Tag Archives: angina




Stressed out?

Stress is a word people use for feeling they feel when everything gets too much.

You might get this if:-

  • You have too much to do
  • If other people are asking a lot of you
  • You are having to deal with things you can’t control

To help keep your heart healthy, you need to take care of your body and your mind

You have a choice in that you can choose how you want to control your life and change it for the better by just taking

10 minutes out.

How does stress affect your heart?

Being stressed often makes you do things which are bad for your heart:-

  • smoking – stop to think whether you could consider a quit smoking day and contact Smokefree Ealing by calling 0208 579 8622 or visit
  • drinking too much – if you need support contact RISE –
    Phone: 020 8843 5900
    24hrs: 0800 195 8100
  • eating unhealthy foods that are high in saturated fat and salt so that you put on too much weight, raise your blood pressure and cholesterol levels.- contact your GP for advice or screening.

If you  smoke , have high blood pressure, high cholesterol or are overweight, you are more likely to get coronary heart disease, which means you might get angina or have a heart attack.

Drinking too much alcohol can cause problems with your heart rhythm, high blood pressure and damage your heart muscle.

If you have stresses you need help with contact IAPT  Self-referral line: 020 3313 5660 or visit :-

find out more about dealing with stress and helping your heart.  download the following:-



Posted by on February 14, 2015 in Training and Advice


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Vascular scaffolds

During the heavy snow in 1980’s I was working as a GP in South Wales and after heavy blizzards I had woken up to find that I was literally trapped in the snow . When I opened the door to go to the coal house to get fuel for my central heating boiler there was a wall of snow blocking my exit and I had to dig a tunnel along the short path to the shed. Having dug myself out the only way I could get to the surgery was by walking up the disused railway line.

During that time it was challenging in that the only way patients could get to hospital was being airlifted by helicopter. We soon set up an emergency plan to manage our patients. We spoke to patients on the phone and then if appropriate we arranged delivery of medication. Local young men rallied together with their motorbikes and set up a courier service and prided themselves by getting medication delivered in record time whilst able residents cleared paths and roads. At the time there was great enthusiasm regarding CBR(Citizens Band Radio) and they facilitated communication between couriers as well as helping those people who had no telephone or connection. It was interesting because most calls were about getting their sick certificates or their Valium prescriptions!!
When the snow cleared surgeries were busy and I particularly remember one consultation about 2 weeks later.
“Dr when we were cut off the Brains (beer) lorry couldn’t get up the hill to the club and I had to help by pushing a barrel by hand and during that time I had an awful pull”. (A common description which could mean anything) “What do you mean by that?” I asked. He responded immediately with a distorted facial expression,”I had an awful gripping feeling across my chest”,he said, clenching his fist and pressing on the middle of his chest. I don’t know how I got the barrel through the door, good job someone was there to help and I came over very cold and sweaty so Dai, the bar man had to pour me a stiff brandy”.
( the resounding, stuttering words of Dr Byron Evans, consultant physician & medical tutor in medical school whilst on a ward round came to me, “Listen here,good boys, if ever you hear a man describe a gripping chest pain and he clenches his fist and draws it to the centre of his chest it has to be cardiac” and he repeated it in Welsh with even greater gusto).
I gently explained that to  that he had probably had a heart attack and prescribed some GTN tablets to put under the tongue if the pain should recur as there was no other specific treatment and getting an ECG was not easy to arrange. At that time a study had been shown that a patients survival rate was greater if they stayed at home especially as ambulances were minimally equipped and the nearest hospital was 20miles away and coronary care units had not evolved generally.
If the pain did recur these patients often became more and more incapacitated to the point that they became bed bound and were called ‘cardiac cripples’ I remember one such patient that I visited frequently and every time a new drug appeared in the form of slow release GTN he was willing to be the ‘guinea pig’ I got to know him very well and on the visits we used to discuss the many photos of pigeons he had decorating his living room and talk about the ins and outs of rearing racing pigeons and where he used to ‘toss’ them.
It was about this time that cardiologists were beginning to perform angioplasties far away in London and if I wanted to refer a patient for an angiogram and or angioplasty they had to travel to London. Many people were fearful of going as several had not come back or returned having had a stroke.

It was not until 1986 that bare metal stents(BMS)were implanted into the coronary arteries.
Since that time preventative measures and treatment has evolved so that peoples lives have been extended and the quality of life improved. Patients at risk are now actively encouraged to change their lifestyle – smoking cessation, low fat diets and regular exercise and medicines such as statins and beta-blockers have decreased mortality by as much as 25%. Investigation by angiogram has led to better understanding of coronary artery disease.
From 1994 implantation of stents has become common place and several generations of bare metal stents (BMS) have been developed often using cobalt chrome alloy.
The permanence of these metallic stents is not considered ideal as they can induce late clotting (thrombosis).
Also, although these stents are highly successful and most people have had significant improvement of symptoms the rate of restenosis (re-narrowing of the treated artery) causes limitation and often results in having to repeat the procedure.

This has led to the development of the DES (drug-routing stents) in 2003. These stents are coated with a special material that release (elutes) a drug(such as paclitaxel, sirolimus or tacrolimus) over a period of 30-90 days in order to reduce restenosis. The polymer coating degrades by the time the drug has been released and the metallic structure remains. DES are more expensive than BMS and are not necessarily superior in terms of reducing death, heart attack or thrombosis. According to NICE, the decision to use either a BMS or a DES should be based on the anatomy of the target vessel and the symptoms and mode of the disease.

During the past 3 yrs Bioresorbable stents (BVS), also referred to as vascular scaffolds, represent a new concept in stents for treating coronary artery disease. Stents are vascular scaffolds that are used to hold open a blocked vessel to restore blood flow to the heart.

Bioresorbable stents are designed to slowly disappear over time, leaving patients with a treated vessel free of a permanent implant. With no material left behind, the vessel has the potential to return to a more natural state and function reducing the risk of late thrombosis. Other advantages may include:
 A reduction in the risk of bleeding complications which can be caused by anti-clotting treatments.
Anti-clotting therapy, with two anti-platelet drugs, is given after a stent is implanted, and it may be that bioresorbable stents require a shorter period of this treatment because of resorption of the device. However, some patients may still need long term anti-clotting treatments because of their underlying heart condition.
 Patient acceptability. Some patients may prefer a temporary implant rather than a permanent one.

Five bioresorbable stents are in various stages of development. So far, clinical studies are encouraging and have shown that bioresorbable stents may offer an additional option to current stents.

On September 25th 2012 Abbott announced that Absorb™, the world’s first drug eluting bioresorbable vascular scaffold (BVS), and it is now widely available across Europe and parts of Asia Pacific and Latin America. Absorb is a first-of-its-kind device for the treatment of coronary artery disease (CAD).
We are awaiting long term follow up………..

If you want to find out more patient information about angioplasty and insertion of stents use the following link:-

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Posted by on October 24, 2013 in Training and Advice


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Are Yew taking a Calcium Channel Blocker such as Amlodipine ?


In 1021, Avicenna introduced the medicinal use of Taxus baccata for phytotherapy in The Canon of Medicine.

I hope that when I explain what this means you will find it all as fascinating as I did……
Firstly, Avicenna, who is he?

Avicenna (Ibn Sīnā) was born c. 980 in Qishlak Afshona, a village near Bukhara (in present-day Uzbekistan), the capital of the Samanids, a Persian dynasty in Central Asia and Greater Khorasan. His mother, named Setareh, was from Bukhara; his father, Abdullah, was a respected Ismaili scholar from Balkh, an important town of the Samanid Empire, in what is today Balkh Province, Afghanistan.


Avicenna had memorised the entire Qur’an by the age of 10. He learned Indian arithmetic from an Indian greengrocer, and he began to learn more from a wandering scholar who gained a livelihood by curing the sick and teaching the young. He also studied Fiqh (Islamic jurisprudence) under the Hanafi scholar Ismail al-Zahid.
He began to study medicine at the age of 16, and not only learned medical theory, but also attended the sick gratuitously and according to his own account, discovered new methods of treatment.
As a teenager, he was greatly troubled by the Metaphysics of Aristotle, (as I am sure many of you will sympathise with!!!)which he could not understand until he read al-Farabi’s commentary on the work. For the next year and a half, he studied philosophy.
Avicenna had memorised the entire Qur’an by the age of 10.  He learned Indian arithmetic from an Indian greengrocer, and he began to learn more from a wandering scholar who gained a livelihood by curing the sick and teaching the young. He also studied Fiqh (Islamic jurisprudence) under the Hanafi scholar Ismail al-Zahid.

The teenager achieved full status as a qualified physician at age 18,and found that “Medicine is no hard and thorny science, like mathematics and metaphysics, so I soon made great progress; I became an excellent doctor and began to treat patients, using approved remedies.” The youthful physician’s fame spread quickly, and he treated many patients without asking for payment. div>

Secondly,what is The Canon of Medicine (Arabic: القانون في الطب‎ al-Qānūn fī al-Ṭibb) is an encyclopedia of medicine in five books compiled by Ibn Sīnā (Avicenna) and completed in 1025.[1] It presents a clear and organized summary of all the medical knowledge of the time. The Canon is considered one of the most famous books in the history of of the chapters is dedicated to cardiology and treatment of hear conditions.Avicenna dedicated a chapter of the Canon to blood pressure. He was able to discover the causes of bleeding and haemorrhage, and discovered that haemorrhage could be induced by high blood pressure because of higher levels of cholesterol in the blood. This led him to investigate methods of controlling blood pressure.
Avicenna introduced the medicinal use of Taxus baccata for phytotherapy.

Phytotherapy is the study of the use of extracts from natural origin as medicines or health-promoting agents. The main difference of phytotherapy medicines from the medicines containing the herbal elements is in the methods of plants processing. Traditional phytotherapy is a synonym for herbalism and regarded as alternative medicine by much of Western medicine. Although the medicinal and biological effects of many plant constituents such as alkaloids (morphine, atropine etc.) have been proven through clinical studies, there is debate about the efficacy and the place of phytotherapy in medical therapies.
Despite Western medicines reservation about the use of herbs the herbal drug “Zarnab”(derived from Taxus baccata)was as a cardiac remedy by Avienna. This was the first known use of a calcium channel blocker drug, which were not in wide use in the Western world until the 1960s.

Taxus baccata is a conifer native to western, central and southern Europe, northwest Africa, northern Iran and southwest Asia. It is the tree originally known as yew, though with other related trees becoming known, it may now be known as English yew, or European yew.

There has been a long association of yew trees in churchyards and there are at least 500 churchyards in England which contain yew trees which are older than the building itself. It is not known why there is this link but there are many theories- from yews being planted over the graves of plague victims to protect and purify the dead (as in All saints,Isleworth where there is a lage Yew growing over a large Plague pit) image
to the more mundane in that yews could be planted in churchyards as it was one of the only places that cattle did not have access and therefore would not be poisoned by eating the leaves. Yew trees are taken as symbols of immortality in many traditions, but are also seen as omens of doom. For many centuries it was the custom for yew branches to be carried on Palm Sunday and at funerals. In Ireland, it was said that the yew was ‘the coffin of the vine’ as wine barrels were made of yew staves. As the wood is so robust, in Medieval times it has been used in making long bows.
A yew tree that many of you may have seen is the one at the entrance of the door to St.Mary’s ‘Perivale our local lovely venue for concerts.

When I read about Avicenna and his herbal medicine Zarnab, a patient called Clifford I looked after about 33yrs ago sprung to mind. This was when I worked as a GP in Maesteg,South Wales. He had been a miner but what I remember most was that he was a pigeon fancier and I remember visiting him regularly and in his lounge the walls were covered with framed photographs of various pigeons he had raced or tossed. He was now virtually bedbound and the he was considered a ‘Cardiac cripple’ which meant he could barely move without getting angina. Angiograms, coronary bypass or modern drugs for angina weren’t available and the few patients that were referred for surgery had to travel to London to the Hammersmith or the Brompton. Then one day I saw a pharmaceutical rep in surgery and he told me about a new drug called Nifedipine (Adalat) that was being recommended for angina aswell as hypertension and it was proving to be very effective, also if the patient bit the orange capsule(NO longer recommended) relief from angina was longer lasting than GTN tablets which was all that was available. I immediately thought of Clifford and was able to offer them to him and it was marvellous to see him come to the door on my next visit. This was my first experience of a Calcium Channel Blocker and experiencing its great value. Incredible to think it took the Western World mealy a 1000 yrs to rediscover this medication. Now a more refined drug called Amlodipine is first line in all patients >55 yrs and Black people for hypertension and we very rarely see patients so incapacitated by angina.

Read more fascinating facts about Yew in my next blog
Posted by Dr Bayer


Posted by on June 28, 2013 in Training and Advice


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