Tag Archives: Heart



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. 


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!


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.

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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But I feel well I don’t need any medication!


During my time as a GP I have heard this on countless occasions after taking someone’s blood pressure for the third time and telling them they will need to be treated.

Indeed when I first started on my career blood pressure medication was certainly not free of side effects and many caused severe postural hypotension resulting in profound dizziness,  lightheadedness, unsteadiness, or feeling of loss of balance to the point of fainting when simply getting out of a chair. Many patients who felt well when they presented after being given medication then developed blurred vision, confusion, general weakness and nausea. It was not surprising that many people refused to continue or simply avoided having their blood pressure taken! However, enough patients took medication for doctors to discover how lowering people’s blood pressure could prolong life and prevent heart and circulatory disease particularly strokes.
Pharmaceutical companies have gradually produced medication with fewer side effects and now we can offer treatment with minimal side effects.

One of the most popular blogs I have written was last years blog on hypertension…pertension-day/ ‎which focused on healthy heart – healthy blood pressure.

As a campaign to reduce the incidence of heart and circulatory disease last year the government proposed that everyone over the age of 40 years should have their blood pressure checked and this was one of every GP’s targets to make sure that was done and will remain an ongoing target. There was an increase of 9.5% of people having their blood pressure recorded in 2013/14. However, it is everyone’s responsibility to know your blood pressure!

Infact, World Hypertension Day 2014 the theme is KNOW YOUR BLOOD PRESSURE

High blood pressure is just one of the risk factors for developing heart and circulatory disease, along with high cholesterol, diabetes and other lifestyle factors. As many as 5 million people in the UK are walking around, undiagnosed, with high blood pressure.

The only way to know whether you have high blood pressure is to have it measured.
Your blood pressure can be measured at most pharmacies, in the work place or gym and many people have machines in their homes.(for home machines make sure they are approved by consulting a list of currently validated machines on British Hypertension Society
British hypertension
Blood pressure UK
has campaigned for people to take their blood pressure
You can have your blood pressure checked for free anywhere in the UK by simply logging in to the following website and putting in your postcode to find the nearest blood pressure station.

High blood pressure – or hypertension

This means that your blood pressure is constantly higher than the recommended level. High blood pressure is not usually something that you can feel or notice, but over time if it is not treated, your heart may become enlarged making your heart pump less effectively, which could lead to heart failure.

Having high blood pressure increases your chance of having a heart attack or stroke.

Are you too old to be treated?
The benefits of treatment of hypertension in older patients (ie over the age of 80years is evident, reducing BP to a level of 150/80 is associated with large reductions in stroke, mortality and heart failure risk. Different regimens with equal BP reductions have similar effects on outcomes, so should be individually tailored. Systolic blood pressure (elevated top reading) rather than Diastolic blood pressure (elevated bottom reading) reduction is significantly related to lower Cardiovascular risk in older people.

There isn’t always an explanation for the cause of high blood pressure, but these can play a part:

  • not doing enough physical activity
  • being overweight or obese
  • having too much salt in your diet
  • regularly drinking too much alcohol
  • having a family history of high blood pressure.

Even if you don’t have high blood pressure, making simple lifestyle changes may help prevent you having it in the future.

What can you do to reduce your blood pressure?
If your doctor or nurse says you have high blood pressure, he/she is likely to encourage you to make some lifestyle changes to help reduce it. This may include increasing your physical activity, losing weight, reducing the salt in your diet, cutting down on alcohol and eating a balanced, healthy diet.

Salt’s effects on your body
Salt works on your kidneys to make your body hold on to more water.

This extra stored water raises your blood pressure and puts strain on your kidneys, arteries, heart and brain.

 Reducing salt by 3g/day might prevent approx 10,000 deaths and 10,000 Cardiovascular events each year
 This would exceed the benefits of smoking cessation programmes, weight loss interventions and statins
 Reducing salt intake by as little as 1g/day may be more cost effective than BP lowering drugs

High sodium effervescent drugs should be avoided in patients with or at risk of hypertension or Cardiovascular events.
It is advised not to take soluble Over The Counter(OTC) medication such as painkillers, vitamin C etc. (NB this does NOT apply to 75mg dispersible aspirin which is fine. See what is the sodium content of medicines? )

The Consensus Action on Salt and Health (CASH) has looked at examples of the most popular foods eaten by several different age groups based on the National Diet and Nutrition Survey (NDNS), and has compiled ‘typical shopping baskets’, which have revealed some alarming results. For example, based on types of foods eaten by a student (18-22 year old), a shopping basket of higher salt products can contain up to 58g of salt, while that of a mother (30-39 year old woman) can contain up to 64g of salt – the equivalent of 128 bags of crisps. However, if they were to make some simple switches to lower salt options, the shopping basket of the student could be reduced to 22g of salt and that of the mothers’ could be reduced to 18g of salt, the equivalent of just 36 bags of crisps – cutting their salt intake by a staggering 62% and 72% per week respectively. This shows us that by making more informed choices we could all improve our long term health and reach the 6g a day maximum recommended intake for salt.

Heart and saltHow to reduce salt intake

(6g of salt a day is the maximum you should eat, and the less you eat the better.)
NB 6g of salt = 2400mg sodium

Sodium: reduce intake to
o 80% of salt is hidden in processed foods, and only 20% added
 Bread, breakfast cereals, table sauces tend to be high in salt
o To avoid hidden salt, start label looking and look for
 Low salt (1.5g per 100g food) avoid!
o Confusingly, some labels cite sodium rather than salt content
 1g sodium = 2.5g salt, so 0.6g per 100g food is high Potassium: potassium rich foods include:
 Fruit (not just bananas!), pulses, beans, vegetables (esp spinach), oily fish, chicken

10 practical tips

  • Eat out less
  • Remove the salt shaker from the dinner table
  • Add other flavours (herbs and spices) when you’re cooking
  • Remove the salt cellar from the dinner table
  • Eat less processed foods
  • Use fresh or frozen vegetables
  • Use shop-bought sauces and marinades sparingly
  • Limit processed and cured meats
  • Use lower salt cheeses
  • Pay attention to sweet foods
  • Use the FREE SaltSwitch App is a new feature of the popular health app, FoodSwitch, which was developed by CASH. The app allows users to scan the barcode of nearly 90,000 packaged foods sold across major UK supermarkets using their smartphone camera to receive immediate, easy to understand colour-coded nutritional information along with suggested similar, less salty products by 100g.

Salt reduction programme results released on 15/4/2014 showed has led to a fall in population blood pressure. From the fall in blood pressure that was due to salt reduction, there has been a saving of approximately 18,000 stroke and heart attack events a year, 9,000 of which would have been fatal

Another way of reducing salt is increasing potassium but if you are taking medication for blood pressure discuss this with your doctor.

Why potassium helps to lower blood pressure
potassium is a chemical which helps to lower blood pressure by balancing out the negative effects of salt. I heard potasquoted as”Potassium could be called the great detergent of arteries.

Your kidneys help to control your blood pressure by controlling the amount of fluid stored in your body. The more fluid, the higher your blood pressure.

Your kidneys do this by filtering your blood and sucking out any extra fluid, which is then stores in your bladder as urine. This process uses a delicate balance of sodium and potassium to pull the water across a wall of cells from the bloodstream into a collecting channel that leads to the bladder.

Eating salt raises the amount of sodium in your bloodstream and wrecks the delicate balance, reducing the ability of your kidneys to remove the water. By eating more fruit and vegetables, you will increase your potassium levels and help to restore the delicate balance. This will help your kidneys to work more efficiently – and help to lower your blood pressure to a healthy level.

However, it is possible to have too much of a good thing. To make sure that you don’t overdose on potassium, it is best to get your daily potassium from natural sources (fruit, vegetables and other foods) and avoid taking supplements.
To reap the benefit of more potassium in your life, try to eat at least five portions of fruit and vegetables every day. (A portion is about the same size as your closed fist). Not only will this help to lower your blood pressure, it will also help you to avoid certain cancers, bowel problems and even heart attacks or strokes.

Good sources of potassium include: potatoes, sweet potatoes, bananas, tomato sauce (without added salt or sugar), orange juice, tuna (fresh, frozen or tinned, but avoid tuna packed in brine), yoghurt and fat-free milk.

If you have kidney disease, or are taking certain blood pressure medications, a large increase in potassium could be harmful. In this case, avoid taking potassium supplements and check with your doctor before dramatically increasing your potassium intake.

If your blood pressure is very high or these lifestyle changes do not reduce it enough, your doctor is likely to prescribe you medication to control it and to reduce your risk of having a heart attack or stroke.

Especially if you are 40 years or older get your blood pressure checked and


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Reflections of heart stories – Ella

My next memorable story:-


One morning at the end of surgery I was asked to phone a mum about her 9 month baby Ella. I pride myself in knowing the young children in the practise but on this occasion I could not  recall having seen Ella. When I phoned, even after talking to the mum I still could not think who we were discussing even after asking mum directly. Mum’s main worry was that Ella was constipated and all she wanted was something to ease the problem. With a combination of not knowing the baby and the fact she was under 12months I was not happy to prescribe anything over the telephone so I asked the mum to bring her to the surgery.
Examination of baby
After about half an hour mum arrived carrying Ella. Mum was a short slim lady, hence I would not have expected to see a large baby but this baby was pale and small and certainly not at all wholesome. Infact I was instantly concerned. When a baby is not thriving it can be for absolutely any reason  and it was imperative that the infant was examined thoroughly. It was not long before I discovered the reason. Ella had a loud machinery heart murmur diagnostic of an atrial septal defect (hole in the heart) and was in heart failure with a very fast heart rate  and poor breath sounds. There was no time to waste but before doing anything I had to break the news to mum. Like many Mothers she took the news very well and was almost relieved to think she was not being an over anxious mum, but when she asked dad to come to the surgery he was devastated. Meanwhile, I had telephoned the paediatricians to arrange an urgent referral. Ella was seen promptly but it was evident this baby needed specialist care and she was eventually referred to Great Ormond Street after stabilising her heart failure. Ella went on to have open heart surgery and made an excellent recovery. The memory of this came back a couple of weeks ago when she ran upstairs ahead of mother for her routine immunisation full of chat about school and thrilled to let me see her scar and listen to her heart and share her story with the medical student.

Congenital heart disease is caused when something disrupts the normal development of the heart. As a baby develops during pregnancy, there are normally several openings in the wall dividing the upper chambers of the heart (atria). These usually close during pregnancy or shortly after birth. In this case it was a failure of a hole in the wall between the two upper chambers of the heart to close.
It’s thought most cases of congenital heart disease occur when something affects the heart’s development during about week five of pregnancy. This is when the heart is developing from a simple tube-like structure into a shape more like a fully developed heart.
While some things are known to increase the risk of congenital heart disease, no obvious cause is identified in most cases.
To learn more about congenital heart disease the following link is useful:-


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Reflections of heart stories – Mrs.Evans

My next memorable story:-
I had only been working in General Practise for a few weeks and was well aware that patients I saw were either new patients or those who could not get an appointment with their usual doctor and reluctantly  were willing to consult with the ‘new’ doctor.

As I was the doctor on call for home visits that day I remember being asked to go out on an emergency call to a patient with chest pain.
Doctors bag
I arrived at a block of flats and made my way to the second floor and after knocking the door a distant,weak, breathless voice requested that I  should  enter. There was Mrs. Evans sitting in a chair, breathless clutching her chest and a look of great dismay at seeing a strange doctor arrive ( patients at that time were used to seeing ‘their doctor’ call at any time of day or night and wanted an explanation as to why a strange doctor was present)  I immediately apologised and gave a feeble excuse as to why Dr Llewellyn was not available. It was immediately evident that she needed urgent hospital admission. After a brief explanation of my concern I asked to use her telephone (mobile phones did not exist) as I wanted to call an ambulance. I had read her notes prior to the visit and after arriving took a brief recent history of her current problem. I was aware she had a pacemaker fitted and she had had heart problems and that day had felt very weak, dizzy and tired. Before I had chance to fully examine her she suddenly arched her back gasping and at the same time exclaiming, “I want to change my will, I want to change my will,” and then slumped back in the chair lifeless. I gently pulled her to the floor and started cardiac massage and within the next minute or so the ambulance-men arrived with oxygen and ambu-bag.
She became vaguely conscious and she was carried by stretcher to the ambulance. Her pulse  remained very slow and  I assumed her pacemaker was failing and she needed to go to Cardiff which was about 20 miles away, as the local hospital would not be able to replace the pacemaker. In those days ambulances were minimally equipped and ambulance-men had very limited first aid training so they relied on the GP to advise the best course of action. Having recently worked  on a busy general medical ward I was well versed at stabilising patients before transfer to a specialist unit. Hence, I directed the ambulance to the local cottage hospital and  there I put up an intravenous infusion with isoprenaline to maintain the heart rate until the patient reached Cardiff. Giving the accompanying experienced nurse appropriate instructions the ambulance sped off in haste along narrow roads to its destination. In due course  Mrs.Evans was fitted with a new pacemaker and discharged after 10 days.
The day after her discharge I was sitting in my consulting room in earshot of reception when I heard a bold voice exclaim, “I would like to see a doctor but please don’t let me see that dreadful doctor that thumped me on the chest and took me to the wrong hospital. I am lucky to be alive!”

Mrs.Evans had had a pacemaker fitted to treat third degree heart block which is a problem that occurs with the heart’s electrical system. This system controls the rate and rhythm of heartbeats. (“Rate” refers to the number of times your heart beats per minute. “Rhythm” refers to the pattern of regular or irregular pulses produced as the heart beats.)
Heart blockWith each heartbeat, an electrical signal spreads across the heart from the upper to the lower chambers. As it travels, the signal causes the heart to contract and pump blood.
Heart block occurs if the electrical signal is slowed or disrupted as it moves through the heart.

Third-degree heart block limits the heart’s ability to pump blood to the rest of the body. This type of heart block may cause fatigue (tiredness), dizziness, and fainting. Third-degree heart block requires prompt treatment because it can be fatal.

I would like to think that I had saved her life but the patient never recognised that. But as a wise old GP told me, “Never expect to be thanked when you think you deserve it but accept the thanks with grace when you think you don’t deserve it!”


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Chest pain -MI
When Peter  got in the car at 12.30am and drove from the house his wife looked out of the window she thought “he must be going to his mother’s and went back to bed. How wrong she was because Peter aged 65 yrs had woken with pain in the chest and recognised that this was something different and he knew he had to seek medical advice immediately. He drove himself to the nearest hospital and soon was diagnosed with a heart attack and after emergency treatment was transferred to a neighbouring hospital to have a stent inserted.
Peter is retired but a Type A personality ‘on the go’ involved in as many organisations he can fit into his life and certainly not someone to wait for things to happen!
He now puts as much energy into his Cardiac Rehabilitation as he puts into chairing a meeting.

Similarly, when Lucy 39 yrs a research biologist, pregnant with her third child telephoned me one evening and described her heavy central chest pain and how she felt very anxious, sweaty and was short of breath my reaction was to tell her to go straight to A&E and she was also diagnosed with a heart attack and subsequently went on to have a stent inserted. A surprising diagnosis as she was slim, a non smoker and young but nevertheless the presenting symptoms raised the alarm bells.

Likewise, when Dai 56 yrs came to the surgery with the story of increasing heaviness in the chest with breathlessness a week ago after rolling a barrel of beer up to ‘the Club’ as the Brewery lorry had broken down on the hill. He was revived with a glass of brandy but an ECG later demonstrated that he had suffered a heart attack.

In the same way, Bill who was a 60 yrs old bo’sun on a sailing ship and described severe indigestion when at sea, worse on exercise and again on investigation shown to have had a heart attack and subsequently had a quadruple bypass and in due course went back to sea.
In all these cases the patient had that feeling that their pain was different and overwhelmed with anxiety and fear that it may be cardiac.

Even if the pain is not assumed to be cardiac pain initially if other risk factors are taken into account such as in the case of Mrs.Patel, a 65yr old diabetic who had developed some vague chest pain on exercise and was worried, on further investigation was found to have had a ‘silent’ heart attack and subsequently followed up by a triple bypass.

As a medical student we are also told of the unpredictability of the heart and my first tutorial with a cardiologist was that of his examining a patient, reassuring them that there heart was in good order and the patient dying at the bus stop with a heart attack. Most of us are aware of this by hearing of a friend, relative or celebrity dying in the same way, but for the most part there is adequate warning.

All these stories remind us that coronary artery disease is out there and can strike at anytime in many different forms and often the chest pain is not the main feature and can be in different parts of the upper body.
Heart attack

It is for this reasons that doctors have joined together to formulate a scoring system of chest which is based on signs and symptoms which are relatively easy to recognise and can dictate how urgently action should be taken. In all the examples of the above patients presenting with chest pain each person would have scored at least 3 points.

 Components of the Marburg Heart Score
Score component Assigned points

  • Age/gender (female ≥ 65, male ≥ 55). 1
  • Known clinical vascular disease 1
  • Patient assumes cardiac origin of pain 1
  • Pain worse with exercise. 1
  • Pain not reproducible by palpation. 1

1 point is assigned for each score variable. 3 different risk categories are derived:
low risk = 0–2 points; intermediate risk = 3 points; high risk 4–5 points.

If you or someone with you scores >3 points and you strongly suspect they are having a heart attack it is important to act immediately:-

    • Dial 999 and ask for an ambulance if you suspect that you or someone you know is having a heart attack.
    • If the casualty is not allergic to aspirin and it’s easily available, give them a tablet (ideally 300mg) to slowly chew and then swallow while waiting for the ambulance to arrive

The aspirin will help to thin the blood and restore blood supply to the heart.In my early career this life threatening pain could only be treated with very strong painkillers such as diamorphine commonly known as heroin (an important component of my doctors bag at the beginning of my career) and bed-rest and watchful waiting preferably at home.Now for treating Heart attacks there are two main treatment options for people with the most serious form of heart attack; an ST segment elevation myocardial infarction (STEMI):

  • a combination of medication to dissolve the blood clot and restore the flow of blood to the heart (this is known as thrombolysis)
  • surgery to widen the coronary artery, which is usually done using a technique called coronary angioplasty.

To read more about heart attack:-

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Posted by on February 15, 2014 in Training and Advice


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Tomorrow  is St Valentine’s Day a time to show affection for someone often in a secretive way by card or a secret message and portrayed by the symbol of the heart or by passing time with someone special.
The story of Saint Valentine of Rome states that he was imprisoned for performing weddings for soldiers who were forbidden to marry and for ministering to Christians, who were persecuted under the Roman Empire. According to legend, during his imprisonment, he healed the daughter of his jailer, Asterius and to show his silent love for her, before his execution he wrote her a letter signed “Your Valentine” as a farewell.

During my studies of Traditional Chinese medicine based on teachings passed down over thousands of years the symptoms of heart imbalance include palpitations, shortness of breath, sweating easily, mental restlessness, insomnia, forgetfulness, chest pain, tongue pain, and burning urine. Hence, in order to prevent heart disease it is important to look after your emotional health, mental function, memory, and spirituality (in the sense of being at ease with oneself) as well as maintaining a good lifestyle.
The role of the heart (xin), known in traditional Chinese physiology as the ruler of the other organs, has exceptional importance. Its function in traditional Chinese medicine parallels its Western anatomic function of pumping blood throughout the body to maintain life.

There are many different terms used in Chinese to signify the psyche or mind, but in medical literature words that include Spirit (or Shen) is commonly used. In a similar way the prefix ‘psycho’ is used in western medical terms. It refers to our physiological vitality as well as consciousness, and the function of thinking and feeling. This ‘spirit of mind’ is said to reside in the Heart and its outward manifestation are our emotions. Hence, the concept of Spirit or Shen in Chinese Medicine is not ‘spiritual’ in any conventional religious sense. Psychological diseases are seen as pathological abnormalities of the Shen, which reside in the Heart. The channels of energy for different organs are known as Meridians.
Heart meridianThe Heart Meridian starts from the heart, and divides into three branches. One of these branches emerges under the arm and runs along the inner side of the forearm, elbow and upper arm. It then crosses the inner side of the wrist and palm and ends at the inside tip of the little finger.  Along the Meridian at the wrist is an acupuncture point known the Shen Men and this a well known point to use for calming the mind. There is another Shen Men point on the upper earlobe also used to calm the mind. I noticed that both Princess Diana and Cherie Blair had Chinese herbs applied in these points when they were going through personal stresses. I frequently use this acupuncture point for anyone suffering stress or anxiety and to help people attempting to quit smoking with good effect.
Heart pinyinThe Chinese view of the Heart is more than just a pump to move blood. The Chinese pinyin character of the Heart not only reflects the physical shape of the Heart, but also that it is a bowl or receptacle that communicates and governs the body, bringing animation to life and a ‘joie de vivre’. The Heart is the reason why we have to go and see wonderful scenery, be well rested, have good food and drink, in order that life is more refined.
However, the key to this radiating Shen is that it comes from a space or void that is the receptacle of the Heart. To achieve this space the Heart must be calm, tranquil and peaceful so the communication of Shen is not blocked or obstructed.

The flow of energy or Qi, as it is described in Chinese Medicine, ensures that the joy of living is felt. If we pursue our Western lifestyle of being constantly ‘on the go’, striving for more possessions, more knowledge, constantly stimulating our senses, we are filling up our Heart receptacle, which is then blocking the free communication, and movement of our Shen and making us vulnerable to disease and psychological disorders.

The Heart oversees the functioning of the body so that happiness or unhappiness, illness or health, longevity or premature death all depend on the Heart.

That is an Eastern perception but when I reviewed the empirical research of Friedman & Rosenman (1959) (both cardiologists) there seemed to be some remarkable similarities!
They found that people with type A personality run a higher risk of heart disease and high blood pressure than type Bs.
Their theory was based on an observation of the patients with heart conditions in their waiting room.

Unlike most patients, who wait patiently, some people seemed unable to sit in their seats for long and wore out the chairs. They tended to sit on the edge of the seat and leaped up frequently.

What was unusual was that the chairs were worn down on the front edges of the seats and armrests instead of on the back areas, which would have been more typical. They were as tense as racehorses at the gate. The two doctors labeled this behavior type A personality.
They conducted a longitudinal study to test their hypothesis, in which 3200 middle aged managers and executives (all men) were given questionnaires over a eight and a half year duration.

Examples of questions asked by Friedman & Rosenman:

• Do you feel guilty if you use spare time to relax?

• Do you need to win in order to derive enjoyment from games and sports?

• Do you generally move, walk and eat rapidly?

• Do you often try to do more than one thing at a time?
From their responses, and from their manner, each participant was put into one of three groups:

Type A behavior: competitive, ambitious, impatient, aggressive, fast talking.

Type B behavior: relaxed, non-competitive.

Type C behavior: ‘nice,’ hard working but become apathetic when faced with stress
Type A personality
Eight years later 257 of the participants had developed coronary heart disease. By the end of the study 70% of the men who had developed coronary heart disease (CHD) were type A personalities.

The behavior type A personality types makes them more prone to stress-related illnesses such as CHD, raised blood pressure etc.

Despite this study having been carried out in the 1950’s and with limitations it still seems to be upheld.
It is not surprising there is such an increase in meditation, mindfulness and yoga amongst those experiencing stress. Research has shown that by participating in regular yoga and /or meditation there is a significant decrease in blood pressure.

Look after your heart and the hearts of those around you by having a calm, peaceful and happy day.

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Posted by on February 13, 2014 in Training and Advice


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The heart is a muscular pump which pumps the blood around the body and lungs and the rate and regularity is one of the important indicators of how healthy you are. You can check your hear rate by feeling your pulse and counting how many times your heart beats in a minute and the regularity of the rhythm.
The following video shows how this is done:-

Finding your pulse
The easiest places to find your pulse are:

  • Your wrist
    Put one of your hands out so you’re looking at your palm.
    Use the first finger (your index finger) and middle finger of your other hand and place the pads of these fingers on the inside of your wrist, at the base of your thumb.
    Press lightly and feel the pulse. If you can’t feel anything press slightly harder or move your fingers around until you feel your pulse.
  • Your neck
    Press your index and middle finger gently against the side of your neck, next to your windpipe.

Press lightly to feel your pulse. You may need to move your fingers around if you can’t find your pulse

How to check your pulse
Once you’ve found your pulse, continue to feel it for about 20-30 seconds. Feel your pulse and check if it’s regular or irregular. You can work out your heart rate in beats per minute (bpm) by:
counting the number of beats in your pulse after 60 seconds, or
counting the beats for 30 seconds and multiplying by two.
If your pulse feels irregular, you should check for a full 60 seconds.

What should you check?
PulseYour heart rate:
Most adults have a resting heart rate between 60 and 100 bpm
Your heart rate may be lower if you do lots of exercise and are very fit. Some athletes have heart rates ranging from 40 to 60 bpm.

Your heart rhythm:
Occasional irregularities such as missed beats are very common and usually nothing to worry about, but it is still best to check this with your doctor.
An irregular pulse could also be a sign of an arrhythmia (an abnormal heart rhythm), such as Atrial Fibrillation (AF). This is more likely if you are 65 or older.

If your pulse is irregular or if you’re concerned in any way about your pulse you should make an appointment to see your GP.

Sound icon
What does a regular heart rhythm sound like?
Listen to the example heart rhythms below to help you spot an irregular heart beat:click on text below:-
Normal heart rate

Irregular heart beat


Posted by on February 7, 2014 in Training and Advice


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Recently we held a Cardiopulmonary Resuscitation training afternoon at the surgery. This is compulsory for all surgery staff to attend on a regular basis. On this occasion we also advertised it in the surgery as an open invitation to any patients to attend. We felt that it was good to members of the public (patients) to be given the opportunity to attend as these will be the people we may be working with if an event should happen.
However, the interest was less than we expected but one patient wrote the following:-

I wanted to thank you for giving me the opportunity to attend your first aid training course, it was a privilege to be able to attend. Although I had attended a first aid course a few years ago, I found that the quality and content of this one, was superior. The course covered a range of topics including CPR, care of the unconscious patient, choking, anaphylaxis and heart attacks, with plenty of opportunities to practice and get involved. I found the use of a dummy to practice CPR particularly useful as was the discussion of the realistic scenarios one might face and the best course of action to take. This is something, that was certainly lacking in the course I attended previously. The interaction with the other members of the audience was also very useful. Since a number of staff members, doctors and nurses from the avenue and other surgeries attended, I had the opportunity to hear of their opinions and methods when it comes to first aid. Overall I found the course very insightful, helpful and satisfying. I would strongly recommend it to everyone be it healthcare professionals or patients. The skills you learn can literally make the difference between life and death.
I think that it’s wonderful that the surgery is allowing patients to attend these courses. I think this is a wonderful opportunity for everyone and the price is extremely competitive to the say least. I will most certainly be looking out for any other courses like this that might be available.

Thank you to this patient for sending me their comments. When I have attended this course before expectant parents seem to be the most interested especially as these training sessions cover accidents and acute problems in children.
If you would be interested in attending a CPR training session please contact
Sangeeta Kathuria ( practise manager)
It would be helpful if you could suggest what time and day would be most convenient- the sessions usually last 3 hours.


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imageOne early morning in February 3 years ago the phone rang and it was the wife of our Best man at our wedding. She was letting us know that she had woken in the night to a strange sound and following attempts at resuscitation by herself and the ambulance crew he had died suddenly. He was a handsome,highly intelligent,charming doctor/dentist/medical director of a pharmoceutical company who had been negotiating with NICE to accept Aricept as a treatment for Dementia.He had also been training for his 7th full marathon which he had taken part in and raised thousands of pounds for leukaemia following the death of his son’s best friend at the age of five.It was unbelievable and a total shock to all such a loss of someone so special. The night before he had been listening to opera with friends singing along with gusto and passion as he was also a musician, a pianist with talent.The funeral was an amazing musical tribute and those who spoke talked about his life with humour and sadness. Afterwards, his friends and colleagues commented that he had seemed the healthiest of everybody and as we chatted agreed it would have been a great party but it lacked one person. He was an ordinary East End lad made good commonly known as ‘Paul boy’! His only fault was that he was a Tottenham supporter which meant many an Saturday afternoon or a Boxing Day was spent in raucous banter whilst ‘the lads’ watched their rivals play – nothing more exciting than a London Derby!
This was an adult sudden cardiac death (SCD)as there was no evidence of disease on examination of his body after death and it was presumed death was due to sudden cardiac arrest,when the heart abruptly and without warning stops pumping.
Ironically, the week after he died the drug was passed!

I was reminded of this when a young attractive 25year old lady attended surgery recently devastated as she had lost her young partner in the same way. This young man had died suddenly without warning and his young partner and family had been left devastated.
She then told me that his mother had become very keen to support the charity CRY was founded in 1995 to raise awareness of conditions that can lead to young sudden cardiac death (YSCD); sudden death syndrome (SDS); SADS. She was also taking part in the CRY Heart of London Bridges Walk 2013 on 7th July. There main reason for supporting this charity is that it funds screening of anyone who could considered at risk as shown on the link. What a brave lady, the love she had for this man was tangible and this family had also lost someone very special whose life had just begun. The family are keen to support this charity as it raises money to screen anyone at risk and support research projects aswell as support bereft families.


CRY holds ECG screening clinics for those aged 14 to 35 at a number of established locations around the UK including Belfast, Cardiff, Colchester and London.The CRY mobile screening unit facilitates various screening events at other locations in the UK – often organised by CRY supporters. Details of where these clinics are and how to book are on the website.

What happens when sudden cardiac death(SCD) occurs
When SCD occurs, no blood can be pumped to the rest of the body. It is responsible for half of all heart disease deaths.
Sudden cardiac death occurs when the heart’s electrical system malfunctions. It is not a heart attack (also known as a myocardial infarcation). A heart attack is when a blockage in a blood vessel interrupts the flow of oxygen-rich blood to the heart, causing heart muscle to die. So if the heart can be compared to a house, SCD occurs when there is an electrical problem and a heart attack when there is a plumbing problem.
The most common cause of cardiac arrest is a heart rhythm disorder or arrhythmia called ventricular fibrillation (VF). The heart has a built-in electrical system. In a healthy heart, the sinoatrial node, the heart’s natural “pacemaker” triggers the heartbeat, then electrical impulses run along pathways in the heart, causing it to contract in a regular,rhythmic way. When a contraction happens, blood is pumped.
But in ventricular fibrillation, the electrical signals that control the pumping of the heart suddenly become rapid and chaotic. As a result, the lower chambers of the heart, the ventricles, quiver or fibrillate instead of contracting, and they can no longer pump blood from the heart to the rest of the body. If blood cannot flow to the brain, the brain becomes starved of oxygen, and the person loses consciousness in seconds. Unless an emergency shock is delivered to the heart to restore its regular rhythm using a machine called a defibrillator, death occurs within minutes. It’s estimated that more than 70 percent of ventricular fibrillation victims die before reaching the hospital.
When CPR and an AED (automated external defibrillator) are used together, the chance of survival following a cardiac arrest goes up to 50%, a ten-fold increase over CPR alone.


This is why you may see Automated External Defibrillator (AED) machines are being hung on walls in supermarkets or other public places. I have frequently seen them in French supermarkets and hyper stores.
It is amazing that the nearest limited access AED is in Twickenham in a fitness club and the nearest 24 hr public access AED machine is outside an accountants office. To see the location of AED machines click on the link below:-

Who should be screened?
It is recommended that screening is requested via your GP if there have been any young sudden deaths in the family. Or if there are symptoms of:

Chest Pain (exercise related)
Severe Breathlessness
Prolonged Dizziness

This checklist has been designed to help you determine whether you have a heart rhythm problem. If you have more than one of the symptoms below, see your GP.

    • Have you fainted or passed out during exercise, while emotional or when startled?
    • Have you ever fainted or passed out after exercise?
    • Have you ever had extreme shortness of breath during exercise?
    • Have you ever had extreme fatigue associated with exercise (much more so than others of your age and level of fitness)?
    • Have you ever had discomfort, pain or pressure in your chest during exercise?
    • Has a doctor ever ordered a test for your heart?
    • Have you ever been diagnosed with an unexplained seizure or fit?
    • Have you been diagnosed with epilepsy that fails to respond to medication?
    • Have you ever had exercise-induced asthma that medication didn’t control well?
    • Are there any family members who had a sudden, unexpected, unexplained death before age 50 (including cot death, car accident or drowning)?
    • Are there any family members who died suddenly of heart problems before they were 50?
    • Are there any family members who have had unexplained fainting or seizures?
      Do you have any relatives with the following conditions:
      Hypertrophic cardiomyopathy: thickening of the heart muscles.
      Long QT syndrome: a condition that results in a very fast, abnormal heart rhythm, which can cause fainting.

What is happening by way of research?

VeniceArrhythmias, a biannual meeting started in 1989 and, year after year, has become one of the most important international congresses in the field of arrhythmology with almost 3000 attendees and with more than 400 invited speakers.
As you read many cardiologists and electrophysiologists are preparing their abstracts to be presented at the Venicearrythmia conference next held in October 2013
VeniceArrhythmias, a biannual meeting started in 1989 and, year after year, has become one of the most important international congresses in the field of arrhythmology with almost 3000 attendees and with more than 400 invited speakers.image
At other venues and during the year there will be similar events. It is through these events that there have been major breakthroughs in screening and prevention of sudden death.Research in the channelopathies and cardiomyopathies is progressing rapidly and in the future it is expected that the majority of the genes involved will be discovered.
In the future, it may also be possible to diagnose all carriers easily – even in those people who have a normal ECG reading. It may also be possible to choose the best treatment based on the type of mutations involved, and the treatment may even be designed based on this knowledge.
In the meantime, better understanding of these conditions and improvements in methods for diagnosis should still result in better management. It is crucial that, when a heart disease such as a channelopathy or cardiomyopathy is diagnosed, all immediate blood relatives should be evaluated by a specialist cardiologist to find out if they have an inherited heart disease.

It needs to be considered in sudden death in especially younger adults where the post Mortem fails to provide a cause of death, it is important to send the heart to a pathologist who specialises in this field of medicine and this may be a relative, friend or attending doctor who makes that request.
However, to help this research and appreciate the true incidence there must be a change in the Law.
In the UK, unexplained sudden death is frequently recorded as due to death from natural causes. Until the law is changed and coroners have to refer hearts on to specialists we will not know the true figures. CRY’s fast track coroner / pathology service enables the cause of death in a sudden death case to be established more quickly and accurately than might otherwise happen if left to a local coroner lacking expertise in cardiac pathology.

Tests That Predict Risk

There are a number of tests that can be performed to determine if some- one is in a group that is at high risk for cardiac arrest. These include:
Echocardiogram – a painless test in which ultrasound waves are used to create a moving picture of the heart. The test can measure the strength of the heart’s pumping function (ejection fraction) and identify other problems that may increase a person’s risk for SCD.

Electrocardiogram – A painless test in which electrodes are attached to the patient’s chest to record the electrical activity of the heart in order to identify abnormal heart rhythms. Certain arrhythmias could point to an increased risk of SCD.imageHolter monitor – A cell phone-size recorder that patients attach to their chest for one to two days, recording a longer sampling of their heart rhythm. After the recorder is removed, the tape is analyzed for signs of arrhythmia.
Event recorder – a pager-sized de- vice that also records the electrical activity of the heart over a longer period of time. Unlike a holter moni- tor, it does not operate continuously. Instead, patients activate the de- vice whenever they feel their heart beating too quickly or chaotically.
Electrophysiology study (EPS) – This test is performed in a hospital. A local anesthetic is used to numb areas in the groin or neck and thin flexible wires called catheters are
advanced through veins into the heart under x-ray to record its electrical signals. During the study, the electrophysiologist studies the speed and flow of electrical sig- nals through the heart and paces the heart to see if arrhythmias can be induced. The physician can also determine if a patient has had a prior heart attack or evidence of prior heart damage without know- ing it. All of this information can help determine whether the patient is in a group at higher risk for SCD.There is another interesting device
The AliveCor Heart Monitor app is designed for medical professionals, patients and health conscious individuals to record, display, store and transfer accurate single-channel electrocardiogram (ECG) rhythms. These recordings could be saved on the mobile phone or shared with others (such as your doctor) via email. The app is CE-mark approved.
imageThe Heart Monitor snaps onto your iPhone 4 or 4S like a case and wirelessly communicates with the app on your phone. No pairing between your iPhone and the Heart Monitor is required. The free AliveECG app will be available for download from the Apple App Store when you receive your Heart Monitor. Once in the app, create a free account and you’re ready to begin recording ECGs. It’s that easy to get started. provides you with anytime, anywhere, fully secure, online access to all of your ECGs. Once you have the Heart Monitor and the AliveECG app you can create an account that gives you access to your ECG data.


There are a number of things people can do to decrease the likelihood of becoming a victim of sudden cardiac death. To begin with, living a “heart healthy” life can help reduce the chances of dying of cardiac arrest or other heart conditions. This includes ex- ercising regularly, eating healthful foods, maintaining a reasonable weight, and avoiding smoking.
Treating and monitoring diseases and conditions that can contribute to heart problems, including high blood pressure, high cholesterol, and diabetes, is also important.
Finally, for some patients, preventing sudden cardiac death means controlling or stopping the abnormal heart rhythms that may trigger ventricular fibrillation.

Treating arrhythmias is done in three ways:

Medications – Medications, includ- ing ACE inhibitors, beta blockers, calcium channel blockers, and antiarrhythmics, can control abnormal heart rhythms or treat other conditions that may contribute to heart disease or SCD. But taking medication alone has not proved to be very effective in reducing cardiac arrest. These medications are sometimes taken by patients who also have an ICD, in order to reduce how often it fires.

Implantable cardioverter defibrillators (ICDs) – These devices have been very successful in preventing sudden cardiac death in high-risk patients. Like a pacemaker, ICDs are implanted under the skin. Wires called leads run from the ICD to the heart, and the device monitors the heart to detect any abnormal rhythms. If a dangerous arrhythmia is detected, the ICD delivers an electrical shock to re- store the heart’s normal rhythm and prevent sudden cardiac death. The ICD can also act like a pacemaker if the heart is beating too slowly.

Catheter Ablation – In this technique, radiofrequency energy (heat), cryotherapy (freezing), or other energy forms are used to destroy small areas of heart muscle that cause the dangerous, rapid heart rhythms. The energy is delivered through catheters that are positioned through the veins or arteries to the heart. Catheter ablation is sometimes done in patients who have an ICD to decrease the frequency arrhythmias the number of ICD shocks.


If anyone has any particular concerns Dr Livingston has a special interest in this condition and is very knowledgable and would be pleased to discuss any related problem.

Posted by Dr Bayer


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Cardiac arrest App

imageRecommended by the British Heart Foundation

You may have seen this on TV but do you own it?
Hearing the Bee Gees takes me back to my happy youth…. And Vinnie’s ‘my boy’

Stayin’ Alive with Hands-only CPR
If someone has collapsed and isn’t breathing normally, pushing hard and fast to the beat of Stayin’ Alive by the Bee Gees can save a life.

A useful website to learn more about Cardiovascular disease which is an umbrella term for all diseases of the heart and circulation, including heart disease, stroke, heart failure and congenital heart disease.


British Heart Foundation – Hands-only CPR.

Collectively, heart and circulatory diseases cause more than a quarter of all deaths in the UK, accounting for more than 159,000 deaths each year. The cost of premature death, lost productivity, hospital treatment and prescriptions is estimated at £19 billion.

The free app explains how to carry out Hands-only cardiopulmonary resuscitation (CPR) on someone in cardiac arrest using hard and fast chest compressions. The app also allows you to practice by making use of accelerometer hardware built into most smartphones. It means your mobile can measure the rate and depth of practice compressions, telling you if they need to do the compressions faster or slower; or whether they should push harder or softer.



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