NOT A MEMBER? JOIN TODAY! November/December 2015 1 Your details

Title First name Last name KEEP HEARTS BEATING FREE House name/number Street

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2 Your Heart Matters membership Please tell us how you would prefer to read your Heart Matters magazine (select one option only). PLUS Magazine delivered to me every two months.  Top tips for Online version of Heart Matters magazine every two months (we will send you an email to tell you when the magazine is available online). healthy meals Please ensure you have provided us with a valid email address above. in a hurry In addition to your Heart Matters membership, you can receive a bi-monthly e-newsletter with the latest news from Heart Matters. Tick here to receive it (please ensure you have provided us with a valid email address above).

3 Keeping in touch 10WAYS TO By submitting this form, you agree to us adding your details to our database, so that we can contact you about this matter going forward. We would also like to keep you up to date with news about our work and ways you can get involved. REBUILD YOUR Yes please, I’d like to hear from you by email CONFIDENCE Yes please, I’d like to hear from you by text message or MMS No thank you, please do not contact me by mail Our Christmas cards fund life saving research that keeps more families together at Christmas. No thank you, please do not contact me by telephone From time to time we may allow other similar or partner organisations to contact our supporters. If you do not wish to hear from them, please tick here Purchase BHF Christmas cards online and Visit bhf.org.uk/christmascards We will keep your details safe and you can unsubscribe or change your preferences at any time by calling 0300 330 3322. receive free delivery on orders over £10, or our BHF shops to view and purchase Please read our Privacy Policy for more details. exclusive to Heart Matters readers. the full range of cards, or order by calling 4 This section is for healthcare professionals or Heart Support Groups only Enter discount code*: CHRISTMAS2015 0116 232 4195. Are you a healthcare professional? Yes No Mark of Name of your organisation 71693 Praying Angel (10 pack) £3.25 71727 Cut Out House (10 pack) £3.25 71736 12 Days Pear Tree (10 pack) £3.25 71751 O Christmas Tree (10 pack) £3.25 What is your profession? Community dietitian Dietitian Doctor Pharmacist Community nurse Practice nurse Hospital nurse 71755 Glitter Robin (10 pack) £3.25 71731 Kings & Shepherds (10 pack) £3.25 Other (please specify) Are you a member of a Heart Support Group? Yes No FIGHT strength How many printed copies of Heart Matters magazine (per issue) would you like to receive? 1 10 25 50 100 FOR EVERY Triumphing over the emotional and By providing the BHF with any personal data, you consent to the collection and use of this information in accordance with the above purposes and our privacy statement, which can be found at bhf.org.uk. HEARTBEAT *Discount valid until 31 December 2015, while stocks last. Terms & Conditions apply, see website for details bhf.org.uk physical scars of heart surgery © 2015 British Heart Foundation, a registered charity in England & Wales (225971) and Scotland (SC039426)

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2 Heart Matters Heart

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REBUILD YOUR YOUR REBUILD

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. 7862. 282 0203 call gift, your about questions any have you If 70060. to BHF’ ‘NOCOMMS text SMS, and calls of out opt To research. saving

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NOT A MEMBER? JOIN TODAY! November/December 2015 1 Your details

Title First name Last name KEEP HEARTS BEATING FREE House name/number Street

City/Town County Postcode THIS CHRISTMAS

Date of birth PULL OUT AND KEEP Home/work phone Mobile phone Risk factors THE BIG Email FREEZE explained RECIPE Why are you signing up for Heart Matters membership? Cut your CARDS For myself Because I’m caring for someone with a heart condition For my work Other (please specify) chances of heart disease 2 Your Heart Matters membership Please tell us how you would prefer to read your Heart Matters magazine (select one option only). Magazine delivered to me every two months.  PLUS Online version of Heart Matters magazine every two months (we will send you an email to tell you when the magazine is available online). Top tips for Please ensure you have provided us with a valid email address above. healthy meals In addition to your Heart Matters membership, you can receive a bi-monthly e-newsletter with the latest news from Heart Matters. Tick here to receive it (please ensure you have provided us with a valid email address above). in a hurry

3 Keeping in touch 10WAYS TO By submitting this form, you agree to us adding your details to our database, so that we can contact you about this matter going forward. We would also like to keep you up to date with news about our work and ways you can get involved. REBUILD YOUR Yes please, I’d like to hear from you by email CONFIDENCE Yes please, I’d like to hear from you by text message or MMS No thank you, please do not contact me by mail Our Christmas cards fund life saving research that keeps more families together at Christmas. No thank you, please do not contact me by telephone From time to time we may allow other similar or partner organisations to contact our supporters. If you do not wish to hear from them, please tick here Purchase BHF Christmas cards online and Visit bhf.org.uk/christmascards We will keep your details safe and you can unsubscribe or change your preferences at any time by calling 0300 330 3322. receive free delivery on orders over £10, or our BHF shops to view and purchase Please read our Privacy Policy for more details. exclusive to Heart Matters readers. the full range of cards, or order by calling 4 This section is for healthcare professionals or Heart Support Groups only Enter discount code*: CHRISTMAS2015 0116 232 4195. Mark of Are you a healthcare professional? Yes No Name of your organisation 71693 Praying Angel (10 pack) £3.25 71727 Cut Out House (10 pack) £3.25 71736 12 Days Pear Tree (10 pack) £3.25 71751 O Christmas Tree (10 pack) £3.25 What is your profession? Community dietitian Dietitian Doctor Pharmacist Community nurse Practice nurse Hospital nurse 71755 Glitter Robin (10 pack) £3.25 71731 Kings & Shepherds (10 pack) £3.25 Other (please specify) strength Are you a member of a Heart Support Group? Yes No FIGHT Triumphing over the emotional and How many printed copies of Heart Matters magazine (per issue) would you like to receive? 1 10 25 50 100 FOR EVERY physical scars of heart surgery By providing the BHF with any personal data, you consent to the collection and use of this information in accordance with the above purposes and our privacy statement, which can be found at bhf.org.uk. HEARTBEAT *Discount valid until 31 December 2015, while stocks last. Terms & Conditions apply, see website for details bhf.org.uk © 2015 British Heart Foundation, a registered charity in England & Wales (225971) and Scotland (SC039426)

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2 Heart Matters Heart

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BEAT

HEART PetersCover Kate photography: Or visit bhf.org.uk/heartmatters to sign up online today. online up sign to bhf.org.uk/heartmatters visit Or

EVERY FOR

special-edition covers special-edition

and send it back to us at no charge. charge. no at us to back it send and FIGHT their surgery scars on our on scars surgery their

Michelle and Valerie share Valerie and Michelle

It’s easy to sign up. Just fill in the form attached attached form the in fill Just up. sign 26 to 3435_RecipeFolder_PrintReady_Winter.indd easy It’s

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physical scars of heart surgery heart of scars physical

FOR EVERY FOR

Triumphing over the emotional and and emotional the over Triumphing

FIGHT

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

physical scars of heart surgery heart of scars physical

FOR EVERY FOR

and emotional the over Triumphing FIGHT SHARE Heart Matters: friends and family members can join up at strength

bhf.org.uk/heartmatters of Mark

Mark of Mark

CONFIDENCE

© British Heart Foundation 2015, a registered charity in England and Wales (225971) and Scotland (SC039426) Scotland and (225971) Wales and England in charity registered a 2015, Foundation Heart British ©

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REBUILD YOUR YOUR REBUILD

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. 7862. 282 0203 call gift, your about questions any have you If 70060. to BHF’ ‘NOCOMMS text SMS, and calls of out opt To research. saving

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Costs are similar to 01 and 02 numbers. 02 and 01 to similar are Costs HEARTBEAT

*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 life our fund to donation your of 100% receive will BHF The message. rate standard 1 + £3 cost Texts BHF. the for service donation charity a is *This

CONFIDENCE 10

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REBUILD YOUR YOUR REBUILD

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WAYS TO TO WAYS 10

in a hurry a in Lines are open 9am–5pm, Monday to Friday. Friday. to Monday 9am–5pm, open are Lines

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healthy meals meals healthy

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Cut your chances chances your Cut

*

explained explained

CARDS

RECIPE

a difference to people’s lives. people’s to difference a heart disease heart FREEZE

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chances of of chances THE BIG BIG THE time and donation to our shops will help make make help will shops our to donation and time

Cut your your Cut AND KEEP AND

CARDS PULL OUT PULL

UK. Every pound raised, minute of your your of minute raised, pound Every UK. explained explained RECIPE

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Join our fight for every heartbeat in the the in heartbeat every for fight our Join Risk factors factors Risk THE BIG BIG THE

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and grandparents who survive a heart attack attack heart a survive who grandparents and

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FREE

From babies born with life threatening threatening life with born babies From

November/December 2015 November/December

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in four people in the UK, stealing them away away them stealing UK, the in people four in

November/December 2015 November/December But cardiovascular disease still kills around one one around kills still disease cardiovascular But

against heart disease. heart against

of vital treatments that are changing the fight fight the changing are that treatments vital of

Recipe folder Recipe discoveries the to central been has work Our

people living with cardiovascular disease. cardiovascular with living people

that’s transformed the lives of millions of of millions of lives the transformed that’s

For over 50 years we’ve pioneered research research pioneered we’ve years 50 over For FOR SUCCESS FOR

RECIPES Sarah Kidner, Editor Kidner, Sarah

information and support. and information

0300 330 3300 330 0300 on health heart for

*

• Helpline our call experts: the  Ask

healthy eating tools and online community. community. online and tools eating healthy

• take advantage of our online online our of advantage take online:  Get

a Happy New Year. New Happy a

•

fortnightly e-newsletters. fortnightly date: to up  Stay

and Christmas Merry a all you wish I

•

in your recipe folder. recipe your in recipes: healthy  Collect

information and support. and information

research and tips for keeping healthy. keeping for tips and research

us, and that we’ll do our best to offer you you offer to best our do we’ll that and us,

magazine contains real-life stories, the latest latest the stories, real-life contains magazine

our readers’ stories will continue to inspire inspire to continue will stories readers’ our

Kirsty Munn, Derby Munn, Kirsty • 

our bi-monthly Heart Matters Matters Heart bi-monthly our inspired: Be Fold along this line this along Fold

bring, but one thing I’m certain of is that that is of certain I’m thing one but bring,

on looking after my heart” my after looking on

and a recipe folder. recipe a and

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measure tape a BHF, the to introduction

groundbreaking stem cell research. cell stem groundbreaking concentrate to me allows

issues of Heart Matters magazine, an an magazine, Matters Heart of issues

to mend broken hearts (page 23) with with 23) (page hearts broken mend to

latest the includes pack membership

Matters Heart Reading

proud to have met two who are looking looking are who two met have to proud

•  your your lifestyle: healthy your Kick-start

15ZM21N I’m issue, This professors. BHF-funded confidence, too. It’s a daily challenge for for challenge daily a It’s too. confidence,

that can change your life. life. your change can that

Going into the unknown requires requires unknown the into Going

bhf.org.uk

physical scars of heart surgery heart of scars physical HEARTBEAT

those who’ve lived through it. it. through lived who’ve those

Join Heart Matters – the FREE programme programme FREE the – Matters Heart Join

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can regain yours (page 40), and we hear from from hear we and 40), (page yours regain can

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Inside the magazine of Our expert team Senior Cardiac Senior Cardiac Senior Dietitian the British Heart Foundation Nurse Nurse Victoria Taylor November/December 2015 Christopher Allen Maureen Talbot advises on helps manage BHF’s has worked in nutrition and is YOUR BHF NUTRITION genetic information the NHS and the a spokesperson 8 Your letters 26 Rush-hour suppers service and has private sector in for the BHF. She 10 Spotlight Top tips for healthy specialist experience general and cardiac used to work on Women share heart meals in a hurry in cardiology and nursing, for more public health disease experiences in 28 Taste the rainbow cardiac surgery. than 25 years. campaigns. our exclusive survey The health benefits 12 N e w s of colourful meals Physical Activity BHF Associate Registered Funding defibrillators, 32 Ask the expert Specialist Medical Director Dietitian and festive cheer Can nuts be a healthy Lisa Young Dr Mike Knapton Annemarie Aburrow 15 Wear it. Beat it. festive snack? is a BHF Project has been a GP for spent eight years Wear red and help fund Plus Recipe cards Manager with a more than 30 years working for the our life saving research focus on workplace and is a director NHS and now runs 49 Dictionary RESEARCH health and physical at Addenbrooke’s a private nutrition Medical terms explained 23 Brave new world activity advice. Hospital, Cambridge. consultancy. 50 Information How stem cell research and support could help us mend A guide to our broken hearts free resources 34 Fishy tales Online exclusives  Could fish oil and bhf.org.uk/heartmattersmag MY STORY aspirin help stop heart 4 Mark of strength attack and stroke? ≠ Watch: Meet the mum who Meet three women developed a life-threatening who wear the scars of WELLBEING heart condition after giving surgery with pride 40 Building blocks birth to her son 38 Better together Experts offer tips on How David’s partner rebuilding confidence ≠ Interactive infographic: helped him through a after a heart event Explore the results of our complicated recovery survey about women and ACTIVITY heart disease ≠ 10 strange things MEDICAL 44 Back in the saddle you’d never guess increase 16 Calculated risk How Colin overcame ≠ Top 10: Colourful foods that your risk of heart disease – What can you do to the odds to cycle from are no good for you or do they? reduce your risk factors Newcastle to London for heart disease? 46 First steps ≠ 25 healthy foods that you ≠ 15 tips: Canny ways to 19 Ask the experts Exercise experts tell us can cook in five minutes transform your leftover food The pros and cons of how to get active after statins, and chest pain a heart event after a stent insertion 20 Focus on... women and Heart Matters is published by Wardour on behalf of the British Heart Foundation, Greater London House, 180 Hampstead Road, London NW1 7AW. heart disease The British Heart Foundation 2015 is a registered charity in England and We explore issues Wales (225971) and in Scotland (SC039426). ISSN 1745-9753 Views expressed in this magazine are not necessarily those of the around pregnancy British Heart Foundation or Wardour. The BHF does not endorse third-party products and services featured in Heart Matters. Information correct at For Wardour and your heart time of going to press. © BHF 2015. Heart Matters is printed on paper from Managing Editor: Rachael Healy sustainable forests. G204/1115 Art Director: Daniel Coupe 36 Drug cabinet: digoxin For BHF Head of Editorial: Molly Bennett This old drug derived Editor: Sarah Kidner Picture Editor: Johanna Ward Deputy Editor: Sarah Brealey Creative Director: Ben Barrett from foxglove plants Production Editor: Ana Blanco Production Director: John Faulkner Medical Editor: Maureen Talbot; Production Artworker: Jack Morgan is still used to treat Christopher Allen Account Director: Georgina Beach heart conditions Head of Heart Matters: Judy O’Sullivan Managing Director: Claire Oldfield Print: Pindar, part of the YM Group Chief Executive: Martin MacConnol bhf.org.uk 3 COVER STORY “The scar is part of the life I’ve lived” But when the dressing on her chest was ou’re being torn in two,” says Valerie removed, Michelle was shocked by the scar. “YJohnson, 61. “You’ve had this “It did affect me emotionally, especially at wonderful surgery, which has perhaps the start, because I was quite frail,” she says. saved your life, and yet you’re stressing Mark of “I ended up very skinny because of the because you feel unhappy over something surgery and the stress, so I think you noticed as minor as a scar.” [the scar] more.” Valerie, from Thirsk, North Yorkshire, had Michelle experienced complications a heart attackD in 2004 and stentsD fitted in related to the wires holding her breastbone 2005. When her anginaD began to advance together and needed a second procedure to in 2013, it became clear she would have to remove them, which set back her recovery. undergo bypassD surgery. STRENGTH However, only four months after surgery, “I’m a very proactive patient,” says Valerie, Heart surgery leaves a she held a coffee morning and raised who works at a doctor’s surgery handling IT distinctive mark that can BHF shop style more than £2,500, half of which went to and data. be challenging to accept. Michelle wears the BHF (the rest was split between “I went down to intensive care to have Rachael Healy meets three Right: Pink prom dress, Golden Jubilee National Hospital We found our a look around and I knew everything Monsoon, £19.99; and Inverclyde Royal Hospital that was going to happen. But the inspiring women who wear patent leather shoes, festive outfits and Cardiology Department). accessories in BHF chest scar never really impacted on their scars with pride M&S Limited Edition, £7.99; As Michelle recovered her my consciousness.” black beaded bracelet, £1.99. shops. Find your strength, she tentatively began nearest shop at Immediately after surgery, pain RESEARCH The cost of this to exercise. She took up running bhf.org.uk/shops and tiredness were the biggest outfit (£29.97) would help again in the year after her surgery issues. But as Valerie started to heal, us cover vital lab costs and now does regular half-marathons she felt she’d lost her confidence. for charity. “Once I got back to exercise, “I hated my scar. It was this awful fissure “Be proud... you’ve Below: Massimo Dutti there was no issue at all,” she says. Michelle down my front,” she says. “I knew it was won the battle” dress, £34.99. also loves weight training and the strength necessary and I was grateful to be alive, but RESEARCH The cost of workout programme, CrossFit. I couldn’t bear to look at it in the mirror. ichelle Houston discovered she had this outfit (£34.99) could While her physical recovery progressed, “I didn’t have a partner at the time, but I Ma heart condition aged 23. She was a fund one hour of a young Michelle was still coming to terms with her dreaded being intimate with anybody and jet-setting air hostess with a love of exercise, scientist’s time scar. She experienced keloid scarring, where so it was a total shock when, one evening part of the skin becomes lumpy. “It was really in February 2011, she had to be rushed to hard because a lot of people just stared,” she Advances in heart surgery hospital. She’d had a transient ischaemic explains. “I’d do anything I could to cover it André Simon, Consultant Cardiac Surgeon at attack (TIA)D, also known as a mini-stroke. up and I pretty much stayed in the house for Royal Brompton Hospital, tells us how heart Tests revealed Michelle, now 27, had an the first couple of months to deal with it.” surgery has developed during his 21-year career atrial septal defect (‘hole in the heart’) and Michelle saw a psychologist for a while, “There’s been a drive towards minimally invasive partial pulmonary venous connection defect but time and the support of her partner, surgery. We developed minimally invasive (where veins carry blood from the lungs to Matthew, and family made the biggest ventricular assist device implantation in the last five the wrong side of the heart). Surgery was difference. They all view her scar as a sign of years. We open both sides of the chest with small scheduled for summer that year. bravery. “It was just something I had to deal incisions [less than 2cm] and don’t go through the “I put it to the back of my mind and didn’t with myself and get used to the fact it was sternum at all. In mitral valve surgery, you operate really think about it,” says Michelle, who never going to change,” she says. from the right side via a very small incision. This lives in Greenock, Renfrewshire. “At first, Now, Michelle feels great, physically has upsides. If you need another heart operation, I thought they were going to do keyhole and emotionally. She got married in May you don’t have the risks of opening the breastbone surgery, so I was thinking: ‘That’s fine, I don’t this year, and she and Matthew enjoyed a twice. Patients heal quicker and go home quicker; need to worry.’ But when Hamish Walker, the honeymoon exploring Vietnam. She’s also they have fewer wound-healing complications and, Consultant [at the Golden Jubilee National decided to pursue a new career as a fitness for many, you can’t really see the scars.” Hospital], told me what was actually going instructor and wants to help raise awareness to happen, I was in absolute shock.” about adult congenital heart diseaseD. ≠ Can oils reduce a scar’s appearance? “You can’t do Surgeons told Michelle they’d open her “Be brave,” Michelle advises. “Afterwards, much with ointments to make the scar smaller,” says breastbone, but try to minimise scarring. don’t be worried about your scar. Just be Dr Simon. “Keep it dry and clean. Don’t pick or peel.”

Photography: Kate Peters; styling:Photography: Niki Kate Peters; hair and make-up: Brodie; Julie Read Focused on surgery, she wasn’t too worried. proud and know that you’ve won the battle.”

4 Heart Matters bhf.org.uk 5 exposing my scar. It affected my thoughts of tough, you should feel embarrassed about myself as feminine and as a woman.” something that marks you as a survivor. Like Michelle, Valerie experienced keloid “Just before I went in for my surgery, I scarring and was given steroid tape to help. opened up my own page on Facebook. It’s Having never been body conscious, Valerie a place where everybody can show off their was shocked at how her scar made her feel. scars. I’ve had so many people share theirs “I had my 60th birthday in March 2014 and for the first time; it’s been amazing.” I went to Center Parcs with the family,” Valerie After an overwhelming response, Shell BHF shop style says. “They went off swimming and I couldn’t had an idea. She wanted to create a calendar Valerie wears bear to go. I just sat by the pool crying with beautiful photography that would show Left: Blue silk dress because I didn’t want to expose my chest.” people of all ages baring their scars. and bolero shrug, Valerie’s family were very supportive. “Within two weeks of coming out of Fenn Wright Manson, Eventually, she entered the pool and no one hospital, I had managed to find quite a few £39.99; court shoes, stared, but she wore high-necked outfits for models,” says Shell. “People seemed really BHF shop style Uterqüe, £16.99. the whole summer. As the months passed, interested and wanted to be involved. It took Shell wears RESEARCH The cost of she began to accept the scar. A big turning off really fast.” Right: Strapless this outfit (£56.98) point was entering a new relationship. Shell organised every element of the cocktail dress, could help fund a “He said to me, if it wasn’t for the scar, calendar. She’s training to be a make-up artist Coast, £24.99; PhD student there wouldn’t be a me. That was so and put her skills to use on the photoshoots. patent shoes, River emotionally supportive,” Valerie explains. The 2016 calendar is now finished. It Island, £7.99; chunky Below: Debenhams “I began to see that. It was the key to getting features Chanel Murrish, who entered the bracelet, £0.99. dress, £14.99 my head around the whole thing. record books for having open heart surgery Total: £33.97 RESEARCH The cost of “We all collect scars as we go through life, minutes after being born, a 15-year-old Top: Monsoon this outfit (£14.99) some emotional, some physical; to me the boy who loves parkour (a sport involving dress, £19.99. could buy 15 sterile bypass is both in a huge way, but I’m here urban acrobatics) despite having had several RESEARCH The cost plastic flasks, used and I’m alive. I’ve been to dark places, but surgeries, and many other brave survivors. of Shell’s outfits by our researchers to I’m still a desirable, attractive woman and “Up until I got the news that I was going would pay for one grow cells in culture the scar is part of the life I’ve lived.” to have surgery, I didn’t realise that so many assay kit, which people go through this every day and have helps researchers these scars,” says Shell. analyse blood and “I get people looking... After her operation, Shell developed atrial tissue samples fibrillationD, which made recovery trickier. but I feel quite proud” But talking to her new online friends helped irect confrontation and a unique personal her deal with the emotional side of the Dproject helped Shell Williams, 26, come to surgery. “I started to feel quite down,” she terms with her scar. Born with a mitral valve says. “I decided to talk to people and focus on prolapse, her health was monitored from the the calendar as much as I could. I spoke to so age of seven. Shell, from Wolverhampton, many people whose scars were worse than discovered in January 2014 that she needed mine, or they’d had more surgeries. Seeing surgery to repair the valve. how they coped with it, how confident they “I was really scared,” she says. “I’ve got two were, really changed how I felt.” kids and I was working at the time; it changed Shell praises her NHS treatment before and “I had my photoshoot a month after surgery,” my whole life. I thought about the scar and after surgery, and enjoyed meeting people she says. “Having my scar out and seeing the Support from the BHF how people would react if they saw it.” at cardiac rehab. However, she believes a reaction of people really did help me feel ≠ Order our free booklet, Heart to heart – She decided to do research and began patient network could be helpful, especially more confident. I do get people looking at it heart disease and your emotional talking to people, via Facebook, who had for young people. “There could be more and noticing it, but I feel quite proud of it.” wellbeing, for tips on the psychological already had similar surgeries. “So many done for the emotional impact,” she says. “It’s side of heart surgery. See page 50. people were ashamed of their scar,” Shell not something people really think about.” ≠ Buy a copy of Shell ’s calendar at facebook. ≠ Share experiences with other heart says. “I thought there should be no reason Shell found revealing her own scar in the com/ShowThemWithPrideCalendar and patients at community.bhf.org.uk.

why, after going through something so styling:Photography: Niki Kate Peters; hair and make-up: Brodie; Julie Read calendar helped her emotional recovery. help raise funds for our life saving research.

6 Heart Matters bhf.org.uk 7 BEHIND THE The writer of our star letter each issue can win a gorgeous Radley Matinée purse worth HEADLINES YOUR LETTERS £75, with ample room for all We love to read your emails, letters and tips, so keep writing: The Telegraph 16 September 2015 your essentials. Or, if you prefer, [email protected] or Heart Matters, British Heart Foundation, choose this red heart-shaped “Children without gardens more Greater London House, 180 Hampstead Road, London NW1 7AW rug (about 1.5m long). Can hot chocolate likely to be obese” Children with no access to a garden prevent heart attacks? between the ages of three and five are far more likely to be overweight or obese by People who had the flavanol drink had the time they reach seven, a study showed. lower blood pressure, lower cholesterol have been taking them regularly levels and less arterial stiffness than the The BHF says: Doing physical READER’S TIP (14 years in my case) and have STAR have more than likely survived control group. The study’s authors say activity at recommended levels, be I have read with interest never experienced any side into old age. My brother was this would lead to a lower risk of coronary that at home, school or in a local park, your articles about recovery effects whatsoever. LETTER fortunately born late enough heart diseaseD, including heart attackD, is essential to improving our children’s after a heart event. Tony Buck, Eastwood, Cardiac problems run in my to take advantage of this. and cardiovascular diseaseD. heart health and preventing future When I came out of Nottinghamshire family – my father died in the The second is that A drawback of the news coverage heart and circulatory diseases. hospital after a quadruple late 1960s and my mother in information about lifestyle was the suggestion that drinking hot Many children and young people heart bypassD, I made a wish Heart Matters Medical Editor the early 1980s of heart issues. choices and preventing heart chocolate, or eating chocolate, might in the UK are not achieving the list of things I would like to Maureen Talbot says: It’s good My brother required a double disease is so accessible now. have the same effect. Chocolate contains recommended 60 minutes’ activity each do as I recovered, starting to see someone speaking up for bypass operation. No one has any excuses for not fat and sugar and might not have an day. Most adults also fail to achieve the with a visit to a local garden statins. As your experience shows, Thankfully, I am now 65 and knowing this. adequate level of flavanols. The study was minimum recommended 150 minutes centre. It gave me great many people taking statins very fit. I think what has helped I have been an avid reader also very small; using a larger number of a week of moderate-intensity physical satisfaction to tick off the don’t experience any side effects. me is following a healthy of Heart Matters for the people may not yield the same results. activity. Remember, it’s never too late to items as I completed them, Statins can reduce the risk of lifestyle. I run 15 to 20 miles last five years. It keeps me Many news outlets did not mention that get more active to improve your health. so I hope this suggestion cardiovascular diseaseD, and per week and play four hours abreast of the latest medical the study was part-funded by Mars, which may help other people. have proven benefits for those of badminton, coupled with a science and developments provided the drinks. Peter Fontaine, Marcham, who have been diagnosed with healthy diet. in cardiac treatments. And The story was covered more accurately The Guardian 20 August 2015 Oxfordshire coronary heart diseaseD or are When I look back at the it’s so informative relating by The Guardian, which did mention at increased risk of strokeD. last 40 years or so, I see two to guidance on lifestyles, the association with Mars and reported: “Working longer hours increases Heart Matters Deputy Editor profound changes. The first is rehabilitation and more. So “Substances found in cocoa, fruit and stroke risk, major study finds” Sarah Brealey says: Thanks Hooray for the BHF the march of medical science. in sickness and in health I will The Mirror 12 September 2015 tea could help healthy people keep their The likely toll of long working hours is for this helpful suggestion. In January 2014, I had a heart If my parents had been born never stop reading it! heart and circulation in good working revealed in a major new study which shows Readers who find this useful attack. After three days in 20 or so years later they would Alan Smith, Rotherham “A daily mug of hot chocolate could order as they get older.” that employees still at their desks into the might also enjoy our article intensive care in hospital in stave off a heart attack” Tracy Parker, our Heart Health Dietitian, evening run an increased risk of strokeD – about rebuilding confidence South Africa, I was allowed home and also had two stents fitted. My sincere thanks go to the said: “Flavanols have been shown to and the longer the hours they put in, the after a heart event on page with two stents and a bag of I was astounded to learn about BHF for these publications. They The Sun ran a similar headline, claiming: have a benefit to the heart. However, higher the risk. 40 – plus extra tips online at assorted pills. his professionally managed have helped to reduce my fears “Hot chocolate reduces heart disease risk”. fruit and vegetables, such as dark green bhf.org.uk/confidence. And that’s all the help I recovery plan. and minimise the guesswork in If only things were so simple. vegetables, berries and beetroot are also The BHF says: There could be a causal received from the medical To help me, Geoff gave me my long-term recovery plans. This was a relatively small study of a source of these compounds. relationship behind the link. Sudden profession – no advice on copies of the British Heart Alan Ball, Durban, South Africa 100 healthy adults aged 35 to 60, half “In addition to this, fruit and vegetables death following long working hours is Plus side of statins rehabilitation, exercise regimes, Foundation publications he had of whom were given fruit-flavoured provide us with a range of other vitamins, often caused by a stroke, brought on What a great and inspiring story diet or depression. received on leaving hospital. drinks containing 450mg of flavanols minerals and fibre and should form a core by long and repeated periods of stress. about Chris Courtenay Williams’ By mid-year I was fit enough There are three invaluable Share your story derived from cocoa, while the other half part of a balanced, healthy diet. This is However, this was not demonstrated in return to football after a heart to travel to the UK to stay booklets entitled Cardiac If you’d like to share your had similar drinks without the flavanols. consistent with our whole diet approach this study. More research is needed if attackD and a stentD. Just one with friends in Leominster. rehabilitation, Tests for heart story with Heart Matters, Flavanols are naturally occurring to healthy eating which emphasises the we are to understand the links between observation though – he says: “I Coincidentally, their neighbour, conditions and Medicines for your email [email protected] antioxidant compounds found in plants. importance of balance and consumption stroke and heart disease and working don’t like having to take [statins] Geoff, had suffered a heart heart, as well as your informative or write to Sarah Brealey, Study participants consumed the drinks of a range of foods rather than individual long hours. because of the side effects.” attack some weeks earlier magazine Heart Matters. Heart Matters, British Heart twice a day for a month. nutrients or ingredients.” This study highlights that doctors There seems to be too much Foundation, Greater London The study was carried out by should pay particular attention to ≠ emphasis these days on the bad Next issue Building a new life after a heart event. House, 180 Hampstead researchers at Düsseldorf University in Discover how other compounds in fruit cardiovascular risk factors when they side effects of statins and little Plus: Walking sports, diets compared and some fishy research. Road, London NW1 7AW. Germany and was published in the British and vegetables can help your health, on advise people who work long hours.

mention of people like me who Illustration: Carlo Giambarresi Journal of Nutrition. page 28.

8 Heart Matters bhf.org.uk 9 NEWS

Go online Explore an interactive SPOTLIGHT ON… infographic revealing further Familial expectations Fortunately, I when I woke crying because I women, 6% of men) and to feel survey results, Women felt they had to support was scared. He was there from their doctor wasn’t listening, (8% at bhf.org.uk/ Women and family as usual while dealing have a wonderful the minute I was admitted to of women, 4% of men). womensurvey. with health problems. One husband who is hospital in a coma and for days Heart disease kills similar respondent wrote: “My family did not leave my side.” numbers of women and men in were initially supportive but my carer and we Among our respondents, a the UK, but fewer than a third heart disease expected me to get better and share everything” heart condition was more likely of our respondents knew this. to heart disease and so may With the right support, life can back to normal in a few weeks.” to strengthen a relationship than This lack of awareness can lead never mention them to the continue after a heart event. What’s it like being a woman with heart Woman who is disabled Another woman wrote: “My following a stroke weaken it. people to ignore their symptoms doctor. Heart disease devastates A mother-of-three who has disease? Sarah Brealey analyses the parents think there isn’t anything or put off making important the lives of millions of women suffered heart rhythm problems results of our exclusive reader survey wrong and still expect me to run Diagnosis lifestyle changes. One woman in the UK every year – so if in and high blood pressureD for them around and sort out all he believed I was ‘faking’.” Only 41% of women surveyed who needed a heart bypassD doubt, just ask. 40 years wrote: “I refuse to give their problems. Sometimes I feel Another woman, who had a said getting a heart diagnosis wrote: “As a non-smoking “It’s also critical for doctors to in. I get great support from my omen are more likely dementia was living with us. It I’m in a hamster wheel and just heart attack, said: “My husband had been straightforward, woman, I had no idea that I was make an accurate diagnosis. The doctors. My medication has to have difficulty was a nightmare. I was always wish to get off for a while.” could not cope with my heart compared with 51% of men. The at risk in my 40s.” key is listening to the patient, been increased, but I carry on Wgetting heart problems so tired and depressed, with no Women were much less condition, and decided to leave process was “difficult” or “very Mike Knapton, our Associate interpreting the symptoms and diagnosed. And after diagnosis, help and support.” likely to feel supported by their me for someone else.” difficult” for 22% of women, Medical Director and a GP for providing clear advice.” they are less likely to get the Women were much less partner – 44%, compared with But many partners were caring. compared with just 13% of men. more than 20 years, said: “This Support in the workplace My husband support they need, according likely to have time to look after 64% of men. One woman with One woman wrote: “My husband Women were more likely to be survey suggests a significant and consistent access to cardiac used to be my to our survey of Heart Matters themselves – 46% said they did, heart failureD said: “My husband was my rock and still is. He told there was nothing wrong number of people don’t think rehab could also help people members with heart conditions*. compared with 67% of men. was not supportive and I think would sit up with me at all hours with them initially (10% of their symptoms could be related living with heart conditions. carer. Now he has There is a clear need for extra dementia and I Support support, particularly for people One in three women surveyed who have caring responsibilities. find it very hard to care for an elderly or disabled Mike Hobday, our Director of How did you feel? look after him” family member, compared with Policy, said: “We know that social Woman with heart failure fewer than one in four men. care is seriously under-funded, 1 Family members were a big 2 I felt I had to 3 Caring for my children 4 I felt I had to put following a heart attack Nearly half of women (48%) said which has led to over half a source of love and support ignore what was and/or elderly relatives while others before myself they didn’t get the support they happening to me coping with a heart condition needed as a carer or parent with I had children for the sake of left me feeling emotionally and with my life – I run three times a heart condition. Fewer men helping others physically drained a week, do keep-fit classes and (32%) felt this way. aged 14 and nine have just turned 79!” One woman said: “I was carer and no help and for my mother for 20 years, and ≠ Turn to page 20 for more shortly after my heart attackD, no follow-up care” on women and heart disease. Woman who experienced she was admitted to hospital Read about heart issues complications following numerous times. I could no affecting older women in our a heart attack longer cope with looking after Jan/Feb 2016 issue. her but had to fight social services to get extra help.” million fewer people getting Some women with heart social care in 2015 than six years Share your story conditions had to look after ago. We’re working with other Want to tell us about living children or grandchildren organisations to campaign for with a heart condition, being while also caring for a spouse the government to increase a carer or getting respite or elderly parents. One woman funding for social care.” care? Email us at HMeditor@ Women Men Women Men with a heart rhythm problem Women were less likely to feel Women Men Women Men bhf.org.uk or write to the

said: “I had two young children they had support they needed – 25% 16% 39% 20% 32% 20% Illustrations: Gibbs Andrew address on page 8. *1,923 Heart Matters members with a heart-related condition surveyed online in July 2015 and my mother who had 55%, versus 68% of men. 44% 56%

10 Heart Matters bhf.org.uk 11 NEWS

Saving lives in an emergency Thanks for your donations Dates for your diary e’re making Thank you to everyone who took part Now is the time to contact your GP Wpublic access in our Bag it. Beat it. campaign this and ask about the flu jab. It’s free to defibrillators and year. With your help, we’ve collected over-65s and those with long-term conditions, including heart disease. CPR training more thousands of bags of items to sell in widely available in our shops and help fund life saving 12 December Banbury Symphony communities across heart research. Orchestra Christmas Concert, A England. We have received Your donations go towards the Celebration of Life in Music. A festive £1m in funding from the £100m of research we fund each year. family concert raising money for the Department of Health, We only fund the best scientists, from BHF. Tickets £10 (accompanied under- 18s free) from banburysymphony.org following the government’s social enterprises, community world-renowned cardiologists to PhD or 01608 645 589. commitment in the March 2015 groups and any commercial students starting out in their careers. budget to invest in and improve organisations working in That’s why our PhD researchers got 13 December Sheffield Chase defibrillator availability. partnership with the NHS behind the campaign to Bag it. Beat it. the Pud. Join our one-mile festive Organisations in England Ambulance Service or a fun run for the whole family. Visit can now apply to the BHF for local charity. bhf.org.uk/sheffieldchasethepud or call 0300 330 3322. free community packages that Working with Welsh women include up to five public access ≠ If you live in England and We’ve started a two-year partnership with Wales-wide 11 February Roll Out the Red Ball. defibrillators and our Call Push would like to apply, visit women’s organisation Merched y Wawr. With the help of Join us at The Savoy, London, to Rescue CPR training kit. This will bhf.org.uk/defibsDH. more than 6,000 members in 279 branches, we could raise celebrate Heart Month and raise funds help give local communities the over £20,000 for our life saving work. for research. We’ll be rolling out the life saving skills and equipment ≠ If you live in Scotland, Wales Catherine Kelly, our Director of Prevention, Survival and red carpet for guests including BHF Ambassador Pippa Middleton for a to improve survival rates from or Northern Ireland, find out Support, said: “Heart and circulatory disease isn’t just a champagne reception, three-course D out-of-hospital cardiac arrests . more about our part-funded man’s issue. It affects around 3.5 million UK women and meal and dazzling entertainment. Organisations that are eligible defibrillator programme, at kills more than a quarter of women in Wales. We need to Tickets £250 from bhf.org.uk/rollout. to apply include charities, bhf.org.uk/defibgrants. ensure more women are aware of this issue.” ≠ Read more about women and heart disease on page 10. 13 February Queen Elizabeth Olympic Park Run. Run 5K or 10K in our brand new London event. Visit bhf.org.uk/ Time for a DECHOX olympicparkrun. Partnership makes an amazing £5m Do you love chocolate a bit too much? Our partnership with Diabetes It may be time for a DECHOX, and you 28 February Harewood House Half UK and Tesco has raised more can raise vital funds while you do it. Win a limited- Marathon. Run muddy off-road tracks than £5m in its first year. Last March, 19,000 Dechoxers and steep forest inclines. Visit bhf.org. Tesco colleagues have went chocolate-free for a whole edition diary! uk/harewood or call 0845 130 8663. been fundraising in stores, month. Any cocoa was a no-no, even his year, Collins’ fundraising efforts for 12 March Peak District Mountain Bike distribution centres and cappuccino sprinkles. It wasn’t easy, Tthe BHF will surpass £50,000. Ride. Our tough 23- or 40-mile ride head offices. Thanks to their but determination and dedication saw To celebrate this milestone, Collins is back. Visit bhf.org.uk/peak or call efforts and everyone who has them raise £774,000 for the BHF. DECHOX is giving all Heart Matters readers the 0845 130 8663. generously donated, we can Planning for DECHOX in March chance to win a special BHF diary for 2016. Everest Base Camp Trek. now fund projects to improve 2016 is under way and it’s going to As part of our exclusive partnership, The Collins 2016 diary 17 March Challenge yourself to give up chocolate for March Enjoy breathtaking scenery on this the health of the nation and be bigger than ever. Think you’ve got what it takes?Sign up by 29 Feb at bhf.org.uk/dechox Collins has created two red limited-edition offers handy tips for ©British Heart Foundation, a registered charity in England and Wales (225971) and Scotland (SCO39426) challenging trek. Visit bhf.org.uk/ help save lives. Sign up now at bhf.org.uk/dechox. diaries featuring tips on how to help a healthy heart everest or call 0844 847 2788. The money raised has number of people meeting maintain a healthy heart every day. already delivered a project national guidelines on The 2016 diaries are on sale now, win, email your name and address to 19 March London to Reading Bike called Beat the Street in physical activity increased priced £8.75 (A5) and £7.25 (slim). They’re heartmatterscomp@collins-debden. Ride. A 40-mile countryside ride. Visit bhf.org.uk/londontoreading or call east London, which helped from 35 per cent to 45 per Do you know a Heart Hero? Each summer we available nationwide from retailers co.uk or write to: Heart Matters draw, 0845 130 8663. 40,000 people move more by cent, rising to 53 per cent present our Heart Hero Awards to deserving individuals including WHSmith and Amazon. Up to Collins Debden Ltd, Westerhill Road, challenging them to see how three months later. and groups across the UK who have impressed us with £0.90 from every diary sold directly funds Campsie View, Bishopbriggs, Glasgow 7 April Roubaix Challenge. Cycle far they could walk and cycle Next year, the money you their efforts to fight heart disease through research, our pioneering research, support and care G64 2QT. We’ll find our lucky winners London to Lille, 155 miles in 2 days, then watch the famous challenge and in their local area. raise will help us run the campaigning or support. for heart patients and their families. by selecting 12 letters and 12 emails When this project ran in project in a further six areas There are 24 diaries up for grabs – at random. Entries must arrive by take on the course. Visit bhf.org.uk/ roubaix or call 0844 847 2788. seven towns in 2014, the across the UK. Who will you nominate? 12 A5 and 12 slim. For your chance to 18 December 2015. Visit bhf.org.uk/heartheroes to find out more.

12 Heart Matters bhf.org.uk 13 FESTIVE NEWS Chase the JOIN Pud is back Get out and get active at THE one of our Chase the Pud events this November and December, as you dress up and join dozens of other FIGHT ● Santas hunting our dashing Set yourself a desserts. Our series of short, fundraising challenge Hayley Chew (left) holds her WIBI kit, while Donna holds a four festive fun runs are great for ● Get friends and Need a new with her fellow Co-op fundraisers the whole family. family involved Taking place in towns shopping bag? and cities across the UK, Since October, all large ● Raise funds for our they’re the perfect way to retailers in England must life saving work entertain the kids before an afternoon of Christmas charge shoppers for carrier shopping. To sign up for an bags (this was already life-threatening heart rhythms. village in Lincolnshire and “We have 44 team members event in Sheffield, Cardiff, happening in Northern Wear it. It can be inherited, but tests on set up a coffee shop. So last in store,” says Donna, “and York and more, visit Ireland, Scotland and her heart have shown Hayley February, they held a bigger everyone said yes and donated bhf.org.uk/chasethepud Wales). So make sure you’re doesn’t have the condition. event – a coffee and cake day, a really nice prize for the or call 0300 330 3322. Beat it. But when she was pregnant with a raffle, competitions and tombola as well. The Co-op kitted out with one of our By joining the fun of with her youngest child, she games to add to the fun. supported us too, by giving us stylish jute bags, foldable started to feel so tired she “We were overwhelmed by an iPad mini, so we had a really shoppers or cotton totes. Wear it. Beat it. you could hardly get out of bed. the amount of people that good first prize for the raffle.” Win a Christmas hamper! Prices start at £1.99. Visit can raise cash for life Tests showed a problem with came,” Hayley says. “Some On the day, staff made The BHF Christmas hamper is back. You could win a classic Marks & your nearest BHF shop, buy saving research. Donna one of her heart valves. The people who walked through donations to wear jeans to work Spencer hamper, worth £150, packed with festive goodies, including Graham and Hayley Chew first time she and her family did the door knew my story, others classic Christmas pudding, a luxury nut selection, coffee, tea, luxury from our online giftshop discovered what a great Wear it. Beat it. Hayley, 34, was didn’t have a clue and wanted We were shortbread, chocolates, plus lots of other delicious (cotton totes not available feeling that brings recovering from open heart to share theirs. It was absolutely foods and drinks. There’s a hamper to be online) at bhf.org.uk/bags surgery to repair the mitral brilliant and we raised nearly overwhelmed won in each of our BHF shops, and Furniture or call 0845 246 4050. hen Hayley Chew valve. The procedure gave her £500. My daughter also asked & Electrical stores. was just 13, her father a new lease of life, but she also her headteacher if they could by the amount Tickets are only £1, so pop into your local Wdied from a heart wanted to do Wear it. Beat it. in have a non-uniform day, which of people BHF shop and take a chance. The winners condition no one knew he had. her father’s memory. raised another £98. will be drawn on Monday 21 Winter volunteers They were watching television “We did a family walk of eight “The money is so important. that came” December at 4pm, so you’ll be This Christmas, we need volunteers together when he collapsed miles, which is a lot for me,” It pays for so much, from able to collect it from the to help fight heart disease in their and died with no warning. Hayley says. “I bought plain red hospital equipment to research and bought red BHF t-shirts to shop where you bought the local community. “He passed on Valentine’s Day,” t-shirts and the kids decorated into things like gene testing.” complete the look. ticket in time for Christmas. Joining the BHF is a great way to she says. “I remember it like it them how they wanted. Friends Customers joined in by meet new people, be part of a team was yesterday.” sponsored us and we raised A great day at work buying raffle and tombola and use your skills while helping Her father had hypertrophic about £300.” Donna Graham works at the tickets, red cakes and goodies raise funds for life saving research, cardiomyopathyD, a condition Soon after, Hayley and her Co-op in Campbeltown, Argyll from the baking stall, and so we can improve the lives of those that can occasionally cause husband Chris moved to a and Bute, where staff and portions of the special red Thai affected by heart disease. customers raised £1,240 by curry at the store deli. Our volunteers help out in shops, taking part in Wear it. Beat it. They also used the ‘Guess at events, by fundraising for us and by Go on, get ‘reddy’ for Wear it. Beat it. on Friday 5 last February. how many feathers in the boa’ delivering heart-healthy information February 2016. Go to bhf.org.uk/red or call 0300 Donna lost her mother to game that came in the Wear it. to the community they live in. We 330 0645 and get your free Wear it. Beat it. red heart disease and knows many Beat it. kit. It was a big hit. have a range of opportunities to suit everywear fundraising kit, featuring lots of goodies of her colleagues also have “It was just a great buzz everyone, however much or little time personal reasons for supporting because everybody was behind you can give. and ideas that make joining in super-easy. the BHF. So it was easy to get it,” Donna says. “It was a really ≠ Visit bhf.org.uk/volunteer, their support for Wear it. Beat it. great day.” pop into your local shop or call

Hamper shown is for illustration purposes only – contents may vary illustration purposes may only – contents is for Hamper shown 0300 456 8353 to find out more. Inspired to raise funds? To help us fund more crucial research, call 0300 330 0645 or go online at bhf.org.uk/red. 14 Heart Matters bhf.org.uk 15 MEDICAL Calculated Smoking If you are a smoker, giving up is the single biggest thing you can do to help your heart. Smokers are almost twice as likely to have a heart attack compared with those who have never smoked. Chemicals in cigarette smoke damage arteries, force your heart to work harder and make blood more likely to clot (raising heart attack or stroke risk). The risk to your health starts to drop soon RISK after you give up, so it’s never too late. You can do plenty to reduce your chances of heart attack or stroke, whether you have coronary heart disease or been told you’re at risk. Sarah Brealey and Senior Cardiac Nurse Christopher Allen explain Type 2 diabetes What is it? More than three million people in the UK e’re used to seeing High cholesterol Weight and waist size have been diagnosed with diabetes, but headlines about What is it? checked regularly anyway. What does being overweight mean? Caribbean origin are at ‘severe’ risk an estimated 600,000 people may have it what will or won’t Cholesterol is a fatty substance What can I do about it? Being overweight or obese increases if their waist is over 90cm (35½in). without realising. Diabetes is a condition increase your risk of found in the blood. Too much ‘bad’ Help to reduce your cholesterol by your risk of CVD (and conditions For white European men, a waist size where the amount of glucose in your blood cardiovascular disease cholesterol can increase your risk reducing the saturated fat (butter, including type 2 diabetesD). Your body of 102cm (40in) means ‘severe’ risk. is too high. It puts you at much higher risk (CVD)D. Some headlines of developing CVD. It can cause cheese, full-fat milk and meat) you mass index (BMI) is a way to tell if Women of minority ethnic origin are of CVD, partly because high glucose levels can’t Wbe trusted, but we do know that atheromaD to build up inside artery eat, replacing with unsaturated fats you’re overweight or obese. Typically, a at ‘severe’ risk with a waist over 80cm can lead to blood vessel damage. with lifestyle changes and medication walls, preventing enough blood such as olive, rapeseed or sunflower BMI of 25 or above means you may be (31½in). A waist over 88cm (35in) puts How do we know this? you can help reduce your risk of a heart reaching the heart or other parts oil and oily fish and nuts instead. If overweight and a BMI of 30 or above is white European women at ‘severe’ risk. We are helping to fund several research event – even if you’ve had one already. of the body. If a piece of atheroma your risk of a heart attack or stroke is classified as obese. How do we know this? projects that could lead to new treatments We’ve funded research for more than 50 breaks off, a blood clot can form, more than one in 10 over the next 10 Does my shape matter? Several population cohort for type 2 diabetes. At the University years and our discoveries have helped blocking blood supply to the heart (a years, you are likely to be prescribed BMI is not the only Nearly studies (which follow of Leeds, BHF Professor Mark Kearney develop medications, treatments, health heart attackD) or the brain (a strokeD). a statin, which helps reduce your measure of risk. Having large groups of people (pictured) is helping us to understand programmes, and more to combat your risk Cholesterol is measured by looking cholesterol level and, as BHF research too much weight over time) funded by links between diabetes and CVD. His team of heart disease. at your HDL (good) cholesterol and has shown, reduce your risk of heart around your middle 30% the BHF have helped us is trying to develop a new treatment for your non-HDL (bad) cholesterol. attack or stroke. raises risk of CVD, of UK adults have understand how weight people with diabetes, aimed at repairing Non-HDL cholesterol should be lower You can benefit from making high blood pressureD, hypertension and body shape affect damaged blood vessels. Another than 4mmol/L (millimols per litre of lifestyle changes, including being diabetes and stroke. disease risk. The BHF programme is finding ways to prevent blood), or no higher than 3.4mmol/L physically active and eating well. Typically, your health is at ‘increased’ Centre on Population Approaches effects of diabetes in people who have CHD. if you have CVD or if you’ve been If you already have CVD, taking risk if you’re a man with a waist over for Non-Communicable Disease What can I do about it? told your risk of a heart attack or a statin – even if your cholesterol 94cm (37in), or a woman with a waist Prevention specialises in research to If you have diabetes, it’s very important to stroke is more than one in 10 over level is low – will reduce your risk of over 80cm (31½in). prevent diseases such as coronary control your blood glucose, blood pressure the next 10 years, according to NICE further events. Does ethnic origin change things? heart disease (CHD)D. Researchers are and cholesterol. Eating a healthy diet, (National Institute for Health and Yes. People of some ethnic groups, looking at the effects of obesity and being active and controlling your Care Excellence) guidelines. Already had a heart including South Asian, African- physical inactivity, and how to reduce weight all help manage these things How would I know? Caribbean, black African, Chinese their impact. and reduce your risk of developing You may not be able to tell that you attack or stroke? and Middle Eastern are at risk of What can I do about it? CVD. Type 2 diabetes is linked have high cholesterol. That’s why it’s You probably know that developing health problems at a lower If you are overweight or have a waist to the amount of fat in a really good idea to have an NHS your risk of having another is BMI than the white population. size that puts you at risk, losing weight your body, so if you lose Health Check (available in England increased. But there’s lots you People of South Asian and Chinese will help. Make small, long-term enough weight, you only, or a Keep Well health check in can do to reduce your risk, origin are advised to have a BMI below changes, such as reducing portion may stop experiencing Scotland) if you’re over 40. If you’ve including taking medications 23 to reduce their risk of developing sizes and being more physically active. symptoms, although they already been diagnosed with CVD, and using the tips outlined here. type 2 diabetes. Men of South Asian, can return, especially if

your cholesterol levels should be Illustration: Carlo Giambarresi Chinese, black African and African- ≠ Check your BMI at bhf.org.uk/BMI. you regain weight.

16 Heart Matters bhf.org.uk 17 MEDICAL

How to get in touch ASK THE Call the Heart Matters Helpline on 0300 330 2333 for more information. To EXPERTS suggest a question, email Our panel of experts answer your health questions [email protected].

Statin uncertainty Q I am a 55-year-old man and are estimated to save 7,000 having a heart attack or stroke Speak to your GP or pharmacist and don’t have heart disease, lives each year in England. is greater than 10 per cent, if you’re not sure. but my GP has prescribed me The decision to take a you will be asked to consider There are other ways to a statin. Should I take it? statin is an important taking a statin. Most reduce cholesterol, including: one, as it will probably be doctors also recommend losing weight; being physically ‘Should recommended that you statins for people who active; and following a healthy

Illustration: Carlo Giambarresi Dr Mike Knapton says: I take a statin?’ is a common take the medication have diabetesD. diet, inspired by the traditional question in my surgery, for a long time. The risks, as with Mediterranean diet. High blood pressure particularly when newspaper Firstly, consider the all medicines, Weigh up the pros and What is it? How we’re helping to find answers stories advocate benefits or benefits for you. For include possible cons of taking a statin and Blood pressure is the force exerted by e’re funding many pieces to measure physical function as report dire side effects. people diagnosed side effects. remember, a healthy diet, blood against your artery walls as it Wof research to explore CVD people get older, so we can better Statins have been available with coronary heart Serious side physical activity and not circulates around the body. High blood risk. Just one example is the prevent or treat health problems. for the past 30 years. They diseaseD or stroke effects are rare smoking are also important pressure (hypertension) means your blood Southall and Brent Revisited study, Professor John Danesh is are taken once a day and can there is proven and can be for your heart health. pressure is equal to or higher than the involving nearly 5,000 European, BHF Professor of Medicine and reduce risk of developing benefit, so your reversed if you recommended level (140/90mmHg). It Indian-Asian and African- Epidemiology at the University cardiovascular diseaseD, which GP or cardiologist stop taking the affects nearly 30 per cent of adults in the Caribbean men and women. The of Cambridge. His team leads can result in heart attackD or will recommend you statin. One risk is Dictionary UK. Your risk increases as you get older. study has been collecting data several major research projects, strokeD. They work by inhibiting take a statin. muscle pain, ranging DICTIONARY

Medical words, MEDICAL TERMS EXPLAINED under the skin on your chest, Ablation Procedure to correct connected to your heart by one a normal heart rhythm. It can be or more wires (leads). It monitors Aor control certain types of Echocardiogram Sometimes done using medicines (chemical heart rhythm and can deliver a arrhythmias. Involves using called an ‘echo’. This is an cardioversion), or by giving the E controlled electric shock if you discovering new ways to predict radiofrequency waves to destroy ultrasound to examine the How would I know? since 1989. an enzyme in the liver called If, as in your case, you from mild pain to heart a controlled electric shock have a life-threatening abnormal abnormal electrical pathways. structures within the heart, such with a defi brillator (electrical heart rhythm. Angina An uncomfortable as heart valves, and to see how cardioversion). feeling, tightness or pain in well the heart is pumping. MRI scan MRI stands for Congenital heart disease A heart your chest that may also be felt Electrocardiogram (ECG) A simple, M ‘magnetic resonance abnormality someone is born with imaging’. An MRI scan is a test in your arms, neck, jaw, back painless test to record the heart’s – for example, a hole between the identified by a or stomach. The symptoms of that produces extremely detailed electrical activity. Small sticky chambers of the heart (known pictures of your internal organs, angina are usually caused by patches (electrodes) are put onto as a ‘hole in the heart’). There are including your heart. It is very coronary heart disease. your arms, legs and chest. These many types of congenital heart good at showing the structure Angiogram X-ray pictures that are connected to a machine that disease; some are due to faulty of your heart and blood vessels, show whether the arteries are picks up and records the electrical genes or chromosomes. and prevent heart disease narrowed and, if so, how narrow and it can also measure the fl ow High blood pressure is not usually It is helping us understand HMG-CoA reductase. This do not have CVD, you a severe muscular signals of your heartbeat. An D they have become. A coronary Coronary artery bypass surgery of blood through your heart and operation to treat coronary heart GTN spray A nitrate medicine angiogram examines the some of your major arteries. disease. Arteries from your chest G that helps relax blood vessel coronary arteries. walls, improving blood supply to Pacemaker Small device wall and arm, or veins from Arrhythmia An abnormal heart the heart muscle. Provides quick P implanted under the skin on small symbol your leg, are used to bypass the the chest, connected to the heart rhythm. relief from angina symptoms. blocked or narrowed coronary by one or more wires (leads). Atheroma Fatty material that Heart attack Known medically arteries, improving blood fl ow to Monitors the heart’s electrical can build up on artery walls. as a ‘myocardial infarction’, the heart muscle. H signals and can stimulate the Sometimes called ‘plaques’. or ‘MI’. This describes a sudden Coronary heart disease (CHD) When heart to contract and produce a Atrial fi brillation (AF) An abnormal loss of blood fl ow to part of the the walls of the coronary arteries heartbeat if required. heart rhythm in which the heart muscle. Most heart attacks something you can notice, but it can the complicated reasons why and stroke. Professor Danesh reduces the production of nevertheless may have problem called (the arteries that supply blood atria (the upper chambers of are caused by atherosclerosis, Stent A short tube of to the heart muscle) become the heart) beat in an irregular the build-up of atheroma S expandable stainless-steel narrowed due to a gradual mesh that is inserted into an pattern. People with AF have an (plaque) within artery walls. If build-up of atheroma. artery to hold it open after an are explained in irregular, sometimes fast, pulse. the atheroma becomes unstable, CT scan ‘Computerised angioplasty, improving the fl ow Bypass See coronary artery a piece may break off and lead tomography’ scan. A type of of blood through the artery. B bypass surgery. to a blood clot. This can block a X-ray, which is useful for looking An interruption of blood Cardiac arrest The ultimate coronary artery, causing a heart Stroke at internal organs, such as your fl ow to part of the brain, causing C medical emergency, when attack and irreversible heart heart or lungs. With some CT brain cells to die or become a person’s heart stops pumping muscle damage. It is a medical scans, a special dye (called a damaged. This happens if an blood round their body and they emergency and can lead to a contrast medium) is injected into artery carrying blood to your damage the arteries, which can increase South Asians are at such high risk established a decade-long study cholesterol in the liver and so been offered a statin rhabdomyolysis. stop breathing normally. Cardiac cardiac arrest. a vein in your arm before the test. brain becomes blocked, or if an arrests in adults can be caused Heart failure Condition where the This helps show the blood vessels artery bleeds into your brain. A by a heart attack. heart is less effi cient at pumping on the surface of the heart. stroke is a medical emergency. plain English in Cardiomyopathy Disease of the blood around the body. Diabetes A condition in which heart muscle in which it becomes High blood pressure Also called Transient ischaemic attack (TIA) glucose (sugar) levels in the weakened, enlarged and/or D ‘hypertension’. High blood T Occurs during a temporary blood are too high. There are two blockage in the brain’s blood stiff , depending on the type of pressure is when the pressure main types of diabetes: type 1, supply. Doesn’t cause permanent cardiomyopathy. It aff ects people required to pump blood is where your body stops producing brain damage. Symptoms usually of all ages and is usually inherited. consistently higher than the insulin, and type 2, where your pass within 24 hours. Cardiovascular disease (CVD) recommended level. This puts body can’t use the insulin it Includes all diseases of the heart extra strain on your heart and Ventricular tachycardia (VT) A that collected detailed information produces, usually because excess life-threatening heart rhythm your risk of heart attack and stroke. Over of developing type 2 diabetes reduces cholesterol levels in following a health check Like all medicines, and circulation, such as coronary blood vessels, and over time can V fat in organs prevents the insulin that starts in the ventricles. heart disease and stroke. increase your risk of having a our dictionary from working eff ectively. Diabetes Causes the heart to quiver or Cardioversion A treatment for heart attack or stroke. increases your risk of developing ‘fi brillate’ in a disordered way so it some arrhythmias to help restore Implantable cardioverter defi brillator cardiovascular disease. stops pumping blood around the I (ICD) A small device implanted Call the Heart Matters Helpline on 0300 330 3300 body. This is a cardiac arrest. if you want to know more bhf.org.uk time, if it is not treated, the heart may compared with Europeans. Work on CVD risk factors in more than the blood. Statins have been by your GP or nurse. If statins can interact on page 49. 49

become abnormally large and its pumping published this year suggests amino two million people in 130 different Photography: Johanna Ward prescribed to millions of people your 10-year risk of with other drugs. action will be less effective, which could acid disturbances (in particular surveys in 25 countries. lead to heart failureD. If you’ve been The team wants to understand diagnosed with CVD, then you should have We want to prevent how genes, blood biochemistry Chest pain worries your blood pressure checked regularly, or and lifestyle affect your risk, Q I had a stent fitted after usually improve the symptoms your tongue. Always remember as part of an NHS Health Check (England) and treat health individually and combined. Our being diagnosed with angina, of anginaD, but there may be that if resting and using or Keep Well health check (Scotland). problems” support will enable Professor but a week later I’m still narrowings in other arteries your spray during an angina What can I do about it? Danesh’s unit to develop new having some chest pain. too. These might not be severe attack hasn’t worked, call for Once diagnosed, it’s important to keep tyrosine) may be a focus for future statistical tools to analyse data Is this normal? enough to require another an ambulance – you may be to a healthy weight, cut down on salt and research, potentially paving the from such detailed studies. stent, so you may still have having a heart attack. alcohol, and stay physically active, as well way for targeted treatments for Research we helped fund at the Senior angina symptoms – this is why It is also possible that you as taking any prescribed medication. South Asian people. University of Leicester suggested Cardiac Nurse working with your doctor to are experiencing discomfort Current work includes a 25-year there may be a genetic link Christopher get your medication right is so because the stent is taking follow-up with study participants between being short and having a Talk to us Allen says: important. The tablets you take time to settle. This is quite Go online to measure changes in the health higher risk of CHD. Further research A stentD is fitted every day should keep most of normal, but make an Watch our new animation about of the heart and circulation (with will help us understand the genes when an artery is very narrow your symptoms under control, appointment to see your GP atherosclerosis at bhf.org.uk/athero. a special focus on the health of involved and how they act to affect and restricting blood flow to but for any flare-ups you may and check if they want to See 10 odd things that might affect your the brain’s blood vessels) and early both height and risk of developing Heart Matters Helpline the heart muscle. The stent will want to use a GTN sprayD under review your medications. heart risk at bhf.org.uk/risky. signs of diabetes. We also want heart disease. 0300 333 2333 Need more information? Go online to bhf.org.uk/experts for more medical questions answered 18 Heart Matters bhf.org.uk 19 MEDICAL

n this country, pregnancy is low risk,” says Dr Sara becomes enlarged and weakened in late pregnancy or Thorne, a Consultant Cardiologist who specialises following childbirth. It can be mild or severe and is in adult congenital heart diseaseD and heart difficult to diagnose, as symptoms, such as fatigue and disease in pregnancy. “That said, heart disease is swollen ankles, are similar to those of pregnancy. the biggest single cause of maternal deaths in the Jennie was diagnosed following an echocardiogramD. UK. There is a 50 per cent increase in how much “I was told I had heart failureD as a result of peripartum your “heart has I to do by the end of the first trimester; cardiomyopathy,” she says. “That was a big shock. I was that has to be sustained for six months.” moved to the cardiology ward straight away. I broke If you have a heart condition, get specialist advice down in tears and thought I was going to die. I started before trying to conceive. “It’s important to see the to write a goodbye letter to my loved ones.” right cardiologist, preferably alongside an obstetrician,” Jennie was prescribed beta blockers and ACE advises Dr Thorne. “If you’re being seen by a congenital inhibitors. “It meant I had to stop breastfeeding,” she says. heart disease service, they should have the right degree “That was heartbreaking, but I have pictures of our last of knowledge, but if you’re seeing a general cardiologist, feed. Letting Michael go home from hospital without me you may need to ask to be referred to a specialist.” was hard, but his dad, Will, looked after him; that gave She says women should be particularly them a special bond. They came in every careful if they suffer from cardiomyopathyD day. Michael gave me something to live for.” or diseases affecting the aorta (such as Dr Sara Thorne, When Jennie came home, she was still Marfan syndrome or Loeys–Dietz syndrome) MD FRCP weak. Friends rallied round and her mother Consultant or mitral or aortic valve stenosis. Pulmonary came to help. “There were a lot of emotions,” Cardiologist at arterial hypertension (which is rare but she says. “I was angry one minute, shocked Queen Elizabeth more common in women) can be extremely the next minute, confused the next. It was Hospital dangerous in pregnancy, so women would Birmingham like a grieving process.” usually be advised against having a child. A year later, Jennie is still taking “It’s important not to fall pregnant medication but is back at work as a accidentally,” says Dr Thorne. “Think about contraception. paediatric nurse two days a week, doing eight-hour shifts There are several heart conditions where you will not instead of the 12 hours she used to. be able to take the combined pill. If you are taking a Many women with peripartum cardiomyopathy make progestogen-only pill, get advice to ensure you choose a complete recovery, but there is a high risk of a relapse the most effective one. in future pregnancies. “We’ve been told I might not “Pregnancy may make your condition worse, so be able to have another baby,” says Jennie. “That was Focus on… consider how you would cope with a baby,” adds Dr upsetting, but we’re glad we’ve got Michael.” Thorne. “And if you have a heart condition, it may be better to have your family in your 20s – don’t put it off.” Gestational diabetes Some women won’t realise they have heart conditions Jennie also developed gestational diabetesD during women and until problems arise and, although numbers are small, pregnancy. This is fairly common, especially after 28 heart attacksD are one of the biggest causes of maternal death in the developing world. It’s worth reducing your risks before you get pregnant. “Lose weight if you are Research into rare conditions heart disease overweight, take regular exercise, stop smoking and Spontaneous coronary artery dissection happens In the first of a two-part series, Sarah manage issues like high blood pressureD,” says Dr Thorne. when inner layers of a coronary artery tear away Brealey explores issues of pregnancy from the outer layer. It can lead to a heart attack Peripartum cardiomyopathy Jennie’s story and can be fatal. Eighty per cent of sufferers are and your heart and meets two women Like most new mothers, Jennie Warren (left) was looking women, and 30 per cent are in late pregnancy or who fought back from health issues forward to life with her baby. But two days after coming have recently given birth. We’re funding the UK’s home with Michael in 2014, she says: “I woke up and first research into this poorly understood condition. felt like I’d been hit by a bus. I had no energy and was We’re also funding research into pulmonary arterial short of breath.” She assumed this was due to her long hypertension – a condition affecting blood vessels labour, or breastfeeding, but it turned out to be a life- in the lungs. Women are four times more likely to threatening heart condition. be affected, possibly because sex hormones play a Jennie, 38, from Tewkesbury, Gloucestershire, had role in the development of the condition.

Photography: Emli Bendixen peripartum cardiomyopathy, a condition where the heart

20 Heart Matters bhf.org.uk 21 More than 40% increase in the

blood circulating Left: Jennie and one-year-old in a mother’s Michael; above: Rachel and body during 12-year-old Francesca pregnancy weeks, affecting up to 18 out of every 100 women who unit for three weeks; Rachel visited every day. Francesca give birth in England and Wales. Symptoms include was then in and out of hospital for her first five years. dry mouth, needing to urinate frequently, tiredness Rachel had just had a pacemakerD fitted when and infections such as thrush. It can be controlled with Francesca became critically ill with pneumonia, diet and exercise, but some women need medication. septicaemia and renal failure aged 12 months. “Coping Untreated, it can cause premature birth or health issues with a poorly child when you’re not well yourself is for the baby, such as low blood sugar. difficult,” says Rachel. “The nurses were worried about It often goes away after birth, but you’re at increased me and kept asking me to rest. But I stayed by my risk in future pregnancies. You’ve an increased risk of daughter’s bed all night. You find this inner strength developing type 2 diabetes too, which Jennie now has when you go through something like this. I was going and controls with diet and medication. She says: “I’ve lost to be there for my precious daughter.” weight and I make the time to go walking and running.” Francesca, now 12, has been diagnosed with a chromosomal disorder and needs care for most aspects Congenital complications Rachel’s story of daily life. “She’ll never be independent and that’s my Rachel Adam-Smith, 38, from Boston Spa, West Yorkshire, biggest concern with my own health problems,” says was born with transposition of the great arteries (TGA), a Rachel. She’s brought up Francesca on her own since congenital condition where the main blood vessels 2007, but says her mum has been “a rock”. leaving the heart are the wrong way round. Rachel is now on her second pacemaker. She says: Rachel had surgery to correct her condition at 10 “You learn to appreciate life more, and it’s made me months old. Heart surgery in infancy can make you prone determined to do all I possibly can for my daughter.” to arrhythmiasD. Since her teenage years, Rachel has had a fast, often irregular, heartbeat, treated with beta Pre-eclampsia blockers. Aged 24, she had a cardioversionD to resolve it. This affects up to six per cent of women during the In the past, women like Rachel rarely lived long second half of pregnancy or soon after giving birth. enough to become pregnant. “Now, thousands of Early signs include high blood pressure and protein women with congenital heart disease have been able to in your urine. Women are tested for these at antenatal have children, with careful monitoring and care,” explains appointments, as symptoms may not be obvious. Most Dr Thorne. “If you have congenital heart disease, talk to cases are mild, but it can have serious complications for your consultant. I would test the function of their heart both mother and baby if not treated. It will usually go beforehand with an exercise test, and see them in a joint away after birth. clinic with an obstetrician and a nurse specialist.” Although the exact cause isn’t known, having diabetes When she fell pregnant, Rachel had scans every two and high blood pressure could increase your chances of weeks. “I did well until 32 weeks, then one morning my developing pre-eclampsia, so it’s important to follow a heart rate went up to 200 bpm,” she says. “I had another healthy lifestyle to reduce your risk as much as you can. cardioversion, then went into heart failure. I was kept in hospital until they decided to deliver.” ≠ Next issue: which heart problems are more likely to At 36 weeks, doctors decided to deliver Rachel’s affect older women? daughter by caesarean. “Francesca needed to be resuscitated,” Rachel says. “I was just coming round from the general anaesthetic when she was taken to special Find free support care and put on a ventilator. I wasn’t allowed out of bed ≠ Watch our video of Jennie and heart disease. See page 50. to see her for the first day, which was difficult.” Michael at bhf.org.uk/pregnancy. ≠ Find information and supportive After a few days, Rachel left hospital, though she was ≠ Order our free booklet Women and conversation at bhf.org.uk/women.

Photography: Emli Bendixen still recovering. Francesca remained in the special care

22 Heart Matters RESEARCH

Help the BHF. Donate now. 0300 330 3322* or bhf.org.uk/donate *Cost similar to 01 or 02 numbers newBRAVE Stem cell research has WORLD advanced greatly since Dolly the sheep (right) and may help us reverse heart Stem cell research attack damage could reveal new ways to help us mend broken hearts, as Sarah Kidner discovers

hances are you’ve heard of Sir Ian Wilmut, Professor stem cells. Even if you haven’t, Emeritus at the you’ll know of Dolly the cloned MRC Centre for sheep – the original ‘poster Regenerative Medicine girl’ of this sensational field of scientific research. Twenty years ago, Dolly’s creation saw Cscientists accused of ‘playing God’, but Denning, Professor of Stem Cell Biology at coaxed into becoming any human body while stem cell research does raise ethical the University of Nottingham. “But what cell. Today, you can simply take a skin questions (see page 25), it may also hold was once impossible is now possible.” biopsy or a blood sample from a patient, the key to mending hearts damaged He’s referring to induced pluripotent isolate skin or blood cells and, by adding by a heart attackD and has many other stem (iPS) cells. Their development won four genes, convince them that they are potential uses. Two professors at the Shinya Yamanaka and John Gurdon the stem cells. “The gene cocktail used can cutting edge of stem cell research tell us Nobel Prize for Physiology or Medicine in differ, but the most common factors are how their work could affect people’s lives 2012. But what are iPS cells, and why is this called the Yamanaka factors, after Shinya in the future. type of research such a big deal? Yamanaka, and are all stem cell-related genes,” explains Professor Denning. “It’s an amazing iPS cells explained The beauty of the iPS cell technique Until recently, to conduct stem cell lies in its simplicity. “Everybody thought breakthrough” research scientists needed to obtain he [Yamanaka] was crazy when he Professor Chris Denning human embryonic stem cells from spare presented iPS cells at one big international “Ten years ago, we couldn’t have IVF embryos with the consent of those conference. Within a year several labs had

Photography: Science Photo Library;Photography: Science Photo Imperial London College Dr Gabor Foldes, conceived of these studies,” says Chris involved. These embryonic cells could be repeated the technique. Yamanaka was

bhf.org.uk 23 The number of There has specific genes never been needed to convert a standard human a better time cell into a stem cell to support 4 the BHF” BHF Professor Michael Schneider

dish. This is because the cells retain the BHF Professor Michael Schneider and genetic abnormalities present in those his team at Imperial College London are who donated the skin biopsy.” leading research to explore how we can kick-start heart cells to regenerate or repair New drug therapies? following a heart attack. Their focus is on ‘Patients in a dish’ could also help create the limited number of stem cells, which new drugs. “If you’re a person with a already exist within the heart muscle, All we took condition and someone says they want to and to “learn how they might contribute from that test 1,000 different drugs in you, you would to heart repair in the case of injury,” says say ‘I think not’ – some of them might be Professor Schneider. patient was harmful,” says Professor Denning. “But if Specifically, the team aims to learn how you can replicate these things, you can ask the heart’s own stem cells become more Embryonic a skin biopsy if those drugs work when tested in a dish.” effective at creating new heart muscle He says what makes this cutting- following a heart attack. stem cells the size of edge work worthwhile is seeing the “Our main emphasis is on finding highly Embryonic stem cells used in research are the head of a impact it might have on people’s lives. cloneable cells with the ability to become donated by couples that have undergone “Once in a while, you have a little bit of a all the needed cell types in the heart,” says in vitro fertilisation (IVF) treatment. They matchstick” breakthrough, but I have to say that the Professor Schneider. “It’s too early to say choose to donate spare embryos that Professor Chris Denning thing that made me happiest was when how this might work, but it may be that would otherwise be destroyed, so that we published our 2011 paper. Our clinical doctors deliver drug-like molecules or stem cells can be extracted for use in colleagues forwarded it on to a patient’s hormones into the body to activate stem research. Only embryos at a very early family and the father replied to thank us cells in the heart to become new cardiac stage of development (up to 14 days) for the work we’re doing in this area. That muscle. Or, they may be useful for cell can be used. is why we’re doing it.” grafting in the catheter lab, at the time of Using stem cells We’ll only fund research using a superstar; the Japanese government week and do the same again?’ It’s not a heart attack or later on.” embryonic stem cells where: invested £65.1m in him. Just six years later, going to happen. Understanding of these techniques is in research ≠ the application has been through a he won the Nobel Prize.” “Now, I can take a skin biopsy, do the “We are reaping continually growing. “There has never The BHF supports essential research thorough scientific review panel, to genetic programming that turns it into been a better time to support the BHF using stem cells because we believe which researchers must show that this Patient in a dish stem cells and keep growing them. We’re the harvest of several than now,” says Professor Schneider. “We they have the potential to cure project could not be carried out in By adding specific growth factors, you still working with the same population decades of painstaking are reaping the harvest of several decades conditions that are incurable today. another way can turn iPS cells into beating heart cells of cells we reprogrammed in 2008 and of painstaking research and the advances We fund research that uses stem ≠ there is a licence from the Human in a dish. This means it’s possible to study all we took was a skin biopsy the size of research” and their progress into the clinic have cells from human or animal embryos Fertilisation and Embryology Authority people with heart conditions without a matchstick head.” Professor Michael Schneider never happened at a faster rate.” and adult tissues, because we believe ≠ there is approval from an independent conducting invasive procedures. Professor Denning uses iPS cells to When someone suffers a heart attack, cells that both approaches are important. research ethics committee. “Imagine you have an inherited heart research inherited conditions that lead in the heart are starved of oxygen and Enjoyed this? Many of the advances in stem cell condition,” says Professor Denning. “I say: to sudden death. “When patients with die. This can lead to the chronic and life- research have only been possible More work to be done Read about the work of PhD student D ‘I would like to investigate it using some this condition get stressed or experience limiting condition heart failure , for which Arya Moez into iPS cells and the support through the knowledge and insight Heart and circulatory disease kills one of your heart cells, so I need to crack your strange stimuli, they can start to there’s currently no cure. We don’t know from her mentor David Grieve. Visit gained using embryonic stem cells. in four people in the UK, but stem cell chest open and cut out a little piece of your experience terrible arrhythmiasD,” he how to mend or regenerate dead cells, but bhf.org.uk/moez or order our Jul/Aug We recognise that this is an area research holds real promise to help us heart. But because the cells only last a few explains. “What we’re able to do in a lab is stem cell research could unlock new ways 2015 issue on 0870 600 6566. some people have concerns about. save lives in the future.

weeks in the lab, can I come back the next mimic the person’s condition in a culture of doing precisely that. Photography: Thomas Mein

24 Heart Matters bhf.org.uk 25 NUTRITION

Make friends with your microwave Quick meals from scratch Microwaves have a bad reputation. If you only use yours to 14 Chicken RUSH-HOUR reheat leftovers and coffee, you’re missing out. Foods cooked in Cut chicken portions into chunks and then During winter the lure of speedy a microwave can be tasty, as well as time- and energy-efficient. add to stir-fry or pasta, for a satisfying meal comfort food is hard to resist. For a quick breakfast, scramble eggs in the microwave, add in 30 minutes. Senior BHF Dietitian Victoria spinach and fresh chopped tomatoes and put in a warm tortilla 15 Eggs suppers Taylor and Nadine Richards wrap (which can also be heated in the microwave). To steam A quick foundation of many filling dishes. vegetables, chop and place them in a bowl with a little water, Mix spring onions, tomatoes, mushrooms present top tips for healthy meals in a hurry cover and microwave for two to four minutes. and peppers into scrambled eggs and serve on wholemeal toast. Or boil new potatoes in a saucepan and halfway Preparation Once defrosted and reheated, tomato sauce also chop fish and combine with raw egg, through cooking, add an egg to boil too. 1 Take stock can help you make quick meals such as breadcrumbs and herbs to make fishcakes. Chop them both up into a green salad. Or Good store cupboard staples include spaghetti bolognese. 10 Veg your bets make an easy egg-fried rice (search online reduced-sugar-and-salt baked beans, tinned 5 Stock pot Extra vegetables are the ideal base for a for “BHF fried rice”). tomatoes and dried pulses, which all count Freeze leftover stock in ice-cube trays. ratatouille or a stew. Chop peppers, onions 16 Baked beans towards your 5-a-day. One third of your food Simply pop a cube or two into the pan when and courgettes, add tinned tomatoes and Spruce up baked beans for a fast, fun meal. should be a starchy carbohydrate, preferably you’re next cooking. Homemade stock has simmer. Cooked vegetables, cut into chunks, Choose reduced-sugar-and-salt varieties a high fibre as wholegrain variety, so stock less salt than many shop-bought varieties; are perfect for a frittata. Add them to a frying and add your favourite spice, such as up on brown rice, wholewheat pasta and some stock cubes are about 50 per cent salt, pan, whisk eggs with a little milk, pour over paprika, mustard powder or curry powder. wholewheat cous cous. Keep a full herb and so always check the label. and allow to set. Chop in onions, garlic and mushrooms to spice rack to add flavour to meals too. 6 Plain gains 11 Wine and dine help towards your 5-a-day. 2 The big freeze Cook portions of plain meat or fish, then A cup of wine added to stew, 17 Fish fillets Ready meals are quick, but can be high in freeze. This provides a base for dishes bolognese or chilli makes the Steam fillets in the microwave. saturated fat, salt and sugar. Homemade including curries, salads or pies topped with flavour richer. Pour wine into Make sure steam doesn’t pizza bases, stored in the freezer, are a good vegetable mash. plastic boxes or sealable bags 50% escape by placing the fish alternative. Control the amount of extra salt 7 A healthy mash-up and freeze. It doesn’t freeze Salt content in a covered microwaveable and fat by topping with fresh vegetables, Save energy by pre-cooking a batch of completely, so it’s easy to of some container (or cover with cling reduced-fat cheeses and lean meats. Healthy jacket potatoes in the oven. Reheat in the scoop out of the freezer when film). While it cooks, make stew, chilli and pasta can also be cooked in microwave later or use as mash to top a fish you need it. stock cubes a salad and couscous. In 10 big batches and frozen. Defrost when you’re or cottage pie. This works for sweet potatoes 12 Mince matters minutes, you’ll have a meal. pushed for time or too tired to cook. too, and they count as one of your 5-a-day. Fajitas are an easy way to use up cooked 18 Tinned fish 3 Save your energy mince. Reheat extra-lean beef or turkey If you don’t have time for our microwave A microwave is the most energy-efficient Transforming leftovers mince with spices and place in a tortilla tip (above), you can still make yourself a way to cook, but there are other ways to 8 Chicken tonight wrap with veg, salad and low-fat yoghurt fish supper. Try tinned fish in spring water. save. Match your pan size to your hob Leftover baked or roast chicken makes great (rather than sour cream). Combine raw It’s already cooked, so you can quickly drain ring. Boil only as much water as you need sandwiches, but you could do so much mince with eggs and breadcrumbs and oven it, then scoop it straight into salads, potato using a kettle, not the hob. Par-boil starchy more with it. Cut chicken into strips, add cook to make burgers or meatballs, or fill salads or onto wholemeal bread with vegetables before roasting to reduce oven spices and stir-fry with vegetables. Mix with crisp lettuce leaves with cooked mince and cucumber and tomato. Add to omelettes, time and cut food into smaller chunks. Bulk shredded salad leaves, peppers, grated vegetable chunks to make lettuce parcels. jacket potatoes or tortilla wraps, too. Use cooking then freezing is energy-efficient too. carrots and an olive oil and vinegar dressing. 13 Tooty fruity reduced-fat mayonnaise and dressings to 4 Saucy, but nice Add to pasta and tomato sauce. Or, simmer Blended fruit makes delicious smoothies. avoid extra calories. Tomato sauce and a healthier version of veg and add low-salt stock for a quick soup. Freeze puréed fruit in ice-cube trays (or white sauce (mix plain flour and unsaturated 9 Fishing for ideas freeze chunks of lemon, orange or berries in spread then whisk in low-fat milk, or use Stop leftover cooked fish drying out by water) and add to drinks. Overripe bananas Go online cornflour and leave out the spread) can be adding it to dishes right at the end to warm it can be blended with milk for a naturally Enjoyed this article? Discover 25 healthy made in batches and frozen in sealable bags. through. Or, cook rice in low-salt stock, with sweet milkshake with no need to add sugar. foods you can cook in five minutes or Add dill, parsley or mushrooms to make onion, sweetcorn, chopped tomatoes, beans Puréed berries are great on top of porridge, fewer at bhf.org.uk/speedy.

Photography: Getty sauces that form the basis of many meals. and spices, then flake in the fish. You could low-fat yoghurt or rice pudding.

26 Heart Matters bhf.org.uk 27 NUTRITION

As a guide, a third of our diet should be Taste the fruits and vegetables, a third starchy carbohydrates (preferably high fibre as wholegrain versions) and the final third lean protein-rich foods (meat, fish, beans, lentils) and reduced-fat dairy products. RAINBOW Eating small amounts of foods high in fat Colourful plates of food are and sugar is OK too. The eatwell plate is appealing, but are they healthy a tool to help you plan a balanced diet. too? Dietitian Annemarie Visit bhf.org.uk/eatwellplate. Aburrow reveals all

odern chefs consider food Eating a variety of foods will help you get presentation an art form, so essential nutrients and, by doing so, you’ll colourful plates are highly naturally embrace a broad colour palette. prized. But getting the right Fruits and vegetables are particularly proportion of foods from colourful, so a rainbow plate can help you the major food groups is far towards your 5-a-day. Plus, you’re more likely moreM important than creating a rainbow. to enjoy eating an attractive meal. There’s no evidence that eating a balance of colours leads to a balance in RED nutritional content, although the natural Properties: Contain antioxidants including compounds (phytochemicals) that give lycopene (in tomatoes), anthocyanins (red fruit and vegetables their colour may be berries, including strawberries), ellagic acid beneficial. Many of these phytochemicals (strawberries, raspberries and pomegranate) are antioxidants (natural chemicals that and astaxanthin (crab, salmon and prawns). are thought to protect against harmful Health benefits: Lycopene gives red fruits substances called free radicals), and diets their colour. It is thought to have antioxidant rich in foods that contain these, like fruits properties that may help protect against and vegetables, are associated with lower CVD and has been reported to help reduce levels of cardiovascular disease (CVD)D. blood pressure and cholesterol. Photography: Sara Morris

28 Heart Matters bhf.org.uk 29 NUTRITION

Colourful swaps Original Swap

Fish in white sauce with Fish in white sauce with added like sweetcorn, peach, papaya lettuce, limes, mange tout, sugar Suggestions: Aubergines, steamed cauliflower and parsley, cauliflower, peas and and egg yolk are also rich in the snap peas. blackberries, blackcurrants, mashed potato sweet potato mash antioxidant beta-cryptoxanthin. Top tip: Stir peas into cooked purple grapes, red cabbage. Like beta-carotene, our bodies rice to add colour and nutrients. Top tip: Slice ready-cooked, Tuna pasta bake with cheesy Tuna pasta bake with can convert beta-cryptoxanthin However, most of these studies Search online for “BHF biryani” vacuum-packed beetroot (not sauce and sweetcorn homemade tomato sauce, into vitamin A. While some are based on mice, or human to find our recipe for spiced rice pickled or in brine) and add it to courgette and sweetcorn studies have suggested health cells in the lab, rather than with peas and other vegetables. salads or toast. Jacket potato with cheese Jacket potato, reduced-salt/sugar benefits, such as reducing the people. Further research is and coleslaw baked beans and green salad risk of rheumatoid arthritis and needed in humans, including BLUE / PURPLE WHITE / BEIGE certain cancers, the evidence into whether eating broccoli will Properties: Anthocyanins Properties: Anthoxanthins are Potato frittata Green vegetable frittata is not strong enough for us to have the same effect as taking give blue and purple foods their the pigments that create white recommend specific fruits or sulforaphane supplements. rich colours. or cream colours. Beef chilli and boiled rice Beef, pepper, tomato and vegetables. However, including We’re currently funding several Health benefits: Anthocyanins Health benefits: Some sweetcorn chilli, served with yellow fruits and vegetables studies to find out whether are powerful antioxidants, which studies have suggested that rice and peas in your diet helps you towards sulforaphane could help protect may have a role in protecting anthoxanthins may reduce the your 5-a-day. against the damage caused cells from damage. However, risk of CVD and inflammatory Cottage pie (beef and gravy Lentil pie, with a tomato sauce, Suggestions: Butternut squash, by heart attacks, strokeD and the positive effects seen in lab conditions such as arthritis, but with mashed potato topping) topped with sweet potato and honeydew melon, lemons, gestational diabetesD. studies have not been seen in there is not enough evidence for butternut squash mash papaya, peaches, persimmons, There is evidence to suggest human studies. us to recommend white fruits swede, yellow peppers. lutein and zeaxanthin-rich Purple beetroot is rich in and vegetables over those of Chicken and pasta salad Salad made from chicken Top tip: Add yellow peppers to vegetables, like kale, spinach, nitrates, which may help reduce other colours. with mayonnaise breast, pasta, green salad leaves, beetroot and cucumber chilli, bolognese and salads, or broccoli and peas, may help blood pressure. This conclusion The humble potato – a starchy swede to casseroles. prevent and slow the progression is based partly on research we’ve carbohydrate – gets a lot of bad Roast chicken with Roast chicken with a selection of of an eye disease, age-related funded, although we need to press, but potatoes are one of Lycopene is more easily ORANGE roast potatoes roasted sweet potato wedges, macular degeneration. do more research in humans. As the biggest sources of vitamin absorbed in the body when it’s Properties: High in carotenoids, carrots, broccoli and peppers Rather than focusing on a well as beetroot, purple lettuce, C in our diets and are full of cooked (such as in a homemade such as alpha-carotene and 30g particular fruit or vegetable, aim carrots, green beans, spinach, potassium too. Eat the skins for tomato sauce). While there beta-carotene. to increase the total amount cabbage and radishes are high in extra fibre and avoid adding fat is some research to support Health benefits: Beta-carotene nutrients in food may not always to have plenty of orange fruits of dried apricots of both in your diet, and don’t nitrates. Overall, there are many when you cook them. Bananas lycopene’s health benefits, much gives yellow and orange fruits be replicated by supplements. and vegetables. Citrus fruits like contains fibre, forget leafy green vegetables. ways that fruit and veg can help (which have creamy flesh under of it is low quality, so more and vegetables their colour Taking individual supplements oranges are low in vitamin A but Suggestions: Apples, asparagus, reduce your risk of CVD, so it’s that yellow skin), parsnips and research is needed. and is converted to vitamin A should be avoided, unless high in vitamin C. Dried apricots iron, potassium avocados, celery, courgettes, best to focus on eating more mushrooms are also good Don’t let that stop you in the body, where it helps us recommended by your doctor, are a great source of fibre, iron, and calcium cucumbers, green grapes, leeks, and a wide variety. sources of potassium – an including red fruits and veg in make hormones and keeps our as it’s easy to consume too potassium and calcium too (but important mineral for normal your diet. As well as the usual eyes healthy. Carrots, butternut much. There is no evidence that stick to a 30g portion as dried GREEN heart and muscle function. vitamins, minerals and fibre squash, pumpkin and sweet eating beta-carotene from foods fruits are high in energy). Properties: The pigment The truth about E numbers Suggestions: Bananas, celeriac, that come with all fruits and potato are all good sources of is harmful, however, so it’s fine Suggestions: Cantaloupe chlorophyll gives green fruits Food colourings are added to many manufactured foods. garlic, Jerusalem artichokes, vegetables, the pop of colour this vitamin – hence the saying melon, mangoes, nectarines, and vegetables their colour, but Some are natural, such as curcumin (E100), the yellow mushrooms, onions, turnips, will add interest to everyday that carrots will help you to orange peppers, pumpkin, many green vegetables are rich substance in the spice turmeric. This is used in some drinks, white peaches. dishes. Add pomegranate seeds see in the dark. In the past, sweet potatoes. in other nutrients too. Broccoli, condiments, confectionery, dairy products, and processed Top tip: Make mash exciting or cherry tomatoes to a green population studies suggested Top tip: Add dried apricot or cabbage, Brussels sprouts, kale meats and vegetables. There are also many artificial food with cooked celeriac or salad or cous cous (search online vitamin A (along with vitamins C mango to porridge or cereal. and pak choi are all sources of colours, such as caramel (E150a-d), which is often added to Jerusalem artichokes. Either for “BHF jewelled couscous” to and E) could help prevent heart sulforaphane and glucosinolate. cola drinks, and tartrazine (E102) – found in fruit squashes, mash on their own or together see our recipe) or strawberries to attacksD. However, large trials YELLOW These vegetables also contain fizzy drinks, instant puddings, custard powder, soups, sauces with potatoes. a bowl of porridge. of vitamin A supplementation Properties: Contain carotenoids lutein and zeaxanthin, as do and ice cream. All food colours go through the rigorous safety Suggestions: Cherries, either alone or in combination including beta-carotene and peas, sweetcorn, yellow peppers assessments of the European Food Safety Authority (EFSA); cranberries, radishes, red with other vitamins haven’t beta-cryptoxanthin. and eggs. the assignment of an E number shows they’ve been approved apples, red grapes, red peppers, confirmed this. The relationship Health benefits: As with Health benefits: Studies suggest (E stands for Europe). During this process, an ‘acceptable Go online Find out which 10 colourful tomatoes, watermelon. observed in the original studies orange fruit and vegetables, that sulforaphane may help daily intake’ is established, so the European Commission can foods you should avoid at Top tip: Add chopped tomatoes may have been a coincidence, beta-carotene gives yellow protect against blood-vessel decide which foods it can be used in, and in what quantity. bhf.org.uk/rainbow.

to omelettes or burritos. or the benefits of consuming varieties their colour. Foods Photography: Sara Morris damage and certain cancers.

30 Heart Matters bhf.org.uk 31 NUTRITION Heart health questions? How to get in touch ASK THE Call the Heart Matters Heart Matters Helpline Helpline on 0300 330 3300 for more information. To is here to help, with EXPERT suggest a question, email Our Senior Dietitian Victoria Taylor shares nutrition advice [email protected]. free information and Nutty knowledge support about your Q I’m confused – are nuts fat. Too much of this can With the festive sugar too. If you’re at a party, a healthy snack? contribute to raised cholesterol remember that nuts are often heart health levels, so only eat them season... many salted, which may make you Victoria Taylor says: With the occasionally. Chestnuts are of us will be feel thirsty and encourage you festive season looming, many an exception – they’re lower to consume more alcohol. of us will be tempted by nuts in all types of fats and higher tempted by nuts” Plain nuts are healthier, but more often than usual, whether in starchy carbohydrate than they don’t have to be boring. they’re nibbles at a party or a other nuts. 30g (a small, cupped handful) Dry frying or toasting nuts in bowlful of nuts in their shells. As a substitute for foods which is about 175kcal. If you the oven gives them a stronger Nuts have a high fat content, high in saturated fat and sugar find this hard to stick to once flavour – particularly for so are high in energy. In most (such as biscuits, chocolates a packet is open, buy nuts you almonds, hazelnuts and pecans. nuts this is mainly unsaturated or cakes), nuts can be a good have to shell yourself. Having Try adding spices like Chinese fat: either polyunsaturated choice. The high protein and to crack them takes more time five-spice, paprika or cayenne fats in walnuts and pine nuts, fibre content makes them a so you may eat fewer. Shell-on pepper. For a sweeter flavour, or monounsaturated fats in satisfying snack and they nuts are also generally unsalted try cinnamon or vanilla extract. almonds, pistachios, pecans contain nutrients such as (pistachios are an exception). If you keep an eye on portion and hazelnuts, for example. vitamin E, potassium and Try to avoid dry-roasted, sizes and avoid unhealthy Brazil nuts, cashews magnesium. But watch salted, flavoured or honey- additions like salt and sugar, and macadamia nuts your portion sizes. roasted nuts, which come nuts can be a healthy choice are higher in saturated A portion of nuts is with extra salt and sometimes between or with your meals. Fast way to fat loss? Q Several of my during other times. diseaseD and diabetesD, but (0.5–1kg) a week is achievable. Talk to us friends have lost There are different more research is needed before This is the safest approach. weight on the 5:2 versions, but the 5:2 this can be proven. We don’t Our booklet Fact not fads will diet. I have anginaD diet involves eating yet know if this diet can be kept help you to get started. You and am hoping to a normal, healthy up long-term, how it compares can order it from bhf.org.uk/ lose weight before my diet for five days every with other weight-loss HMpublications or by calling heart bypassD surgery week and ‘fasting’ on approaches and what pattern 0870 600 6566. later this year. Do you the remaining two of fasting is most effective. think this diet is a good days. On a ‘fast’ day, you Not everyone can safely fast, choice for me? would typically consume so if you are considering it, Dictionary

DICTIONARY

Medical words, MEDICAL TERMS under the skin on your chest, EXPLAINED connected to your heart by one Call the Heart Matters Helpline Ablation Procedure to correct a normal heart rhythm. It can be between 500 and 600kcal. you should talk to your GP, or control certain types of or more wires (leads). It monitors A Echocardiogram Sometimes done using medicines (chemical heart rhythm and can deliver a arrhythmias. Involves using called an ‘echo’. This is an cardioversion), or by giving the E controlled electric shock if you radiofrequency waves to destroy ultrasound to examine the heart a controlled electric shock have a life-threatening abnormal abnormal electrical pathways. structures within the heart, such with a defi brillator (electrical heart rhythm. Angina An uncomfortable as heart valves, and to see how cardioversion). feeling, tightness or pain in well the heart is pumping. MRI scan MRI stands for Congenital heart disease A heart your chest that may also be felt Electrocardiogram (ECG) A simple, M ‘magnetic resonance abnormality someone is born with imaging’. An MRI scan is a test in your arms, neck, jaw, back painless test to record the heart’s – for example, a hole between the identified by a or stomach. The symptoms of that produces extremely detailed electrical activity. Small sticky chambers of the heart (known pictures of your internal organs, angina are usually caused by patches (electrodes) are put onto as a ‘hole in the heart’). There are including your heart. It is very coronary heart disease. your arms, legs and chest. These There is some evidence especially if you have diabetes. many types of congenital heart good at showing the structure Victoria Taylor says: Angiogram X-ray pictures that are connected to a machine that disease; some are due to faulty of your heart and blood vessels, show whether the arteries are picks up and records the electrical genes or chromosomes. and it can also measure the fl ow narrowed and, if so, how narrow signals of your heartbeat. An D they have become. A coronary Coronary artery bypass surgery of blood through your heart and operation to treat coronary heart GTN spray A nitrate medicine angiogram examines the some of your major arteries. disease. Arteries from your chest G that helps relax blood vessel coronary arteries. walls, improving blood supply to Pacemaker Small device wall and arm, or veins from Arrhythmia An abnormal heart the heart muscle. Provides quick P implanted under the skin on small symbol , your leg, are used to bypass the the chest, connected to the heart rhythm. relief from angina symptoms. blocked or narrowed coronary by one or more wires (leads). Atheroma Fatty material that Heart attack Known medically arteries, improving blood fl ow to Monitors the heart’s electrical can build up on artery walls. as a ‘myocardial infarction’, the heart muscle. H signals and can stimulate the The 5:2 diet is based on to suggest intermittent In the meantime, eating Sometimes called ‘plaques’. or ‘MI’. This describes a sudden Coronary heart disease (CHD) When heart to contract and produce a Atrial fi brillation (AF) An abnormal loss of blood fl ow to part of the the walls of the coronary arteries heartbeat if required. heart rhythm in which the heart muscle. Most heart attacks (the arteries that supply blood atria (the upper chambers of are caused by atherosclerosis, Stent A short tube of to the heart muscle) become the heart) beat in an irregular the build-up of atheroma S expandable stainless-steel narrowed due to a gradual mesh that is inserted into an pattern. People with AF have an (plaque) within artery walls. If build-up of atheroma. artery to hold it open after an are explained in irregular, sometimes fast, pulse. the atheroma becomes unstable, CT scan ‘Computerised angioplasty, improving the fl ow Bypass See coronary artery a piece may break off and lead tomography’ scan. A type of of blood through the artery. B bypass surgery. to a blood clot. This can block a X-ray, which is useful for looking An interruption of blood Cardiac arrest The ultimate coronary artery, causing a heart Stroke at internal organs, such as your fl ow to part of the brain, causing C medical emergency, when attack and irreversible heart a principle known as fasting helps with weight a balanced diet and being heart or lungs. With some CT brain cells to die or become a person’s heart stops pumping muscle damage. It is a medical scans, a special dye (called a damaged. This happens if an blood round their body and they emergency and can lead to a contrast medium) is injected into artery carrying blood to your stop breathing normally. Cardiac cardiac arrest. a vein in your arm before the test. brain becomes blocked, or if an arrests in adults can be caused Heart failure Condition where the This helps show the blood vessels artery bleeds into your brain. A by a heart attack. heart is less effi cient at pumping on the surface of the heart. stroke is a medical emergency. plain English in Cardiomyopathy Disease of the blood around the body. Diabetes A condition in which heart muscle in which it becomes High blood pressure Also called Transient ischaemic attack (TIA) glucose (sugar) levels in the weakened, enlarged and/or D ‘hypertension’. High blood T Occurs during a temporary blood are too high. There are two blockage in the brain’s blood stiff , depending on the type of pressure is when the pressure main types of diabetes: type 1, supply. Doesn’t cause permanent cardiomyopathy. It aff ects people required to pump blood is where your body stops producing brain damage. Symptoms usually intermittent fasting. This is loss, and some studies more active will help you lose of all ages and is usually inherited. consistently higher than the insulin, and type 2, where your pass within 24 hours. Cardiovascular disease (CVD) recommended level. This puts body can’t use the insulin it Includes all diseases of the heart extra strain on your heart and Ventricular tachycardia (VT) A produces, usually because excess and circulation, such as coronary blood vessels, and over time can V life-threatening heart rhythm fat in organs prevents the insulin that starts in the ventricles. heart disease and stroke. increase your risk of having a our dictionary from working eff ectively. Diabetes Causes the heart to quiver or Cardioversion A treatment for heart attack or stroke. increases your risk of developing ‘fi brillate’ in a disordered way so it some arrhythmias to help restore Implantable cardioverter defi brillator cardiovascular disease. stops pumping blood around the I (ICD) A small device implanted Call the Heart Matters Helpline on 0300 330 3300 body. This is a cardiac arrest. if you want to know more where you eat normally at have linked it to lower weight steadily and gradually – bhf.org.uk on page 49. 49 certain times and then fast rates of coronary heart a weight loss of 1–2 pounds 0300Call rates are similar to 01 and 02 numbers. Lines333 are open 9am–5pm, Monday to Friday2333 Enjoyed this article? Look out for the truth about fad diets and freaky food routines in our Jan/Feb 2016 issue. Find all of our

Photography: Johanna Ward nutrition information at bhf.org.uk/nutrition.

32 Heart Matters RESEARCH £3.9m Total provided by the BHF to fund Professor Fishy tales Armitage’s trial Could a daily dose of aspirin and fish oil help prevent heart attacks and stroke in people with diabetes? Senior Cardiac Nurse Christopher Allen puts the questions to Professor Jane Armitage

for seven years to see whether a daily entered correctly into IT programs that our participants a dedicated 24-hour free CV Professor Jane Armitage dose of aspirin reduces their heart attack can analyse the data.” phone service for any questions they Professor of Clinical Trials and stroke risk. The trial will also examine have or information they need to give us. and Epidemiology at the whether a fish oil supplement benefits Million-pound question These queries are dealt with by different University of Oxford people with diabetes. The BHF has provided £3.9m to fund the members of the team.” ≠ Honorary Consultant in “Fish oil may have a small impact trial. “When you’re carrying out research While trial costs are significant, the Public Health Medicine in on reducing clotting and very small into the effect of older drugs that are result could be a low-cost, life saving the Nuffield Department of beneficial effects on cholesterol, but there no longer under patent, it’s incredibly solution. “Aspirin is cheap and easy to Population Health (NDPH) is more uncertainty than with aspirin,” difficult to get any funding from drug take, and if we can show clearly that ≠ Co-ordinates large-scale clinical trials says Professor Armitage. “What this trial companies,” explains Professor Armitage. benefits outweigh risks, then a very including the MRC/BHF Heart Protection allows us to do, in a very neat way, is test “Without the BHF, we may not have been general recommendation can be made Study, SEARCH and HPS2-THRIVE two treatments at the same time in what able to carry out this research to the high that people with diabetes should take ≠ Main research interests are lipids and the is known as a 2x2 trial.” standards we’re currently working at. Your a daily aspirin,” says Professor Armitage. epidemiology of cardiovascular and other Participants don’t know if they’re taking “This could have a huge impact and chronic disease, including osteoporosis aspirin and the supplement, a placebo prevent many people dying or having or a combination of the two. A quarter This could a heart attack or stroke.” spirin is commonly prescribed are receiving aspirin and a placebo following a heart attackD or strokeD fish oil, a quarter aspirin and fish oil, a have a huge November/December 2015 to reduce your risk of having quarter placebo aspirin and fish oil and A FREE PULL OUT another. It helps prevent blood clots that the remaining quarter a placebo aspirin impact and AND KEEP THE BIG FREEZE RECIPE D Risk factors CARDS form when fatty plaques (atheroma ) and placebo fish oil. Every six months, explained Cut your chances of prevent many heart disease rupture in the arteries. Clots can disrupt participants complete a questionnaire PLUS Top tips for healthy meals in a hurry 10WAYS TO blood flow to the heart or brain. about their health, including whether REBUILD YOUR people dying” CONFIDENCE Contrary to some popular belief, they have had a heart attack or stroke healthy people should not take a daily during this time. Mark of aspirin because the risk of bleeding The study will follow people for seven supporters are helping us to answer a strength Triumphing over the emotional and FIGHT FOR EVERY physical scars of heart surgery HEARTBEAT counterbalances any benefits. However, years, on average, until 2017. “The very important question.” bhf.org.uk an ambitious BHF-funded clinical trial, response has been fantastic and we’d The bulk of the funding pays for staff Enjoyed this article? led by Professor Jane Armitage from the really like to thank everyone who is taking managing the trial. “As well as our admin Read more: University of Oxford, aims to discover part,” says Professor Armitage. team, who handle the questionnaires and ≠ Stem cell research could help repair whether people with diabetesD could She admits that keeping track of data input, we have a further two senior heart attack damage (page 23) benefit from a small daily dose of aspirin. 15,000 people isn’t always easy. “We administrators responsible for the overall ≠ What are the main risk factors for Their increased risk of heart attack and have a dedicated admin team who work running of the study. Associate Professor cardiovascular disease? (page 16) stroke means benefits may outweigh risks. tirelessly, keeping things ticking over Dr Louise Bowman and I have joint clinical ≠ Is digoxin toxic? (page 36) day to day,” she says. “The biggest part and overall responsibility alongside the Go online: Ambitious trial of their job is translating all of the data other doctors and nurses involved in the ≠ Read more about the trials we fund at Professor Armitage is studying 15,000 and information that comes in via the running of all other aspects of the trial,” bhf.org.uk/research

people with diabetes (type 1 and type 2) questionnaires and making sure this is all says Professor Armitage. “We also offer Photography: Getty

34 Heart Matters bhf.org.uk 35 MEDICAL

We use digoxin November/December 2015 heart muscle has become less at the maximum dose you can FREE

PULL OUT AND KEEP THE BIG Enjoyed this article? to reduce the effective at pumping blood tolerate before using digoxin. FREEZE Risk factors RECIPE explained CARDS Cut your chances around the body, so allowing These usually include beta of heart disease Read more: PLUS strain the heart Top tips for healthy meals it more time to fill with blood blockers, ACE (angiotensin- in a hurry ≠ Risk factors explained page 16 10WAYS TO REBUILD YOUR is under” before it pumps can help to converting enzyme) inhibitors CONFIDENCE ≠ Stem cell research page 23 improve symptoms. such as ramipril, and ARBs ≠ Fish oil’s potential benefits page 34 Mark of (angiotensin receptor blockers) strength FIGHT Triumphing over the emotional and Q Is digoxin right for me? such as candesartan. FOR EVERY Visit bhf.org.uk/drugcabinet: HEARTBEAT physical scars of heart surgery A If you have atrial fibrillation, bhf.org.uk ≠ Anticoagulants it’s likely your beta blockers or Q Can I take digoxin ≠ Diuretics calcium channel blockers will with my existing heart ≠ Warfarin be increased to the maximum medications? dose you can tolerate before A Digoxin can interact your doctor considers digoxin. with some common heart may also be tested if symptoms treatment as soon as possible. If this didn’t improve your medications, including suggest there is too much If you experience heart rhythm symptoms or reduce your heart verapamil and amiodarone. If digoxin in your blood (see disturbances, you must go to rate to an acceptable level, you’ve already been prescribed box, below) or if you have A&E for an electrocardiogram then digoxin may be added in. one of these, your doctor kidney problems, as the drug is (ECG)D and a blood test. Digoxin is occasionally given may choose alternatives or cleared from your body by the DRUG on its own if someone has recommend you don’t start kidneys. Side effects include permanent atrial fibrillation digoxin at all. nausea, vomiting, diarrhoea, Dictionary

DICTIONARY

and is very physically inactive, tiredness, insomnia, visual Medical words, MEDICAL TERMS EXPLAINED under the skin on your chest, Ablation Procedure to correct connected to your heart by one a normal heart rhythm. It can be or control certain types of or more wires (leads). It monitors A done using medicines (chemical Echocardiogram Sometimes CABINET arrhythmias. Involves using heart rhythm and can deliver a called an ‘echo’. This is an cardioversion), or by giving the E controlled electric shock if you radiofrequency waves to destroy ultrasound to examine the heart a controlled electric shock have a life-threatening abnormal abnormal electrical pathways. structures within the heart, such with a defi brillator (electrical heart rhythm. Angina An uncomfortable as heart valves, and to see how cardioversion). feeling, tightness or pain in well the heart is pumping. MRI scan MRI stands for Congenital heart disease A heart your chest that may also be felt Electrocardiogram (ECG) A simple, M ‘magnetic resonance abnormality someone is born with imaging’. An MRI scan is a test in your arms, neck, jaw, back painless test to record the heart’s – for example, a hole between the identified by a or stomach. The symptoms of that produces extremely detailed electrical activity. Small sticky chambers of the heart (known pictures of your internal organs, according to NICE (National disturbances, palpitations and angina are usually caused by patches (electrodes) are put onto Q as a ‘hole in the heart’). There are Are there side effects? coronary heart disease. including your heart. It is very your arms, legs and chest. These many types of congenital heart good at showing the structure Angiogram X-ray pictures that are connected to a machine that disease; some are due to faulty of your heart and blood vessels, show whether the arteries are picks up and records the electrical Digoxin genes or chromosomes. and it can also measure the fl ow narrowed and, if so, how narrow signals of your heartbeat. An D they have become. A coronary Coronary artery bypass surgery of blood through your heart and operation to treat coronary heart GTN spray A nitrate medicine angiogram examines the some of your major arteries. disease. Arteries from your chest G that helps relax blood vessel coronary arteries. walls, improving blood supply to Pacemaker Small device wall and arm, or veins from Arrhythmia An abnormal heart the heart muscle. Provides quick P implanted under the skin on small symbol , your leg, are used to bypass the the chest, connected to the heart rhythm. relief from angina symptoms. blocked or narrowed coronary by one or more wires (leads). Atheroma Fatty material that Heart attack Known medically Institute for Health and Care Digoxin can have side fainting. In rare cases, increased arteries, improving blood fl ow to Monitors the heart’s electrical A can build up on artery walls. as a ‘myocardial infarction’, the heart muscle. H signals and can stimulate the Sometimes called ‘plaques’. or ‘MI’. This describes a sudden Coronary heart disease (CHD) When heart to contract and produce a Atrial fi brillation (AF) An abnormal loss of blood fl ow to part of the the walls of the coronary arteries heartbeat if required. heart rhythm in which the heart muscle. Most heart attacks (the arteries that supply blood atria (the upper chambers of are caused by atherosclerosis, Stent A short tube of to the heart muscle) become the heart) beat in an irregular the build-up of atheroma S expandable stainless-steel narrowed due to a gradual mesh that is inserted into an pattern. People with AF have an (plaque) within artery walls. If build-up of atheroma. artery to hold it open after an are explained in irregular, sometimes fast, pulse. the atheroma becomes unstable, CT scan ‘Computerised angioplasty, improving the fl ow Bypass See coronary artery a piece may break off and lead tomography’ scan. A type of of blood through the artery. B bypass surgery. to a blood clot. This can block a X-ray, which is useful for looking An interruption of blood Digoxin can also be used in Excellence) guidelines. effects if you’re given the levels of digoxin in your Cardiac arrest The ultimate coronary artery, causing a heart Stroke Q at internal organs, such as your fl ow to part of the brain, causing Why have I been medical emergency, when attack and irreversible heart C heart or lungs. With some CT brain cells to die or become a person’s heart stops pumping muscle damage. It is a medical scans, a special dye (called a damaged. This happens if an blood round their body and they emergency and can lead to a Derived from the contrast medium) is injected into artery carrying blood to your stop breathing normally. Cardiac cardiac arrest. a vein in your arm before the test. brain becomes blocked, or if an arrests in adults can be caused Heart failure Condition where the This helps show the blood vessels artery bleeds into your brain. A by a heart attack. heart is less effi cient at pumping on the surface of the heart. stroke is a medical emergency. plain English in Cardiomyopathy Disease of the blood around the body. Diabetes A condition in which heart muscle in which it becomes High blood pressure Also called Transient ischaemic attack (TIA) glucose (sugar) levels in the weakened, enlarged and/or D ‘hypertension’. High blood T Occurs during a temporary blood are too high. There are two blockage in the brain’s blood stiff , depending on the type of pressure is when the pressure main types of diabetes: type 1, the late stages of heart failure, Similarly, if you have heart wrong dose, so it’s important blood can cause heart rhythm cardiomyopathy. It aff ects people supply. Doesn’t cause permanent required to pump blood is prescribed this medication? where your body stops producing brain damage. Symptoms usually CV Dr Ross McGeoch of all ages and is usually inherited. consistently higher than the insulin, and type 2, where your pass within 24 hours. Cardiovascular disease (CVD) recommended level. This puts body can’t use the insulin it Includes all diseases of the heart extra strain on your heart and Ventricular tachycardia (VT) A produces, usually because excess and circulation, such as coronary blood vessels, and over time can V life-threatening heart rhythm fat in organs prevents the insulin that starts in the ventricles. heart disease and stroke. increase your risk of having a our dictionary from working eff ectively. Diabetes Causes the heart to quiver or Cardioversion A treatment for heart attack or stroke. increases your risk of developing purple foxglove plant, some ‘fi brillate’ in a disordered way so it arrhythmias to help restore Implantable cardioverter defi brillator cardiovascular disease. stops pumping blood around the I (ICD) A small device implanted Most commonly, we use Consultant but this is becoming less and failure, it’s recommended that to have regular tests to check disturbances (arrhythmias). Call the Heart Matters Helpline on 0300 330 3300 body. This is a cardiac arrest. A if you want to know more bhf.org.uk on page 49. 49 Digoxin was first digoxin to treat abnormal Cardiologist less common, because more all other medications are given the levels in your blood. You These are serious and require used to treat heart heart rhythms (arrhythmiasD), ≠ Consultant effective drugs are available. including atrial fibrillationD, Interventional complaints 200 years as part of a treatment plan to Cardiologist Q How does it work? ago. Dr Ross McGeoch slow the heart rate. The aim is at Hairmyres A Digoxin is a type of drug Are there any adverse effects? tells Senior Cardiac to reduce the strain the heart is Hospital, East Kilbride called a cardiac glycoside. Recent studies have highlighted concerns ensure their levels of the drug are within under because, over time, this ≠ Trained in Glasgow Their function is to slow your about digoxin. If you have been prescribed carefully defined limits. When needed, it is Nurse Christopher can wear out the heart muscle and Toronto heart rate down and improve it, it’s because your doctor has decided that still a powerful, useful drug.” Allen about modern and lead to heart failureD. the filling of your ventricles benefits outweigh the risks for you. Digoxin is currently prescribed to uses for the drug For those who already have (two of the chambers of the “We’ve known that digoxin can be hundreds of thousands of people in a degree of heart failure, it can to tolerate these types of heart) with blood. For people problematic for a long time, particularly England and Wales. It isn’t usually first also be useful in decreasing medications, or used in with atrial fibrillation, where when mixed with some other medications,” choice for irregular heartbeat or heart the level of strain on their combination with them if you the heart beats irregularly, a says Dr Mike Knapton, the BHF’s Associate failure. You may be given it because you heart. At present, however, need a further reduction in different volume of blood is Medical Director. “This is why digoxin is can’t tolerate another medication, or it’s more common that you’d your heart rate. While digoxin pumped out each time. This only prescribed after careful consideration. because you need additional treatment. be given a beta blocker, such may help to reduce your means an irregular amount of The dose of digoxin is crucial as too little If you take digoxin and are worried as bisoprolol, or a calcium heart rate, it will not get your vital oxygen is sent to the brain won’t help, but too much can cause about your health, speak to your doctor channel blocker, such as heart rhythm back to normal. and the rest of the body, which nausea, vomiting and changes to the and make sure you should be on it, that diltiazem, first. Instead, this is done by other can lead to symptoms like heart’s electrical system. People taking the dose is correct and that you are being Digoxin would usually be types of medications, such light-headedness and lethargy. digoxin should get regular blood tests to monitored adequately.

prescribed if you’re unable as amiodarone. If you have heart failure, your Illustration: Robert Samuel Hanson

36 Heart Matters bhf.org.uk 37 MY STORY

Now, we try Better to look back and laugh at the funny TOGETHER moments” Sometimes the road to recovery is a was bed-bound. The consultants decided it had to be a himself,” says Rachel. “There’s that challenge of telling bypassD. The operation was scheduled for the Saturday, him: ‘You don’t need to be pushing this hard today.’” long, hard slog, but the right support but they wanted to insert an intra-aortic balloon pump “My cardiac nurse told me not to overdo it on a good can make that journey easier, as [used to help keep the hearts of critically ill patients day because I’d crash the next day,” David says. “There David Presland tells Rachael Healy pumping], to ease the demand on the heart. That got my were so many learnings from this.” attention; I knew it was getting serious.” On the good days, Rachel and David walked the just couldn’t have done it without my wife,” “Things moved phenomenally quickly,” says Rachel, same route to the local shop. One day, after steady says David Presland, 43. “Rachel dealt with 40. “To watch someone who was very active suddenly improvement, David couldn’t do it any more. Now, “ Ithe frustrations, the low points and the funny deteriorate was incredibly shocking.” when walking or talking, he sometimes experiences moments… she’s been there every day.” Surgery was brought forward to Thursday and went breathlessness and chest pain. David has dealt with heart surgery and a strokeD as smoothly. David wants to reassure others undergoing an A CT scanD revealed his grafts are fine. Heart disease in well as the effects of heart disease, but his positive operation: “It will hurt, but that won’t last. You’re going to the smaller arteries appears to be causing the problem. outlook and the support of his wife have helped him on have some highs and lows, but that’s normal.” With the help of his surgeon Marius Berman, David is the way to recovery. After two days, he was taken by wheelchair to another trying additional medications and is determined to make David’s health problems started late last year, when ward. As he tried to stand, he collapsed. a good recovery, even if it’s a slow process. he experienced breathlessness and chest pain while “I came to when I was about to have an MRI scanD,” he “I just need to know where the limit is for the new me,” out walking. He visited his GP, who conducted an says. “I remember voices, but it was all black. I couldn’t says David. “It took a while to get my head around that. I electrocardiogram (ECG)D. Worrying results meant feel my leg… I couldn’t feel my arm… I had 30 minutes in bought myself a paddleboard because I live near a river. David needed an angiogramD. the MRI... the longest time of my life. I was thinking: ‘How I will get to do that. But I’ve had to accept that some This revealed one blocked artery and two others with am I going to work? How am I going to drive?’” sports, like snowboarding, I may not be able to do.” serious obstructions. David was told he would need David’s symptoms were caused by a stroke, but after 24 “When you’re having a good day, go out and do stuff,” further treatment. “But at that stage,” he says, “I was hours he started to regain movement. The next few days says Rachel. “If not, just watch a box set. Acknowledge convinced they were wrong.” were tough, but Rachel was by David’s side throughout. that there are bad days and you will get through it.” “The Papworth team were great,” says Rachel. “They David advises others to maintain a routine and set Facing surgery were very good at signposting signs of progress. It was achievable goals, such as building up to a two-mile walk. In February, David was climbing stairs in a country pub important from my perspective to understand what “I still get up at 7am to make my wife a cup of tea, as if I when tiredness overwhelmed him. Rachel, seeing he was David was going through so I could focus on getting him were going to work,” he says. “I will go back to work, so I grey and having trouble standing, called an ambulance. through the tough days.” don’t want it to be a shock to the system.” David, who lives in Elton, Peterborough, ended up Rachel thinks these goals are useful. “That’s important, in Papworth Hospital. His condition deteriorated fast. New limits Fortunately, they both held on to their sense of humour. because then he has a sense of achievement,” she says. “I was admitted on a Sunday,” he says. “By Wednesday I When David was released from hospital, the effects of the “We try to look back and laugh at the funny moments,” David has many long-term goals too. “I’ve bought stroke made many everyday tasks difficult. He attended says David. “Like when we nearly got evacuated from myself a new classic car project,” he says. “Next year, I am Free help from the BHF physiotherapy to help him regain full movement. critical care for a fire. I was getting really hot, so I would’ve planning to do a 13-mile obstacle course; it might not be Rachel continued to be a vital emotional support. been glad to get some fresh air!” possible, but that is a goal. ≠ Having heart surgery – a booklet for adults getting “Without her, I wouldn’t have made it through,” says “It’s just about looking for those funny things and “Rachel keeps saying she is starting to see the old me ready for an operation. David. “She was strong enough to stay positive. A couple finding the bright side of the situation,” says Rachel. again, with some spark back.” ≠ The road ahead – a DVD guide to treatments. of times I lost my rag because I couldn’t do small things “David’s a surfer, so I’d asked his surgeon: ‘Any chance you To order either, call 0870 600 6566 or visit like open a bottle of water. I had to learn very quickly to could make the scar look like a shark bite?’ They said no…” Turn over bhf.org.uk/HMpublications. ask her to do simple tasks for me. She had to deal with all Together, David and Rachel focused on staying positive For tips on building confidence after illness

of the emotions.” Photography: Johanna Ward and making physical progress. “He’ll always try and push

38 Heart Matters bhf.org.uk 39 WELLBEING

Tips from those who’ve been there Find new interests that wasn’t the case.” “I started painting and Trevor Munkenbeck found discovered I had a talent his heart attack had big for it, and I took a cartoon emotional effects (Mar/Apr conf idence course and discovered 2015 issue) I can draw, which is amazing. I really enjoy it and it’s been A positive outlook quite a surprise.” “At first I couldn’t walk Suzanne Swinson far. But I’d go out and re-evaluated her priorities walk for five minutes and after a heart transplant build up, even if it was (Jul/Aug 2014 issue) just a minute extra each day. I told myself that Take time to heal instead of seeing how far “It takes time to adjust to I had to go, I would look it. Time is a great healer. back and see how far I I started to think that I had come.” wouldn’t be able to do Rehana Browne (right) things I had done before, like survived a cardiac arrest walking on Dartmoor, but when she was 22

surgery, he says: “I was a bit depressed. lessons, which I hadn’t done for a long time. I thought my tennis days were over.” I started playing with other friends, just A visit from his cardiac nurse a few days having a gentle knockabout, to build up my after returning from hospital was the first strength and my muscles.” step towards rebuilding that confidence. It took “a good six months” to regain his “She had a plan for my recovery and that tennis skills, but in June he and his doubles really lifted my spirits,” he says. partner won the men’s doubles trophy at the ny health difficulty tends Cardiac rehabilitation helped Alan build Whitstable Lawn Tennis Club. to rock people’s world. CV Dr Mary Welford upon this. “I was saying, ‘They have just fixed Alan’s biggest tip for rebuilding Health problems can lead Consultant Clinical my heart, I don’t want to break it again’. confidence is to talk to others about your to changes of role and how Psychologist Being able to exercise under supervision experiences and concerns. “I was a bit you feel about yourself,” ≠ Chairman of the helped – that built my confidence up,” Alan reluctant to talk to anybody initially, but it’s explains Consultant Clinical Compassionate Mind says. “And I met people in the same position one of the best things you can do,” he says. “It Building Psychologist Dr Mary Welford. “Your focus Foundation as me, which was really helpful.” can be someone close to you, or your cardiac “ A ≠  shifts to your health instead of previous Specialist interests in physical disability nurse. I also talked to a volunteer at cardiac passions, which creates a different sense of and pain management Courting fitness rehab, who’d been through something who you are. You’re in unfamiliar territory ≠ Author of The Compassionate Mind Alan’s dream was to get back to playing similar. To share with someone and know and anything that is unfamiliar can knock Approach to Building Your Self Confidence tennis, which he was told he could do that it is not just you, it happens to other BLOCKS your confidence.” eventually. He exercised in the gym in the people and you can recover, is very helpful.” Confidence is often shaken For Alan Henderson, 66 (pictured), heart Alan had always played tennis, football meantime but when he did pick up a racquet ≠ More tips from heart patients above. following a heart event. Sarah surgery to repair a faulty mitral valve led and cricket, and loved running. But soon after again, things didn’t go as he hoped. “I was Brealey gets tips on recovery to his loss of confidence. “It affected my retiring as an engineer in 2011, he started slower, while everyone else had improved. perception of who I was. Not being able suffering from shortness of breath. Over the I couldn’t run or serve like I used to.” Turn over...... for psychologists’ tips on rebuilding from those who’ve been there to do things I’ve always done affected my next 18 months, activities fell by the wayside He readjusted his expectations and took confidence after a heart event

and two leading psychologists CharliePhotography: Clift Laura Pannack, confidence in other areas too,” he says. as his symptoms worsened. Following his positive steps to improve. “I started having 40 Heart Matters bhf.org.uk 41 Being able to exercise under supervision helped” How to grow after a heart event Professor Stephen Joseph shares his advice on moving forward CV Professor Stephen Joseph After a heart event such as a heart attackD, Professor in Psychology, many people will feel distressed. You Health and Social Care at might have symptoms such as intrusive University of Nottingham memories, nightmares, anxiety or ≠ Senior member of British difficulty blocking out negative thoughts. Psychological Society’s The first thing is to understand that Register of Psychologists having a heart event is often a traumatic ≠ Author of the book What Doesn’t Kill experience, and that you’re not alone. Us: a guide to overcoming adversity and Perhaps your assumptions about yourself, moving forward (Piatkus Books) for example, as a healthy person or someone who does a particular job, are disaster. It may be better to use the pieces Taking tennis lessons shattered. But it is an opportunity to to build something new, like a beautiful was a positive step reconfigure your assumptions and hopes. mosaic. Sometimes recovery from a heart forward for Alan Post-traumatic stress can lead to post- event is like that. You may not be able traumatic growth. to do all the things you did before, but One patient I worked with had a heart you can let go of them and find things to attack and was frightened he would have replace them. ‘Be back at work in six weeks’ time’, but more result, but usually it undermines your efforts. another. His thoughts kept returning I’ve developed a six-stage THRIVE tips for specific daily or weekly goals that are relevant Be your own cheerleader. Think of what you to the original event, and he started model for helping yourself. It stands for: to you. would say to a friend. panicking. But that helped him realise Taking stock – take time to make sense of what has happened to you. Look after building 6 Recognise success 10 Don’t dwell on the past Often, people yourself by eating well, being physically Acknowledge when you have taken a step in People may blame themselves following a active, learning to relax and connecting confidence the right direction. Don’t minimise it or say: heart event – for poor lifestyle choices, not reprioritise their with other people. ‘I should have been able to do that before.’ noticing symptoms or seeking help sooner, family life or social Harvesting hope – being hopeful for the 10Dr Mary Welford, Consultant Clinical 3 Time to talk or pushing themselves too much. We tell future. Stories of other people who have Psychologist, shares her expert tips Have a specific time when you discuss your 7 Be good to yourself people that it’s not their fault, but there are relationships” got through similar experiences can offer health with friends and family so it doesn’t Do things because you want to. For every things they can do to improve their situation inspiration and hope – the stories in Heart 1 Accept your feelings become the constant topic of conversation. appointment you put in your calendar, try to now – for example, making lifestyle changes. how much he loves life and wants to live Matters are examples, or you could join Realise that how you’re feeling is normal. If it feels difficult, try doing it alongside an book in something else you’ll enjoy. Look forward, not back. each day to the full. He’s developed his a support group. Developing a health problem turns your activity. Talking while you go for a walk or love of reading history, which helps him Re-authoring – think of yourself as a attention to your health and you might start over a meal can feel less pressured. 8 Look ahead put things into perspective. He realised survivor, not a victim. to notice things you wouldn’t have noticed If you can’t do what you did before, it can how caring his wife has been, and instead Identifying change – noticing the before. Your attention will move to those 4 Cardiac rehabilitation help to look at the direction of travel towards Free help from the BHF of taking his marriage for granted, he now positive changes you’re experiencing, concerns; just recognising that is important. Attending cardiac rehabilitation is a good it. Would it help to read books or magazines spends more time with her. such as new strengths or interests. way of getting support following a heart about a sport you enjoyed, if you can’t play? ≠ Try our free booklet, Heart to heart: Often, people reprioritise their family Valuing change – think about what’s 2 Focus on other things event. If you are having upsetting thoughts Can you move towards doing it, or something heart disease and your emotional life or social relationships; they realise that important to you and how you can pay Try not to think about your health all the most or all of the time, then ask your doctor related to it, in the future (after checking with wellbeing. Order from bhf.org.uk/ the most important thing in their lives is more attention to those parts of your life. time. Instead, set aside a time each day to or cardiac rehab team to refer you for your medical team)? HMpublications or call 0870 600 6566. their relationships with other people. Expressing change in action – doing think about it and the rest of the time, try to psychological support. ≠ Call our Heart Matters Helpline on Imagine that a vase that’s precious to concrete things, whether it’s signing up postpone the thoughts. That can reduce the 9 Don’t be too critical 0300 330 3300 for information and you has been shattered. You can pick up for a charity run, enrolling in an evening anxiety and even the physical sensations you 5 Realistic goals Self-criticism holds back confidence. People support on heart-related issues, or email the pieces and put it back together. It may class or cooking a nice meal to show your notice. Then you can move it from daily to Set goals that are measurable, and that think criticising themselves is helpful, that [email protected]. look the same, but it’s vulnerable to future partner how much you love them.

Photography: Laura Pannack every couple of days, and then every week. you can feel achievement from. Not just, they’ll push themselves harder or improve as a

42 Heart Matters bhf.org.uk 43 ACTIVITY Back in the saddle Dealing with heart problems caused Colin Mallen to lose faith in his body. He tells Rachael Healy how he’s conquered his fears

hen Colin Mallen discovered he had “I was having Sunday lunch with my heart problems 12 years ago, he parents and my heart started racing,” says Wvowed to keep doing his favourite Colin. “They called an ambulance and I was activities. “I used to do a lot of exercise,” says taken to the local hospital where they gave Colin, 52, from Whitburn, Tyne and Wear. me a cardioversionD to get it back to the Chris, centre, is 50 years “I was quite competitive and did a lot of right rhythm. I was then advised to have Colin battled anxiety with the older than the youngest cycling, rock climbing and weights.” an ICD (implantable cardioverter help of his partner, Shirley, member of his team Having coronary heart diseaseD on top defibrillator)D implanted.” whom he married in July of life-threatening heart rhythms and The ICD and a diagnosis of ventricular unexpected complications, Colin’s been tachycardia (VT)D – a potentially life- through more than most and returning threatening fast heart rhythm – meant Colin Colin was checked at the hospital and Colin’s family were by his side through all accidentally punctured and I had to to exercise was tough, physically and had to reassess his lifestyle. “The doctor they changed the settings on his ICD. of this uncertainty. “Shirley and my mother have life saving open heart surgery. It emotionally. However, with the support told me that rock climbing was out of the “After that, I was shocked a few times – all were a great support. If it wasn’t for them, was then a long recovery for four months.” “I still get anxiety. I can be on my bike and of his family and partner, Shirley, he’s during exercise,” says Colin. “I was playing I would’ve just given up and watched the do 200 miles and I’m absolutely fine, but I conquered the toughest days. five-a-side football and it went off twice. telly every day. I couldn’t have got through Road to recovery can walk around the block and get a panic Colin and Shirley have always stayed If it wasn’t for I was exercising in the house and it went it without them,” he says. Shirley provided vital support while Colin attack,” he says. “But they are now few and active together. “I met Colin 14 years ago,” off six times.” “I told him not to give up,” says Shirley. recovered. “The winter of 2013 was quite far between, thankfully.” says Shirley, 44. “I asked him out on a date exercise, I think “But it was quite a struggle, because for a severe and Shirley couldn’t drive. She used On 22 August, Colin did the Newcastle because I noticed he was into fitness, which Losing confidence lot of patients like him, anxiety kicks in and to get a bus, then a metro, then walk up to to London bike ride to raise money for the is what I’m into as well. We used to do a I would have These incidents knocked Colin’s confidence. they do give up.” the Freeman Hospital through the snow, BHF and found training was a helpful step to lot of running together, as well as walking, “I had counselling and they said that maybe In January 2012, Colin had surgery to every day, for over a month,” he says. recovery. “If it wasn’t for exercise,” he says, “I scrambling, climbing and cycling.” struggled to this part of my life – serious exercise – remove the device. However, he started to “It was tough, but it was something that think I would have struggled to fully recover.” Facing Colin’s illness strengthened his and fully recover” was over,” he says. “I was really depressed experience chest pain on the cycle to work. I just did, because I was going there for Shirley travelled to London to meet him Shirley’s relationship; last July, they married. because it was a massive part of my life; it Hospital tests revealed a blocked coronary someone I love,” says Shirley. at the finish line with a celebratory bottle Appropriately, their honeymoon was a two- was what I was all about.” artery. Colin needed a stentD procedure. Back at home, Colin experienced panic of champagne. “You’re not defined by your week cycling tour of the Netherlands. question,” he says. “I was a welder, but the However, information from Colin’s “I didn’t feel in great health afterwards,” attacks again and feared they were linked illness,” she says. “You’re an individual and welding would interfere with the ICD, so ICD showed the device had not been he says. “I was getting panic attacks and to his heart condition. A holter monitor, you can get better.” Unexpected diagnosis I couldn’t do that any more.” triggered by abnormal heart rhythms. “The severe anxiety. Then, I was walking my which recorded his heart rate and rhythm, Back in 2003, Colin was out running when Colin switched professions and is now a cardiologist said they were inappropriate dog on Boxing Day 2012, when I fell to showed this wasn’t the case. ≠ For more advice, read our free booklet he collapsed and was rushed to hospital. Mencap support worker, but didn’t want to shocks,” Colin explains. “The ICD was having my knees. They took me into hospital and Reassured, Colin began to regain Get active, stay active. See page 50. Tests revealed a two-inch-long scar across give up on fitness. “A month after I had my more of an impact on my life than the discovered I was in VT again.” confidence in his body. He attended a the bottom of his heart, possibly caused by ICD implanted, I went cycling with Shirley. It actual heart condition.” Colin was advised to have a catheter few physiotherapy sessions and then radiotherapy he received in 1997. He was was activated and knocked me off my bike Inappropriate shocks are a potential ablationD procedure in January 2013. slowly began to exercise by himself. “I just Go online discharged, but began regular check-ups. into some nettles,” he says. “That was a kick risk of an ICD, affecting 10–15 per cent of Serious complications from this are rare, but got back on my bike,” he says. “I started Colin’s partner Shirley shares her story Five years passed without incident, until in the teeth; I must admit, I went through a patients, but with the right medical care, happened to Colin. “Unfortunately, I was climbing indoors again and did weights. at bhf.org.uk/colinmallen.

one weekend in 2008. period where I didn’t do a great deal.” the risk can be minimised. Photography: Rebecca Lupton the unlucky one,” he says. “My ventricle was I just gradually, gradually got fitter.

44 Heart Matters bhf.org.uk 45 ACTIVITY

FIRST exercise steps

It’s good to stay active after a heart event, but where do you start? Sarah Brealey shares tips from three members of a cardiac rehabilitation team Getting active Lisa Docherty Eddie Caldow Stefan Birkett Even if you don’t have a Highly Specialist Exercise Exercise Specialist heart condition, physical Cardiovascular Physiologist with with expertise in activity can reduce your Rehabilitation 10 years’ rehab exercise testing risk of heart disease. It Nurse experience and research can also help you control your weight, reduce blood The cardiovascular rehabilitation team at Salford Royal NHS pressure and cholesterol, Foundation Trust is BHF Alliance’s Team of the Year, 2015 and improve mental health.

hen you’ve had a heart How do I start getting Which types of exercise recommend waiting a few I can’t walk because of my the Rate of Perceived Exertion I’ve never exercised in my event, it’s natural to active after a heart event? are best? weeks, until you’ve started arthritis/balance problems. scale, where you judge how We try to set life. Why would I start now? W wonder if it’s safe to Lisa Docherty: Gentle walking Stefan Birkett: Walking costs cardiac rehabilitation and can What can I do? hard you’re working, based goals that are LD: Some of our patients exercise any more, but being is the best way to start, even nothing. You can do it at a level be assessed by a professional. EC: For people who can’t walk on factors such as how heavy haven’t exercised for a long active can strengthen your if it’s just for two minutes. Do to suit you, and it can build up If you have had prompt much, swimming or aqua your breathing is and how easy specific to the time, but when they start heart and aid recovery. It’s vital what you can manage. Do it your fitness before you start treatment after a heart attackD, aerobics can be very beneficial. it is to talk. This helps you to patient and cardiac rehab they discover it’s to get the right support though. every day until it feels easier, rehab. After that, the choice of you may quickly feel better It is low weight-bearing and exercise at the right level. It’s something they enjoy. And it Attend cardiac rehabilitation then increase the time, and exercise is up to you, as long as physically and want to get doesn’t put much strain on fine to be a little bit short of achievable” can benefit your heart health. sessions, if possible; ask your later the speed. Aim to be your health professional agrees. back to whatever you used to the joints. But check with your breath, but not so breathless doctor if you haven’t received exercising for 15–20 minutes do, but it is still best to let the specialist first. you can’t talk. Chest tightness, But I don’t like gyms and an invitation after a few at a time by weeks four to six. But I’ve always done heart recover. We wouldn’t dizziness, palpitations and can’t use the equipment. weeks. We asked cardiac rehab By this time you should also cycling/tennis/football – recommend doing any sport How do I know if I am shortness of breath are warning LD: Cardiac rehab centres have professionals a few questions have started attending cardiac can’t I do this instead? without seeking the advice of pushing myself too hard? signs. If you experience these, fully equipped gyms, and for

Photography: Dan Kenyon about those vital first steps: rehabilitation sessions. Eddie Caldow: We would a professional first. SB: At cardiac rehab, we explain stop and seek medical advice. the first few classes we give

46 Heart Matters bhf.org.uk 47 ACTIVITY DICTIONARY

under the skin on your chest, MEDICAL TERMS EXPLAINED connected to your heart by one or more wires (leads). It monitors Ablation Procedure to correct a normal heart rhythm. It can be Echocardiogram Sometimes heart rhythm and can deliver a Aor control certain types of done using medicines (chemical E called an ‘echo’. This is an controlled electric shock if you arrhythmias. Involves using cardioversion), or by giving the ultrasound to examine the have a life-threatening abnormal What can I do when? radiofrequency waves to destroy heart a controlled electric shock structures within the heart, such heart rhythm. Everyone’s recovery is different, so check with your doctor or cardiac rehab team abnormal electrical pathways. with a defibrillator (electrical as heart valves, and to see how MRI scan MRI stands for before returning to or taking up exercise. You may find that you will need longer Angina An uncomfortable cardioversion). well the heart is pumping. M ‘magnetic resonance one-to-one support, showing than we’ve suggested below to recover, but here is a typical timeline: feeling, tightness or pain in Congenital heart disease A heart Electrocardiogram (ECG) A simple, imaging’. An MRI scan is a test how the machines work and your chest that may also be felt abnormality someone is born with painless test to record the heart’s that produces extremely detailed helping people understand in your arms, neck, jaw, back – for example, a hole between the electrical activity. Small sticky pictures of your internal organs, why they are doing what they Time following heart attack Time following heart surgery or stomach. The symptoms of chambers of the heart (known patches (electrodes) are put onto including your heart. It is very are doing. That helps to build angina are usually caused by as a ‘hole in the heart’). There are your arms, legs and chest. These good at showing the structure confidence. But there are lots of coronary heart disease. many types of congenital heart are connected to a machine that of your heart and blood vessels, other ways to keep active, too. When you Walking, cycling on When you Walking, cycling on Angiogram X-ray pictures that disease; some are due to faulty picks up and records the electrical and it can also measure the flow feel ready a stationary bike , feel ready a stationary bike show whether the arteries are genes or chromosomes. signals of your heartbeat. of blood through your heart and sexual activity How can I motivate myself 1–4 weeks Housework, such narrowed and, if so, how narrow Coronary artery bypass surgery An GTN spray A nitrate medicine some of your major arteries. to exercise? 1 week Making light snacks, as hanging out they have become. A coronary operation to treat coronary heart G that helps relax blood vessel Pacemaker Small device EC: We recommend setting pottering round the washing, tidying, angiogram examines the disease. Arteries from your chest walls, improving blood supply to P implanted under the skin on weekly goals, then tracking house and garden, dusting, with rests. coronary arteries. wall and arm, or veins from the heart muscle. Provides quick the chest, connected to the heart progress using a pedometer peeling vegetables Light gardening, such Arrhythmia An abnormal heart your leg, are used to bypass the relief from angina symptoms. by one or more wires (leads). or by measuring how far you while sitting as potting. Sexual rhythm. blocked or narrowed coronary Heart attack Known medically Monitors the heart’s electrical activity (but don’t Atheroma Fatty material that arteries, improving blood flow to as a ‘myocardial infarction’, signals and can stimulate the 2 weeks Light housework, H use your arms to can build up on artery walls. the heart muscle. or ‘MI’. This describes a sudden heart to contract and produce a such as making Do what you support yourself) Sometimes called ‘plaques’. Coronary heart disease (CHD) When loss of blood flow to part of the heartbeat if required. beds, washing Atrial fibrillation (AF) An abnormal the walls of the coronary arteries heart muscle. Most heart attacks Stent A short tube of can manage. up and preparing heart rhythm in which the (the arteries that supply blood are caused by atherosclerosis, expandable stainless-steel Do it every simple meals 4–6 weeks Golf – walking the S course and putting, atria (the upper chambers of to the heart muscle) become the build-up of atheroma mesh that is inserted into an day until it 3–4 weeks Housework, such not the full swing the heart) beat in an irregular narrowed due to a gradual (plaque) within artery walls. If artery to hold it open after an as hanging out pattern. People with AF have an build-up of atheroma. the atheroma becomes unstable, angioplasty, improving the flow feels easier” washing, tidying, 8 weeks Bowls, dancing irregular, sometimes fast, pulse. CT scan ‘Computerised a piece may break off and lead of blood through the artery. dusting, with rests. Bypass See coronary artery tomography’ scan. A type of to a blood clot. This can block a Stroke An interruption of blood walk or for how long. We try Carrying shopping 10–12 weeks Swimming, road B bypass surgery. X-ray, which is useful for looking coronary artery, causing a heart flow to part of the brain, causing to set goals that are specific bags or pulling a cycling Cardiac arrest The ultimate at internal organs, such as your attack and irreversible heart brain cells to die or become shopping trolley. to the patient and achievable 12 weeks Racket sports, fishing, C medical emergency, when heart or lungs. With some CT muscle damage. It is a medical damaged. This happens if an for them, whether it is walking Light gardening, a person’s heart stops pumping scans, a special dye (called a emergency and can lead to a artery carrying blood to your such as gentle golf with full swing, lifting with friends or family, getting blood round their body and they contrast medium) is injected into cardiac arrest. brain becomes blocked, or if an weeding or potting children, vacuuming, back to running, or gardening. mowing the lawn, digging, stop breathing normally. Cardiac a vein in your arm before the test. Heart failure Condition where the artery bleeds into your brain. A pushing supermarket arrests in adults can be caused This helps show the blood vessels heart is less efficient at pumping stroke is a medical emergency. I’m quite fit already; I don’t 5–6 weeks Vacuuming, ironing, trolleys, carrying shopping. by a heart attack. on the surface of the heart. blood around the body. Transient ischaemic attack (TIA) think cardiac rehab is for me. moderate gardening Your breastbone and the Cardiomyopathy Disease of the Diabetes A condition in which High blood pressure Also called Occurs during a temporary (mowing the lawn, T EC: It can be perceived as a muscles in your chest heart muscle in which it becomes glucose (sugar) levels in the ‘hypertension’. High blood blockage in the brain’s blood light hoeing) D low-level exercise class, for take time to heal, so do weakened, enlarged and/or blood are too high. There are two pressure is when the pressure supply. Doesn’t cause permanent not do lifting or heavy people who can’t do very 7–8 weeks DIY, lifting stiff, depending on the type of main types of diabetes: type 1, required to pump blood is brain damage. Symptoms usually much. But modern cardiac arm activity in the first cardiomyopathy. It affects people where your body stops producing consistently higher than the pass within 24 hours. rehab is about pushing people 12 weeks as it could delay of all ages and is usually inherited. insulin, and type 2, where your recommended level. This puts Ventricular tachycardia (VT) A to their full potential and the healing process Cardiovascular disease (CVD) body can’t use the insulin it extra strain on your heart and V life-threatening heart rhythm getting them back to work, or Includes all diseases of the heart produces, usually because excess blood vessels, and over time can that starts in the ventricles. to where they want to be. in this, which can be really and circulation, such as coronary fat in organs prevents the insulin increase your risk of having a Causes the heart to quiver or helpful. Being in a group Find free support heart disease and stroke. from working effectively. Diabetes heart attack or stroke. ‘fibrillate’ in a disordered way so it I’m frightened to exercise environment is supportive ≠ Read our free booklet Cardiac rehabilitation – your quick guide. Cardioversion A treatment for increases your risk of developing Implantable cardioverter defibrillator stops pumping blood around the in case my chest pain returns. and if anyone needs further Order it from bhf.org.uk/HM publications or call 0870 600 6566. some arrhythmias to help restore cardiovascular disease. I (ICD) A small device implanted body. This is a cardiac arrest. EC: It’s normal to worry about psychological support, we can ≠ Go online to find inspiring activity stories at returning to exercise. We tell put them in touch with people bhf.org.uk/activity. Call the Heart Matters Helpline on 0300 330 3300 if you want to know more people that they’re not alone who can help.

48 Heart Matters 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 (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 Printer perfect Women and heart disease M37 We’ve updated our website to make it even easier to print

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Angina HIS6 Foundation’s Heart British the of members are who booklets at homepatients heart young –of gostories the toon based bhf.org.uk/HMpublicationsand .

Atrial fibrillation – your quick guide G963 with created were 14min) / (9min films short These Blood pressure HIS4 My Story/Their Story Cardiac rehabilitation – your quick guide G964 PRESENTS Developed with young patients Caring for someone with a heart condition HIS20 MY STORY/ THEIR STORY and based on true events, these

Coronary angioplasty HIS10 MY STORY THEIR STORY Coronary heart disease is the UK’s single award-winning films follow a biggest killer. For over 50 years we’ve pioneered research that’s Diabetes and your heart transformed the lives of people living with heartHIS22 and circulatory conditions. Our work has been teenage girl who is diagnosed central to the discoveries of vital treatments that are changing the fight against heart disease. But so many people still need our help. Electrocardiogram – your quick guide G965 YOU’RE FINE ONE DAY...... AND THE NEXT, BANG! From babies born with life-threatening with a heart condition. They can heart problems to the many Mums, Dads and Grandparents who survive a heart attack and endure the daily battles of heart failure. Having heart surgery Join our fight for every heartbeat in the UK. HIS12 help start a conversation about Every pound raised, minute of your time and donation to our shops will help make a Heart attack – your quick guide difference to people’s lives. G966 how heart conditions affect ©British Heart Foundation 2013, registered charity in England and Wales (225971) and in Scotland (SC039426) G995/0714 young people. Order code: G995 Heart rhythms 4PAN1T HIS14 4 Panel Digipak Adobe InDesign 05/17/11 mk Paste OFA tag here.

Order your free guides by calling 0870 600 6566 or visiting bhf.org.uk/HMpublications 50 Heart Matters THE BIG FREEZE BIG THE Ingredients Vegetarian shepherd’s 3 tsp olive oil 1 tsp each dried thyme and 1 red onion, chopped dried oregano 3 carrots, sliced Freshly ground black pepper, pie with champ topping to taste Preparation time: 35–40 minutes 2 sticks celery, finely chopped Each portion contains: 400g (14oz) can green lentils, Cooking time: 1 hour 10 minutes 200g (7oz) swede, peeled and Energy Sugars Fat Saturates Salt drained and rinsed Serves 4–6 (makes 2 pies; each 1643kJ23% 13.9g 5.8g 1g 0.31g finely diced 390kcal Low Low Low Low 900g (2lb) floury potatoes, pie serves 2–3 – serve one pie 20% 15% 8% 5% 5% 1 tbsp plain flour fresh; freeze the other one) % = an adult’s reference intake washed (leave peel on) and 150ml (¼ pint) homemade or cut into small chunks reduced-salt vegetable stock 3–4 spring onions, chopped 150ml (¼ pint) red wine 3–4 tbsp skimmed or semi- 400g (14oz) can chopped skimmed milk tomatoes in rich natural juice

Method 1 Heat 2 tsp oil in a non-stick spring onions gently for 3–5 saucepan. Add onion, carrots, minutes. Drain potatoes; return celery and swede; sauté over a to pan. Mash potatoes; stir in medium heat for 8–10 minutes, spring onions and milk. Season until softened. Stir in flour; with black pepper. Cover to cook gently for 1 minute. Stir keep hot. in stock, red wine, tomatoes, 3 Preheat oven to herbs and black pepper. Bring 200°C/180°C fan/gas mark 6. to the boil, stirring; reduce Divide lentil mixture between heat, cover and simmer for 20 2 ovenproof dishes. Top each minutes. Stir in lentils; simmer, portion with champ; spread uncovered, for a further 10 roughly with fork, covering minutes, stirring occasionally. lentil mixture. Place one 2 Meanwhile, for champ dish on baking sheet (freeze topping, put potatoes in a second pie – see Anne’s tip separate pan; cover with cold below). Bake in oven for 20–25 water. Bring to the boil; simmer minutes, until the topping is for 15 minutes, until tender. In nicely browned. Serve with meantime, heat remaining oil cooked peas. in a small, non-stick pan; sauté Anne Sheasby Our resident food writer Anne’s tip Anne has had more than “If you have frozen and defrosted one 26 cookery books published pie, bake as above but increase cooking covering bread, soup, time. Freeze for up to 3 months.” vegetarian meals and more. THE BIG FREEZE BIG THE Ingredients Italian-style 2 tsp olive oil 225g (8oz) button mushrooms 350g (12oz) small shallots, 400g (14oz) can chopped chicken casserole peeled tomatoes in rich natural juice 1 red pepper, deseeded and 150ml (¼ pint) homemade or Preparation time: 30 minutes Each portion contains: diced reduced-salt chicken stock Cooking time: 1 hour 15 mins Energy Sugars Fat Saturates Salt 1286kJ23% 12.1g 7.4g 1.7g 0.51g 3 carrots, sliced 150ml (¼ pint) red wine Serves 4 (serve 2 portions fresh; 306kcal Low Low Low Low freeze the other 2) 15% 13% 11% 9% 9% 6 skinless, boneless chicken 1 tsp each dried thyme and % = an adult’s reference intake thigh fillets (about 525g/1lb dried oregano 3oz trimmed weight), Freshly ground black pepper, trimmed of fat, each cut in to taste half or into quarters 1 tbsp cornflour 1 clove garlic, crushed (optional)

Method 1 Preheat oven to 180°C/160°C 3 Remove from oven; return fan/gas mark 4. Heat oil in a casserole to hob. Mix cornflour Recipes: Anne Sheasby; food Sara Lewis; styling: prop styling: Anne Sheasby; Recipes: Tony Hutchinson; photography: William Shaw flameproof, ovenproof casserole. with a little cold water in a small Add shallots, red pepper and bowl; stir into casserole. Bring to carrots; sauté over a medium the boil, stirring; simmer for 2–3 heat for 5 minutes. Add chicken minutes, stirring. Serve casserole pieces; cook until sealed all over, with small baked potatoes, turning occasionally. Add garlic broccoli and green beans. (if using); cook for 1 minute, stirring. Stir in all remaining ingredients, except cornflour; bring to the boil. 2 Cover; bake in oven for about 1 hour or until chicken is cooked and tender, stirring once. Anne’s tip “To freeze 2 portions, cool cooked casserole completely, then transfer to an airtight container. Cover, seal and These recipes are from Heart Matters November/December 2015 label. Freeze for up to FREE

Risk factors PULL OUT explained AND KEEP magazine, Nov/Dec 2015. THE BIG November/December 2015 Cut your chances FREEZE of heart disease RECIPE 3 months. Defrost, then CARDS PLUS Top tips for healthy meals FREE Try Tuscan bean and veg If you’d like to receive Heart Matters and in a hurry

PULL OUT Risk factors AND KEEP reheat until piping hot (in a explained THE BIG 10WAYS TO FREEZE Cut your RECIPE REBUILD YOURchances of CARDS heart disease stew (Nov/Dec 2013). Call you’re not a member, join for free by calling CONFIDENCE PLUS Top tips for healthy meals moderate oven or gently on Mark of in a hurry 0870 600 6566 or go to 0300 330 3300 (costs are similar to 01 and 02 10WAYS TO REBUILD YOUR CONFIDENCE FIGHT strength the hob) before serving.” FOR EVERY HEARTBEAT Triumphing over the emotional and bhf.org.uk physical scars of heart surgery bhf.org.uk/recipesearch. numbers) or visit bhf.org.uk/heartmatters. Mark of strength FIGHT FOR EVERY Triumphing over the emotional and HEARTBEAT physical scars of heart surgery bhf.org.uk THE BIG FREEZE BIG THE Ingredients 4 red peppers, cut in half 100ml (3½fl oz) passata or Fish fillets with grilled lengthways tomato juice red pepper sauce 2 tsp olive oil Freshly ground black pepper, 1 small red onion, finely to taste Preparation time: 25 minutes, Each portion contains: chopped 4 frozen sustainable white fish plus cooling Energy Sugars Fat Saturates Salt 1032kJ23% 10.9g 4.8g 1g 0.49g 1 stick celery, finely chopped fillets Cooking time: 45–55 minutes 245kcal Low Low Low Low Serves 4 (you may have sauce 12% 12% 7% 5% 8% 150ml (¼ pint) homemade or leftover, which can be frozen) % = an adult’s reference intake reduced-salt vegetable stock

Method 1 Preheat grill to high. Place Push purée through a sieve peppers, cut-sides down, on into rinsed-out pan; discard rack in grill pan. Grill for 10–15 contents of sieve. Reheat minutes, until skin is blackened sauce gently until piping hot and charred. Remove from before serving. heat. Cover with damp kitchen 3 Meanwhile, cook fish paper; leave until cool enough from frozen in a preheated to handle. Remove and discard oven according to packet skin, cores and seeds; chop instructions (cooking pepper flesh. temperatures and times 2 Heat oil in a non-stick will vary). saucepan. Add onion and 4 Serve cooked fish with celery; sauté gently for about red pepper sauce spooned 10 minutes, until softened. over or alongside. Serve Add red pepper flesh; sauté with potatoes, carrots and for 1 minute. Stir in stock, shredded greens or cabbage. passata and black pepper. Bring to the boil; reduce heat, cover and simmer for 15–20 minutes, stirring occasionally. Remove from heat; cool slightly. Purée mixture in a blender or food processor until smooth. Anne’s tip “You can freeze the sauce in Anne cooks each recipe for an airtight container for up to us twice (at least!) to ensure 3 months. Defrost and reheat everything we recommend is gently in a pan on the hob healthy and delicious. For even until piping hot.” more meal ideas, visit bhf.org.uk/recipesearch. THE BIG FREEZE BIG THE Ingredients 2 large crisp eating Baked apples with apples, such as Granny Smith or Braeburn spiced sultanas 40g (1½oz) sultanas Preparation time: 10 minutes Each portion contains: 3 tsp soft light brown sugar Cooking time: 30–40 minutes Energy Sugars Fat Saturates Salt 719kJ23% 37.8g 0.4g 0g 0g 1 tsp ground mixed spice Serves 2 170kcal High Low Low Low 9% 42% 1% 0% 0% 3 tbsp unsweetened % = an adult’s reference intake apple juice

Method 1 Preheat oven to 200°C/180°C dividing evenly and pushing fan/gas mark 6. Score around it down into centres. Combine circumference of each apple apple juice and remaining sugar, using a sharp knife; remove core stirring to dissolve sugar; drizzle from each apple, keeping apples over top of stuffed apples. whole. Stand apples upright in 3 Bake in oven for 30–40 Recipes: Anne Sheasby; food Sara Lewis; styling: prop styling: Anne Sheasby; Recipes: Tony Hutchinson; photography: William Shaw an ovenproof dish. minutes (depending on size 2 Mix sultanas, 2 teaspoons of and type of apples) until apples the sugar and the mixed spice are cooked and tender. Serve together in a small bowl. Spoon immediately with low-fat mixture into centre of each apple, custard or natural yogurt.

Anne’s tips “Try using ground cinnamon instead of mixed spice. Or swap chopped ready-to-eat dried apricots or figs for the sultanas. “The whole apples won’t freeze well, but you can peel and chop any leftovers and freeze to use as cooked fruit at a later date. The cooked, filled apples will also keep in 10 MINUTES TO CHANGE YOUR LIFE the fridge for 2–3 days.” Time to eat well ≠ To find out more about maintaining a healthy diet, read Carrot, sultana and orange our free booklet Time to eat well. traybake (Oct/Nov 2012). Visit bhf.org.uk/HMpublications Call 0870 600 6566 or go to or call 0870 600 6566. bhf.org.uk/recipesearch.