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FILL IN THIS FORM, TEAR, FOLD, MOISTEN AND SEAL Inside the magazine of the British Heart Foundation Spring 2017

YOUR BHF 4 Your letters 6 N e w s Sudden change A stroke can seem like the end BHF breakthrough in Jason explains how he learned of life as you know it. heartbeat research to adapt after a cardiac arrest It’s a feeling familiar to many 8 Spotlight on... Turn to page 41 people who experience a sudden air pollution health issue, whether it’s a cardiac Why this is an invisible arrest, heart attack or something problem, and how you else. But life can go on. Sometimes it can reduce your risk 10 Behind the headlines is different. Sometimes it is possible Is working out at the to make positive changes. weekend enough? Jason Gutridge felt like his life 49 Dictionary was over when he suffered from a Medical terms sudden cardiac arrest. He explains explained how he learned to adjust (page 41). 50 Information In our cover story (page 11), three and support inspiring survivors, Paul, Mark and A guide to our Margaret, explain how they’ve free resources discovered that there is a life after a stroke and have even embraced MY STORY new opportunities. We’re working to 11 Life after stroke Three stroke survivors stop people suffering from strokes, share their inspiring too. That’s why Professor Joanna recovery stories Wardlaw is researching a type called 22 Riding high lacunar stroke (page 35). It leaves How pursuing new holes in the brain that can lead to interests helped problems processing information Mike through his MEDICAL NUTRITION and even dementia. She’s trying to heart problems 15 Ask the experts 26 Rise and shine find new treatments. Are branded Start your day right All our research aims to find medicines better? Plus with one of these solutions for real problems, so we migraine and stroke must-try breakfasts can stop the devastation of heart 16 Testing times: echo and circulatory disease. That’s what How echocardiograms can help diagnose drives Professor Paolo Madeddu, too heart problems (page 32). In a fascinating interview, 18 Vital statistics: he tells us how the pain that comes RESEARCH weight and waist with a heart attack could actually 32 No pain, no gain? What these help the body to heal itself. How pain could help measurements can 28 Plant power when it comes to tell you about your How to get protein heart attacks heart risk without meat, and the 35 Watch this space 19 Focus on: endocarditis benefits it can bring How a little-known We look at this rare 31 Ask the expert stroke can leave heart infection and ‘Clean eating’ and Sarah Brealey, Editor Cover photography: Greg Funnell. Photography:Iwan Gareth Jones Funnell. photography: Greg Cover holes in the brain speak to those affected artificial sweeteners

2 Heart Matters Our expert team Recipe writer BHF Associate Senior Cardiac Nurse Moyra Fraser Medical Director Emily Reeve is our resident food Dr Mike Knapton has worked in writer. She’s a former has 30 years of general and Telegraph food experience as a cardiology nursing columnist and GP and is a director with a background in author of numerous at Addenbrooke’s cardiac rehab. cookery books. Hospital, Cambridge.

Consultant Senior Cardiac Nurse Senior Dietitian Cardiologist Maureen Talbot Victoria Taylor Dr Rajan Sharma has worked in the NHS began her career in Our guest expert and private sector in the NHS and public is Head of Clinical general and cardiac health campaigns. Services at St nursing for more than She advises on George’s Hospital 25 years. She leads the nutrition and acts as in London. BHF Clinical Team. our spokesperson.

Online exclusives bhf.org.uk/heartmattersmag ≠ Watch: How are we changing lives through research? We reveal the ‘bench to bedside’ process

≠ Look inside the body in this animation and discover what happens when you exercise ≠ Meet the stars of our cover ≠ Watch what happens when story, as they discuss the Plus Recipes: ACTIVITY you breathe in polluted air and reality of life after a stroke healthy brunch 44 Six super find out how to protect yourself reasons to bowl ≠ Quiz: High-protein food is WELLBEING Our guide to getting ≠ Play our simple swaps game, very trendy, but how much do 38 Choosing wisely started with bowls to give the food you love a you actually know about this How do you make 46 Fit for surgery? Mediterranean twist fashionable food group? decisions about your Waiting for an treatment quickly? operation? Learn how 41 The psychology getting active can help of recovery Heart Matters is published by Wardour on behalf of Getting back to the British Heart Foundation, Greater London House, 180 Hampstead Road, London NW1 7AW. normal after a sudden The British Heart Foundation is a registered charity in England and change in your health (225971) and in (SC039426). ISSN 1745-9753 Views expressed in this magazine are not necessarily those of the British Heart Foundation or Wardour. The BHF does not endorse For Wardour third-party products and services featured in Heart Matters. Information Managing Editor: Rachael Healy correct at time of going to press. © BHF 2017. Heart Matters is printed Art Director: Colin Wilson on paper from sustainable forests. G204/0317 Designer: Louise Hewlett For BHF Creative Director: Ben Barrett Editor: Sarah Brealey Production Director: John Faulkner Features Editor: Lucy Trevallion Production Manager: Jack Morgan Production Editor: Annette Ward Account Director: Georgina Beach Content Officer: Sherry-Lee Jackson Managing Director: Claire Oldfield Print: Eclipse Colour Print Ltd Chief Executive: Martin MacConnol bhf.org.uk 3 READER’S TIP I always have a bag of frozen mixed berries in the freezer. Add some to the YOUR LETTERS fresh fruit of your choice, to We love to read your emails, letters and tips, so keep writing: make an extra healthy and [email protected] or Heart Matters, British Heart Foundation, luxurious crumble, especially if the topping GreaterFacebook “f” LogoLondonCMYK / .eps Facebook “f” Logo CMYK / .eHouse,ps 180 Hampstead Road, London NW1 7AW includes chopped nuts, oats FIND US facebook.com/BHF @TheBHF instagram.com/the_bhf and seeds. Margaret Wragg, Altrincham, Cheshire

cooked as you describe would STAR be consistent with a heart- LETTER healthy diet, and we could also have said that eggs poached Cycling around the world Obviously, for many 18,000 miles. A couple of or fried in a little unsaturated My husband has always reasons, it was not practical months and he hopes to oil on wholegrain toast are enjoyed cycling. Even as a to do the actual trip, but have completed his ‘round healthier than a fry-up. teenager, it was a favourite in miles he could! Only a the world trip’. I too had way of relaxing at weekends, couple of months after his a heart operation, a valve Healthy pies touring around the lovely operation, he was back on replacement and single I was interested in your article scenery of Scotland. his bike, doing what he could bypass, three years before ‘Have your pie & eat it’ (Winter Five years ago, he had manage safely. Five years my husband, and have a 2016/17). I now make many a triple heart bypassD at later, he has been out almost pacemaker. I accompany pies and pasties using ordinary Papworth Hospital. As he every day, building up the him sometimes on trips bread dough instead of pastry. recovered, he decided he distances, usually from home around Norfolk, but certainly I make it from scratch, but you would get his fitness back by and occasionally on holiday can’t match his fitness – could use packet bread mix keeping his cycling going, when we took our bikes or motivation! (choose one which is lower in but decided he needed a with us. I am immensely proud of salt) and use a tablespoon of challenge. He had read a We have been married his achievements, and would olive oil in the dough to help book by a young guy who almost 52 years; my husband say to anyone else facing it stretch. Let it rise once, then had cycled around the world, is 75 now. In the five years heart operations: roll out thinly over your dish. It and thought: “Now there’s since his operation, he “Nothing’s impossible!” doesn’t need an extra rise. You a challenge!” has clocked up almost Stella Carslaw, Norwich can glaze as usual. I find that the amount of dough for one bread roll can Egg issues A quarter-teaspoon of avocado Our Senior Dietitian be used to make a decent-sized I’m fed up with the way the oil in a small pan is perfectly Victoria Taylor replies: pasty, which I fill with lots of BHF constantly censures fried sufficient to fry an egg in, Thank you for your letter. veg and beans. food as the devil’s work, while especially if you put a lid on When we used the term ‘fry-up’ Mary Bendall, Worcestershire promoting other ways of the pan to allow the steam to we were referring not only cooking as super virtuous. help cook it. It still tastes like to fried eggs, but describing Take page nine in the Winter a proper fried egg, though! To a traditional fried breakfast Share your story issue of the magazine, for write off fried eggs as if they are including, for example, If you’d like to share your example. “The BHF says: Eggs somehow deadly dangerous is sausages, bacon and black story with Heart Matters, are nutritious... Poached eggs a bit silly, in my view. pudding. Collectively this email [email protected] on wholegrain toast is much Michael Mitchell, Spalding, makes a breakfast that’s high or write to Sarah Brealey, healthier than a fry-up.” Lincolnshire in calories, salt and Heart Matters, British Heart A ‘fry-up’ conjures up a vision saturated fat. Foundation, Greater London of the typical greasy spoon on It’s true House, 180 Hampstead the A20, doesn’t it? But eggs that Road, London NW1 7AW. can be fried with very little fat. eggs

4 Heart Matters Have your say on Heart Matters Tell us what you enjoyed about this issue of Heart Matters so we can meet your needs better. Go to bhf.org.uk/heartsurvey to take our short survey. You can take it even if you did our Winter survey. If you don’t have internet access, post your comments to Editor Sarah Brealey at the address on the left.

The evolving NHS subsequent treatment. Our Statins and grapefruit Heart Matters Medical Editor Readers may be interested target time between the The Winter edition of Heart Maureen Talbot replies: to hear about changes in the logging of the ambulance call Matters has several references Thank you for your letter. care of heart patients that I and the patient being in the to statins. [Page 29 suggests You are correct that grapefruit find impressive. hospital with everything ready “balanced meals” and includes and grapefruit juice interact I had a heart attackD in to go was 120 minutes, shorter “half a grapefruit”.] with simvastatin, increasing January 1995 and was whisked than the then national target I have been taking statins for its level in your blood, and off for the standard treatment of 150 minutes. more than 10 years. The leaflet should be avoided if you in those days – a clot-busting So the patient journey with my latest supply explains: are taking this statin. Large drug (thrombolysis). I needed that had taken me more “Grapefruit juice contains one quantities of grapefruit juice further investigation, so was than two years is now being or more components that can interact with atorvastatin, put on the waitlist for an accomplished in two hours – alter how the body uses some but the occasional glass of angiogram, eventually rising a startling achievement for medicinal products, including grapefruit juice, or half a to the top. As a result, I had an the NHS. simvastatin film-coated tablets. grapefruit, is thought to angioplasty in April 1997. John Walsh, Swindon Consuming grapefruit juice be safe. This chain of events gave should be avoided.” Currently, healthcare me an interest in cardiology Running after recovery Please include some professionals advise it is safe and I started getting involved I am 56 years old and in late information on statins and to drink grapefruit juice and in patient and public 2015 I was suffering with grapefruit in your next edition. eat grapefruit if you’re taking representation groups. bad chest pains and severe John Bowers, Gwynedd other types of statins. It was in this role a few years breathlessness when I was ago that I was involved with out walking my dog. I, like Claire Marie Berouche had a heart attack and was later the introduction of primary many men, ignored the pain diagnosed with heart failure. She went from being a busy percutaneous coronary until I was advised to see my customer service manager to struggling to stand up for too intervention (angioplasty) in GP. I had two ECGs, which long. But she is learning to live with, and accept, “the new my local area. This was a new were clear, but as a precaution Claire”. You shared your support on Facebook. treatment for heart attack I was sent for a heart scan and patients that saw them taken an angiogram. I’m 55 and I’ve just been straight to the operating Astonishingly, the angiogram diagnosed with hypertrophic room for an angiogram and found I needed a quadruple cardiomyopathyD... trying to bypass, as my arteries were cope and understand... this is 95 per cent blocked. great inspiration In July 2016 I had Fi Elizabeth Lipscomb your limitations and can get surgery and am now back back to taking your favourite at work. The care I received Well done Claire, I had a walks, just that bit slower and from the staff at Castle sudden cardiac arrest at 34, have more rests. When you Hill Hospital near Hull was still looking forward to seeing need to sleep, go to sleep, phenomenal and I am now every new day don’t fight it. You learn to live back walking my dog and Eileen Young again, just in a different way. doing lots of gym work. Tracy Barron This year I’m planning I was diagnosed at 46 with to take part in the Great heart failure. My life ended Well done Claire, thank you for Our cycling range is ideal for your daily commute or a BHF challenge North Run and raise some when I found out, or so I sharing your story xx and has been designed with worthy funds for the BHF. thought. You begin to know Heather Terry comfort in mind. Our star letter Anyway, here’s to the BHF writer can win a BHF-branded and all the researchers – cycle jersey worth £45. keep working hard! Designs may vary depending on Martin Wood, Next issue Angiograms explained, what we can learn from other stock availability countries, and meet the BHF’s new Medical Director. Photography: Sam McElwee East Riding, Yorkshire

bhf.org.uk 5 NEWS

first line of defence against infections – and Part of the placenta, where Pre-eclampsia discovered a new role for them in maintaining it attaches to the womb, a healthy pregnancy. The researchers viewed down a microscope hope thanks to compared the blood from healthy women and women with pre-eclampsia. In the healthy women’s blood, they saw that neutrophils BHF research interacted with T-cells – another type of white blood cell essential for the immune research discovery could lead to a new system. But in women with pre-eclampsia, the Atreatment for a condition that can affect neutrophils failed to interact with the T-cells. pregnant women, helping to reduce the The researchers suggest that neutrophils number of stillbirths and premature births. may help the T-cells encourage blood Pre-eclampsia affects up to six per cent vessel growth to ensure regular placental of pregnancies. In the most serious cases, it development. This could pave the way can be life-threatening for the mother and for new treatments to make defective baby or cause premature birth, but even mild neutrophils work effectively, helping the cases can raise the risk of heart disease for the placenta develop normally. mother and baby later in life. Researchers from Queen Mary University ≠ Find out more at bhf.org.uk/ of London, part-funded by the BHF, looked at preeclampsia. Read about pregnancy and neutrophils – white blood cells that act as the heart disease at bhf.org.uk/pregnancy.

Anyone can do a marathon MPs in the lab This May, MyMarathon is back. Are you ready for a new challenge? Or is a This spring we are holding EU, and the challenge we marathon on your bucket list, but you don’t lab visits around the UK so now face to ensure medical have the time to train through the winter MPs can learn about BHF research is understood months? Whether it takes you four hours, research. These visits allow and prioritised during four days or four weeks, you decide the politicians to see first-hand upcoming negotiations. pace and the place. the importance Last year more than 30,000 people took of government part in MyMarathon, taking on 26.2 miles support for life in a way that was a challenge for them. Our saving medical MyMarathon champs raised more than £1m. research. This We’ll be with you for every step, with has become all training and fundraising tips to take you to the more urgent the finish line. Sign up now for free at following the bhf.org.uk/mymarathon or call decision for the 0300 330 3322 for more information. UK to leave the NEWS BITES ≠ CBE for BHF director from 2004 to 2016, which has coastline to raise £100,000 Professor Peter Weissberg, enabled breakthroughs that for the BHF, meeting BHF our former Medical Director, are today saving lives. researchers and supporters received a CBE for his services along the way. He had to medical research and ≠ Trail of two hearts congenital heart disease cardiovascular health. He led Kieran Sandwell, 45, is walking and the trail celebrates the our research funding strategy 5,000 miles around Britain’s end of his long battle with

6 Heart Matters Supporter Days 2017 Dates for your diary Join us at one of our local Supporter Days to find out how you’re helping Now Bored of bake sales or fancy dress? us fight heart disease. You will get Embrace your wild side and sign up to become a Heart Flyer to experience the the chance to: unforgettable thrill of a tandem skydive. ≠ Tour a BHF-funded lab to see the For a fundraising pack visit bhf.org.uk/ latest research heartflyers or call us on 0300 330 3322. ≠ Learn CPR for free, joining our Declutter to help save lives nation of lifesavers 13–14 May London to Oxford Trek. ≠ Hear inspiring real-life stories Why not take some time to have a spring clear- Walk 100km through day and night in our prestigious endurance challenge. and meet incredible volunteers, out, and donate what you don’t need to the BHF? There are also 50km options: London to fundraisers, heart patients and heart Each week in the UK, around 3,000 families Henley day trek and Henley to Oxford health professionals lose a loved one to heart and circulatory disease. night trek. Visit bhf.org.uk/L2Otrek or ≠ Celebrate the excellent work of our Donating your unwanted stuff to our shops call 0845 130 8663. supporters in our Heart Hero Awards. means we can raise funds for life saving research. We have eight Supporter Days Visit bhf.org.uk/bagit to order your free bags 14 May Cotswolds Bike Ride. Our popular bike ride in the beautiful across the UK: London 23 June, and declutter pack complete with handy hints to Cotswolds countryside is back for 2017. 27 June, Belfast 29 June, get you decluttering together. We’re looking for Take on a 30- or 50-mile route. Visit 4 July, Newcastle good quality clothes, shoes, books, DVDs, CDs, bhf.org.uk/cotswoldsbikeride or call 7 July, Bristol 21 July, Swansea homeware and children’s toys. 0845 130 8663. 12 September and Leicester Book a free collection on 0808 250 0175, or 27 September. Register at drop it into your local BHF shop. Remember to 17 May Tower of London Run. Steeped in history, this iconic London landmark bhf.org.uk/conferences. Gift Aid your stuff for free, helping us raise an plays host to this 5K or 10K run. Visit extra 25 per cent! bhf.org.uk/tower or call 0845 130 8663. 28 May Edinburgh Marathon and Half Marathon. Try one of the flattest Pippa pops in marathon routes in the UK – great for first-timers. Visit bhf.org.uk/edinburgh ippa Middleton or call 0844 477 1181. Psurprised members of our London Heart 28 May Great Manchester Run. Help us Support Group with a run all over heart disease in the North heart-healthy afternoon West’s biggest 10K. Visit bhf.org.uk/ tea. She created dishes greatmanchesterrun or call 0844 477 1181. from Heartfelt, a book featuring more than 100 3–4 June TrekFest Brecon Beacons. delicious recipes, devised in Choose from two different distances and collaboration with the BHF. tackle high peaks, including Pen y Fan All proceeds will help us fund life saving Pippa. “The determination and energy in in south Wales, while taking in beautiful research to fight heart disease. the room was inspiring.” views. Visit bhf.org.uk/brecon or call 0844 847 2788. “It was such a pleasure to meet Join or learn more about support members from British Heart Foundation groups at bhf.org.uk/heartsupport or call 10–11 June Nightrider London. Heart Support Groups and hear about our Heart Helpline on 0300 330 3311. Buy Nightrider is a unique way to explore each of their challenging journeys,” said Pippa’s book at bhf.org.uk/heartfelt. the capital. Visit bhf.org.uk/nightrider or call 0844 847 2788. 18 June London to Bike Ride. Cycle through country lanes with a heart disease, thanks to a residents found that triumphant finish by the sea. Visit heart transplant eight years the average Brit hasn’t bhf.org.uk/l2b or call 0300 456 8355. ago. Follow his progress at ridden a bike in nine atrailoftwohearts.com. years, with one in 24–25 June London to Brighton Trek. Our most famous trek, from five avoiding the the nation’s capital to Brighton ≠ Brits aren’t biking saddle for more Racecourse. Visit bhf.org.uk/L2Btrek Our latest survey of 2,000 UK than 10 years. or call 0845 130 8663. bhf.org.uk 7 NEWS

Recent BHF research has also in plant-based foods] can shown a strong association help defend you against these Spotlight on… between short-term exposure oxidant pollutants, making you to air pollution and admission less susceptible to the negative to hospital for strokeD and death effects of air pollution.” from stroke. Other research But should you exercise if air pollution suggests that breathing you’re in an area with high air in air pollution can lead to pollution? For most people in the Air pollution contributes to around 40,000 atherosclerosis – the build-up of UK and Europe, outdoor physical premature deaths in the UK each year and is linked fatty material inside the arteries activity has overwhelming health to heart attack and stroke. Lucy Trevallion looks that can lead to a heart attack. benefits compared with the at the evidence and how you can reduce your risk Blood supply to the brain potential risk of air pollution. is also affected, so the risk of Even in high-pollution areas, developing conditions like benefits usually outweigh risks. dementia will increase too. Dr Audrey de Nazelle, Lecturer Professor Kelly says: “It’s in Air Pollution Management he UK government’s plans widespread damage. Professor estimated that those who at Imperial College London, to tackle air pollution Frank Kelly, Director of the die prematurely in the UK are suggests people walk or cycle T were deemed “woefully Environmental Research Group at losing on average six months where possible (air pollution inadequate”. That’s what it King’s College London, explains: of life due to air pollution levels are usually higher in a was told by the High Court in “All of the organs in the body exposure. The people who die car). Choose routes away from November, in a case brought seem to be affected in some way prematurely in London will be traffic, she says even a few by environmental charity by breathing in air pollution.” dying up to maybe 10 years metres away from traffic can ClientEarth. This wasn’t the Some of the biggest earlier than they should.” make a difference. “If you’re first time the government has problems are the increased risk Air pollution exposure in walking on a wide pavement, been taken to court over its of heart and circulatory disease, the womb has been linked walk as far from the road as poor air pollution plans. In 2015 or the worsening of these to premature births, health possible. If you’re cycling, you’re the government was ordered conditions for people already problems and behavioural better off on a segregated cycle to make plans to bring air affected by them. Thanks to difficulties in children. lane, but even better on a side pollution within legal limits. BHF-funded researchers at the road,” she says. London has the worst air University of Edinburgh, we Protect yourself Public Health England advises pollution in the UK, followed by now know a lot more about But there are easy ways to protect that when pollution is at a , Manchester and how air pollution affects your yourself from air pollution: moderate level, adults with heart Bristol (air pollution is usually heart. Dr Nick Mills, Senior ≠ Eat more fruit and vegetables. problems, or who experience worst in cities). At sites in London, Clinical Research Fellow at our ≠ Have a balanced diet. symptoms such as sore eyes or a air pollution levels are monitored Centre of Research Excellence, ≠ Be physically active. cough, should consider reducing hourly and must not exceed a set says: “We found that tiny Professor Kelly says: “A diet high strenuous physical activity, limit (200 micrograms of nitrogen ‘nano-particles’ in diesel in antioxidants [found mostly particularly outdoors. dioxide per cubic metre) more exhaust produce highly reactive than 18 times a year. But in 2016 molecules called free radicals this limit was broken at 59 of the that can injure blood vessels. 97 measurement sites. These nano-particles – less than Enjoyed this article? a thousandth of a millimetre ≠ Visit uk-air.defra.gov.uk for Invisible problem wide – prevent blood vessels air pollution updates or call You can’t see it, but it is there: from relaxing and contracting 0800 55 66 77 to hear an invisible problem. Since the properly. The disturbance to recorded information. particles are so small – around a blood vessel function means ≠ Watch our animation about quarter of the width of a strand there is an increased risk of clots how air pollution affects your of hair – they can get into the developing in coronary arteries, body at bhf.org.uk/pollution. bloodstream and go on to cause which can cause a heart attackD.”

8 Heart Matters Taking action schemes and set out how we will improve Two of the most common and harmful air quality through a new programme of types of air pollution are particulate matter Clean Air Zones. We will update our air (mostly from road traffic and industry) and quality plans in the spring.” nitrogen dioxide (largely from vehicles and London Mayor Sadiq Khan promised to power stations). reduce air pollution by introducing an ultra- Dr de Nazelle says: “In the centre of low emission zone, more electric charging London, about 50 per cent of NO2 and points, and more electric or hybrid buses. particulate matter is from road transport. Since 2010 the BHF has provided £3.2m Transport is where we can have the most to research the link between air pollution impact at a local level.” and heart and circulatory disease. David A spokesperson for Defra (the McColgan, BHF UK policy lead for air Department for Environment, Food & Rural pollution, says: “We want to elevate the Affairs) says: “We are firmly committed to debate around air pollution and tackle poor improving the UK’s air quality and cutting air quality across the country. Air pollution is £3.2m harmful emissions. That’s why we have a priority in our prevention agenda.” committed more than £2bn since 2011 to BHF funding for increase the uptake of ultra-low emissions ≠ Read our full air pollution policy at research into vehicles, support greener transport bhf.org.uk/airpollutionpolicy. air pollution

55 OXFORD CIRCUS

bhf.org.uk 9 BEHIND THE HEADLINES

Is working out at the weekend enough?

Daily Mail 20 January 2017 “Obese are more likely to survive heart operations, say doctors” Research funded by the British Heart Foundation found that obesity is associated with a lower risk of in-hospital as any physical activity will help protect death following heart surgery. This is Daily Express 9 January 2017 your heart.” despite overwhelming existing evidence “Being a weekend warrior is as Although the study talks about that obese people are at higher risk of healthy as being a gym bunny” ‘weekend warriors’, it didn’t look at the cardiovascular death in everyday life. days of the week people exercised, but the Researchers from the University of One or two physical activity sessions number of exercise sessions. A participant Leicester found the risk of death in hospital at the weekend could be enough to could have exercised heavily on Monday after heart surgery was nine per cent in reduce your risk of dying from heart and Wednesday and be classed as a underweight patients, four per cent in and circulatory disease and cancer, ‘weekend warrior’. normal weight patients, three per cent in research suggests. It’s important to note that the overweight patients, three per cent in obese The researchers, from Loughborough percentage of participants classed as patients who are considered to be low or University and the University of , ‘weekend warriors’ was very small (3.7 moderate risk, and four per cent in obese tracked the physical activity of 63,591 per cent) and only 11 per cent were in patients who are considered high risk. adults from England and Scotland over the ‘regularly active’ category. Therefore, a 12-year period. while the study looked at more than They found the benefits of working 63,000 people, the majority were classed The BHF says: These findings go out in one big session (such as one long as ‘inactive’ if they didn’t do any physical against common practice, where weight 150-minute walk) were the same as activity, or ‘insufficiently active’ if they did loss is recommended before surgery, or doing smaller chunks of physical activity some activity but less than 150 minutes where very obese patients are refused (such as walking briskly for 30 minutes per week. The findings about ‘weekend surgery. Although we always recommend every weekday). warriors’ and regularly active people are a healthy waistline for those trying to Chris Allen, Senior Cardiac Nurse at the based on only 9,460 people. lower their risk of heart disease, this BHF, said: “The recommended 150 minutes A strength of the study is that it large study strongly suggests that being of moderate-intensity activity a week may looked at a wide variety of activities, overweight can give patients added sound overwhelming. Some people find a including light and heavy housework and protection when facing heart surgery. ‘little and often’ approach to exercise more gardening, along with walking, cycling, But the study only looked at patients manageable, but others find it easier to fit football and running. These all count while they were still in hospital and it all into one or two days a week. towards your 150 recommended minutes cannot be used to predict the long-term “Exercising regularly has also been of activity a week. survival of heart surgery patients. To shown to improve a person’s mood, a Media coverage was generally quite properly understand these results, we benefit that may not be felt so greatly accurate, although it didn’t always make it need to fund more research into the by ‘weekend warriors’. But whatever your clear that the study didn’t look specifically mechanisms involved. approach, keeping active is important, at weekends.

10 Heart Matters COVER STORY

Life after STROKE Stroke can be sudden and devastating, but for some people, there are new horizons beyond it. Sarah Brealey hears the stories of three inspiring survivors

Mark’s story “In one sense, my life changed overnight,” says Mark Flood, who had a strokeD aged just 14. “One moment I was a normal teenager, wanting to have water fights, build treehouses, meet girls, and draw, and then I was being approached by everybody at my school, saying: ‘What has happened to you?’” Having a stroke at such a young age is rare. For Mark, now 20, its effect on his life has, in part, been positive. “The whole experience gave me an attitude that life is precious,” he says. “I realised I wasn’t invincible. I thought: I don’t want to waste time.” Mark, from Glasgow, started making it didn’t go away.” Doctors thought Mark short films with friends. They set up an had an infection, but couldn’t tell what animation business when he was 17. He was causing it and antibiotics didn’t help. says: “Thankfully it worked out and it’s still “I had the stroke on the night of 16 working out.” December,” he says. “I was already quite But at the time, having a stroke was poorly. I was lying on the sofa. Then the terrifying. There was the initial fear that right side of my body went strange – I he might die, but he also feared that his think my face started to droop. ability to draw, along with the career he “I was taken to hospital and it turned out dreamed of, might have gone for ever. I’d had a stroke, which baffled the medics Watch online Mark recalls the lead-up to the stroke. because I was only 14.” ≠ See Mark and Paul talking about “At the beginning of December 2010, I Mark was found to have an undiagnosed their experiences of having a stroke developed what seemed to be a flu or hole in one of his heart valves, which he’d at bhf.org.uk/lifeafterstroke. fever,” he says. “We dismissed it at first, but probably been born with. A bacterial bhf.org.uk 11 infection called endocarditis (see page 19) had developed on his faulty I still think valve, causing the flu-like symptoms. A stroke can sometimes occur as a about the fact complication of endocarditis. “For the first couple of days in hospital that I am one of I basically couldn’t move,” says Mark. “I the lucky ones” couldn’t walk. I was in a wheelchair for a week or two. It seemed like my hands and legs were equally useless.” But gradually he saw signs of progress. On Christmas Day, he managed to leave his room for a glass of water. “That was when I and my family thought I was going to be OK,” he says. “That gave me the motivation to keep going.” Mark had daily physiotherapy exercises to help him regain muscle strength. “I remember doing simple exercises with the hospital physio, like catching and throwing a ball, walking along a straight line on the floor,” he says. “They gave me putty to mould in my hands, to get the strength back.” To Mark, the biggest priority was to regain full use of his hands. “Even at 14, I wanted to work in animation and film. On one of the early days in hospital a nurse came up to me and said: ‘I hear you are an artist, would you like to draw something?’ She gave me a pencil and I just couldn’t hold it. I thought: ‘This is it, game over.’ That scared me most, apart from dying – that my dream might just go out of the window.” Mark spent a month in hospital, and gradually started drawing again. “When I finished the hospital treatment I was able to start getting my life back to the way it was,” he says. “But it could never really be the same, in a positive way, because I had a new outlook of gratitude. Those two months of my life, as I get older, are more and more insignificant. But I still think about the fact that I am one of the lucky ones.” Mark hopes his story will help others.“Stroke can be a hopeless experience for a while,” he says. “If my story gives someone the inspiration to get back to full health, it makes everything I went through worthwhile.”

12 Heart Matters Paul’s story The whole Paul Brimble’s father died of a stroke in the 1980s. “He had a stroke at 64 and a more experience gave severe stroke at 67, which wiped out the whole left side of his body,” says Paul. “He me an attitude lasted another two years and seven months, that life is but he just lay there and wasted away. To me, that was what a stroke was.” precious” When Paul, from Midsomer Norton, near Bath, suffered pain and numbness in his wrist, it never occurred to him that this could be a stroke. “I play in a 60s rock and roll band,” he says. “I went to set up the equipment and I had a strange feeling in my wrist.” He didn’t take it too seriously, but after seeing a pharmacist, was advised to go to hospital. A doctor spotted he had atrial fibrillation (AF)D, a type of abnormal heart rhythm. This raises your risk of stroke, because irregular flow of blood means clots are more likely to form. These can move to the brain and cause a stroke. After further tests, Paul was told he’d had a stroke, but had difficulty believing it, as he felt fairly well. Two days later, he had a severe attack of AF in hospital. “I came over really hot and my heart rate was off the scale, going both ways, high and low,” he says. “That was when I realised I was quite ill.” Paul continued to suffer with his AF. He had three cardioversionsD and three ablationsD to restore his heart to its normal

Photography: Antonio Petronzio Photography: Antonio rhythm, but none worked for more than a few days. This affected him mentally and emotionally. “I felt so bad that before my third ablation, I told the doctor if they couldn’t sort it out, not to worry about bringing me round,” he says. “When I came round, the doctor said: ‘I am going to fit you with a pacemaker next week.’ He did, and my life changed completely.” After eight months, Paul was able to return to work full-time. He is still working aged 69, and plans to retire later this year. Paul’s stroke affected his right hand and he worried his career as a drummer could be over. To his relief, he’s been able to re-join his band, The Sneakers. “I have no feeling bhf.org.uk 13 in the palm of my right hand, but I can use prematurely. “Leading up to the birth I had my fingers and thumbs so I am still playing,” horrific headaches and was being violently he says. “I do lose the odd stick. I can’t tie sick all the time,” she says. “They put it shoelaces and I struggle with buttons, but down to the pregnancy but I now realise it that’s pretty much all.” was probably related to the stroke.” Early last year, his doctor warned him On the day of her stroke, Margaret was that he was overweight and at risk of on the mother and baby ward without developing diabetes. She referred him for her baby. “Because she was so small, three months with a slimming group, and Alexandria was in the special care baby Paul also started walking regularly. “I have unit,” she says. “I got up to make myself lost three-and-a-half stone and I still go to some toast. And that’s the last thing I the slimming group,” he says. “I feel on top can remember.” of the world now.” Although stroke is rare in young women, Margaret’s stroke happened He’s given up fish and chips and cut pregnancy increases the risk, especially after giving birth back on alcohol. He says he used to be immediately after giving birth, when “addicted” to ice cream, but now chooses there’s an increase in substances in your low-fat yoghurts or sugar-free jellies. He’s blood that cause clotting (this is the body’s no longer classed as at risk of diabetes natural mechanism to prevent blood loss and his blood pressure has reduced. during and after delivery). “I didn’t look after myself very well Margaret spent two weeks in hospital. before,” he says. “Now I am committed After the first week she was able to have to looking after myself. You don’t get her daughter with her. Alexandria is now many chances at life. I have come to the studying psychology at university. “She’s conclusion that life is precious.” grown up to be a lovely young woman,” Margaret regularly Margaret says. does 5K runs Margaret didn’t suffer any long-term Margaret’s story physical problems, but her language skills “Even if you are a slow runner, you are have been affected. “I have trouble spelling faster than someone on the sofa,” says words, whereas I used to be able to spell Margaret Tunney. Since having a stroke 18 anything,” she says. “And sometimes I can’t years ago, she worried that she might have find the right names for things. It can be another one. But she knows that keeping quite annoying.” 1.2m active helps reduce her risk, and also gives She works part-time in a school kitchen, her a sense of achievement. as well as helping to look after her elderly stroke survivors “I couldn’t even run until I was in my 40s,” mother. She cycles to work every day and in the UK says Margaret, now aged 51. “In October, for several years has attended military-style I did my first half marathon. I was so proud.” fitness classes, as well as 5km Park Runs Her stroke came the day after giving on Saturdays. birth to her younger daughter, seven weeks “I like to go for a run on Sunday morning too,” she says. “I run along the canal and it is beautiful. I like that it is calming, the sense of doing something for yourself, and the What is a stroke? sense of achievement you get by running A stroke happens when the blood supply to part of your brain is further and further.” cut off, causing brain cells to become damaged or die. Margaret also tries to eat healthily, and This can be because a blood vessel supplying the brain is takes statins to reduce her risk of another blocked by a clot or because a blood vessel in your brain bursts. stroke or heart attack. The same type of blood clots can cause heart attacks and “Stroke can happen to anyone for all stroke, so reducing your risk of heart attack (for example by kinds of reasons,” she says. “You might die keeping to a healthy weight, eating healthily, exercising or or you might be badly disabled. But that’s taking statins) will also reduce your risk of stroke. not always the case. I have recovered and ≠ Read about our research into stroke on page 35. I am lucky. There is life after a stroke.”

14 Heart Matters MEDICAL

How to get in touch ASK THE Call the Heart Matters Helpline on 0300 330 3300 for more information. To EXPERTS suggest a question, email Our panel of experts answer your health questions [email protected].

Are brands better? Q My friend says branded them to recoup money spent immunosuppressant), lithium medications are better than on development and testing. (for mental health conditions) unbranded ones, but I think Once that patent expires, other and epilepsy medications are generic versions are the companies can sell the drug also examples where different same. Who is right? under its generic name, usually brands may be absorbed more cheaply. The unbranded differently by the body, so may Senior Cardiac Nurse drug has to be identical in its have a different effect. Emily Reeve says: active ingredient, strength, Tell your doctor if you have Medicines often have more safety and the way it is taken. These a preference for a version of a than one name – a generic Medicines also contain medicine, for example, if you name (which is the active inactive ingredients, which differences find that size and shape of ingredient of the medicine) and are used to formulate the are rarely tablet easier to swallow. a brand name. The brand name active ingredient into a tablet, is chosen by the manufacturer liquid or cream, and these can significant” to help with marketing. For vary. This is why medicines example, Lipitor is the brand containing the same active There are a few exceptions. Dictionary Medical words, DICTIONARY name given by Pfizer to the ingredient, but made by Some slow-release medications MEDICAL TERMS EXPLAINED

Ablation A procedure to to help restore a normal A correct or control certain to the ultrasound scan used heart rhythm. It can be done there is too much in the blood, types of abnormal heart during pregnancy. using medicines (chemical rhythms. It involves using can increase your risk of getting cardioversion), or by giving cardiovascular disease which radiofrequency waves to Familial hypercholesterolaemia the heart a controlled electric includes having a heart attack destroy the abnormal (FH) A genetic condition that shock with a defi brillator F or a stroke. identified by a electrical pathways. results in very high cholesterol (electrical cardioversion). Angina An uncomfortable levels. Having FH gives you a Coronary artery bypass surgery feeling, tightness or pain in much higher risk of getting CHD. Implantable cardioverter An operation to treat coronary your chest that may also be felt Idefi brillator (ICD) A small heart disease. Arteries from device implanted under the in your arms, neck, jaw, back Heart attack Known medically your chest wall and arm, or skin on your chest, connected generic medicine atorvastatin. different manufacturers, may may be absorbed by the or stomach. The symptoms of as a ‘myocardial infarction’, veins from your leg, are used to H to your heart by one or more angina are usually caused by or ‘MI’. This describes a sudden bypass the blocked or narrowed wires (leads). It monitors your coronary heart disease. loss of blood fl ow to part D coronary arteries, improving heart rhythm and can deliver Atrial fi brillation (AF) An of the heart muscle. Most blood fl ow to the heart muscle. a controlled electric shock if abnormal heart rhythm in heart attacks are caused by Coronary heart disease (CHD) you have a life-threatening which the atria (the upper atherosclerosis, the build-up When the walls of the coronary abnormal heart rhythm. chambers of the heart) beat in of atheroma (plaque) within arteries (the arteries that supply an irregular pattern. People with artery walls. If the atheroma small symbol , blood to the heart muscle) AF have an irregular, sometimes becomes unstable, a piece Pacemaker A small device become narrowed due to a fast, pulse. may break off and lead to a P implanted under the skin gradual build-up of plaques, on the chest, connected to blood clot. This can block a called atheroma. your heart by one or more Bypass See coronary artery coronary artery, causing a heart wires (leads). Monitors the B bypass surgery. attack and irreversible heart Diabetes A condition in heart’s electric signals and When a pharmaceutical look different. These differences body differently – this can muscle damage. It is a medical which glucose (sugar) can stimulate your heart Cardiac rehabilitation Also D emergency and can lead to a levels in the blood are too to contract and produce a Ccalled ‘cardiac rehab’, this cardiac arrest. high. There are two main heartbeat if required. is an education and exercise Condition where types of diabetes: type 1, Heart failure programme to help you recover the heart becomes less where your body stops from a cardiac event and get effi cient at pumping blood Stroke An interruption of producing insulin, and type back to as full a life as possible. around the body. S blood fl ow to part of the are explained in 2, where your body can’t use brain, causing brain cells to Cardiomyopathy Disease of High blood pressure Also called the insulin it produces, usually die or become damaged. This the heart muscle in which it ‘hypertension’. High blood because excess fat in organs happens if an artery carrying becomes weakened. It may pressure is when the pressure prevents the insulin from blood to your brain becomes become thickened, enlarged required to pump blood is working eff ectively. blocked, or if an artery bleeds and/or stiff , depending on the consistently higher than the Diabetes increases your into your brain. A stroke is a type of cardiomyopathy. It recommended level. This puts risk of developing medical emergency. aff ects people of all ages and is extra strain on your heart and company discovers a new drug, are rarely significant, which include slow-release versions cardiovascular disease. usually inherited. blood vessels, and over time Cardiovascular disease (CVD) can increase your risk of having Ventricular tachycardia Also Echocardiogram Sometimes Includes all diseases of the heart a heart attack or stroke. V called ‘VT’. A very fast, called an ‘echo’. A test to abnormal heart rhythm that and circulation, such as coronary E High cholesterol Cholesterol is a examine the structures within starts in the ventricles (the heart disease and stroke. waxy substance that is mainly plain English in the heart, for example the heart lower chambers of the heart). Cardioversion Treatment for made in the body and plays a valves, and to see how well the This is a medical emergency some abnormal heart rhythms vital role in how every cell works. heart is pumping. It is similar that, if not treated, can lead to However, high cholesterol, when Call the Heart Matters Helpline on 0300 330 3300 a cardiac arrest. if you want to know more they take out a patent so no is why generic and branded of calcium channel blockers bhf.org.uk our dictionary 49 one else can make the drug for medicines are almost like diltiazem, veraprimil and on page 49. a period of time. This allows always interchangeable. nifedipine. Ciclosporin (an

Managing migraine risk Q I get migraines with aura Some people will most common type of discuss your overall risk of heart and I’ve been told I am at a know a migraine is strokeD, involving a clot disease and stroke, because higher risk of stroke. Is this developing because in an artery supplying there are steps you can take to true and is there anything I they experience an the brain. But this isn’t reduce your risk. These include can do about it? ‘aura’ before the necessarily cause for alarm. knowing your blood pressure headache strikes. Your overall stroke risk may be measurement and treating this Dr Mike Knapton says: The aura is often low, especially if you’re young. if it is high. Statin treatment can Migraine is a common type described as seeing There is also evidence also reduce your risk of stroke by of headache, affecting about flashing lights, a linking migraines with heart managing your cholesterol levels. one in five women and one in sensation of pins and disease and stroke, but this It is also important to consider 15 men. It is typically a severe needles, and/or feeling is much less well established taking steps to improve your headache, often on one side dizzy or unsteady. than links between migraine health by adopting a healthy of the head, which may be Studies suggest with aura and stroke. diet, not smoking, keeping to accompanied with nausea migraine with aura I recommend that you ask a healthy weight and taking and/or vomiting. doubles the risk of the your GP or practice nurse to regular physical activity.

Photography: Johanna Ward Need more information? Go online to bhf.org.uk/experts for more of your questions answered. bhf.org.uk 15 MEDICAL

Echocardiograms Q Why would I have an echocardiogram? CV Dr Rajan Sharma A An echocardiogram is ≠ Consultant an important investigation Cardiologist for anyone with suspected ≠ Head of Clinical heart failureD, heart valve Services at problems or cardiomyopathyD. St George’s TESTING It can help your doctor Hospital, London make an early diagnosis. TIMES You might be referred for an echocardiogram, for example, An echocardiogram because of symptoms such as problem is and the likely breathlessness and/or a heart prognosis, which then helps provides ultrasound murmur (an unusual sound your doctor decide on images of your heart. in your heartbeat). This test is appropriate treatment options. Dr Rajan Sharma also used to diagnose patients Follow-up is very important with inherited heart disease, and must be done once or explains this common including cardiomyopathy. twice yearly for heart failure test to our Senior It uses ultrasound scanning and valve disease patients to Cardiac Nurse to give a picture of your heart. see how they are responding It is cost-effective and safe. to their medication and/or Emily Reeve device (such as a pacemakerD Q When might I have an or ICDD). echocardiogram? A There are three main areas Q What does the test involve? for its use: diagnosis, prognosis A A transthoracic echo (TTE), and follow-up. At any of these the most common type, points, it can provide measures involves the patient taking their of heart function, including an clothes off from the waist up, abnormalities, a full scan will ejection fraction (the amount lying on a couch on their left be performed. of blood pumped out of the side and an ultrasound probe heart with each heartbeat – being placed on the chest and Q I’ve heard you can get 3D a ‘normal’ level is around abdomen to take images. ultrasound scans – is it true? 55 per cent). This helps to An echocardiogram can be a A Yes, although in the UK 2D is establish how severe the full scan or a focal scan. A full still more common. 3D is good scan takes 40–45 minutes and at quantifying heart function gives a complete assessment and there are fewer variations Dictionary of the size and function of all in results caused by variations Medical words, DICTIONARY heart structures. The British in investigation technique – MEDICAL TERMS EXPLAINED

Ablation A procedure to to help restore a normal A correct or control certain to the ultrasound scan used heart rhythm. It can be done there is too much in the blood, types of abnormal heart during pregnancy. using medicines (chemical rhythms. It involves using can increase your risk of getting cardioversion), or by giving cardiovascular disease which radiofrequency waves to Familial hypercholesterolaemia the heart a controlled electric includes having a heart attack destroy the abnormal (FH) A genetic condition that shock with a defi brillator F or a stroke. identified by a electrical pathways. results in very high cholesterol (electrical cardioversion). Angina An uncomfortable levels. Having FH gives you a Coronary artery bypass surgery feeling, tightness or pain in much higher risk of getting CHD. Implantable cardioverter An operation to treat coronary Society of Echocardiography this is particularly useful for your chest that may also be felt Idefi brillator (ICD) A small heart disease. Arteries from device implanted under the in your arms, neck, jaw, back Heart attack Known medically your chest wall and arm, or skin on your chest, connected or stomach. The symptoms of as a ‘myocardial infarction’, veins from your leg, are used to H to your heart by one or more angina are usually caused by or ‘MI’. This describes a sudden bypass the blocked or narrowed wires (leads). It monitors your coronary heart disease. loss of blood fl ow to part D coronary arteries, improving heart rhythm and can deliver Atrial fi brillation (AF) An of the heart muscle. Most blood fl ow to the heart muscle. a controlled electric shock if abnormal heart rhythm in heart attacks are caused by Coronary heart disease (CHD) you have a life-threatening which the atria (the upper atherosclerosis, the build-up When the walls of the coronary abnormal heart rhythm. chambers of the heart) beat in of atheroma (plaque) within arteries (the arteries that supply an irregular pattern. People with artery walls. If the atheroma small symbol , blood to the heart muscle) AF have an irregular, sometimes becomes unstable, a piece Pacemaker A small device become narrowed due to a fast, pulse. may break off and lead to a P implanted under the skin gradual build-up of plaques, on the chest, connected to blood clot. This can block a called atheroma. your heart by one or more recently introduced focal measurements such as ejection Bypass See coronary artery coronary artery, causing a heart wires (leads). Monitors the B bypass surgery. attack and irreversible heart Diabetes A condition in heart’s electric signals and muscle damage. It is a medical which glucose (sugar) can stimulate your heart Cardiac rehabilitation Also D emergency and can lead to a levels in the blood are too to contract and produce a Ccalled ‘cardiac rehab’, this cardiac arrest. high. There are two main heartbeat if required. is an education and exercise Condition where types of diabetes: type 1, Heart failure programme to help you recover the heart becomes less where your body stops from a cardiac event and get effi cient at pumping blood Stroke An interruption of producing insulin, and type back to as full a life as possible. around the body. S blood fl ow to part of the are explained in 2, where your body can’t use brain, causing brain cells to Cardiomyopathy Disease of High blood pressure Also called the insulin it produces, usually die or become damaged. This the heart muscle in which it ‘hypertension’. High blood because excess fat in organs happens if an artery carrying becomes weakened. It may pressure is when the pressure prevents the insulin from blood to your brain becomes become thickened, enlarged required to pump blood is working eff ectively. blocked, or if an artery bleeds and/or stiff , depending on the consistently higher than the scans, lasting 20–25 minutes. fraction. Cost is the only reason Diabetes increases your into your brain. A stroke is a type of cardiomyopathy. It recommended level. This puts risk of developing medical emergency. aff ects people of all ages and is extra strain on your heart and cardiovascular disease. usually inherited. blood vessels, and over time Cardiovascular disease (CVD) can increase your risk of having Ventricular tachycardia Also Echocardiogram Sometimes Includes all diseases of the heart a heart attack or stroke. V called ‘VT’. A very fast, called an ‘echo’. A test to abnormal heart rhythm that and circulation, such as coronary E High cholesterol Cholesterol is a examine the structures within starts in the ventricles (the heart disease and stroke. waxy substance that is mainly plain English in the heart, for example the heart lower chambers of the heart). Cardioversion Treatment for made in the body and plays a valves, and to see how well the This is a medical emergency some abnormal heart rhythms vital role in how every cell works. heart is pumping. It is similar that, if not treated, can lead to However, high cholesterol, when Call the Heart Matters Helpline on 0300 330 3300 a cardiac arrest. if you want to know more It is mainly for people with some places have 3D scanners bhf.org.uk our dictionary 49 suspected heart failure. and not others. In the future, it’s on page 49. If it suggests there are likely we will see more 3D scans.

16 Heart Matters the leak and whether it can be You might repaired or replaced.

be referred Q What are the latest for an echo developments in this area? A The most exciting if you have development is that echocardiograms can now suspected be used beyond hospitals. There are pocket-sized devices valve disease” providing access for more patients. Image quality has also got better over the years, with clearer images. We’re working on echocardiography for patients who don’t yet have symptoms and appear to have a normal heart, but have very early signs of disease. This can be useful for people having chemotherapy for breast cancer, for example, which can sometimes damage the heart. If damage is detected early by echocardiography, stopping chemotherapy can Illustration: Robert Samuel Hanson allow the heart to recover. In future, I hope echos will Q What is a TOE and why view as the ultrasound signal Q Are there any after effects? give more information in a single would you have one? doesn’t have to travel as far. A Not for the standard scan – not just heart and valve A A transoesophageal echo echocardiogram. After a TOE function, but also mapping out (TOE) is much more focused Q Do I need to do anything to you will feel like you can’t coronary arteries. and less commonly used than prepare for the test? swallow for a couple of hours. If a TTE. It’s an invasive test as the A Not for a standard they haven’t had sedation, most Enjoyed this article? probe is on the end of a long echocardiogram (TTE), but for people can carry on as normal endoscope that the patient has a TOE you will need to fast for in the afternoon if they have ≠ Watch our echocardiogram to swallow. The scan is taken four hours beforehand and two had it in the morning. videos at bhf.org.uk/echo. from inside the oesophagus, hours afterwards. ≠ Look out for our which is right next to the heart. Q What will it tell me? Summer 2017 issue to learn The test provides views of Q Will it hurt? A Either type of all about angiograms. the back of the heart from the A TOEs can be uncomfortable, echocardiogram can give a ≠ Read about ECG at bhf. left atrium, and is mostly used but should be tolerable. You will better understanding of your org.uk/testingtimes, or call for patients with problems in usually be offered anaesthetic condition. For example, if 0870 600 6566 to order our this area, including mitral valve (general or, more often, local) someone has a leaky valve, Winter 2016-17 issue. disease. It can give a clearer and/or some form of sedation. it can tell you the severity of bhf.org.uk 17 MEDICAL

VITAL STATISTICS WHY SHOULD I KNOW MY… weight and waist size? Senior Cardiac Nurse Emily Reeve talks to the BHF obese (over 30). You can see Associate Medical Director Dr Mike Knapton about if you are in a higher risk why it’s important to know your real size category, and then use BMI to calculate a target weight Which numbers should I know? risk of heart disease. Obesity and monitor progress Weight on its own doesn’t tell us increases your risk of conditions towards this over time. a lot, as a healthy tall person will that put you at risk of heart and For your waist generally weigh more than a circulatory disease and circumference you just healthy short person. This is why conditions, such as high blood need a tape measure we use a measurement called pressureD and type 2 diabetesD. (like the one received body mass index (BMI). This is Your weight can also raise your in your Heart Matters your weight (in kilos) divided by risk of many types of cancer, welcome pack). Measure the square of your height (in such as bowel, womb, your waist at the mid-point metres). While this calculation oesophagus, pancreas and some between the bottom of your isn’t perfect (it can give a breast cancers. In fact, one in 20 ribs and the top of your hips. For misleading result for people cancers in the UK are linked to European women this should with lots of muscle mass and being overweight or obese. be no more than 88cm (35in) pregnant women, for example), Carrying extra weight puts and for European men no more it can be a quick and useful increased strain on the joints, so than 102cm (40in). People guide to help assess whether there’s an increased risk of joint of African Caribbean, Black someone is within their healthy problems and osteoarthritis, as African or South Asian heritage weight range and, if not, how far well as worsening arthritis if you should have a circumference outside it they are. already have it. of no more than 80cm (32in) Another useful measurement for women and 90cm (35.5in) is your waist circumference. What should my numbers be? for men, as studies show they This is important because your If you know your height and are at risk with a lower waist body shape can affect your risk weight, you can calculate your measurement than white of heart and circulatory disease. own BMI. Online calculators European people. Visceral fat, which is stored allow you to put in your height around your abdominal organs and weight in either imperial and increases your waist size, or metric (use the same for both Find out more is linked to an increased risk of measurements). Find ≠ We’ve got lots of resources to help you manage your weight. heart and circulatory disease – one on the BHF website at These include our free booklet Facts not fads: your guide more so than fat that is stored bhf.org.uk/BMIcalculator. to healthy weight loss. Download or order it at bhf.org.uk/ around the hips and thighs. Depending on the result, HMpublications or from 0870 6500 6566. this will put you into one ≠ Find all our food articles online at bhf.org.uk/nutrition, or Why should I know of four groups: low weight/ check out our heart-healthy recipes at bhf.org.uk/recipefinder. these measurements? malnourished (BMI below Your weight and body shape can 18.5), normal weight (18.5–25), make a real difference to your overweight (25.1–30) and Next issue Why should I know my blood sugar levels? 18 Heart Matters MEDICAL

Focus on… endocarditis This infection of the heart’s inner lining is rare, but some people with heart conditions are at higher risk. Senior Cardiac Nurse Emily Reeve speaks to two people affected by the condition

Tom thought he’d caught the flu, but tests revealed it was endocarditis Photography: Dan Prince

hen Tom Aylott developed endocarditis, it Tom was at risk of endocarditis because he’d had an seemed like a bout of flu. “One evening I aortic valve replacement nine months earlier, aged 33. Wstarted to come down with a flu-like He had been fit and active, a keen surfer and temperature and severe shivering fits,” he says. “I rugby player, until he was diagnosed with Marfan constantly felt cold and nothing I did could make me syndrome, which can affect the connective tissues of warm. It was a doctor friend who recommended that I the body. As a result, he needed urgent open heart went to A&E. Blood tests showed I had a staphylococcal surgery. Tom experienced heart rhythm problems infection, with symptoms consistent with endocarditis.” following the surgery, but was back at work when A CT scan and a transoesophageal echocardiogramD he fell ill. (TOE) helped to confirm the diagnosis. Tom stayed in “The consultants believe the bacteria had attached hospital for two weeks. itself to my replacement aortic arch,” he says. bhf.org.uk 19 “Having read about endocarditis since, I realise how Endocarditis: the expert’s view lucky I was, particularly in getting treated very early Professor Jonathan Sandoe, How is it diagnosed and treated? before the infection could develop and spread further.” Associate Clinical Professor in It can be difficult to diagnose. If you Some patients stay in hospital for the course of their Microbiology at the University of have symptoms, diagnosis would be intravenous antibiotics or come in for treatment as a and Honorary Consultant confirmed with blood samples day patient, but Tom had most of it at home. “I stayed Microbiologist at Leeds Teaching tested in the lab to find bacteria. An in hospital for a week, during which time they trained Hospitals NHS Trust, explains echocardiogramD can show an me to give myself IV antibiotics at home and this abnormal bacterial growth on the continued for two months afterwards,” he says. How common is endocarditis? valve. It is treated with intravenous Tom says he is now “absolutely fine”. He’s even It affects one in 30,000 people in antibiotics, usually for 4–6 weeks. started surfing again, although, following advice from the UK, which is about 2,000 Some people need valve surgery. If his cardiologist and surgeon, he no longer plays rugby diagnoses each year. you have a device, it may be removed. because of the risk of injury. In July 2016 he cycled

Who is at risk? What are the long-term effects? Tom is now I wasn’t Your risk is increased by having: A lot of people with endocarditis surfing again • Congenital heart disease need surgery, due to damage to aware of how • Previous endocarditis the heart valves caused by the dangerous it • Heart valve replacement infection. There are potential • Heart valve disease – either complications including stroke (see could be” stenosis (a narrowed valve) or page 12). Infection can spread from regurgitation (a leaking valve) the valve to places such as the • Heart devices joints or bones of the back, which • Intravenous drug use. may cause ongoing joint or back If you have a problem with a pain. One in five people die from valve or you have man-made endocarditis during a hospital stay. from Newcastle to Paris for the BHF, riding 600 miles in materials in the heart, it is easier for a week. “It was tough,” he says. “But I am glad I did it. It bacteria to lodge there, and your Are there preventative antibiotics? felt like quite an achievement to get there.” body may not be able to fight off NICE recommends people should Tom is keen to raise awareness of endocarditis. “I was the infection. Intravenous drug not usually be given antibiotics aware I might be more susceptible to infections users are at risk even if they don’t before a medical or dental following surgery,” he says. “But I wasn’t aware of how have heart problems. procedure. This is because these dangerous it could be. I would go straight to hospital if procedures are no longer thought the symptoms returned. Educating people is important.” What are the signs and symptoms? to be the main cause of endocarditis Feeling tired and awful, and appetite and taking antibiotics carries some Losing a loved one: Helen’s story loss. Symptoms are flu-like, but flu risk. Preventative antibiotics are Helen Moulford says her husband Bill was her “soul symptoms tend to get better within sometimes needed, and your doctor mate”. Together, they were raising a three-year-old 10 days, while endocarditis should discuss this with you. daughter and two children from Helen’s previous continues. People also experience relationship. She still misses him every day, following shivers, shakes and night sweats What advice would you give to his death from endocarditis in February 2015. (fever in the night, so sheets or patients who’ve had valve surgery? Bill’s heart murmur was detected during a routine nightclothes may be wet when you Look after your teeth and see the medical when he was 33. He had a bicuspid aortic wake). This is an important symptom dentist regularly. If the kind of valve – a relatively common abnormality of the heart, to tell your doctor about. Always bacteria that colonise teeth enter which often causes no problems. seek medical help urgently if you the bloodstream, they can cause “He was told his heart was otherwise fine and he’d be think you may have endocarditis. endocarditis. Try to avoid injury or reviewed again when he reached 65,” says Helen. Early diagnosis makes treatment cuts, and keep these clean if you do Bill knew it was important to look after his teeth. easier and more successful. get them to reduce risk of infection. People with any type of heart valve abnormality are at risk of endocarditis, which can be caused by dental

20 Heart Matters Helen with late husband Bill, who fell ill with endocarditis years after a diagnosis of a bicuspid aortic valve

bacteria entering the bloodstream. He was rigorous weight and wasn’t sleeping properly,” says Helen. “I about his dental hygiene and saw the dentist regularly. was frantic because my beloved man wasn’t getting In 2014, Bill fell ill. “He got a really bad cough,” Helen any better. We kept going back to the doctor. The GPs says. “They suspected it was whooping cough. A chest were wonderful, they just weren’t aware of the risk of X-ray showed his lungs were clear; they gave him endocarditis. It is hard to diagnose.” antibiotics and it got better; he stopped the antibiotics; Bill got progressively worse. One day it dawned on they gave him steroids and blood tests. This cycle went Helen that he might actually die. “It was such an awful on for five months.” feeling,” she says. “We rushed him into hospital and Flu-like symptoms that don’t go away can be a sign within two hours the young man in the assessment of endocarditis, but no one spotted it. “He was losing unit said: ‘It’s his heart. There’s a massive infection in his aortic valve.’ To us, this seemed like good news, that it meant they could cure it, but it was too late. Research into endocarditis “You never get over the trauma of holding your We’re trying to stop people suffering from loved one in your arms and watching them die. I still endocarditis. Professor Jennifer Potts is a BHF miss him terribly.” Senior Research Fellow at the University of York. Now, like Tom, Helen wants to raise awareness of Her lab looks at the structure and function of endocarditis in people who are at risk (see box, on proteins on the surface of bacteria and how page 20). She says: “I really don’t want it to happen to these cause endocarditis. Her team is studying anyone else. We were taking all the precautions, so we how bacteria are able to form antibiotic-resistant didn’t think about his heart. colonies on the surfaces of heart valves and devices “If you get something that looks like flu and it such as pacemaker leads. If we understand this, we doesn’t go away, seek medical attention and insist that may be able to prevent endocarditis in future. they check your heart. If they find it, they can treat it and you have a good chance of survival.” bhf.org.uk 21 MY STORY RIDING high Mike Keavey faced multiple heart problems, but he’s loving life again after finding new interests and rekindling old ones, as he tells Rachael Healy

Mike with his bike – one of the new hobbies he’s taken on since his triple bypass surgery

22 Heart Matters ike Keavey has been on a long and often difficult journey back to health. He’s been fitted with a Photography: Chris Close pacemaker, which was later replaced with an implantable cardioverter defibrillator (ICD)D, and has been M diagnosed with angina and heart failureD. He’s also undergone triple heart bypass surgery and later had a procedure to treat two more arteries. Mike, pictured with The singer and guitarist, 69, lives in the Black Isle, wife Dianne, still enjoys near Inverness, with his wife Dianne, 46. With her playing the guitar support, he’s made it through the darkest days and is living life to the full, riding a new motorbike and learning to speak German. It was during a routine GP visit in 2011 to check on his Ups and downs: type 2 diabetesD that a nurse spotted Mike’s heartbeat Mike’s health journey was very slow. This came as a surprise. He was referred to ≠ April 2011: During a GP visit, a nurse hospital and tests revealed he needed a pacemakerD. spots Mike’s heartbeat is slow. Once it was fitted, Mike’s heartbeat returned to a ≠ May 2011: Hospital visit for tests. normal level. But he started experiencing symptoms, ≠ July 2011: Pacemaker fitted. such as chest pain while he was out walking. An ≠ September 2011: Mike experiences echocardiogram and other tests revealed Mike had chest pains. anginaD, but it also showed that some of his coronary ≠ October 2011: Echocardiogram. arteries were blocked. In January 2012, Mike underwent ≠ November 2011: Further tests reveal triple bypass surgery. Mike has angina and blocked arteries. “I can’t describe the feeling when you’re first told you ≠ January 2012: Triple bypass surgery. need open heart surgery – I thought it was only old men ≠ Spring 2012: Cardiac rehab sessions. who need surgery,” Mike says. “But it changed my life.” ≠ Winter 2013–14: Mike experiences He noticed an immediate improvement, but after a breathlessness, feels he is slowing down. few months felt like he was slowing down again. Mike ≠ March 2014: Further tests lead to heart was diagnosed with heart failure and his pacemaker was failure diagnosis. swapped for an ICD (a cardiac resynchronisation therapy ≠ June 2014: Initial visit to Aberdeen to defibrillator, which can be used to treat heart failure). see surgeon for tests. Mike is told he could “Before I had the ICD fitted, I was going downhill,” says benefit from having an ICD fitted. Mike. “I was disappointed because it seemed to me the ≠ September 2014: Pacemaker removed bypass hadn’t worked, but then I got the new device and and ICD fitted. I’ve been great ever since.” ≠ May 2015: After experiencing leg pain, Mike has an endarterectomy. Living with heart failure Mike’s parents both suffered from heart disease, but getting to grips with multiple health issues was still a When he started experiencing numbness in his leg learning experience for Mike and Dianne. while out walking the dogs, Mike called Mandi. On her “I was pretty doom and gloom to begin with,” says advice, he returned to his GP to discuss his leg trouble. Dianne. “It came as a bit of a shock the first time heart He needed an endarterectomy – a procedure where the failure was mentioned, as the term is quite devastating. inner lining, and any fatty material (plaque), is removed But you find out more about it, then pick yourself up from a narrowed artery to improve blood flow. Mike had and get on with it.” treatment for two blockages in his leg. Mike was assigned a heart failure nurse, Mandi “I’m 90 per cent back to normal now,” says Mike. “I can Smith, to help him understand the condition and find take the dogs out for a walk without stopping.” ways to live with it. “It was wonderful knowing I could phone her, because I didn’t know what to expect from Finding support heart failure,” says Mike. “I might get a pain, then I Mike says he’s feeling positive and that’s thanks to could phone her up and ask if that’s OK. She does an family support, his healthcare professionals and a incredible job.” change of diet. bhf.org.uk 23 “The family was really supportive – my daughter Gail called me every day from Australia,” says Mike. “During the bypass, Dianne was down at the hospital every day. Afterwards, she looked after me and took time off work. Dianne doesn’t like blood, so considering that, she did pretty well! She’s fantastic – the love of my life.” Dianne adds: “He’s been very courageous through all of his illnesses – although he can be a wuss sometimes! He is very good at sharing his experiences to help other people, such as friends who have cardiac problems too.” Beyond his family, Mike found support at cardiac rehabilitationD. Initially, he was sceptical about attending, but Dianne persuaded him to give it a go. “I know a few friends who’d had bypass surgery and a couple of them said: ‘I don’t need to do that, I know when I’m better’,” Mike explains. “But you really get into it and you learn so much about what to work towards.” When the course finished, Mike joined a gym, continued walking the dogs every day and does the odd workout in the house. He also changed his eating habits. He now eats fewer carbohydrates and makes sure those he does eat are wholemeal. “The weight started falling off,” he says. Mike has now lost three and a half stone. “It’s helped with everything,” he says. “I feel better and I look better.” Dianne has supported Mike through the New skills toughest times Experiencing health issues made Mike realise he wants to spend more time doing the things he loves. “It’s the beginning of a new part of my life,” says Mike. “I still play wee gigs down the road, but I’m much more interested in being out with the dogs and being with Dianne.” Back in the sixties, Mike used to ride a moped. In 2015, he decided to treat himself to a motorbike and is now working towards his full licence. Pacemakers and ICDs “I take it all around the Black Isle,” he says. “I even Pacemakers and ICDs can both help the heart get back into a normal drove down to Aberdeen to meet my son Ben. I’m still a rhythm, so what’s the difference? learner at the moment. Dianne doesn’t want me to pass my test yet because it means I’ll get a bigger bike!” ≠ ICDs monitor your heart rhythm and deliver a controlled electric shock The couple are big Formula 1 fans and will be if you have a life-threatening abnormal heart rhythm. This can be one big heading to the Belgian Grand Prix in August, combined shock or a series of smaller ones depending on what’s needed. You may with a holiday in Germany. They’ve made friends who need an ICD if you had a life-threatening heart rhythm, have a condition live out there, and Mike is now teaching himself to such as cardiomyopathyD, or have heart failure, which puts you at risk of a speak German. life-threatening heart rhythm. “I’ve been learning for two years and I wouldn’t have done that if I hadn’t had my bypass surgery,” he says. ≠ Pacemakers monitor the heart’s electrical signals and stimulate the “I’ve got lots to look forward to. I really appreciate heart to contract if it beats too slowly. Most pacemakers just work when everything I have.” needed, but some send out impulses all the time to keep your heart pumping normally. You may need a pacemaker if your heart beats too slowly or too fast.

Find out more ≠ Cardiac resynchronisation therapy is available in combination with ≠ Visit bhf.org.uk/HMpublications to download or either a pacemaker or ICD. It helps to treat heart failure by co-ordinating order one of our free booklets about heart surgery, the electrical impulses in the heart’s four chambers, improving the heart failure and more. heart’s ability to pump blood.

24 Heart Matters Questions about your heart condition?

How do I follow a heart-healthy diet? Why have I been prescribed this medication?

What does this diagnosis Why do I mean for me? need this test? Call the Heart Matters Helpline on 0300 333 2333* or email [email protected] *Heart Matters Helpline open 9am–5pm Monday–Friday. Similar cost to 01 and 02 numbers. NUTRITION Rise and shine Bored with breakfast? Senior Dietitian Victoria Taylor presents some quick and easy ideas to make you fall in love with your morning meal

t’s the meal we are most likely fruit, and spices such as nutmeg, option if you are trying to lose weight. The to skip, but a healthy breakfast cinnamon, ginger and mixed spice. coloured flecks look a bit unusual, but you hasI huge benefits. Having a meal shouldn’t taste it so you can enjoy with first thing makes it easier to avoid Try it savoury your usual toppings. Grated carrot or unhealthy snacking, but a good For something unusual, why not butternut squash work well too and will breakfast can also expand the range experiment with savoury porridge? Using add a subtle sweetness – you could even of nutrients in your diet and help you dried herbs or spices is healthier than mix grated carrot, cinnamon and raisins reach your 5-a-day. What’s more, if you adding salt, and you can try vegetables with your oats for a ‘carrot cake’ porridge. find that the morning sets the tone for such as mushrooms, spinach or peas as a the rest of your day, then a balanced topping – whatever takes your fancy. Think Toast with the most breakfast might make it easier to make of it as an oaty risotto! There are whole cafés devoted to toast, good food choices later too. which shows the variety this breakfast However, we often eat it in a rush, so Veg adventures staple offers. While white toast with butter we can fall into bad habits or just eat For a mix of sweet and savoury, and to up and sugary jam isn’t an ideal everyday the same thing every day. But breakfast your intake of fruit and veg, replace some choice, the right bread and toppings can needn’t be boring: read on for tips on of your porridge oats with raw grated make it a nutritious start to the day. how to give a healthy, tasty boost to courgette. Add it to the uncooked oats and If you like variety, then rolls, English your mornings. cook as usual. The veg will bulk out your muffins, bagels, pitta breads and even portion but is lower in energy, so it’s a good tortilla wraps can all be good choices. Be Porridge perfection aware that salt content varies, so check Porridge is a great choice. As well as food labels to choose one with the lowest traditional oats, it can be made with Mix grated carrot, salt content, and pick a wholegrain version grains such as quinoa, rye, buckwheat, to benefit from the fibre. brown rice, or barley. Think of porridge cinnamon and raisins Skip butter in favour of an unsaturated or grains as a neutral base, then add with oats for a carrot fat spread, or just go straight to your main variety with toppings. Experiment with topping – ideally one that will add fruit nuts and seeds, fresh, dried or frozen cake porridge” (sliced banana or berries) or vegetables

26 Heart Matters Does eating breakfast help you lose weight? Eating breakfast is often part of weight-loss advice, but while adults who skip breakfast are more likely to have a higher BMI or to be overweight, there isn’t enough of the right type of research to show whether this is cause and effect. It could be that eating breakfast is a sign of a healthy lifestyle. In any case, healthy eating isn’t just about weight loss – it’s about getting the right nutrients and avoiding unhealthy foods, too.

(avocado, grilled mushrooms, grilled or means you don’t need to add any oil. Add raw tomatoes, or wilted spinach). eggs towards the end of the cooking time Go online Add protein too so that your meal is to ensure a runny yolk. balanced. This could be a poached egg, ≠ Find 14 delicious heart-healthy tinned sardines, or low-fat soft cheese. Nut ≠ Check out our simple meals infographic porridge ideas to brighten up your butters and baked beans are protein-filled for an all-in-one baked breakfast at morning at bhf.org.uk/porridge. options too, but check labels and choose bhf.org.uk/simplemeals. ≠ Discover seven healthy ones with the least sugar and salt and no ≠ Don’t miss the recipe pullout in our breakfasts for busy people at added palm oil for nut butters. centre pages for interesting cooked bhf.org.uk/busybreakasts. options such as mushroom and ≠ See our list of popular cereals ranked Cooked breakfasts cauliflower frittata or sweet potato rosti best to worst at bhf.org.uk/cereal. Traditional cooked breakfasts are high in with poached egg. saturated fat, salt and calories. But there are simple ways to make it healthier. These include: Breakfast on the go ≠ Grilling rather than frying If you need an instant breakfast, it’s easy the morning, try our bircher muesli, ≠ Choosing lean back bacon rather than to rely on shop-bought breakfast bars, which you can make up in a large batch streaky bacon biscuits and muffins. Always read the and put in airtight portion-sized boxes ≠ Skipping the sausages nutritional information to choose those in the fridge to use over the week. Mix ≠ Poaching the eggs instead of frying in with least saturated fat, sugar and salt. low-fat plain yoghurt with a no-added- butter or bacon fat It can be better to make your own sugar muesli and fruit such as fresh ≠ Serving with wholegrain toast rather in advance. Try our recipes for banana strawberries, frozen mango chunks or than fried bread. oatmeal muffins and banana bread stewed plums for a creamier alternative. If the appeal of a fry-up is the simplicity at bhf.org.uk/recipefinder. You can A peanut butter and banana sandwich of cooking everything in one pan, that’s prepare these in advance and even made with wholegrain bread is another still possible. Cooking your breakfast in the freeze them. For grab-and-go ease in easy, filling option.

Photography: Sara Morris oven in a tray lined with greaseproof paper

bhf.org.uk 27 NUTRITION Plant POWER Everyone needs protein, but it’s not all about steak. Our Heart Health Dietitian Tracy Parker explores the power of plant protein

rotein is essential for a healthy far, replace some of the meat in dishes diet. You might think meat is like stews, chilli or Bolognese sauce with the best way to get it, but beans or lentils. there’s growing evidence that swapping a diet rich in animal How much protein? protein (such as meat and Most adults need around 0.75g of protein Pdairy) for one high in pulses, nuts and per kilo of body weight per day (for the grains could help you live longer. average woman, this is 45g, or 55g for There are many pulses to In 2016, new dietary guidelines placed men). That’s about two portions of meat, choose from: all contain greater emphasis on non-meat sources of fish, nuts or tofu per day. As a guide, a protein and fibre protein. We don’t need to avoid meat and protein portion should fit into the palm dairy entirely, but it does remind us that we of your hand. need a varied diet to stay healthy. In the UK, on average we eat almost Pulses Proteins are known as the building double the protein we need. This isn’t 8g per three-tablespoon serving blocks of life as they break down into automatically a problem, but it depends Pulses are an inexpensive protein choice, amino acids that help the body grow and where your protein is coming from. Meat- are high in fibre and a source of iron. They repair. Our hair, skin and muscle are all are part of the legume family and include made from the protein we eat. all beans, peas and lentils. A daily serving Animal foods and three plant sources – helps to lower your cholesterol level and soy protein, quinoa and Quorn – contain all counts toward your 5-a-day. If you buy the essential amino acids needed for good 0.75g tinned pulses, check the label and choose health. Other plant sources of protein lack Protein you need ones that have no added salt or sugar. one or more of the essential amino acids. They are easy add-ins to sauces, soups and Sometimes animal protein is thought of as per kilo of body stews, even if they’re not used in the a ‘complete protein’ for this reason. But it’s weight each day original recipe. not true that vegetarians will lack protein, or that you need to eat plant-based heavy diets have been linked to increased proteins in certain combinations. Eating a risks of heart disease, diabetes, some variety of plant protein each day gives you cancers and may also shorten your life. We all the essential amino acids you need. should eat more peas, beans and lentils, Ease into meatless meals by going two portions of fish a week, and eat no meat-free one day a week. Try replacing more than 70g of red and processed meat meat with foods like fish, dairy and eggs per day. before swapping for plant-based proteins. Here are 10 meat-free protein sources to If meat-free meals seem like a step too get you started.

28 Heart Matters Meat-free can be unhealthy too The vegetarian option isn’t automatically a healthy choice. Mock meats like nuggets, veggie burgers and hot dogs contain protein but can be loaded with salt. Vegetarian options such as cheesy pastas or veg curries in creamy or oily sauces are often high in fat, saturated fat, salt and calories. To reap the health benefits, replace meat with more veg, beans, pulses, soya and wholegrains.

Soya beans related to chard and spinach. It Nuts 8g per 100g serving of tofu is a good protein food, but it’s 8g per 30g serving Unlike other pulses, soya beans not the amount that is Nuts provide a good dose of Muscle minus meat are a complete protein, impressive, it’s the type. Unlike protein in a handful and are It’s a myth that you need comparable in quality with cereals, quinoa has all of the packed with fibre. Although lots of protein if you are animal protein, but are low in essential amino acids you they are high in fat, and active. Athletes who train fat and contain fibre and iron. find in animal protein. hence calories, most more than once a day Eating 25g of soya protein a It is an easy substitute of this fat is heart- should eat twice as much day, instead of meat, can help for rice and healthy unsaturated protein as the average lower cholesterol levels. This is pasta. fats. But stick to a adult, but most of us equivalent to a glass of soya handful per day (30g). already do. It’s better to milk, a pot of soya yoghurt or spread your protein over an 80g serving of tofu. Seeds the day, combined with 7g per 30g serving carbohydrates for energy, Quinoa Like nuts, seeds contain leaving the protein for 8g per 185g serving healthy unsaturated fats muscle repair and growth. (five tablespoons and protein. They Germany’s Strongest Man when cooked) can be easily Patrik Baboumian, Ironman Quinoa is cooked added to salads champion Dave Scott, and eaten like a and pasta or and British cyclist Lizzie grain, but is you can eat Armitstead all avoid meat actually a seed of a them plain as a and are very successful. green vegetable simple snack. bhf.org.uk 29 Sources of protein Portion Protein (g) Nuts Peanuts 30g 8 Walnuts 30g 4 Hazelnuts 30g 4 Seeds Sunflower 30g 6 Pumpkin 30g 7 Pulses Baked beans 3 tbsp (120g) 6 Chickpeas 3 tbsp (105g) 8 Lentils 3 tbsp (120g) 9 Soya Tofu 100g 8 Soya milk 200ml 6 Cereals & grains Wholegrain rice 185g cooked 7 (75g uncooked) Fish and vitamin D. There is no limit Wholegrain bread Medium slice 3 25g protein per 140g serving to how many eggs you can eat, Oats (uncooked) 40g 4 of baked fish but if you have familial Wholemeal pitta 58g 5 White fish is a low-fat protein hypercholesterolemiaD then Dairy source. Oily fish, such as talk to your doctor or dietitian Milk 200ml 7 sardines, mackerel or salmon, for advice about your intake. Cheddar cheese 30g 8 Yoghurt (plain) 150ml 7 are a little higher in fat but Quorn 100g 11 contain omega-3 fatty acids, Eggs (boiled) 1 medium (60g) 7 which are heart healthy. Oily Fish 100g 21 fish are also good sources of vitamins A and D. Aim to have What your daily protein intake might look like two portions of fish a week, of Breakfast Egg on toast 9g which one should be oily. Lunch Salmon sandwich 27g Dinner Veg and lentil chilli with brown rice 16g Cereals and grains Total: 52g 3g per slice wholemeal bread Recommended: 45–55g Wholegrain breads, rice and pasta have more protein, fibre Quorn™ and iron than white versions. 11g per 100g serving Brown rice with beans, or bread Like soya, Quorn is a complete rice. It is sold in a range of with hummus or nut butter, protein. It is made from an forms from mince to fillets, so Improving your can give you as much protein edible fungus and has a can easily be swapped with as a piece of meat. meat-like texture. It is naturally meat, but take care to read health and the low in saturated fat. It contains labels as the salt content environment Eggs more fibre than an equivalent can vary. 14g per two medium eggs portion of baked beans, Eating less meat doesn’t (120g serving) wholemeal bread or brown Dairy just affect your health. It’s a myth that eggs are bad 8g per 30g cheese Going meatless once a for your heart. Eggs do contain Milk, yoghurt and cheese are week can help reduce your cholesterol, but it’s the Find out more great sources of protein and carbon footprint and save saturated fat added while ≠ Top 10 meatless recipes at also contain calcium to keep resources like fossil fuels cooking them or on foods bhf.org.uk/meatfree. our bones healthy. Choosing and fresh water. Giving served with them that you may ≠ Discover how much you lower-fat dairy options will up meat for just one meal need to worry about in terms know about protein at help reduce your saturated fat could save the daily water of blood cholesterol levels. bhf.org.uk/proteinquiz. intake without compromising usage of nine people. Eggs are good sources of B12 on protein or calcium.

30 Heart Matters NUTRITION

How to get in touch ASK THE Call the Heart Matters Helpline on 0300 330 3300 for more information. To EXPERT suggest a question, email Our Senior Dietitian Victoria Taylor shares nutrition advice [email protected]. Spring clean Q What is ‘clean eating’ and ready meals. For most of us, Clean eating gurus. While it’s true that there should I be doing it? these are positive changes. are some foods we should However, as with all fads, presents be eating less of and others Victoria Taylor says: ‘Clean there are extreme versions of an image of we should eat more of, this is eating’ is a term that has been clean eating and these don’t a world away from thinking used a lot over the past year or have a sound basis. It’s often perfection that about foods in terms of clean two. But what it actually means recommended that dairy and isn’t realistic” and dirty. Clean eating presents is not very clear. It is used to wheat are excluded from the an image of perfection that mean anything from making diet, even for those who have isn’t realistic. In real life, some simple, healthy changes to not been diagnosed with an fed – attributes that don’t days may be better than others your existing diet, to adopting intolerance or allergy. Coconut change the fact it is high in and having flexibility in your a rigid diet that excludes whole oil is often promoted, despite saturated fat. There is similar diet is important if it’s going food groups. being high in saturated inconsistency over sugar. to be a pattern of eating for What everyone seems fat, which is linked to Although white sugar is the long term, rather than a to broadly agree on is the high cholesterolD. definitely not viewed as ‘clean’, continuous cycle of deprivation benefits of eating more Butter is avoided by some honey, maple syrup and juices, and guilt. whole foods, such as fruit and clean eaters, but not by which are also sources of free vegetables, grains and pulses, others, while most who sugars, are usually included ≠ See our guide to different and fewer processed foods eat it suggest it should and even encouraged diets at bhf.org.uk/diets. such as cakes, biscuits and be organic and grass- by some clean eating

Faking it Q I keep reading that sugar Sorbitol, acesulfame them to health depends on your reasons for is bad for you. Are artificial K, aspartame, problems including using them. They are certainly sweeteners any better? saccharin, sorbitol, cancers, liver damage better for our teeth, and for sucralose, stevia and and premature births, people with diabetes they Victoria Taylor says: Health xylitol are the main are probably the reason can provide a sweet taste problems such as obesity and artificial sweeteners. for this. However, without affecting blood tooth decay are linked to the These are added before sweeteners glucose levels. When it comes amount of sugar in our diets. We to many foods, either can be added to food to weight loss, the research is know from our national dietary on their own or in in Europe, the European more mixed, as there’s some surveys that most adults in the combination with sugars, Food Safety Agency (EFSA) limited evidence that they may UK eat too much sugar. as well as being available to has to approve their use. increase appetite. They might ‘Natural’ alternatives, such as buy in granulated or liquid This is a rigorous process, so help you cut back on sugar, for honey syrups and nectars, are forms to add to our own you can feel confident they example in tea or fizzy drinks. often seen as healthier options, cooking, baking are safe to eat. But, ultimately, you need to but are still sugar in liquid form. and drinks. Whether they reduce the total sweetness of For sweetness without the Some people are are a helpful your diet if you want to calories that come with sugars, reluctant to use artificial addition readjust your tastes in you need artificial sweeteners. sweeteners – stories linking to our diets the long term.

Photography: Johanna Ward Enjoyed this article? Find all of our nutrition information at bhf.org.uk/nutrition. bhf.org.uk 31 RESEARCH

The professor and his team use powerful microscopes to study bone marrow cells Photography: Danny Fitzpatrick Photography: Danny

32 Heart Matters £190,000 To look at using PKCB to No pain, help heart attack patients no gain? Pain may not always be a bad thing, at least when it comes to a heart attack. That’s the theory Professor Paolo Madeddu is investigating, as he tells Sarah Brealey

ain is a common symptom of “Sometimes people with nerve damage a heart attackD. Patients are don’t realise they are getting injured usually given pain relief, often because they don’t have pain,” Professor in the ambulance on the way Madeddu explains. “If someone with to hospital. But what if the pain diabetes has a heart attack they may not is useful? This is the theory feel the pain. We know that patients who ProfessorP Paolo Madeddu is investigating. have a ‘silent’ heart attack have a worse “The theory we are adopting is that when prognosis on average than other heart you have a heart attack, you feel pain, attack patients. We also know there is which is like your body’s alarm system,” says higher mortality in heart attack patients Professor Madeddu. “Symptoms described who are given morphine for pain relief. I in medical textbooks 30 years ago as BHF support am not saying patients shouldn’t be given stressful and painful may actually have a e’ve awarded Professor morphine, but I am saying that the pain useful function.” WMadeddu and his colleagues, may be serving a purpose.” Professor Madeddu has spent three including BHF Professor Costanza decades researching ways to help people Emanueli, more than £700,000 over Self-repair system with heart and circulatory conditions, five years. They are in the third year So what is this purpose? Your bone marrow including the last 17 years trying to help the of studying the circulatory system of is where many new cells in the body are heart heal itself. He’s been at the University the bone marrow in people and mice made, including stem cells, which have the of Bristol since 2005 and is now Professor of with diabetes. They’re using powerful ability to restore damaged tissue. Experimental Cardiovascular Medicine there. microscopes and scanners to look at “Normally bone marrow releases healing Some people experience ‘silent’ or cells in the bone marrow and how substances during a heart attack,” says undiagnosed heart attacks, which may have blood flows around the bone marrow. Professor Madeddu. “We think that the pain few symptoms, if any. It’s estimated that A further £190,000 BHF grant will itself is the signal to guide healing cells as many as 60 per cent of all heart attacks allow them to see if protein kinase C from the bone marrow to the heart. If pain are silent. In some cases these people may beta (PKCB) could improve the outlook is blocked – by diabetes or by painkillers – simply have a higher pain threshold, but it for those with heart attack or diabetic there’s no signal telling stem cells to travel can also be connected with diabetesD. cardiomyopathy (changes in the heart’s to the heart, which will result in more Diabetes is a common cause of structure in people with diabetes, damage to the heart and worse recovery.” neuropathy (nerve damage). This can mean which can lead to heart failure). He’s looking at whether producing pain pain is experienced differently – it may Professor Madeddu is grateful in heart attack patients could help them be stronger or not felt at all. In the UK, 3.6 for BHF support. “The BHF is one recover better, or whether there are other million adults have been diagnosed with of the biggest research funding ways to stimulate the bone marrow to diabetes, and it’s estimated one million may organisations in the UK,” he says. produce healing stem cells. have undiagnosed type 2 diabetes. Numbers “Many countries do not have a Professor Madeddu’s research suggests are rising fast, mostly because of increasing cardiovascular research charity like that if you have diabetes, your body’s obesity levels. Diabetes can double the risk this. We are very lucky. Thank you to ability to deal with a heart attack is doubly of heart and circulatory disease, so people the BHF and all its supporters.” limited. If you have nerve damage, you may with diabetes have a higher heart attack risk. not feel the pain of a heart attack, so the bhf.org.uk 33 RESEARCH

Professor Madeddu may have found a new use for a drug that is already safe and available

body’s ‘alarm’ doesn’t go off and the bone protein, using drugs that are already marrow doesn’t release healing cells. available to treat diabetes. It looks like this 3.6m To make matters worse, bone marrow could help protect bone marrow. Professor itself is less able to act as the body’s repair Madeddu says: “We have shown that using UK adults diagnosed system, even if it does hear the ‘alarm’. This a PKCB inhibitor can control the processes with diabetes is because diabetes damages blood vessels that lead to fatty tissue.” all around the body, meaning that tissues, This would help other parts of the including bone marrow, don’t receive the body as well. “What is good for the oxygen they need. High glucose in the bone marrow can be good for the other blood – a sign of diabetes – also damages organs – preventing obesity and other stem cells. complications of diabetes – and can also “Normally the bone marrow contains protect the heart,” he says. “We are helped stem cells and the network of blood vessels by the fact that PKCB inhibitors are already that supply them,” says Professor Madeddu. commercially available, though not for “But in patients with diabetes there is a this purpose. So clinical trials could start lot of fatty tissue in the bone marrow. So quite soon, in a year or two, if we can prove you have less healthy bone marrow left to that this can prevent inflammation and produce the cells; there are fewer blood formation of fatty tissue. vessels and fewer nerves.” “For drugs that aren’t already Cells in the fatty bone marrow are also commercially available, we would need to more likely to be inflamed. Inflammation is test them much more rigorously for safety, a key process in the development of heart so that would take a number of years longer.” and circulatory disease. Large numbers of patients could benefit – not just those with heart attacks, but also Future treatments people with complications of diabetes, Professor Madeddu is researching ways such as peripheral arterial disease, which to ensure bone marrow stays healthy so it can sometimes lead to amputation. can produce new cells, especially in people Professor Madeddu trained in cardiology with diabetes. and says his work is based on problems he His team is looking at protein kinase C has seen in patients. “This is not research of beta (PKCB), a protein involved in several an abstract hypothesis, it is research to solve cellular processes in the body. Scientists patients’ needs,” he says. “We hope we will be know how to inhibit or ‘turn off’ this able to bring real benefits for patients.”

34 Heart Matters RESEARCH

Watch this SPACE

A little-known type of stroke could be contributing to dementia. Sarah Brealey hears how Professor Joanna Wardlaw and her colleagues are tackling the problem

f you know about stroke, you probably know it’s caused by a failure of blood supply to part of the brain. You might also know that this is caused by a clot blocking the blood flow or a burst blood vessel bleeding into the brain. But few people have heard of lacunar stroke. This Itype of stroke affects the small blood vessels – less than a millimetre wide – deep inside the brain. It was described in post-mortem examinations in the 1950s, when ‘lacunae’, or empty spaces, were spotted in the brain. It accounts for about a fifth of strokes – more than 25,000 a year in the UK. Professor Joanna Wardlaw, Chair of Applied Neuroimaging at the University of Edinburgh, is an expert in brain scanning. Her internationally recognised

35 research focuses on trying to prevent, diagnose and treat stroke more effectively. She and her team are also finding out more about what causes different types of stroke. Little-known problem “For a long time people thought all strokes were due to blood clots or blood vessels bursting,” says Professor Wardlaw. “Only recently have we realised there is a set of strokes caused by problems with small blood vessels. These milder strokes have literally gone under the radar.” Because there has been so little recognition of the problem, our understanding remains poor. This means options for prevention and treatment are limited. Professor Wardlaw is trying to address this. “Lacunar stroke is not usually too physically disabling, but it might stop people being able to live independently if it affects their memory or decision-making,” says Professor Wardlaw. Sometimes described as ‘small’ strokes, they can happen without the patient noticing. The more they happen, the more likely you are to develop problems with thinking or even dementia. This can be combined with mood disorders, depression or balance issues. “Some people have symptoms that lead them to go to the doctor and some don’t,” says Professor Wardlaw. have slowed down a bit or you’ve been forgetting things, “It probably boils down to which part of the brain is but don’t necessarily spot something sudden that you affected. If it falls in a part of the brain that controls your would recognise as a problem.” hand or leg then you’ll go to the doctor, but if it’s in a part Even if the patient does seek help, these strokes are of your brain that controls complex decision-making, for sometimes wrongly classified as another type of stroke example, you might never realise. You might think you or as something else entirely. “For many years, people

BHF stroke research

his is just one example of the BHF abroad, run by the University of Glasgow, Tfunding research to help people to see whether a new clot-busting drug affected by stroke. Many of the risk factors is better at treating stroke. A Cambridge- for stroke and heart disease are the same, based trial has been looking at whether a and we know many of the same processes ‘polypill’ of three different drugs is more are behind both conditions. effective at preventing further strokes in We’ve given researchers at the University people who have already had one. of Cambridge £1m to search for possible We’re funding another trial, called genetic causes of lacunar strokes. Working risk of lacunar stroke will shed more light RIGHT-2, run by the University of with researchers worldwide, as part of the on how the condition works and which Nottingham, to test if giving GTN (nitrate) International Stroke Genetics Consortium, medications might be helpful. patches in the ambulance on the way to they will look at the DNA of 5,000 people We’re currently funding more than a hospital can help treat all types of stroke. who have had a lacunar stroke to see which dozen other stroke research projects, We’re also researching atrial fibrillation, genes could play a role in the disease. including six with the Stroke Association. a major cause of stroke, as well as several Learning which genes can increase your These include a project in the UK and other projects studying causes of stroke. Photography: Chris Close

36 Heart Matters £850,000 BHF funding for trial to try to prevent lacunar strokes in patients who’ve had one

The endothelium works with nerve cells and other cells in the brain. She thinks that when it becomes damaged, messages travelling around your brain slow down or don’t arrive at all. Causes of lacunar stroke are not fully understood, but probably include the same risk factors as other strokes, including old age, smoking, high cholesterol and high blood pressure. And Professor Wardlaw’s team already have some ideas about treatments. Future treatments They have been testing two existing drugs, which are known to have effects on the endothelium. The first is isosorbide mononitrate, part of a group of drugs called nitrates, which are used to treat angina. The other is Professor Wardlaw and her team cilostazol, which is used as an antiplatelet drug (although are testing drugs that could treat it’s not common in the UK), but may also help improve and prevent lacunar strokes endothelial function. With a team in Nottingham and Edinburgh, they are have been looking at scans and calling this problem by running a study, funded by the Alzheimer’s Society, different names,” says Professor Wardlaw. “We found there which has enabled them to plan a larger trial of at least are over 150 different names for what are essentially 200 people, funded by £850,000 from the BHF. holes in the brain.” “We are testing these two drugs individually and She has helped to establish international standards for together, because they may have increased effects when neuroimaging to reduce this problem. She also wants used together,” says Professor Wardlaw. “The pilot has to see doctors taking a more holistic view, rather than been really helpful in telling us how to vary the dose, separately treating stroke, memory problems, mood what kind of side effects people might get, and how well disorders and high blood pressure, which all overlap in people tolerate the drugs.” lacunar patients. The three-year BHF-funded trial will follow people who Problems with the small blood vessels of the brain have had a lacunar stroke. “If the theory is correct, we contribute to around 40 per cent of dementia cases, would hope to find they have reduced risk of another affecting an estimated 350,000 sufferers in the UK. “There stroke of this type, and are less likely to get cognitive is a lot going on in the brain that we don’t understand, impairment,” she says. “We will scan their brains and but treating stroke and dementia as if they are measure what has changed after one year on the completely different is a bit artificial, and we should look different drugs.” at them together,” says Professor Wardlaw. If the trial is successful, they hope to run larger trials to establish this as a treatment. It could potentially be used How do these strokes happen? for prevention too. “If it works in people who have had Professor Wardlaw is studying how these strokes are symptoms, it seems plausible it would work in people caused, and in particular she’s looking at the lining of who haven’t had symptoms but are at high risk, perhaps blood vessels – the endothelium. It is known to play due to family history,” says Professor Wardlaw. “It might a role in processes that lead to heart and circulatory be that you could use it as a treatment for people who disease, but is much less studied in the brain. “The haven’t had a stroke yet.” endothelium has been studied a lot by cardiologists,” says Professor Wardlaw. “But it has been rather ignored in ≠ Discover how we’re funding research throughout the connection to stroke and dementia.” body at bhf.org.uk/beyondtheheart. bhf.org.uk 37 WELLBEING

Choosing WISELY We make thousands of decisions per day, but what if the outcome was life-changing? Lucy Trevallion shares expert tips and speaks to Guy Heywood about his rapid surgery decision

Guy had to make a quick decision about a replacement heart valve

38 uy was only 29 when he understand the situation better, but was diagnosed with a heart realised he had a lot of questions, so made valve problem. He was fit Understanding risk an appointment to visit his surgical team. and active, training as an If you’re presented with statistics, risks amateur boxer alongside his and survival rates, how do you make Who to involve job as a logistics manager, sense of them? For Guy, telling his family about the surgery whenG he started to feel exhausted and get Professor Spiegelhalter says: “Numbers was a difficult experience, but also a huge occasional chest pains. need to be treated with respect. They relief. David Spiegelhalter, Professor of the Unbeknown to Guy, his aortic valve had are not the first things you should be Public Understanding of Risk at the two flaps (leaflets) instead of the normal presented with after a diagnosis.” University of Cambridge, says: “It’s very good three. This doesn’t always cause problems, He advises that if anyone gives you to discuss your options with family, because but in his case the valve wasn’t working statistics for, say, a survival rate for they have to deal with the consequences of properly, putting strain on his heart. His surgery, they should also explain your actions, unlike internet sites and heart valve needed to be replaced quickly. whether it is on average or whether people you don’t know very well.” For Guy, one of the hardest aspects was it has been adjusted for your age or However, Guy found that it can be making a decision about his treatment. general health. It can also be helpful difficult to get frank opinions from loved Agreeing to have open heart surgery was to reframe the statistic – for example, a ones. “At times it was frustrating,” he says. relatively simple as he was told he risked 10 per cent risk of death is also a 90 per “Sometimes I felt like I was speaking to sudden death without it, but he then had cent chance of survival. a shadow of somebody I knew, because to choose between a mechanical and a Heart surgery on average has a I knew they weren’t being truthful with tissue valve. mortality risk of two per cent, which me. And it’s quite hard to communicate The mechanical valve would last Professor Spiegelhalter says is about with people if they’re not being as open longer but require him to take warfarin the same as 3,000 parachute jumps, or as you are and you don’t understand why.” (an anticoagulant) for the rest of his life. around 120,000 miles on a motorbike, Guy says his family didn’t want to impose An animal tissue valve does not require although the risk will vary according to their opinions on him and be responsible lifelong medication, but must be replaced the procedure and the individual. for the choice he made. He reflects: “It just (typically after five to 15 years). The choice made me know that ultimately I had to is one many people who need valve decide for myself.” surgery must make. Guy was able to discuss his options in “The reason why it was so hard was Gathering information detail with one of his doctors. There is because you wouldn’t know until after Professor Bekker says that there are five some debate about whether healthcare surgery if you’d made a good decision,” Guy things you need to understand to be professionals should give patients a says. “There was no right or wrong, they confident you have adequate information personal opinion in situations like this, both had their pluses and minuses and it about your condition. but Professor Spiegelhalter argues: “It’s was all about what life would be like.” These are: everyone’s right to come back and say It’s normal to feel overwhelmed or 1. The name of your condition. ‘What do you think I should do?’ and to get confused when facing a big decision like 2. The symptoms and causes. an honest answer.” this, Hilary Bekker, Professor of Medical 3. How long it will last. Guy found that talking honestly with the Decision Making at Leeds University, 4. The consequences of having it. doctor was “invaluable” and helped him explains. “The brain is incredibly clever 5. Whether it can be cured or managed. come to terms with the situation. When he and chooses what information we attend You can then look at the treatment asked the doctor what he would do in his to,” she says, “and then responds to a options and understand the decision place, he said that because he was young, feeling, and often chooses for us without you’re making. It can be useful to put this he’d have the mechanical valve to avoid us even being conscious of it. knowledge in the context of your lifestyle. having to go through the process again. “When we make a decision consciously, For example, ‘Will I need to cut down my we have to break down and try to hours at work?’ or ‘Will I need to be more The final decision understand all those automatic influences physically active?’ Writing a list of pros and cons can add on us. So when we’re put in a situation Guy was given a lot of written structure to your decision-making process, where we’re suddenly being told we need information to take away, as well as suggests Professor Bekker. to make a decision, we think we can’t do it, the number for an on-call nurse. He She recommends you look at the list

Photography: Gareth IwanPhotography: Gareth Jones but we all have the capacity to.” tried to use internet forums to help him and ask yourself: ‘What is important

bhf.org.uk 39 It’s about how you look at life and what you want for the future”

Guy, with his dog Brave, who helped keep his spirits up after his second surgery

a second time in December 2016, after to my life at this time and what are the developing endocarditis (see page 19), Guy’s top tips for trade-offs?’ “Our values change over time which infected the valve. “Brave, our and what is important to us now may dog, is a great fellow and has helped me decision-making not be important to us later,” she says. to smile and have fun so soon after my “It’s a question of whether we want to second surgery,” he says. 1 Be as knowledgeable as you can. adapt our lives. Ask yourself whether Guy faced the same dilemma a second The BHF has lots of free booklets and something, for example climbing, is time and chose a tissue valve again. He feels information on its website. important to your life or whether it’s just happy with his choice and believes he did 2 Speak to professionals and your something you like doing at the moment.” everything he could to come to the right family. Get more opinions so you can After weighing up the trade-offs, about decision. For Guy, your right to choose is broaden your knowledge again. two weeks before the operation Guy important – so much so that he’s set up a 3 realised which way he wanted to go. “And website and a account telling his Take a bit of time out. Distance yourself from people if you need to, so that was it, I’d made my mind up,” he says. story, both called Free to Choose. you can settle in with the information. “I thought I could live a better quality Professor Spiegelhalter notes that all we of life on a tissue valve, though it might can do is try to make the most informed 4 Use relaxation techniques. have a shorter life than a mechanical valve decisions – predicting the future will never I meditated a lot at the time and that – which comes with its own restrictions. be possible. “Ultimately, none of us know really helped me stay calm and come There is no right or wrong decision; it’s what’s in store for us, or how long we to terms with the situation, instead of about personally how you look at life and will live,” he says. “Part of the joy of being freaking out about it. what you want for the future.” human is not knowing – and being able to 5 Make sure you feel happy with the After his valve replacement, Guy has deal with that.” decision yourself, don’t feel pressured been living life to the full, going parachute by other people, because ultimately jumping, snowboarding, travelling around ≠ For more information see our Heart you’re the one that has to live with it. Asia and spending quality time with valve disease and Heart surgery booklets And I think that’s one of the hardest his dog, Brave. However, he has had to at bhf.org.uk/HMpublications. things, doing it for yourself. undergo a heart valve replacement for

40 Heart Matters WELLBEING

The psychology of RECOVERY A change in health can be hard to accept, especially if it happens overnight. Lucy Trevallion hears about Jason Gutridge’s emotional journey after his sudden collapse

Jason was leading an active life, so heart issues came as a huge surprise Photography: Gareth IwanPhotography: Gareth Jones

t was a crisp, winter morning and resolved spontaneously. “The doctors were urge to keep him tucked up in bed, where Jason cycled in the sunshine past the quite surprised it did that,” he says. he was safe. cabbage fields on his way to work. He Jason had scar tissue on his heart, which “It’s like there’s a tarantula and you’ve got felt very tired, but put it down to that the doctors thought was either congenital to pick it up,” he explains. “That’s how I felt Monday morning feeling. He chained or due to a common virus that can attack about walking out the door. That spider’s up his bike and walked through the heart tissue. The scar tissue disrupted the dangerous; it could bite you; you could die. Ifactory towards his workbench, when he electrical signals that control the heartbeat. Psychologically, the first time I got out of felt an overpowering wave of illness. He Jason was fitted with an implantable bed felt just as scary. It’s a massive barrier. couldn’t speak but knew he needed to sit cardioverter defibrillator (ICD)D to “Walking down to town on my own was down. Just as he did, he collapsed. Luckily, reduce his risk of another event and terrifying. I thought: ‘What if I don’t come his friend caught him as he fell, and called was discharged after two weeks. But the back?’ Your loved ones are sitting at home, an ambulance. emotional effects lasted much longer. waiting, thinking that too. It’s a two-fold It was a huge shock when Jason awoke psychological issue.” in hospital having had a life-threatening Dealing with fear Dr Kelly Buttigieg, a cardiac psychologist episode of ventricular tachycardia (VT)D. He On his journey to recovery, one of the first at King’s College London, explains that was very active and felt healthy. His heart roadblocks was fear, which he describes as it’s common after a heart event to want had returned itself to a normal rhythm, and “an overpowering, self-protective instinct”. to withdraw to a safe place and avoid when another episode of VT struck, it again Both Jason and his wife, 43, had to fight the activities we previously enjoyed.

bhf.org.uk 41 Photography: Gareth Iwan Jones back andrealise that inour fast-paced specialist told himto “slow down”. 42 rehabilitation hard cardiac during pushed himselfvery man–thatwas he –astrong, sporty Jason was sokeen to get back to where he Pushing yourself oftheiridentity,”the carer aspect shesays. are notwhollyfocusedtheir activities on roles that are to meaningful them,sothat to gradually carer return to shouldtry “The notto lettheseroles takeover.important have changedto ‘patient’ and ‘carer’. It’s Dr Buttigieg. You might feel your roles relateyour to partner eachother, explains just wanted to bemeagain.” 30miles–I climbing amountain orcycling –Iwasn’tto normality bothered about “I felt guilty. Ijustwanted to getback what level you’ll recover to,” heexplains. “You feel damagedandyou don’t know recovery, hefelt likeadifferent person. your senseofself. Jasonsays that during A cardiac event canhave on ahugeimpact Regaining identity relying onmy wife to protect me.” the house. That allchangedbecauseIwas fashioned butIwas always themanof strange feeling.very might soundold It bloketobig burly beallvulnerable, it’s a guts to doitonmy own,” hesays. “For a wife withmebecauseIdidn’t have enough alonghisroad.walking “I hadto takemy the garden, andgradually increased itto this fear andincrease your confidence. increase inactivity, which may helpreduce term.” Instead, sherecommends agradual leadto more inthelong actually anxiety our recovery,” shesays. “Avoidance can that canhelpwith some ofthefactors “However, whenwe dothiswe remove “It’s for usto takeastep important Health issuescanalsoaffecthow you and upanddown by walking Jason started D sessions. exercise His compare myself withthem.’ directly different experiences, soit’s notaccurate to may have different cardiac diagnoses and to think: inmy‘Others exercise group exercises thanme.’ could bemore It helpful cardiac rehab group isdoingmore intense think: inmy‘I mustpushharder; everyone them. For might example, aperfectionist aware ofyour thoughts, andreframe One helpfultechnique isto bemore traits,who have shesays. perfectionistic problem.” aheart emotional healthafter this might beunhelpfulfor ourphysical and progression,” says DrButtigieg. “However, to somebenefitsinthepast, suchascareer ourselves indomainslikeourwork hasled wesociety may have found that pushing sought outanoffice job, ashe was the incident.months after Buthesoon Jason went backto eight work part-time, Lack ofconfidence taking hisdaughters climbing taking recovery andhenow enjoys Jason’s familyhelpedhis It can be particularly hard for people canbeparticularly It there’s for you to observe anopportunity rehab. you’re“If unsure about going, askif confidence canimprove through cardiac event, symptoms suchasalackof heart patterns.thinking helpful whenyou getstuck innegative yourself, orvisualisingastop sign, canbe recognise that consciously saying ‘no’ to compassionate to himself. Psychologists stop thethoughts andbemore himself andmakesaconsciousto effort for anhouroraday butthenhesays ‘no’ to Jason says hemight gointo “a weird place” pattern,When hegetsinto thisthinking keep thepace goinglikeIusedto do?’” have issueslike: ‘Am Igoodenough?Can I life.fits backinto working Hesays: “Istill having theself-confidence to feel that he says oneofhisbiggestproblems isstill labour onhisbody. concerned abouttheeffect ofphysical In this adjustment period after a thisadjustment after period In Four years onfrom hisepisode, Jason Heart Matters Heart Jason’s top tips for rebuilding confidence

1 Set yourself a timetable “I would watch the TV for an hour, have breakfast, get up, sit downstairs and do some reading, get a visitor, do a walk in the afternoon, and I’m here, I’m the day passes. You have to have watching my a routine.” kids grow up... 2 Accept visitors “I think visitors, as tiring as they may that’s wonderful” be – and it is extremely tiring – are very important. You get a glimpse of a group first, to manage any nerves or this tired’ or ‘I must get back to work’. We normal life and this gives you hope misconceptions,” Dr Buttigieg says. “Or call this ‘should-ing’ and ‘must-ing’. Try to and encouragement.” invite your loved ones to come along to reframe these thoughts more realistically a cardiac rehab session, the assessment by, for example, thinking: ‘Working half 3 Set realistic goals appointment or final review. You can also days is actually significant progress. I was “You might think of making a cup ask for one-to-one support from your on sick leave just three months ago.’” of tea as a menial task. But these cardiac psychologist if you need it. The Jason still gets frustrated, but now tasks are parts of your life that you teams want to work to support you and appreciates his level of ability and tries can get back.” find a way to meet your individual needs.” not to fall into negative thinking patterns. His daughters, now aged 15 and 13, both 4 Get a little independence Facing frustration enjoy indoor climbing, which he isn’t able “Try to physically be able to do For Jason, an ongoing obstacle is to do. “My pleasure now lies in seeing other things for yourself, such as washing frustration at not being able to do the people do stuff,” he says. “If you don’t twist yourself or walking down the garden things he wants to do, or doing them your mind round to that way of thinking, and back. This will have a huge effect slower or worse than before. you’re for ever going to be in a frustrated on your confidence.” This is quite typical, Dr Buttigieg says, mind-set, and bitterness can creep in. particularly when meaningful roles – like “I only asked ‘Why me?’ once, and then 5 Go outside being a parent, grandparent or friend – are I felt guilty and thought: ‘Why not me?’ “Even if you don’t want to, force affected by the heart problem. I refuse to get bitter and angry about what yourself to go out. The biggest thing “Try to understand which thoughts arise has happened to me. Now I think: ‘I’m here, you can do to get back to your life during times when you are frustrated, I’m watching my kids grow up. If all is to overcome the fear of going out and how they might be unhelpful,” she I can do is watch them grow up, then again – and that’s massive.” says. “Some examples are: ‘I shouldn’t be that’s wonderful.’” bhf.org.uk 43 ACTIVITY

Six super reasons to BOWL This social sport is suitable for all levels of fitness. Rachael Healy finds out why you should try bowls Photography: Getty

44 Heart Matters There’s a club near you gets nearest to the jack gets a point and you’re playing. You’re only doing 30m stints 1 First, you need a place to play. Many wins what’s called the ‘end’,” explains Matt at a time, but you’re doing a lot of them.” bowls players are members of clubs, Wordingham from Bowls England. “It is On top of the walking, your arms will which provide facilities and opponents. added up over 18 or 21 ends.” get a workout as you perfect your bowling There’s usually an annual fee (from £40 to After each end, play is reversed and technique and your leg muscles will £150). A lot of clubs offer free beginner the teams bowl towards the other side of develop as you lunge into the throw. sessions so you can try before you join, the green. Players can try to knock their and then a cheaper fee for your first year. opponents’ bowls away from the jack or There’s a social side “With more than 2,500 clubs across position a bowl to block opposition shots. 5 Many bowls clubs put on regular social England, there’s bound to be one near to You can play singles, pairs or in teams. In functions. There are also opportunities to you,” says Tony Allcock, Chief Executive singles, scoring is a bit different – the first join the club committee or volunteer in the of Bowls England. Go to bowlsengland. player to reach 21 points is the winner. day-to-day running of the club. “There is a com or call 01926 334609 to find a lot of socialising and you don’t have to be club in England. If you’re in Scotland, There are many varieties to try competitive to play,” says Matt. “If you just Wales or Northern Ireland, visit 3 The most common type of bowls is flat want to play with your friends on a bowlsscotland.com (01292 294623), green bowls (represented by Bowls Wednesday afternoon, there’s nothing welshbowlingassociation.co.uk or England), which is played outdoors on a stopping you.” nibabowls.co.uk. level grass surface. But that’s not the only You can also play indoors. Contact way to bowl. There is crown green, It’s perfect for all your local leisure centre to find out if federation, indoor and carpet bowls. Crown 6 “Bowls truly is the sport for all, they have an indoor green. Drop-in green bowls is a regional variety, played on regardless of age, sex or physical ability,” games cost around £5. a grass surface, but with a hump in the says Tony. The gentle pace and lack of middle of the green. Indoor and carpet are contact means you’ll often find children The rules are simple similar to flat green, but played inside. You playing with adults and people of different 2 Next, you need to know the rules. can learn more about crown green, indoor abilities and fitness levels on the same team. Fortunately, they’re easy to learn. or carpet bowls clubs at bowlsclub.org. Despite what you might think, it’s not just Bowls is played on grass (the green). a sport for retirees. “The general bowler is A game starts by throwing the jack (a It’s a gentle way to get active over 55,” says Matt. “But in our international small white ball) down the green. Each 4 “I don’t think you realise how much teams, there is barely anyone over 40. We team has different colour bowls to roll walking you do until you actually play it,” have an under-25 and under-18 international towards the jack. “The person who says Matt. “You can walk three miles while team as well.”

Steve’s story

Steve Bacon, 56, has me company. The bowling club is almost Bowls also provided motivation for played bowls since he was an extended family.” Steve during his recovery. “When you in his twenties, with only Steve is now Development Officer at have heart problems you have to set a short break when he Bowls Leicestershire and plays at least yourself small goals,” he says. “Getting needed heart surgery. three times per week at Birstall BC. He back on the bowling green was one of “It’s a game that can be played by says the friendly nature of the sport has my targets. And in the meantime, going everyone and you find your own level,” he been a real draw. “There’s a social side and down to the club and seeing people says. “You can play on a casual basis or in camaraderie between members,” he says. would keep my spirits up.” clubs or teams with more competition.” “Entertainment gets put on. A lot of clubs Once he got the go-ahead to go back When Steve turned 40, he found out he have coffee mornings and quizzes; some to bowls, the regular activity helped Steve needed quadruple heart bypassD surgery. clubs even have an indoor skittle alley. It increase his fitness levels. “It is a good low “The friendship of the people from the is really good. We try to get local people level of activity, “ he says. “It occupies the club [Syston BC] was great,” he says. “They involved. The best bowling clubs are mind and keeps the body ticking over, would ring me up or pop round to keep where it becomes part of the community.” which is vital as people get older.”

bhf.org.uk 45 ACTIVITY FIT FOR surgery Being active can help you prepare for surgery and improve your recovery. Rachael Healy puts common questions to two experts

aiting for sooner than those who surgery Professor Mike Grocott didn’t. These patients were can be a ≠ Professor of Anaesthesia also less likely to contract stressful and Critical Care pneumonia, which is a time. It Medicine, University potential complication can feel of Southampton following heart surgery. likeW life is on hold. However, ≠ Consultant in Critical Care In a trial at McMaster there is growing evidence Medicine at University University, Canada, bypass that getting moving can Hospital Southampton surgery patients exercised help prepare your mind NHS Foundation Trust twice a week in the run-up and body for an operation. ≠ Leads the Fit-4-Surgery to the operation. Patients Professor Mike Grocott research consortium did a warm-up, around 30 studies the effect of physical minutes of aerobic activity activity on patients before Professor Rupert Pearse such as cycling or brisk they have surgery. He works ≠ Professor of Intensive Care walking, and a cool-down. with patients awaiting Medicine, Queen Mary These patients spent on surgery to remove tumours. University of London average one day less in It’s hoped his research ≠ Leads the Critical Care and hospital and, six months could help develop activity Perioperative Medicine after surgery, reported programmes for patients Research Group better quality of life than facing all kinds of surgery. ≠ Researches ways to those outside the trial. Patients in Professor improve long-term Grocott’s study do two or outlook for patients How could physical three sessions per week undergoing major surgery activity help me on exercise bikes before before surgery? surgery. So far, results are Pre-surgery activity can encouraging. Patients appear to get fitter benefit people with a range of health and recover faster. “We’ve just done the first conditions including coronary heart randomised study that shows quite clearly disease, COPD [chronic obstructive that you could train patients and make them pulmonary disease] and heart failureD. fitter,” he says. “It also shows an improved It has psychological benefits, too. surgery outcome.” “You can be empowered to improve your Similarly, a review of evidence in 2012 journey; therefore, thinking about improving suggested heart surgery patients who lifestyle before surgery is important,” undertook a course of exercise before says Professor Grocott. As well as being their operation were able to leave hospital a distraction from negative thoughts,

46 Heart Matters You can be empowered to improve your journey”

bhf.org.uk 47 physical activity makes your brain produce endorphins, which can reduce feelings of pain and help you feel more positive. Isn’t there a risk I’ll make my condition worse? Many people with heart conditions worry that exercise will put a greater strain on their heart. It’s important to remember that for the majority of heart patients, being active is much more likely to benefit you than cause harm. To put your mind at rest, and so you know what you’re doing is right for your condition, consult your doctor before you start. Professor Grocott says: “If you know you’ve got heart disease then it’s worth consulting someone, because activity is so important exception may be arrhythmogenic right and will lengthen your life.” AT A GLANCE ventricular cardiomyopathy (ARVC). You can also ask your doctor for advice on 1. Know your limits For people with ARVC, it is particularly what kind of activity is best for you. It’s normal to experience mild important to get individual advice from breathlessness during exercise, but your doctor before you start. Intense What sort of exercise would dizziness, feeling unwell, very tired, exercise is usually not recommended for you recommend? or in pain, could be signs you’re people with any type of cardiomyopathy. It can be wise to start small. Even 10 minutes doing too much. If you have an enlarged aorta (such as an of walking per day is better than nothing. 2. Don’t go it alone abdominal aortic aneurysm), you may be “Going for a good walk just once a day is Take someone with you or stick to advised not to do strenuous exercise. likely to improve the fitness of some patients well-populated and well-lit areas quite significantly, in a way that will benefit if you’re doing activities outside. How will I know if I’m doing them when they come to have surgery,” says Knowing plenty of people are too much? Professor Pearse. If you don’t currently do around could help exercise feel When you’re exercising it’s normal to any physical activity, start with a slow walk. less intimidating. experience symptoms of mild Build up speed as you start to feel more 3. Check with an expert breathlessness. “That is what happens comfortable. Be aware of your breathing If you’re feeling nervous, check in when your body is working harder, but and get to know your limits so you can take with a medical professional before anything more than slightly out of breath a rest when you need it (see box, right). increasing your physical activity. is probably a bit too much,” says Professor Build up to a moderate intensity during 4. Be prepared Pearse. “The amounts of activity people activity – so you feel warmer, breathe harder Take your medication with you. have to do to reach that threshold will be and your heart beats faster, but you can still 5. Keep hydrated different, but feeling slightly out of breath, have a conversation. This is unlikely to be Drink water before, during and then recovering within a few minutes and harmful for most people. after you exercise. not feeling unwell or dizzy would be the “Cycling is also good and has the right volume. advantage that it’s a non-load-bearing You may also want to avoid standing up too “Pain is a bad sign. If you’re exercising exercise,” says Professor Grocott. But the quickly, as this can cause light-headedness. and you’re getting pains in your joints main thing is to find an activity that suits “We don’t want people stressing their and muscles, that may be a sign to be you. “You should find something that you bodies in a way that means they become more cautious.” can fit into your lifestyle and that you might injured and their mobility suffers as a result,” even enjoy,” he says. says Professor Pearse. The best type of activity for your heart is Whatever you choose, warm up and cool Having surgery soon? aerobic activity – the kind that causes you down gradually. ≠ Read our complete guide to to breathe a bit faster. This includes dancing, preparing for a hospital stay at bhf.org. aerobics classes, brisk walking and cycling. Are there any conditions that mean uk/prepare or call 0870 600 6566 to Generally, activities to avoid are strenuous you shouldn’t exercise? order your copy of the Jan/Feb 2015 ones such as weightlifting or heavy digging, Most heart patients will be able to issue of Heart Matters. as well as anything that brings on angina. do moderate-intensity exercise. One

48 Heart Matters DICTIONARY

MEDICAL TERMS EXPLAINED

Ablation A procedure to to help restore a normal to the ultrasound scan used there is too much in the blood, A correct or control certain heart rhythm. It can be done during pregnancy. can increase your risk of getting types of abnormal heart using medicines (chemical cardiovascular disease which rhythms. It involves using cardioversion), or by giving Familial hypercholesterolaemia includes having a heart attack radiofrequency waves to the heart a controlled electric F(FH) A genetic condition that or a stroke. destroy the abnormal shock with a defibrillator results in very high cholesterol electrical pathways. (electrical cardioversion). levels. Having FH gives you a Implantable cardioverter Angina An uncomfortable Coronary artery bypass surgery much higher risk of getting CHD. Idefibrillator (ICD) A small feeling, tightness or pain in An operation to treat coronary device implanted under the your chest that may also be felt heart disease. Arteries from Heart attack Known medically skin on your chest, connected in your arms, neck, jaw, back your chest wall and arm, or Has a ‘myocardial infarction’, to your heart by one or more or stomach. The symptoms of veins from your leg, are used to or ‘MI’. This describes a sudden wires (leads). It monitors your angina are usually caused by bypass the blocked or narrowed loss of blood flow to part heart rhythm and can deliver coronary heart disease. coronary arteries, improving of the heart muscle. Most a controlled electric shock if Atrial fibrillation (AF) An blood flow to the heart muscle. heart attacks are caused by you have a life-threatening abnormal heart rhythm in Coronary heart disease (CHD) atherosclerosis, the build-up abnormal heart rhythm. which the atria (the upper When the walls of the coronary of atheroma (plaque) within chambers of the heart) beat in arteries (the arteries that supply artery walls. If the atheroma Pacemaker A small device an irregular pattern. People with blood to the heart muscle) becomes unstable, a piece P implanted under the skin AF have an irregular, sometimes become narrowed due to a may break off and lead to a on the chest, connected to fast, pulse. gradual build-up of plaques, blood clot. This can block a your heart by one or more called atheroma. coronary artery, causing a heart wires (leads). Monitors the Bypass See coronary artery attack and irreversible heart heart’s electric signals and B bypass surgery. Diabetes A condition in muscle damage. It is a medical can stimulate your heart D which glucose (sugar) emergency and can lead to a to contract and produce a Cardiac rehabilitation Also levels in the blood are too cardiac arrest. heartbeat if required. Ccalled ‘cardiac rehab’, this high. There are two main Heart failure Condition where is an education and exercise types of diabetes: type 1, the heart becomes less Stroke An interruption of programme to help you recover where your body stops efficient at pumping blood S blood flow to part of the from a cardiac event and get producing insulin, and type around the body. brain, causing brain cells to back to as full a life as possible. 2, where your body can’t use High blood pressure Also called die or become damaged. This Cardiomyopathy Disease of the insulin it produces, usually ‘hypertension’. High blood happens if an artery carrying the heart muscle in which it because excess fat in organs pressure is when the pressure blood to your brain becomes becomes weakened. It may prevents the insulin from required to pump blood is blocked, or if an artery bleeds become thickened, enlarged working effectively. consistently higher than the into your brain. A stroke is a and/or stiff, depending on the Diabetes increases your recommended level. This puts medical emergency. type of cardiomyopathy. It risk of developing extra strain on your heart and affects people of all ages and is cardiovascular disease. blood vessels, and over time Ventricular tachycardia Also usually inherited. can increase your risk of having V called ‘VT’. A very fast, Cardiovascular disease (CVD) Echocardiogram Sometimes a heart attack or stroke. abnormal heart rhythm that Includes all diseases of the heart E called an ‘echo’. A test to High cholesterol Cholesterol is a starts in the ventricles (the and circulation, such as coronary examine the structures within waxy substance that is mainly lower chambers of the heart). heart disease and stroke. the heart, for example the heart made in the body and plays a This is a medical emergency Cardioversion Treatment for valves, and to see how well the vital role in how every cell works. that, if not treated, can lead to some abnormal heart rhythms heart is pumping. It is similar However, high cholesterol, when a cardiac arrest.

Call the Heart Matters Helpline on 0300 330 3300 if you want to know more bhf.org.uk 49 BHF SUPPORT

Use our booklets, DVDs and information sheets to help you improve your heart Want to measure your blood pressure health and get support on living with a heart condition. To see the whole range at home? Watch our of guides, order the Take heart (G5) catalogue short film on how to do it at bhf.org.uk/ ORDER YOUR FREE GUIDES pressure. Healthy eating and lifestyle Be active for life (physical activity information for over-65s) G364 Heart to heart: heart disease and Cut the saturated fat M4 your emotional wellbeing G954 Eating well G186 Heart transplantation HIS13 Eat well. Shop smart. Save money Heart valve disease HIS11 (DVD – healthy eating on a budget) DVD31 Implantable cardioverter defibrillators (ICDs) HIS19 Everyday triumphs (for mental health service users) G972 Lifelines: heart surgery and after (DVD) DVD10 Facts not fads – your simple guide to healthy weight loss M2 Living with heart failure HIS8 Get active, stay active G12 Medicines for your heart HIS17 Get up and go My progress record (a manual to keep important information (DVD – physical activity for over-65s) DVD32 about your medication, test dates and results) M92M Healthy living, healthy heart One step at a time – living with heart failure (DVD) DVD5 (information for African Caribbean communities) G532 Pacemaker – your quick guide G968 Healthy living, healthy heart Peripheral arterial disease HIS16 (information for South Asian communities) G971/E Physical activity and your heart HIS1 Keep your heart healthy HIS25 Primary angioplasty for a heart attack HIS26 Risking it – short films designed to Reducing your blood cholesterol HIS3 help you tackle risk factors bhf.org.uk/riskingit or DVD21 Returning to work HIS21 Stop smoking G118 Stroke – your quick guide G969 Taste of South Asia (South Asian recipes) G606 Tests HIS9 Taste of the Caribbean (African Caribbean recipes) G503 The road ahead – your guide to Ten minutes to change your life – take time out G926 heart tests and treatments DVD30 Ten minutes to change your life – time to eat well G923 This label could change your life G54 Women and heart disease M37 Your heart, our help G598 Printer perfect Living with a heart condition You can also print most of our information sheets and booklets at home – go to bhf.org.uk/HMpublications. An everyday guide to living with heart failure G275U Angina HIS6 Atrial fibrillation – your quick guide G963 Angina Blood pressure HIS4 This booklet is for people Cardiac rehabilitation – your quick guide G964 with angina and their friends Caring for someone with a heart condition HIS20 Angina and family. It explains what and living angina is, what causes it, how Coronary angioplasty HIS10 life to the full it is diagnosed, and how it is Diabetes and your heart HIS22 Jonathan Kirkman treated. It also explains what Electrocardiogram – your quick guide G965 to do if you get an episode of Having heart surgery HIS12 angina or if you think you may Heart attack – your quick guide G966 be having a heart attack. Heart rhythms HIS14 Order code: HIS6

Order your free guides by calling 0870 600 6566 or visiting bhf.org.uk/HMpublications 50 Heart Matters Inside the magazine of FREE the British Heart Foundation Spring 2017

Spring 2017

YOUR BHF ENJOYED READING FREE PULL OUT AND KEEP 4 Your letters BRUNCH RECIPE CARDS 6 N e w s Sudden change THIS MAGAZINE? Air pollution and A stroke can seem like the end BHF breakthrough in Jason explains how he learned heart disease risk BHF special report of life as you know it. heartbeat research to adapt after a cardiac arrest It’s a feeling familiar to many 8 Spotlight on... Turn to page 41 air pollution Echocardiograms people who experience a sudden Receive your own copy How they can help Why this is an invisible diagnose heart disease health issue, whether it’s a cardiac Plant power Protein doesn't have arrest, heart attack or something problem, and how you and much more… to mean meat else. But life can go on. Sometimes it can reduce your risk On the 10 Behind the headlines FIGHT is diff erent. Sometimes it is possible FOR EVERY Is working out at the Join Heart Matters – the FREE programme HEARTBEAT BEAT to make positive changes. bhf.org.uk Paul's back in the swing weekend enough? that can change your life. of things after a stroke

Jason Gutridge felt like his life 49 Dictionary was over when he suff ered from a Medical terms COD sudden cardiac arrest. He explains explained • Kick-start your healthy lifestyle: your how he learned to adjust (page 41). 50 Information membership pack includes the latest Reading Heart Matters In our cover story (page 11), three and support issue of Heart Matters magazine, an allows me to concentrate inspiring survivors, Paul, Mark and A guide to our introduction to the BHF, a tape measure Margaret, explain how they’ve free resources and a recipe folder. on looking after my heart” discovered that there is a life after a • Be inspired: Heart Matters magazine Kirsty Munn, Derby Fold along this line stroke and have even embraced MY STORY contains real-life stories, the latest research new opportunities. We’re working to 11 Life after stroke and tips for keeping healthy. Three stroke survivors stop people suff ering from strokes, Collect healthy recipes: in your recipe folder. share their inspiring • too. That’s why Professor Joanna recovery stories • Stay up to date: fortnightly e-newsletters. Wardlaw is researching a type called 22 Riding high • Get online: take advantage of our online lacunar stroke (page 35). It leaves How pursuing new healthy eating tools and online community. holes in the brain that can lead to interests helped • Ask the experts: call our Helpline problems processing information Mike through his MEDICAL NUTRITION on 0300 330 3300* for heart health and even dementia. She’s trying to heart problems 15 Ask the experts 26 Rise and shine information and support. Are branded Start your day right RECIPES fi nd new treatments. FOR SUCCESS medicines better? Plus with one of these For over 50 years we’ve pioneered research

All our research aims to fi nd that’s transformed the lives of millions of Recipe folder people living with cardiovascular disease. Our work has been central to the discoveries migraine and stroke must-try breakfasts of vital treatments that are changing the fight solutions for real problems, so we against heart disease. But cardiovascular disease still kills around one 16 Testing times: echo in four people in the UK, stealing them away can stop the devastation of heart from their families and loved ones. From babies born with life threatening How echocardiograms heart problems, to the many mums, dads and grandparents who survive a heart attack and circulatory disease. That’s what and endure the daily battles of heart failure. Join our fight for every heartbeat in the can help diagnose UK. Every pound raised, minute of your drives Professor Paolo Madeddu, too time and donation to our shops will help make a difference to people’s lives. heart problems * (page 32). In a fascinating interview, Text FIGHT to 70080 to donate £3 * 18 Vital statistics: Lines are open 9am–5pm, Monday to Friday. FIGHT FOR EVERY he tells us how the pain that comes *This is a charity donation service for the BHF. Texts cost £3 + 1 standard rate message. The BHF will receive 100% of your donation to fund our life HEARTBEAT Costs are similar to 01 and 02 numbers. saving research. To opt out of calls and SMS, text ‘NOCOMMS BHF’ to 70060. If you have any questions about your gift, call 0203 282 7862. HMSUM15 bhf.org.uk RESEARCH weight and waist © British Heart Foundation 2015, a registered charity in England and Wales (225971) and Scotland (SC039426)

with a heart attack could actually 32 No pain, no gain? What these

help the body to heal itself. bhf.org.uk/heartmatters

How pain could help measurements can at up join can members family and friends Matters: Heart 28 Plant power SHARE

heart-healthy recipes from every issue of your magazine your of issue every from recipes heart-healthy

when it comes to tell you about your How to get protein COLLECT heart attacks heart risk without meat, and the 25/04/2016 10:55 It’s easy3859_Recipe Card Wallet 250416.indd to 26 sign up. Just fill in the form attached 35 Watch this space 19 Focus on: endocarditis benefi ts it can bring How a little-known We look at this rare 31 Ask the expert and send it back to us at no charge. FIGHT stroke can leave heart infection and ‘Clean eating’ and FOR EVERY Sarah Brealey, Editor Or visit bhf.org.uk/heartmatters to sign up online today. Cover photography: Greg Funnell. Photography:Iwan Gareth Jones Funnell. photography: Greg Cover holes in the brain speak to those aff ected artifi cial sweeteners HEARTBEAT bhf.org.uk 2 Heart Matters Spring 2017 UPDATE YOUR CONTACT DETAILS If the details we hold are incorrect or require updating, please complete this form. Alternatively, call the Heart Matters Helpline on 0300 330 3300, or visit our website at bhf.org.uk/login, to update your details.

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We’d be grateful if you could tell us the reason for cancelling your membership. This helps us to improve our service and make sure our records are up to date. The person who normally reads it has passed away. I no longer find it useful. On the I get this information and support from somewhere else. If so, please provide details below: FIGHT BEAT FOR EVERY Tick here to unsubscribe from all other contact from the British Heart Foundation. Paul's back in the swing Find out more in our Privacy Policy at bhf.org.uk/utilities/our-privacy-and-cookies-policy. HEARTBEAT Please note, you must tick the Heart Matters cancellation box in the section above to cancel your membership as well. bhf.org.uk of things after a stroke DUE TO THE TIME TAKEN TO PROCESS THIS INFORMATION, CHANGES MAY TAKE FOUR TO SIX WEEKS TO COME INTO EFFECT

FILL IN THIS FORM, TEAR, FOLD, MOISTEN AND SEAL BRUNCH Ingredients 225g (8oz) sweet potato, 4 portobello mushrooms, Sweet potato rosti, peeled and coarsely grated about 115g (4oz) total weight 2 tsp olive oil 2 large tomatoes, halved egg and mushrooms 3 spring onions, 1 tbsp chopped fresh Preparation time: 15 mins Each portion contains: finely chopped thyme (or try chives, Carbo- Energy Sugars Fat Saturates Salt coriander or basil) Cooking time: 35 mins 23% 3 small eggs hydrate 1138kJ 13.1g 13g 4.1g 0.42g Serves: Two 22.5g 272kcal Low Med Low Low Not suitable for home freezing 14% 15% 19% 21% 7% % = an adult’s reference intake Method 1 Heat the oven to 220°C/ 5 Put the mushrooms and 200°C fan/gas mark 7. Put the tomato halves on a second foil- grated potato in a clean muslin lined baking sheet and brush or tea towel and squeeze out the with the remaining oil. Season excess liquid. with pepper and thyme.

2 Heat half the oil in a small, 6 Put rosti onto upper shelf non-stick frying pan and fry the of oven and mushrooms and spring onion for 3–4 minutes until tomatoes underneath. Roast soft and golden. everything for 30 minutes until rosti are golden and tomatoes 3 Mix the onion and sweet and mushrooms cooked. potato with one egg then season well with ground black pepper. 7 About five minutes before end of cooking time, poach eggs 4 Shape the sweet potato to your liking (see bhf.org.uk/ mixture in four round rosti poached). Serve on the rosti with cakes and place on a foil-lined mushrooms and tomatoes. baking sheet.

Moyra Fraser Our resident food writer Moyra is a former See easy meals with Telegraph food columnist and author of just four ingredients at numerous cookery books. bhf.org.uk/simplemeals. Recipes and food styling: Moyra Fraser; prop styling: Kim Sullivan; photography: William Shaw styling:William styling: Kim prop Recipes Moyra Fraser; and food Sullivan; photography: BRUNCH Ingredients 150g (5oz) chestnut 2 medium eggs Mushroom and mushrooms, sliced 4 tbsp skimmed milk 115g (4oz) red onion, 2 tbsp chopped fresh basil, cauliflower frittata thinly sliced chives or flat-leafed parsley Preparation time: 15 mins Each portion contains: 1 tsp olive oil 25g (1oz) reduced-fat Cooking time: 15 mins Carbo- Energy Sugars Fat Saturates Salt 150g (5oz) cooked cauliflower soft cheese hydrate 988kJ 9.9g 11.5g 3.5g 0.46g Serves: Two 13.3g 236kcal Low Med Low Low (or broccoli), chopped into 1 tbsp (5g) finely grated Not suitable for home freezing 12% 11% 16% 18% 8% bite-sized pieces parmesan cheese % = an adult’s reference intake

Method 1 Put the mushrooms and 3 In a separate bowl, beat onion in a small, non-stick frying together the eggs, milk, herb and pan and stir in the olive oil. The soft cheese and pour into the mixture will look too much for the pan, over the vegetable mixture. pan at first, but the mushrooms and onion will cook down after a 4 Continue to cook over a low few minutes. heat for a further five minutes, then sprinkle with the parmesan 2 Fry together over a low heat and pop under a hot grill for 2–3 for a good 10 minutes, or until minutes to brown the top. Serve the onion and mushrooms are hot or cold with a fresh salad. soft and golden and there’s no excess liquid in the pan. Stir in the chopped cauliflower.

Cook’s tips “The cooked frittata keeps well, wrapped in foil in the fridge for two days. Serve cold

These recipes are from Heart Matters Spring 2017 with salad. FREE “Add any leftovers at Step 1, PULL OUT magazine, Spring 2017. AND KEEP BRUNCH RECIPE If you’d like to receive Heart Matters and CARDS such as roast chicken or Explore easy ways to make Air pollution and heart disease risk you’re not a member, join for free by calling BHF special report chopped roasted vegetables.” your meals Mediterranean 0300 330 3300 (costs are similar to 01 and 02 with our fun tool at Echocardiograms How they can help diagnose heart disease bhf.org.uk/makeitmed. numbers) or visit bhf.org.uk/heartmatters. Plant power Protein doesn't have to mean meat On the FIGHT FOR EVERY BEAT HEARTBEAT Paul's back in the swing bhf.org.uk of things after a stroke BRUNCH Ingredients 115g (4oz) potato, peeled, 75g (2½oz) ricotta cheese Pea and boiled and mashed 1 medium egg yolk 55g (2oz) frozen peas, Finely grated rind of ½ lemon ricotta fritters defrosted and crushed (with 2 tsp chopped fresh mint, a fork) Preparation time: 10 mins, Each portion contains: chives or basil plus 20 mins chilling Carbo- Energy Sugars Fat Saturates Salt 55g (2oz) fresh spinach or hydrate 736kJ 2.2g 9.4g 4g 0.23g A little vegetable oil Cooking time: 20 mins 12.5g 176kcal Low Med Med Low watercress finely shredded Serves: Two (four fritters) 9% 2% 13% 20% 4% % = an adult’s reference intake

Method 1 Stir together all of the 4 Carefully flip over with a ingredients, except the oil, with a palette knife and cook the other little ground black pepper. Cover side. Remove to a plate and with cling film and refrigerate for keep warm. Repeat with the 20 minutes. remaining mixture.

2 Wipe the base of a non-stick 5 Serve warm with roasted frying pan with a little vegetable cherry tomatoes on the vine, oil and place over a medium heat. roasted peppers or ratatouille.

3 Spoon a quarter of the mixture into the hot pan and shape into a round, flat circle. Leave over the heat for a good 2–3 minutes until a golden crust forms underneath.

Cook’s tips “Like the other recipes in this issue, these would be delicious for a leisurely brunch, but good for lunch Moyra carefully creates and tests every recipe to or dinner too.” make sure the dishes we share with you are both Find out how to eat healthy and delicious. For even more meal ideas, more vegetables without visit bhf.org.uk/recipefinder. noticing at bhf.org.uk/veg. BRUNCH Ingredients Oat pancakes with 50g (3½oz) rolled oats For the apple and 50g (3½oz) self-raising flour blueberry compote fruit compote ¼ tsp bicarbonate of soda 1 red dessert apple ¼ tsp ground cinnamon 175ml (6fl oz) apple juice Preparation time: 15 mins Each portion contains*: or ginger Small piece fresh root ginger, Cooking time: 20 mins Carbo- Energy Sugars Fat Saturates Salt hydrate 1660kJ 34.6g 4.6g 0.9g 0.83g peeled and sliced Serves: Two 71.6g 393kcal High Low Low Low 1 dessert apple, about (six small pancakes) 20% 38% 7% 5% 14% 175g (6oz), peeled and 1 tsp arrowroot Suitable for home freezing % = an adult’s reference intake coarsely grated 55g (2oz) blueberries 150ml (¼ pint) skimmed milk 100g (3½oz) fat-free thick 1 egg white yoghurt such as fat-free A little vegetable oil Greek or skyr (creamy Icelandic-style yoghurt)

Method 1 To make the compote, core 5 Remove to a plate and and thinly slice apple (no need to keep warm while you cook the peel). Put into pan with juice and remaining mixture. ginger. Bring to the boil. Simmer until softened, about 10 minutes. 6 Remove the sliced ginger from the compote. Stir about 2 Mix the arrowroot with two two tablespoons of the compote teaspoons of water and stir into liquid into the yoghurt. Serve the apple mixture. Bring to the the warm pancakes with the boil and bubble for one minute, compote and flavoured yoghurt. until lightly thickened. Stir in the blueberries and leave to cool. *Although the total sugars in this recipe are classed as high, the only free sugars are from the apple juice. The 3 In a small bowl mix the first rest is from the fruit, milk and yoghurt. six pancake ingredients. In a large bowl, whisk the egg white until it forms stiff peaks then fold into the oat and apple mixture with a metal spoon.

4 Wipe the base of a small, non- stick frying pan with vegetable oil Want more breakfast and place over a high heat. Drop inspiration? Check out our two or three spoonfuls of mixture 14 delicious heart-healthy into the pan and reduce the Are you a protein pro? porridge ideas at heat. Leave to cook for about five Take our quiz to find out at bhf.org.uk/porridge. minutes on each side. bhf.org.uk/proteinquiz. Recipes and food styling: Moyra Fraser; prop styling: Kim Sullivan; photography: William Shaw styling:William styling: Kim prop Recipes Moyra Fraser; and food Sullivan; photography: