease?

We’ll have to use all of that information to determine or help us determine whether there is a course of concern. There are a whole host of tests that we can use to determine that such as ECGs/echocardiograms, stress tests to look at the function of the heart and other tests to look at the quality of the blood supply to the heart such as an angiogram performed by the wrist. Using a CT scanner to identify any narrowing that gives me cause of concern and if there is then there are treatment options that would remove the narrowing using balloons called stents, which are metal scaffolds to keep the artery open and helpfully reduce your symptoms as a result.

Question: I have idiopathic intracranial hypertension. Am I at higher risk of heart disease and should my GP be more aware of this and be giving me more tests?

Idiopathic intracranial hypertension is not a common condition and it’s a condition which affects your brain and not your heart. It is called idiopathic because we don’t know the specific cause of it, it’s intracranial because it’s in your skull and it’s hypertension so there is a raised blood pressure in your brain.

There are there’s still a lot of debate as to whether idiopathic intracranial hypertension necessarily increases your overall cardiovascular risk. There are a few studies which have indicated some link between having idiopathic intracranial hypertension and increased cardiovascular risk but it’s not definite.

What’s important to note is cardiovascular risks independent of idiopathic intracranial hypertension are still very common, such as, diabetes, high blood pressure, stress levels, high cholesterol, and these problems need to be identified and mitigated to reduce your overall cardiovascular risk.

Question: How does that menopause or a lack of oestrogen contribute to atrial fibrillation?

The highest risk factor for atrial fibrillation and irregular heart rhythm is age so the older you get the more likely you are to get atrial fibrillation. Now with regards to the menopause, studies called The Women’s Health Institute, have revealed a neutral association between the menopause and atrial fibrillation, but what they have shown is a small additional risk in those patients who are perimenopausal or menopausal who take oestrogen.

So if you have hormone replacement therapy that’s only oestrogen based then your risk of atrial fibrillation is higher. That increase in risk of atrial fibrillation is cancelled out if you take progesterone as well, so certainly from an atrial fibrillation perspective, your risk is neutral if you take oestrogen and progesterone and higher if you take oestrogen. The accumulated risk is low and as I’ve said the biggest risk to anyone, male or female, is age – the older you are, the more likely you are to get atrial fibrillation.

Question: How do you recognize the early signs of heart disease?

The signs of heart disease can be quite non-specific. There are a lot of overlapping conditions which can cause a whole range of symptoms which can mimic heart disease. The commonest symptoms that people experience with heart disease could be palpitations, shortness of breath, shortness when you walk, chest pain or chest tightness with exertion.

Patients may also be experiencing swelling, for example of the legs, which could be a sign of heart failure. Pain in the chest could be the onset of narrowings of the heart arteries. So there’s a whole range of symptoms that could be quite non-specific to the untrained eye as to whether this is the early stage of heart disease or not.

If you have any of these symptoms I would advise getting them checked out by your Healthcare professional to determine whether this is actually heart related or not a lot.

Question: I have recently been aware of my heart beating it feels like it quickens and then misses a Beat and it feels like a thudding in my chest I’ve had this on and off for a while over the last few months I’ve noticed it lasts longer and it makes me cough and I can feel it in my neck I can often feel dizzy as well but I have no pain.

A very common question. I would say in a typical week I see at least 20% of my patients with heart rhythm disorders who have exactly the symptoms that I described in the question so I would probably say that the most likely cause of your symptoms is ectopic beats. These are extra heartbeats usually coming from the bottom chamber of the heart.

The way electricity in the heart works is that your heart is made up of four chambers – the top two chambers called the atria and the two bottom chambers called the ventricle. We all have electricity that travels from a small area in the top right chamber that goes to the middle of the heart and for whatever reason other parts of the heart may generate an extra beat of electricity and thats called an ectopic beat. Ectopic beats are very normal and give you symptoms as described above.

There are a variety of other symptoms that people may have; breathlessness, cough, dizziness and this is because your heart is temporarily being activated. Another common symptom is that after the extra beats you feel your heart stopping again. That is normal because once the heart has been electrically activated it needs a period of time to reset itself. Now this isn’t something to worry about, but if you do have concerns or start to experience this regularly then it may be best to see a cardiologist for tests, such as an ECG that records a period of time.

Now the last point I should make is that occasionally these extra beats like ectopic beats are a sign of other things away from the heart and this is the body’s way of telling you to investigate. Experiencing stress anxiety is common for people to have these extra beats and also simple things like being anaemic and your blood count being low.

Question: This patient had a bypass two years ago and wonders what checks they should follow up?

You’ve had a bypass operation before so we know you’ve got significant heart disease but what’s important is moving forward. We record all the risk factors that this patient has to make sure you don’t have future problems and create a bespoke treatment plan to make sure we keep the heart as healthy as possible. This would involve:

  • Monitoring the patient’s blood pressure, making sure all is controlled and within normal range as we know high blood pressure is one of the biggest causes of heart disease.
  • If you’re diabetic, then it’s important to make sure your diabetes is under control.
  • Make sure your cholesterol is well controlled and reduce LDL cholesterol.
  • Lower stress levels.
  • Doing exercise, dietary changes and lifestyle changes.

Patients who’ve had bypass surgery or stents or even heart attacks it’s important the patient undertakes this program because we know those people are more likely to have better outcomes.

Question: I have great concerns about non-sustained ventricular tachycardia. I have been found to have a few episodes on a recent seven day monitor. I have a structurally normal heart after an echocardiogram and I’m premenopausal. I wonder if this is causing the palpitations?

I would guarantee you would find a lot of healthy people with these episodes of nonsustained ventricular tachycardia so I would not get concerned especially if your heart is normal and you don’t have any other medical issues or family history.

Now there are a few patients, depending on your own personal history or family history, where we would want to upgrade the number of investigations, such as, putting you on a treadmill to try and stress your heart, an MRI scan of the heart. Assuming there’s not anything else going on in your own personal and public history then it is possible that being a perimenopausal can generate these extra beats. In my experience, some of my patients have gone into hormone replacement therapy which has a benefit but obviously discuss this with your specialist.

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