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Tag Archives: Heart disease

YOU CAN SAVE A LIFE

 

Cardiac arrest As part of our obligation as a doctor we have to have annual update cardiopulmonary resuscitation training and this also applies to the whole practice team.

We have found over the past few years that it makes sense to have sessions which include a cross-section of staff and even opening it up to patients that want to participate aswell as the the young adults of staff.

A report of a rare miraculously saving of a life 

On December 23rd 2017 Dr Livingston was cosily at home recharging her batteries after a very busy surgery watching “Love Actually” with her daughter and her boyfriend when there was a loud frantic knock at the door. It was the  nextdoor neighbour she was totally beside herself. Her husband had collapsed.

Dr Livingston knew he had heart problems so she immediately went into ‘doctor mode’ She instructed the 2 teenagers ( her daughter had attended CPR training ago but her boyfriend had never attended any training) to bring their phones  ( not usually far from there sides, anyway!) Her daughter who remembered that there was a pocket mask strapped to the stairs in the hall had the presence of mind to grab that as well and the team hurriedly followed the neighbour to the house.  Sure enough the husband was sited against a wall in a collapsed state. Immediate assessment demonstrated he was unrousable, not breathing and with no pulse. He had had a cardiac arrest.

The team managed to drag him onto the kitchen floor. Instantly  the learnt procedure was put into action, and Dr Livingston allocated instructions to her team- the boyfriend called 999 and was communicating with the ambulance service ,very calmly listening and responding appropriately to their questions.

Meanwhile, Dr Livingston had immediately started CPR (basic life support with my daughter). Her daughter maintained good airway and Dr Livingston commenced chest compressions. She commented how exhausting it was and infact had not performed  this for many years in a ‘real situation’ and then only in a hospital situation. Her daughter astutely observed that her mother was getting tired and then took over cardiac compressions. Before the ambulance arrived a police car arrived with a defibrillator. Although she had had training on this but she had never actually used and automated external defibrillator. They followed the spoken voice instructions it gave them.

After about 3 shocks the A.E.D said in a clear voice ‘movement detected’. The team paused in shear amazement ‘It was incredible,’ commented Dr Livingston.

Subsequently, two ambulance crews arrived and they took over and when he seemed stable the patient was transferred to Ealing Hospital. On arrival at hospital the Glasgow coma scale was used to assess the severity of brain injury and prognosis. The initial Glasgow Coma Scale provides a score in the range 3-15; patients with scores of 3-8 are usually said to be in a coma, remarkably his was 15.

This was a true miracle, as it is reported that of cardiac arrests in a hospital set up only 7% of people survive this man not only lived to tell the tale but survived his near-death experience without any damage to his heart muscle or his brain, an outcome extremely rarely seen following an out-of-hospital cardiac arrest.

When Dr Livingston and myself discussed this, I felt empowered to blog about this and Dr Livingston felt it was paramount to share her story with other GP’s by posting on a closed facebook page called Resilient GPs. Usually she would get 1 or 2 responses  but on this occasion had over 700 !!

Many GP’s after reading the account  decided to open up their basic life support training to the staff’s teenagers and family and purchase pocket masks and keep them at home and in the car. Dr Livingston will be advocating to all staff and both her daughters to put a pocket mask in their  cars.

Moreover, the practice would be prepared to offer hosting CPR courses at the surgery for anyone interested or facilitate where a course could be done. 

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When the team  got back home after lots of cups of tea Dr Livingston asked her daughter how she was feeling and was she upset by it?

She admitted it was scary but even though it was 2 years since she had attended the course she said the thing she particularly remembered the trainer saying, 

‘If you dont do anything they will die so you may as well try. Even if just do chest compression that will help. That is what everyone needs to know- have a go !!’

 Dr Livingston felt immensely proud of these teenagers , who not only immediately jumped into action without thinking  but ‘saved a life’.

Well done – an absolute game – changer. 

A week after this there was routine practice training update. The first time with the new practice defibrillator. The trainer simulated a cardiac arrest, which was brilliant, but completely forgot the practices had it’s own device.!!

The most important thing if some one has a cardiac arrest is to fibrillate as soon as possible

A few days later Dr Livingston  passed the gentleman’s son in the street and asked how his father was feeling. He replied, ” he seems fine but that his ribs were aching a lot” he was virtually totally unaware of the magnitude of what had happened and not only had he survived but that his life had been restored without brain injury.

As days went by it gradually it registered this man’s life had been saved by a team that was confident and empowered to act quickly and efficiently and then the team were showered with gifts!

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You could easily learn this skill and be a potential life-saver.

The British Heart Foundation are determined to transform the UK into a Nation of Lifesavers: a country where everyone knows how to save a life.

https://www.bhf.org.uk/heart-health/how-to-save-a-life

Also you could inform the surgery that you wish to participate in training and when enough people have signed up they will arrange a session.

 

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ARE YOU LOOKING AFTER YOUR HEART? – HAPPY VALENTINES DAY…….

     HELP YOUR HEART BY SMALL CHANGES.              

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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 http://www.smokefreeealing.co.uk
  • drinking too much – if you need support contact RISE –  http://www.ealingrise.org.uk
    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 :-

http://www.wlmht.nhs.uk/service/ealing-iapt/

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

Heart

https://www.bhf.org.uk/~/media/files/publications/other-prevention/g926_take_time_out_01_14.pdf

 
2 Comments

Posted by on February 14, 2015 in Training and Advice

 

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Reflections of heart stories – Mrs. Jones

When I first started at the practice in Ealing I remembered a dear couple from Swansea who I saw in surgery on a regular basis. I have to say that I had a bit of soft spot for them as we often reminisced about Wales as I knew the house she was brought up in and understood her enjoyment of laverbread and cockles.
Laverbread and cockles
Laverbread or ‘bara lawr’ in Welsh is an important traditional food of historical value. A national delicacy made from seaweed, it is collected from the beach then washed and cooked to a soft greenish black paste. Made from laver, one of the most nutritious varieties of seaweed, laverbread is full of health benefits. Rich in minerals and vitamins, full of protein and low in calories, this is a real superfood. A rare plant source of vitamin B12, it is also full of iron and iodine. She was always delighted if I managed to bring some from Swansea market bringing back those memories of welsh breakfast where it is served with bacon and egg. Failing that a few Welsh cakes were just as acceptable.
Welsh cakes

She was brought up in Swansea, Wales and as a young teenager had contracted St Vitus dance (also known as Sydenham’s Chorea) and described it very well and was able to demonstrate the involuntary, rapid, uncoordinated jerking movements primarily affecting the face, hands and feet movements associated with the condition. It was named St.Vitus Dance as St Vitus is patron saint of dancers. This condition was not uncommon many years ago And was found to be more common in females than males, most patients were children, below 18 years of age.
St Vitus dance
It was caused as a result of Group A beta-hemolytic Streptococcus infection and occurred in 20-30% of patients of patients with Rheumatic Fever or up to 6 months following the acute infection.
A vast majority of people at sometime in their life will develop a streptococcal infection of the throat characterised by a fever and white spots on the tonsils and swollen neck glands but nowadays this can be easily treated with antibiotics, usually Penicillin with good effect and it is very rarely associated with more widespread infections other than Scarlet Fever.
It was not uncommon in the 1950,s and 1960’s and I recall my mother saying to me as a child if I was fidgeting excessively, “Keep still have you got St Vitus Dance.?”

Mrs.Jones went on to develop an inflammation of the heart and the important valves of her heart were damaged. In my early days in Medicine I saw many patients with Rheumatic Heart Disease and we were disciplined in medical school to train our ears to listen out for murmurs in the heart using our stethoscopes in order to diagnose this problem. Patients were after brought in as test cases for our final examination. At that time we did not have the technology to aid our diagnoses. Needless to say not every medical student acquired this skill and as qualified doctors still could not pick out a murmur on auscultation. This resulted in many people remaining undiagnosed until they were having emergency surgery or developed another illness or went into heart failure during childbirth.
I recall several maternal deaths due to this at that time and young adults being diagnosed and needing heart surgery often carried out by a General Surgeons.
Ultimately,pig heart valves were used to treat these patients and then metal artificial valves, the clicking of which was audible to the patient and they often complained that it kept them awake at night.

Mrs.Jones tended to restrict her lifestyle and grew up as a slim,but feisty young woman and then decided to study for nursing at St. Mary’s hospital and it was when she became pregnant that her heart condition was diagnosed.

When she acquired St Vitus Dance she was not able to be treated with Penicillin as it had not been discovered when she developed this illness. Fleming recounted that the date of his discovery of penicillin was on the morning of Friday, September 28, 1928. It was a fortuitous accident: in his laboratory in the basement of St. Mary’s Hospital in London (now part of Imperial College).

As a result of this disease she developed significant valvular heart disease and miraculously survived and infact was nearly 90yrs before she died. She had the complication of Atrial fibrillation which is a heart condition that causes an irregular and often abnormally fast heart rate.
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A normal heart rate should be between 60 and 100 beats a minute when you are resting, and is regular. You can measure your heart rate by feeling the pulse in your wrist or neck. In atrial fibrillation, the heart rate may be over 140 beats a minute, although it can be any speed.
The main difference between a normal rhythm and atrial fibrillation is that you are unable to predict when the next heart beat will come along, as the heart rate is irregular.
This may lead to a number of problems, including dizziness and shortness of breath. You may also be aware of a fast and irregular heartbeat (palpitations) and feel very tired, breathlessness, dizzy and can experience chest pain (angina) but the worst fear is having a stroke.

Moreover,the way the heart beats in atrial fibrillation it reduces the heart’s efficiency and performance. This can result in low blood pressure and heart failure.

Mrs.Jones was able to tap out her atrial fibrillation in the surgery our on visits to the hospital and gleefully educated many student nurses and doctors into recognising this condition. Remarkably, she only developed mild heart failure and never had a stroke.
If you look at my previous blog this will demonstrate how to take the pulse and to recognise atrial fibrillation

https://102theavenue.wordpress.com/2014/02/07/know-your-pulse/
Or upload the app below on to your iPhone – my son assures me it is easy to use
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When to see your GP
Make an appointment to see your GP if:

  • you notice a sudden change in your heartbeat
  • your heart rate is consistently lower than 60 or above 100 – especially if you are experiencing other symptoms of atrial fibrillation
  • See your GP as soon as possible if you have chest pain.
  • If you notice a sudden change in your heartbeat and have chest pain, see your doctor immediately.

What is happening in the heart when someone develops atrial fibrillation.

The atria are the upper two chambers of the heart that receive blood from the rest of the body. They pump blood into the lower two chambers (the ventricles). Then the ventricles pump blood to the rest of the body. During atrial fibrillation, the atria do not beat normally. Instead, they quiver or “fibrillate.”

Normally, electrical impulses from a small part of the atrium called the sinus node cause the atria to beat. The electrical signal then goes through another part of the heart called the atrioventricular node. Then it goes down to the ventricles, and causes them to beat. First the atria, then the ventricles: it is coordinated, and so the heart pumps blood efficiently. The atria pump, filling the ventricles with blood, and then the ventricles pump.

In contrast, during atrial fibrillation, the electrical impulses come from all over the atria. Instead of pumping efficiently, the atria just quiver. There is an irregular and rapid heartbeat. There is no coordination between the atria and the ventricles. As a result, the atria do not pump all of their blood into the ventricles. Also, the ventricles sometimes pump when they don’t have a lot of blood in them.

A normal heartbeat is 60 to 100 beats per minute, and very regular: beat…beat…beat…beat. During atrial fibrillation, the heart beats at 80 to 160 beats per minute, and is very irregular: beat..beat…..beat….beat.beat.beat….beat.
When the hearts beats rapidly and irregularly, it cannot pump blood out of the heart efficiently. As a result, some people get short of breath. Some people faint.

Atrial fibrillation can lead to the formation of blood clots inside the atria. This is a serious, longer-term problem. These blood clots can travel out of the heart and get stuck in an artery to the lungs (causing a pulmonary embolism), an artery to the brain (causing a stroke) or an artery elsewhere in the body.

How atrial fibrillation is treated
bearing in mind that even if the atrial fibrillation is intermittent it still poses a risk of developing a stroke.

Treatment may involve:

  • medication to prevent a stroke by calculating the level of risk
  • medication to control the heart rate or rhythm
  • cardioversion, where the heart is given a controlled electric shock to restore normal rhythm
  • Catheter ablation, to prevent atrial fibrillation from occurring
  • having a pacemaker fitted to help your heart beat regularly

http://www.nhs.uk/Conditions/Atrial-fibrillation/Pages/Treatment.aspx

Especially during the past 12months Dr Livingston and myself along with our practise nurse have been on a mission to pick up undiagnosed cases of atrial fibrillation and we have diagnosed several cases and they have been treated accordingly. This is something that all doctors should be doing regularly especially if you are over the age of 65.
By the number of older patients I see equipped with modern technology I think they should be either uploading the App or asking their family to do it for them!

 
 

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Apricots – Xing Ren

Apricots
Tián Xìng Rén
甜杏仁
The apricot, Prunus armeniaca, is a species of Prunus, classified with the plum in the subgenus Prunus. The native range is somewhat uncertain due to its extensive prehistoric cultivation. Apricots are originally from China but arrived in Europe via Armenia, which is why the scientific name is Prunus armeniaca
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This week the apricots arrived in the market and as I arrived at the usual stall, the middle-aged stall-holder with a deep voice muttered audibly a string of words that I had not since I was a teenager on an exchange in France. She weighed out 2kg taking out a handful as she took them from the scales and putting a few back to look generous (I smiled as it was a trick I was taught when I worked for Elsie at the greengrocers as a teenager!) I was going to eat some fresh and to dehydrate some to use as snacks and in stews(tajines) desserts and maybe consider making jam to have with a morning croissant.
Summer has definitely arrived the stalls are laden with strawberries and now the apricots have arrived. Apricots are those beautifully golden orange coloured fruits with velvety skin and flesh, not too juicy but definitely smooth and sweet. Some describe their flavour as almost musky, with a faint tartness that lies somewhere between a peach and a plum.
The high beta-carotene content of apricots makes them important heart health foods. Beta-carotene helps protect LDL cholesterol from oxidation, which may help prevent heart disease.
Apricots contain nutrients such as vitamin A that promote good vision. Vitamin A, a powerful antioxidant, quenches free radical damage to cells and tissues. Free radical damage can injure the eyes’ lenses.
As a child, I remember being told to eat carrots so that you could see in the dark but as an adult, it looks like fruit is even more important for keeping your sight. Data reported in a study published in the Archives of Opthamology indicates that eating 3 or more servings of fruit per day may lower your risk of age-related macular degeneration (ARMD), the primary cause of vision loss in older adults, by 36%, compared to persons who consume less than 1.5 servings of fruit daily
In this study, which involved over 100,000 women and men, researchers evaluated theeffect of study participants’ consumption of fruits; vegetables; the antioxidant vitamins A, C, and E; and carotenoids on the development of early ARMD or neovascular ARMD, a more severe form of the illness associated with vision loss. Food intake information was collected periodically for up to 18 years for women and 12 years for men.
While, surprisingly, intakes of vegetables, antioxidant vitamins and carotenoids were not strongly related to incidence of either form of ARMD, fruit intake was definitely protective against the severe form of this vision-destroying disease.
When I am making jam or making a dessert using fresh apricots I always crack a few of the stones to add the seeds as my mother did.

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Having completed my Diploma in Chinese Herbs I recall learning about the apricot kernel/seed Xing Ren which is used for a cough with yellow sputum, low grade fever and sore eyes associated with the common cold but it is only used in small quantities as it is toxic in large amounts(must be avoided in children and pregnant or breast feeding women) and usually used as part of a mixture of herbs (Sang Yu Jin)
It also has anti-bacterial properties and in Chinese terms it expels the wind / heat invading the lung from the exterior (ie treats a cough caused by a virus or bacteria but mild with no systemic affects including high fever)
Xing Ren stops the cough by directing the lung Qi downwards.
My experience of prescribing this formula has shown it to effective in treating upper respiratory tract symptoms but it must be obtained from a reputable Chinese pharmacy.
There have been claims the seeds can be used in anti-cancer treatment.
Apricot seeds contain amygdalin, Vitamin B17 a naturally-occurring substance found mainly in the kernels of apricots, peaches, and almonds. Amygdalin is promoted as a cancer treatment by alternative physicians but there has been insufficient evidence to use it for treatment and no more than 2 seeds/day should be consumed as more could be seriously toxic.

Posted by Dr Bayer

 

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