PULL OUT AND KEEP BRUNCH · ≠ Look inside the body in this animation and discover what happens...

FILL IN THIS FORM, TEAR, FOLD, MOISTEN AND SEAL

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C O D

Spring 2017

FIGHTFOR EVERYHEARTBEATbhf.org.uk

Paul's back in the swing of things after a stroke

BEATOn the

FREE

EchocardiogramsHow they can help diagnose heart disease

PULL OUTAND KEEPBRUNCHRECIPE CARDS

Plant powerProtein doesn't have to mean meat

Air pollution and heart disease risk

BHF special report

2 Heart Matters

A stroke can seem like the end of life as you know it.

It’s a feeling familiar to many people who experience a sudden health issue, whether it’s a cardiac arrest, heart attack or something else. But life can go on. Sometimes it is different. Sometimes it is possible to make positive changes.

Jason Gutridge felt like his life was over when he suffered from a sudden cardiac arrest. He explains how he learned to adjust (page 41).

In our cover story (page 11), three inspiring survivors, Paul, Mark and Margaret, explain how they’ve discovered that there is a life after a stroke and have even embraced new opportunities. We’re working to stop people suffering from strokes, too. That’s why Professor Joanna Wardlaw is researching a type called lacunar stroke (page 35). It leaves holes in the brain that can lead to problems processing information and even dementia. She’s trying to find new treatments.

All our research aims to find solutions for real problems, so we can stop the devastation of heart and circulatory disease. That’s what drives Professor Paolo Madeddu, too (page 32). In a fascinating interview, he tells us how the pain that comes with a heart attack could actually help the body to heal itself.

Sarah Brealey, Editor

YOUR BHF4 Your letters6 News

BHF breakthrough in heartbeat research

8 Spotlight on... air pollution Why this is an invisible problem, and how you can reduce your risk

10 Behind the headlines Is working out at the weekend enough?

49 Dictionary Medical terms explained

50 Information and support A guide to our free resources

MY STORY11 Life after stroke

Three stroke survivors share their inspiring recovery stories

22 Riding high How pursuing new interests helped Mike through his heart problems

RESEARCH32 No pain, no gain?

How pain could help when it comes to heart attacks

35 Watch this space How a little-known stroke can leave holes in the brain

MEDICAL15 Ask the experts

Are branded medicines better? Plus migraine and stroke

16 Testing times: echo How echocardiograms can help diagnose heart problems

18 Vital statistics: weight and waist What these measurements can tell you about your heart risk

19 Focus on: endocarditis We look at this rare heart infection and speak to those affected

NUTRITION26 Rise and shine

Start your day right with one of these must-try breakfasts

28 Plant power How to get protein without meat, and the benefits it can bring

31 Ask the expert ‘Clean eating’ and artificial sweeteners

Inside the magazine of the British Heart FoundationSpring 2017

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Jason explains how he learned to adapt after a cardiac arrest Turn to page 41

Sudden change

bhf.org.uk 3

Heart Matters is published by Wardour on behalf of the British Heart Foundation, Greater London House, 180 Hampstead Road, London NW1 7AW.

The British Heart Foundation is a registered charity in England and Wales (225971) and in Scotland (SC039426). ISSN 1745-9753

Views expressed in this magazine are not necessarily those of the British Heart Foundation or Wardour. The BHF does not endorse third-party products and services featured in Heart Matters. Information correct at time of going to press. © BHF 2017. Heart Matters is printed on paper from sustainable forests. G204/0317

For BHFEditor: Sarah BrealeyFeatures Editor: Lucy TrevallionProduction Editor: Annette WardContent Officer: Sherry-Lee JacksonPrint: Eclipse Colour Print Ltd

For WardourManaging Editor: Rachael HealyArt Director: Colin WilsonDesigner: Louise HewlettCreative Director: Ben BarrettProduction Director: John FaulknerProduction Manager: Jack MorganAccount Director: Georgina BeachManaging Director: Claire Oldfield Chief Executive: Martin MacConnol

Plus Recipes: healthy brunch

WELLBEING38 Choosing wisely

How do you make decisions about your treatment quickly?

41 The psychology of recovery Getting back to normal after a sudden change in your health

ACTIVITY44 Six super

reasons to bowl Our guide to getting started with bowls

46 Fit for surgery? Waiting for an operation? Learn how getting active can help

Online exclusivesbhf.org.uk/heartmattersmag

Our expert team

Senior Cardiac NurseMaureen Talbothas worked in the NHS and private sector in general and cardiac nursing for more than 25 years. She leads the BHF Clinical Team.

BHF Associate Medical DirectorDr Mike Knaptonhas 30 years of experience as a GP and is a director at Addenbrooke’s Hospital, Cambridge.

Senior DietitianVictoria Taylorbegan her career in the NHS and public health campaigns. She advises on nutrition and acts as our spokesperson.

Consultant CardiologistDr Rajan SharmaOur guest expert is Head of Clinical Services at St George’s Hospital in London.

Senior Cardiac NurseEmily Reevehas worked in general and cardiology nursing with a background in cardiac rehab.

Recipe writerMoyra Fraseris our resident food writer. She’s a former Telegraph food columnist and author of numerous cookery books.

≠ Watch: How are we changing lives through research? We reveal the ‘bench to bedside’ process

≠ Look inside the body in this animation and discover what happens when you exercise

≠ Watch what happens when you breathe in polluted air and find out how to protect yourself

≠ Play our simple swaps game, to give the food you love a Mediterranean twist

≠ Meet the stars of our cover story, as they discuss the reality of life after a stroke

≠ Quiz: High-protein food is very trendy, but how much do you actually know about this fashionable food group?

4 Heart Matters

YOUR LETTERSWe love to read your emails, letters and tips, so keep writing: [email protected] or Heart Matters, British Heart Foundation, Greater London House, 180 Hampstead Road, London NW1 7AW

If you’d like to share your story with Heart Matters, email [email protected] or write to Sarah Brealey, Heart Matters, British Heart Foundation, Greater London House, 180 Hampstead Road, London NW1 7AW.

Share your story

STAR LETTER

Egg issuesI’m fed up with the way the BHF constantly censures fried food as the devil’s work, while promoting other ways of cooking as super virtuous.

Take page nine in the Winter issue of the magazine, for example. “The BHF says: Eggs are nutritious... Poached eggs on wholegrain toast is much healthier than a fry-up.”

A ‘fry-up’ conjures up a vision of the typical greasy spoon on the A20, doesn’t it? But eggs can be fried with very little fat.

Cycling around the worldMy husband has always enjoyed cycling. Even as a teenager, it was a favourite way of relaxing at weekends, touring around the lovely scenery of Scotland.

Five years ago, he had a triple heart bypassD at Papworth Hospital. As he recovered, he decided he would get his fitness back by keeping his cycling going, but decided he needed a challenge. He had read a book by a young guy who had cycled around the world, and thought: “Now there’s a challenge!”

Obviously, for many reasons, it was not practical to do the actual trip, but in miles he could! Only a couple of months after his operation, he was back on his bike, doing what he could manage safely. Five years later, he has been out almost every day, building up the distances, usually from home and occasionally on holiday when we took our bikes with us.

We have been married almost 52 years; my husband is 75 now. In the five years since his operation, he has clocked up almost

18,000 miles. A couple of months and he hopes to have completed his ‘round the world trip’. I too had a heart operation, a valve replacement and single bypass, three years before my husband, and have a pacemaker. I accompany him sometimes on trips around Norfolk, but certainly can’t match his fitness – or motivation!

I am immensely proud of his achievements, and would say to anyone else facing heart operations: “Nothing’s impossible!” Stella Carslaw, Norwich

FIND USFacebook “f ” Logo CMYK / .eps Facebook “f ” Logo CMYK / .eps

facebook.com/BHF @TheBHF instagram.com/the_bhf

READER’S TIPI always have a bag of frozen mixed berries in the freezer. Add some to the fresh fruit of your choice, to make an extra healthy and luxurious crumble, especially if the topping includes chopped nuts, oats and seeds.Margaret Wragg, Altrincham, Cheshire

A quarter-teaspoon of avocado oil in a small pan is perfectly sufficient to fry an egg in, especially if you put a lid on the pan to allow the steam to help cook it. It still tastes like a proper fried egg, though! To write off fried eggs as if they are somehow deadly dangerous is a bit silly, in my view.Michael Mitchell, Spalding, Lincolnshire

cooked as you describe would be consistent with a heart-healthy diet, and we could also have said that eggs poached or fried in a little unsaturated oil on wholegrain toast are healthier than a fry-up.

Healthy piesI was interested in your article ‘Have your pie & eat it’ (Winter 2016/17). I now make many pies and pasties using ordinary bread dough instead of pastry. I make it from scratch, but you could use packet bread mix (choose one which is lower in salt) and use a tablespoon of olive oil in the dough to help it stretch. Let it rise once, then roll out thinly over your dish. It doesn’t need an extra rise. You can glaze as usual.

I find that the amount of dough for one bread roll can be used to make a decent-sized pasty, which I fill with lots of veg and beans. Mary Bendall, Worcestershire

Our Senior Dietitian Victoria Taylor replies: Thank you for your letter. When we used the term ‘fry-up’ we were referring not only to fried eggs, but describing a traditional fried breakfast including, for example, sausages, bacon and black pudding. Collectively this makes a breakfast that’s high

in calories, salt and saturated fat.

It’s true that eggs

5

Next issue Angiograms explained, what we can learn from other countries, and meet the BHF’s new Medical Director.

The evolving NHSReaders may be interested to hear about changes in the care of heart patients that I find impressive.

I had a heart attackD in January 1995 and was whisked off for the standard treatment in those days – a clot-busting drug (thrombolysis). I needed further investigation, so was put on the waitlist for an angiogram, eventually rising to the top. As a result, I had an angioplasty in April 1997.

This chain of events gave me an interest in cardiology and I started getting involved in patient and public representation groups.

It was in this role a few years ago that I was involved with the introduction of primary percutaneous coronary intervention (angioplasty) in my local area. This was a new treatment for heart attack patients that saw them taken straight to the operating room for an angiogram and

subsequent treatment. Our target time between the logging of the ambulance call and the patient being in the hospital with everything ready to go was 120 minutes, shorter than the then national target of 150 minutes.

So the patient journey that had taken me more than two years is now being accomplished in two hours – a startling achievement for the NHS.John Walsh, Swindon

Running after recoveryI am 56 years old and in late 2015 I was suffering with bad chest pains and severe breathlessness when I was out walking my dog. I, like many men, ignored the pain until I was advised to see my GP. I had two ECGs, which were clear, but as a precaution I was sent for a heart scan and an angiogram.

Astonishingly, the angiogram found I needed a quadruple

bypass, as my arteries were 95 per cent blocked.

In July 2016 I had surgery and am now back at work. The care I received from the staff at Castle Hill Hospital near Hull was phenomenal and I am now back walking my dog and doing lots of gym work.

This year I’m planning to take part in the Great

North Run and raise some worthy funds for the BHF. Anyway, here’s to the BHF and all the researchers – keep working hard!Martin Wood, East Riding, Yorkshire

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

Our cycling range is ideal for your daily commute or a BHF challenge

and has been designed with comfort in mind. Our star letter writer can win a BHF-branded

cycle jersey worth £45. Designs may vary depending on

stock availability

bhf.org.uk

Claire Marie Berouche had a heart attack and was later diagnosed with heart failure. She went from being a busy customer service manager to struggling to stand up for too long. But she is learning to live with, and accept, “the new Claire”. You shared your support on Facebook.

I’m 55 and I’ve just been diagnosed with hypertrophic cardiomyopathyD... trying to cope and understand... this is great inspirationFi Elizabeth Lipscomb

Well done Claire, I had a sudden cardiac arrest at 34, still looking forward to seeing every new dayEileen Young

I was diagnosed at 46 with heart failure. My life ended when I found out, or so I thought. You begin to know

your limitations and can get back to taking your favourite walks, just that bit slower and have more rests. When you need to sleep, go to sleep, don’t fight it. You learn to live again, just in a different way.Tracy Barron

Well done Claire, thank you for sharing your story xxHeather Terry

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Statins and grapefruit The Winter edition of Heart Matters has several references to statins. [Page 29 suggests “balanced meals” and includes “half a grapefruit”.]

I have been taking statins for more than 10 years. The leaflet with my latest supply explains: “Grapefruit juice contains one or more components that alter how the body uses some medicinal products, including simvastatin film-coated tablets. Consuming grapefruit juice should be avoided.”

Please include some information on statins and grapefruit in your next edition.John Bowers, Gwynedd

Heart Matters Medical Editor Maureen Talbot replies: Thank you for your letter. You are correct that grapefruit and grapefruit juice interact with simvastatin, increasing its level in your blood, and should be avoided if you are taking this statin. Large quantities of grapefruit juice can interact with atorvastatin, but the occasional glass of grapefruit juice, or half a grapefruit, is thought to be safe.

Currently, healthcare professionals advise it is safe to drink grapefruit juice and eat grapefruit if you’re taking other types of statins.

6

≠ CBE for BHF directorProfessor Peter Weissberg, our former Medical Director, received a CBE for his services to medical research and cardiovascular health. He led our research funding strategy

from 2004 to 2016, which has enabled breakthroughs that are today saving lives.

≠ Trail of two hearts Kieran Sandwell, 45, is walking 5,000 miles around Britain’s

NEWS BITES

Part of the placenta, whereit attaches to the womb,

viewed down a microscope

Heart Matters

coastline to raise £100,000 for the BHF, meeting BHF researchers and supporters along the way. He had congenital heart disease and the trail celebrates the end of his long battle with

This May, MyMarathon is back. Are you ready for a new challenge? Or is a marathon on your bucket list, but you don’t have the time to train through the winter months? Whether it takes you four hours, four days or four weeks, you decide the pace and the place.

Last year more than 30,000 people took part in MyMarathon, taking on 26.2 miles in a way that was a challenge for them. Our MyMarathon champs raised more than £1m.

We’ll be with you for every step, with training and fundraising tips to take you to the finish line. Sign up now for free at bhf.org.uk/mymarathon or call 0300 330 3322 for more information.

This spring we are holding lab visits around the UK so MPs can learn about BHF research. These visits allow politicians to see first-hand the importance of government support for life saving medical research. This has become all the more urgent following the decision for the UK to leave the

EU, and the challenge we now face to ensure medical research is understood and prioritised during upcoming negotiations.

MPs in the labAnyone can do a marathon

first line of defence against infections – and discovered a new role for them in maintaining a healthy pregnancy. The researchers compared the blood from healthy women and women with pre-eclampsia. In the healthy women’s blood, they saw that neutrophils interacted with T-cells – another type of white blood cell essential for the immune system. But in women with pre-eclampsia, the neutrophils failed to interact with the T-cells.

The researchers suggest that neutrophils may help the T-cells encourage blood vessel growth to ensure regular placental development. This could pave the way for new treatments to make defective neutrophils work effectively, helping the placenta develop normally.

≠ Find out more at bhf.org.uk/preeclampsia. Read about pregnancy and heart disease at bhf.org.uk/pregnancy.

Pre-eclampsia hope thanks to BHF research

NEWS

A research discovery could lead to a new treatment for a condition that can affect

pregnant women, helping to reduce the number of stillbirths and premature births.

Pre-eclampsia affects up to six per cent of pregnancies. In the most serious cases, it can be life-threatening for the mother and baby or cause premature birth, but even mild cases can raise the risk of heart disease for the mother and baby later in life.

Researchers from Queen Mary University of London, part-funded by the BHF, looked at neutrophils – white blood cells that act as the

77

Now Bored of bake sales or fancy dress? Embrace your wild side and sign up to become a Heart Flyer to experience the unforgettable thrill of a tandem skydive. For a fundraising pack visit bhf.org.uk/heartflyers or call us on 0300 330 3322.

13–14 May London to Oxford Trek. Walk 100km through day and night in our prestigious endurance challenge. There are also 50km options: London to Henley day trek and Henley to Oxford night trek. Visit bhf.org.uk/L2Otrek or call 0845 130 8663.

14 May Cotswolds Bike Ride. Our popular bike ride in the beautiful Cotswolds countryside is back for 2017. Take on a 30- or 50-mile route. Visit bhf.org.uk/cotswoldsbikeride or call 0845 130 8663.

17 May Tower of London Run. Steeped in history, this iconic London landmark plays host to this 5K or 10K run. Visit bhf.org.uk/tower or call 0845 130 8663.

28 May Edinburgh Marathon and Half Marathon. Try one of the flattest marathon routes in the UK – great for first-timers. Visit bhf.org.uk/edinburgh or call 0844 477 1181.

28 May Great Manchester Run. Help us run all over heart disease in the North West’s biggest 10K. Visit bhf.org.uk/greatmanchesterrun or call 0844 477 1181.

3–4 June TrekFest Brecon Beacons. Choose from two different distances and tackle high peaks, including Pen y Fan in south Wales, while taking in beautiful views. Visit bhf.org.uk/brecon or call 0844 847 2788.

10–11 June Nightrider London. Nightrider is a unique way to explore the capital. Visit bhf.org.uk/nightrider or call 0844 847 2788.

18 June London to Brighton Bike Ride. Cycle through country lanes with a triumphant finish by the sea. Visit bhf.org.uk/l2b or call 0300 456 8355.

24–25 June London to Brighton Trek. Our most famous trek, from the nation’s capital to Brighton Racecourse. Visit bhf.org.uk/L2Btrek or call 0845 130 8663.

Dates for your diary

bhf.org.uk

Why not take some time to have a spring clear-out, and donate what you don’t need to the BHF?

Each week in the UK, around 3,000 families lose a loved one to heart and circulatory disease. Donating your unwanted stuff to our shops means we can raise funds for life saving research.

Visit bhf.org.uk/bagit to order your free bags and declutter pack complete with handy hints to get you decluttering together. We’re looking for good quality clothes, shoes, books, DVDs, CDs, homeware and children’s toys.

Book a free collection on 0808 250 0175, or drop it into your local BHF shop. Remember to Gift Aid your stuff for free, helping us raise an extra 25 per cent!

Declutter to help save lives

Pippa pops in

heart disease, thanks to a heart transplant eight years ago. Follow his progress at atrailoftwohearts.com.

≠ Brits aren’t bikingOur latest survey of 2,000 UK

residents found that the average Brit hasn’t ridden a bike in nine years, with one in five avoiding the saddle for more than 10 years.

P ippa Middleton surprised members

of our London Heart Support Group with a heart-healthy afternoon tea. She created dishes from Heartfelt, a book featuring more than 100 delicious recipes, devised in collaboration with the BHF. All proceeds will help us fund life saving research to fight heart disease.

“It was such a pleasure to meet members from British Heart Foundation Heart Support Groups and hear about each of their challenging journeys,” said

Pippa. “The determination and energy in the room was inspiring.”

Join or learn more about support groups at bhf.org.uk/heartsupport or call our Heart Helpline on 0300 330 3311. Buy Pippa’s book at bhf.org.uk/heartfelt.

Supporter Days 2017Join us at one of our local Supporter Days to find out how you’re helping us fight heart disease. You will get the chance to:≠ Tour a BHF-funded lab to see the latest research≠ Learn CPR for free, joining our nation of lifesavers ≠ Hear inspiring real-life stories and meet incredible volunteers, fundraisers, heart patients and heart health professionals≠ Celebrate the excellent work of our supporters in our Heart Hero Awards.

We have eight Supporter Days across the UK: London 23 June, Edinburgh 27 June, Belfast 29 June, Manchester 4 July, Newcastle 7 July, Bristol 21 July, Swansea 12 September and Leicester 27 September. Register at bhf.org.uk/conferences.

8 Heart Matters

Spotlight on…

NEWS

air pollution

The UK government’s plans to tackle air pollution were deemed “woefully

inadequate”. That’s what it was told by the High Court in November, in a case brought by environmental charity ClientEarth. This wasn’t the first time the government has been taken to court over its poor air pollution plans. In 2015 the government was ordered to make plans to bring air pollution within legal limits.

London has the worst air pollution in the UK, followed by Birmingham, Manchester and Bristol (air pollution is usually worst in cities). At sites in London, air pollution levels are monitored hourly and must not exceed a set limit (200 micrograms of nitrogen dioxide per cubic metre) more than 18 times a year. But in 2016 this limit was broken at 59 of the 97 measurement sites.

Invisible problemYou can’t see it, but it is there: an invisible problem. Since the particles are so small – around a quarter of the width of a strand of hair – they can get into the bloodstream and go on to cause

widespread damage. Professor Frank Kelly, Director of the Environmental Research Group at King’s College London, explains: “All of the organs in the body seem to be affected in some way by breathing in air pollution.”

Some of the biggest problems are the increased risk of heart and circulatory disease, or the worsening of these conditions for people already affected by them. Thanks to BHF-funded researchers at the University of Edinburgh, we now know a lot more about how air pollution affects your heart. Dr Nick Mills, Senior Clinical Research Fellow at our Centre of Research Excellence, says: “We found that tiny ‘nano-particles’ in diesel exhaust produce highly reactive molecules called free radicals that can injure blood vessels. These nano-particles – less than a thousandth of a millimetre wide – prevent blood vessels from relaxing and contracting properly. The disturbance to blood vessel function means there is an increased risk of clots developing in coronary arteries, which can cause a heart attackD.”

Air pollution contributes to around 40,000 premature deaths in the UK each year and is linked to heart attack and stroke. Lucy Trevallion looks at the evidence and how you can reduce your risk

Recent BHF research has also shown a strong association between short-term exposure to air pollution and admission to hospital for strokeD and death from stroke. Other research suggests that breathing in air pollution can lead to atherosclerosis – the build-up of fatty material inside the arteries that can lead to a heart attack.

Blood supply to the brain is also affected, so the risk of developing conditions like dementia will increase too.

Professor Kelly says: “It’s estimated that those who die prematurely in the UK are losing on average six months of life due to air pollution exposure. The people who die prematurely in London will be dying up to maybe 10 years earlier than they should.”

Air pollution exposure in the womb has been linked to premature births, health problems and behavioural difficulties in children.

Protect yourselfBut there are easy ways to protect yourself from air pollution:≠ Eat more fruit and vegetables. ≠ Have a balanced diet.≠ Be physically active. Professor Kelly says: “A diet high in antioxidants [found mostly

in plant-based foods] can help defend you against these oxidant pollutants, making you less susceptible to the negative effects of air pollution.”

But should you exercise if you’re in an area with high air pollution? For most people in the UK and Europe, outdoor physical activity has overwhelming health benefits compared with the potential risk of air pollution. Even in high-pollution areas, benefits usually outweigh risks.

Dr Audrey de Nazelle, Lecturer in Air Pollution Management at Imperial College London, suggests people walk or cycle where possible (air pollution levels are usually higher in a car). Choose routes away from traffic, she says even a few metres away from traffic can make a difference. “If you’re walking on a wide pavement, walk as far from the road as possible. If you’re cycling, you’re better off on a segregated cycle lane, but even better on a side road,” she says.

Public Health England advises that when pollution is at a moderate level, adults with heart problems, or who experience symptoms such as sore eyes or a cough, should consider reducing strenuous physical activity, particularly outdoors.

Enjoyed this article? ≠ Visit uk-air.defra.gov.uk for air pollution updates or call 0800 55 66 77 to hear recorded information. ≠ Watch our animation about how air pollution affects your body at bhf.org.uk/pollution.

bhf.org.uk

Taking actionTwo of the most common and harmful types of air pollution are particulate matter (mostly from road traffic and industry) and nitrogen dioxide (largely from vehicles and power stations).

Dr de Nazelle says: “In the centre of London, about 50 per cent of NO2 and particulate matter is from road transport. Transport is where we can have the most impact at a local level.”

A spokesperson for Defra (the Department for Environment, Food & Rural Affairs) says: “We are firmly committed to improving the UK’s air quality and cutting harmful emissions. That’s why we have committed more than £2bn since 2011 to increase the uptake of ultra-low emissions vehicles, support greener transport

schemes and set out how we will improve air quality through a new programme of Clean Air Zones. We will update our air quality plans in the spring.”

London Mayor Sadiq Khan promised to reduce air pollution by introducing an ultra-low emission zone, more electric charging points, and more electric or hybrid buses.

Since 2010 the BHF has provided £3.2m to research the link between air pollution and heart and circulatory disease. David McColgan, BHF UK policy lead for air pollution, says: “We want to elevate the debate around air pollution and tackle poor air quality across the country. Air pollution is a priority in our prevention agenda.”

≠ Read our full air pollution policy at bhf.org.uk/airpollutionpolicy.

£3.2mBHF funding for research into air pollution

9

55 OXFORD CIRCUS

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“Obese are more likely to survive heart operations, say doctors”Research funded by the British Heart Foundation found that obesity is associated with a lower risk of in-hospital death following heart surgery. This is despite overwhelming existing evidence that obese people are at higher risk of cardiovascular death in everyday life.

Researchers from the University of Leicester found the risk of death in hospital after heart surgery was nine per cent in underweight patients, four per cent in normal weight patients, three per cent in overweight patients, three per cent in obese patients who are considered to be low or moderate risk, and four per cent in obese patients who are considered high risk.

The BHF says: These findings go against common practice, where weight loss is recommended before surgery, or where very obese patients are refused surgery. Although we always recommend a healthy waistline for those trying to lower their risk of heart disease, this large study strongly suggests that being overweight can give patients added protection when facing heart surgery.

But the study only looked at patients while they were still in hospital and cannot be used to predict the long-term survival of heart surgery patients. To properly understand these results, we need to fund more research into the mechanisms involved.

Is working out at the weekend enough?

Daily Express 9 January 2017

Daily Mail 20 January 2017

BEHIND THE HEADLINES

“Being a weekend warrior is as healthy as being a gym bunny”

One or two physical activity sessions at the weekend could be enough to reduce your risk of dying from heart and circulatory disease and cancer, research suggests.

The researchers, from Loughborough University and the University of Sydney, tracked the physical activity of 63,591 adults from England and Scotland over a 12-year period.

They found the benefits of working out in one big session (such as one long 150-minute walk) were the same as doing smaller chunks of physical activity (such as walking briskly for 30 minutes every weekday).

Chris Allen, Senior Cardiac Nurse at the BHF, said: “The recommended 150 minutes of moderate-intensity activity a week may sound overwhelming. Some people find a ‘little and often’ approach to exercise more manageable, but others find it easier to fit it all into one or two days a week.

“Exercising regularly has also been shown to improve a person’s mood, a benefit that may not be felt so greatly by ‘weekend warriors’. But whatever your approach, keeping active is important,

as any physical activity will help protect your heart.”

Although the study talks about ‘weekend warriors’, it didn’t look at the days of the week people exercised, but the number of exercise sessions. A participant could have exercised heavily on Monday and Wednesday and be classed as a ‘weekend warrior’.

It’s important to note that the percentage of participants classed as ‘weekend warriors’ was very small (3.7 per cent) and only 11 per cent were in the ‘regularly active’ category. Therefore, while the study looked at more than 63,000 people, the majority were classed as ‘inactive’ if they didn’t do any physical activity, or ‘insufficiently active’ if they did some activity but less than 150 minutes per week. The findings about ‘weekend warriors’ and regularly active people are based on only 9,460 people.

A strength of the study is that it looked at a wide variety of activities, including light and heavy housework and gardening, along with walking, cycling, football and running. These all count towards your 150 recommended minutes of activity a week.

Media coverage was generally quite accurate, although it didn’t always make it clear that the study didn’t look specifically at weekends.

Heart Matters

11

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

STROKELife after

COVER STORY

Mark’s story“In one sense, my life changed overnight,” says Mark Flood, who had a strokeD aged just 14.

“One moment I was a normal teenager, wanting to have water fights, build treehouses, meet girls, and draw, and then I was being approached by everybody at my school, saying: ‘What has happened to you?’”

Having a stroke at such a young age is rare. For Mark, now 20, its effect on his life has, in part, been positive.

“The whole experience gave me an attitude that life is precious,” he says. “I realised I wasn’t invincible. I thought: I don’t want to waste time.”

Mark, from Glasgow, started making short films with friends. They set up an animation business when he was 17. He says: “Thankfully it worked out and it’s still working out.”

But at the time, having a stroke was terrifying. There was the initial fear that he might die, but he also feared that his ability to draw, along with the career he dreamed of, might have gone for ever.

Mark recalls the lead-up to the stroke. “At the beginning of December 2010, I developed what seemed to be a flu or fever,” he says. “We dismissed it at first, but

it didn’t go away.” Doctors thought Mark had an infection, but couldn’t tell what was causing it and antibiotics didn’t help.

“I had the stroke on the night of 16 December,” he says. “I was already quite poorly. I was lying on the sofa. Then the right side of my body went strange – I think my face started to droop.

“I was taken to hospital and it turned out I’d had a stroke, which baffled the medics because I was only 14.”

Mark was found to have an undiagnosed hole in one of his heart valves, which he’d probably been born with. A bacterial

Watch online ≠ See Mark and Paul talking about their experiences of having a stroke at bhf.org.uk/lifeafterstroke.

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12 Heart Matters

I still think about the fact that I am one of the lucky ones”

infection called endocarditis (see page 19) had developed on his faulty valve, causing the flu-like symptoms. A stroke can sometimes occur as a complication of endocarditis.

“For the first couple of days in hospital I basically couldn’t move,” says Mark. “I couldn’t walk. I was in a wheelchair for a week or two. It seemed like my hands and legs were equally useless.”

But gradually he saw signs of progress. On Christmas Day, he managed to leave his room for a glass of water. “That was when I and my family thought I was going to be OK,” he says. “That gave me the motivation to keep going.”

Mark had daily physiotherapy exercises to help him regain muscle strength. “I remember doing simple exercises with the hospital physio, like catching and throwing a ball, walking along a straight line on the floor,” he says. “They gave me putty to mould in my hands, to get the strength back.”

To Mark, the biggest priority was to regain full use of his hands. “Even at 14, I wanted to work in animation and film. On one of the early days in hospital a nurse came up to me and said: ‘I hear you are an artist, would you like to draw something?’ She gave me a pencil and I just couldn’t hold it. I thought: ‘This is it, game over.’ That scared me most, apart from dying – that my dream might just go out of the window.”

Mark spent a month in hospital, and gradually started drawing again.

“When I finished the hospital treatment I was able to start getting my life back to the way it was,” he says. “But it could never really be the same, in a positive way, because I had a new outlook of gratitude. Those two months of my life, as I get older, are more and more insignificant. But I still think about the fact that I am one of the lucky ones.”

Mark hopes his story will help others.“Stroke can be a hopeless experience for a while,” he says. “If my story gives someone the inspiration to get back to full health, it makes everything I went through worthwhile.”

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The whole experience gave me an attitude that life is precious”

Paul’s storyPaul Brimble’s father died of a stroke in the 1980s. “He had a stroke at 64 and a more severe stroke at 67, which wiped out the whole left side of his body,” says Paul. “He lasted another two years and seven months, but he just lay there and wasted away. To me, that was what a stroke was.”

When Paul, from Midsomer Norton, near Bath, suffered pain and numbness in his wrist, it never occurred to him that this could be a stroke. “I play in a 60s rock and roll band,” he says. “I went to set up the equipment and I had a strange feeling in my wrist.”

He didn’t take it too seriously, but after seeing a pharmacist, was advised to go to hospital. A doctor spotted he had atrial fibrillation (AF)D, a type of abnormal heart rhythm. This raises your risk of stroke, because irregular flow of blood means clots are more likely to form. These can move to the brain and cause a stroke.

After further tests, Paul was told he’d had a stroke, but had difficulty believing it, as he felt fairly well. Two days later, he had a severe attack of AF in hospital. “I came over really hot and my heart rate was off the scale, going both ways, high and low,” he says. “That was when I realised I was quite ill.”

Paul continued to suffer with his AF. He had three cardioversionsD and three ablationsD to restore his heart to its normal rhythm, but none worked for more than a few days.

This affected him mentally and emotionally. “I felt so bad that before my third ablation, I told the doctor if they couldn’t sort it out, not to worry about bringing me round,” he says. “When I came round, the doctor said: ‘I am going to fit you with a pacemaker next week.’ He did, and my life changed completely.”

After eight months, Paul was able to return to work full-time. He is still working aged 69, and plans to retire later this year.

Paul’s stroke affected his right hand and he worried his career as a drummer could be over. To his relief, he’s been able to re-join his band, The Sneakers. “I have no feeling

14 Heart Matters

What is a stroke?A stroke happens when the blood supply to part of your brain is cut off, causing brain cells to become damaged or die.

This can be because a blood vessel supplying the brain is blocked by a clot or because a blood vessel in your brain bursts.

The same type of blood clots can cause heart attacks and stroke, so reducing your risk of heart attack (for example by keeping to a healthy weight, eating healthily, exercising or taking statins) will also reduce your risk of stroke. ≠ Read about our research into stroke on page 35.

in the palm of my right hand, but I can use my fingers and thumbs so I am still playing,” he says. “I do lose the odd stick. I can’t tie shoelaces and I struggle with buttons, but that’s pretty much all.”

Early last year, his doctor warned him that he was overweight and at risk of developing diabetes. She referred him for three months with a slimming group, and Paul also started walking regularly. “I have lost three-and-a-half stone and I still go to the slimming group,” he says. “I feel on top of the world now.”

He’s given up fish and chips and cut back on alcohol. He says he used to be “addicted” to ice cream, but now chooses low-fat yoghurts or sugar-free jellies. He’s no longer classed as at risk of diabetes and his blood pressure has reduced.

“I didn’t look after myself very well before,” he says. “Now I am committed to looking after myself. You don’t get many chances at life. I have come to the conclusion that life is precious.”

Margaret’s story“Even if you are a slow runner, you are faster than someone on the sofa,” says Margaret Tunney. Since having a stroke 18 years ago, she worried that she might have another one. But she knows that keeping active helps reduce her risk, and also gives her a sense of achievement.

“I couldn’t even run until I was in my 40s,” says Margaret, now aged 51. “In October, I did my first half marathon. I was so proud.”

Her stroke came the day after giving birth to her younger daughter, seven weeks

prematurely. “Leading up to the birth I had horrific headaches and was being violently sick all the time,” she says. “They put it down to the pregnancy but I now realise it was probably related to the stroke.”

On the day of her stroke, Margaret was on the mother and baby ward without her baby. “Because she was so small, Alexandria was in the special care baby unit,” she says. “I got up to make myself some toast. And that’s the last thing I can remember.”

Although stroke is rare in young women, pregnancy increases the risk, especially immediately after giving birth, when there’s an increase in substances in your blood that cause clotting (this is the body’s natural mechanism to prevent blood loss during and after delivery).

Margaret spent two weeks in hospital. After the first week she was able to have her daughter with her. Alexandria is now studying psychology at university. “She’s grown up to be a lovely young woman,” Margaret says.

Margaret didn’t suffer any long-term physical problems, but her language skills have been affected. “I have trouble spelling words, whereas I used to be able to spell anything,” she says. “And sometimes I can’t find the right names for things. It can be quite annoying.”

She works part-time in a school kitchen, as well as helping to look after her elderly mother. She cycles to work every day and for several years has attended military-style fitness classes, as well as 5km Park Runs on Saturdays.

“I like to go for a run on Sunday morning too,” she says. “I run along the canal and it is beautiful. I like that it is calming, the sense of doing something for yourself, and the sense of achievement you get by running further and further.”

Margaret also tries to eat healthily, and takes statins to reduce her risk of another stroke or heart attack.

“Stroke can happen to anyone for all kinds of reasons,” she says. “You might die or you might be badly disabled. But that’s not always the case. I have recovered and I am lucky. There is life after a stroke.”

1.2mstroke survivors in the UK

Margaret regularly

does 5K runs

Margaret’s stroke happenedafter giving birth

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MEDICAL

Our panel of experts answer your health questions

ASK THE EXPERTS

Managing migraine riskQ I get migraines with aura

and I’ve been told I am at a higher risk of stroke. Is this true and is there anything I can do about it?

Dr Mike Knapton says: Migraine is a common type of headache, affecting about one in five women and one in 15 men. It is typically a severe headache, often on one side of the head, which may be accompanied with nausea and/or vomiting.

Some people will know a migraine is developing because they experience an ‘aura’ before the headache strikes. The aura is often described as seeing flashing lights, a sensation of pins and needles, and/or feeling dizzy or unsteady.

Studies suggest migraine with aura doubles the risk of the

most common type of strokeD, involving a clot in an artery supplying the brain. But this isn’t

necessarily cause for alarm. Your overall stroke risk may be low, especially if you’re young.

There is also evidence linking migraines with heart disease and stroke, but this is much less well established than links between migraine with aura and stroke.

I recommend that you ask your GP or practice nurse to

Need more information? Go online to bhf.org.uk/experts for more of your questions answered.

Call the Heart Matters Helpline on 0300 330 3300 for more information. To suggest a question, email [email protected].

How to get in touch

Are brands better?Q My friend says branded

medications are better than unbranded ones, but I think generic versions are the same. Who is right?

Senior Cardiac Nurse Emily Reeve says: Medicines often have more than one name – a generic name (which is the active ingredient of the medicine) and a brand name. The brand name is chosen by the manufacturer to help with marketing. For example, Lipitor is the brand name given by Pfizer to the generic medicine atorvastatin.

When a pharmaceutical company discovers a new drug, they take out a patent so no one else can make the drug for a period of time. This allows

them to recoup money spent on development and testing. Once that patent expires, other companies can sell the drug under its generic name, usually more cheaply. The unbranded drug has to be identical in its active ingredient, strength, safety and the way it is taken.

Medicines also contain inactive ingredients, which are used to formulate the active ingredient into a tablet, liquid or cream, and these can vary. This is why medicines containing the same active ingredient, but made by different manufacturers, may look different. These differences are rarely significant, which is why generic and branded medicines are almost always interchangeable.

There are a few exceptions. Some slow-release medications may be absorbed by the body differently – this can include slow-release versions of calcium channel blockers like diltiazem, veraprimil and nifedipine. Ciclosporin (an

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A Ablation A procedure to correct or control certain

types of abnormal heart rhythms. It involves using radiofrequency waves to destroy the abnormal electrical pathways. Angina An uncomfortable feeling, tightness or pain in your chest that may also be felt in your arms, neck, jaw, back or stomach. The symptoms of angina are usually caused by coronary heart disease.Atrial fi brillation (AF) An abnormal heart rhythm in which the atria (the upper chambers of the heart) beat in an irregular pattern. People with AF have an irregular, sometimes fast, pulse.

B Bypass See coronary artery bypass surgery.

CCardiac rehabilitation Also called ‘cardiac rehab’, this

is an education and exercise programme to help you recover from a cardiac event and get back to as full a life as possible.Cardiomyopathy Disease of the heart muscle in which it becomes weakened. It may become thickened, enlarged and/or stiff , depending on the type of cardiomyopathy. It aff ects people of all ages and is usually inherited.Cardiovascular disease (CVD) Includes all diseases of the heart and circulation, such as coronary heart disease and stroke.

Cardioversion Treatment for some abnormal heart rhythms

to help restore a normal heart rhythm. It can be done using medicines (chemical cardioversion), or by giving the heart a controlled electric shock with a defi brillator (electrical cardioversion).Coronary artery bypass surgery An operation to treat coronary heart disease. Arteries from your chest wall and arm, or veins from your leg, are used to bypass the blocked or narrowed coronary arteries, improving blood fl ow to the heart muscle.Coronary heart disease (CHD) When the walls of the coronary arteries (the arteries that supply blood to the heart muscle) become narrowed due to a gradual build-up of plaques, called atheroma.

D Diabetes A condition in which glucose (sugar)

levels in the blood are too high. There are two main types of diabetes: type 1, where your body stops producing insulin, and type 2, where your body can’t use the insulin it produces, usually because excess fat in organs prevents the insulin from working eff ectively. Diabetes increases your risk of developing cardiovascular disease.

E Echocardiogram Sometimes called an ‘echo’. A test to

examine the structures within the heart, for example the heart valves, and to see how well the heart is pumping. It is similar

to the ultrasound scan used during pregnancy.

FFamilial hypercholesterolaemia (FH) A genetic condition that results in very high cholesterol

levels. Having FH gives you a much higher risk of getting CHD.

H Heart attack Known medically as a ‘myocardial infarction’,

or ‘MI’. This describes a sudden loss of blood fl ow to part of the heart muscle. Most heart attacks are caused by atherosclerosis, the build-up of atheroma (plaque) within artery walls. If the atheroma becomes unstable, a piece may break off and lead to a blood clot. This can block a coronary artery, causing a heart attack and irreversible heart muscle damage. It is a medical emergency and can lead to a cardiac arrest.Heart failure Condition where the heart becomes less effi cient at pumping blood around the body. High blood pressure Also called ‘hypertension’. High blood pressure is when the pressure required to pump blood is consistently higher than the recommended level. This puts extra strain on your heart and blood vessels, and over time can increase your risk of having a heart attack or stroke.High cholesterol Cholesterol is a waxy substance that is mainly made in the body and plays a vital role in how every cell works. However, high cholesterol, when

MEDICAL TERMS EXPLAINED

Call the Heart Matters Helpline on 0300 330 3300 if you want to know more

there is too much in the blood, can increase your risk of getting cardiovascular disease which includes having a heart attack or a stroke.

I Implantable cardioverter defi brillator (ICD) A small

device implanted under the skin on your chest, connected to your heart by one or more wires (leads). It monitors your heart rhythm and can deliver a controlled electric shock if you have a life-threatening abnormal heart rhythm.

P Pacemaker A small device implanted under the skin

on the chest, connected to your heart by one or more wires (leads). Monitors the heart’s electric signals and can stimulate your heart to contract and produce a heartbeat if required.

S Stroke An interruption of blood fl ow to part of the

brain, causing brain cells to die or become damaged. This happens if an artery carrying blood to your brain becomes blocked, or if an artery bleeds into your brain. A stroke is a medical emergency.

V Ventricular tachycardia Also called ‘VT’. A very fast,

abnormal heart rhythm that starts in the ventricles (the lower chambers of the heart). This is a medical emergency that, if not treated, can lead to a cardiac arrest.

DICTIONARYMedical words, identified by a small symbolD, are explained in plain English in our dictionary on page 49.

Dictionary

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immunosuppressant), lithium (for mental health conditions) and epilepsy medications are also examples where different brands may be absorbed differently by the body, so may have a different effect.

Tell your doctor if you have a preference for a version of a medicine, for example, if you find that size and shape of tablet easier to swallow.

These differences are rarely significant”

discuss your overall risk of heart disease and stroke, because there are steps you can take to reduce your risk. These include knowing your blood pressure measurement and treating this if it is high. Statin treatment can also reduce your risk of stroke by managing your cholesterol levels. It is also important to consider taking steps to improve your health by adopting a healthy diet, not smoking, keeping to a healthy weight and taking regular physical activity.

problem is and the likely prognosis, which then helps your doctor decide on appropriate treatment options.

Follow-up is very important and must be done once or twice yearly for heart failure and valve disease patients to see how they are responding to their medication and/or device (such as a pacemakerD or ICDD).

Q What does the test involve?A A transthoracic echo (TTE),

the most common type, involves the patient taking their clothes off from the waist up, lying on a couch on their left side and an ultrasound probe being placed on the chest and abdomen to take images.

An echocardiogram can be a full scan or a focal scan. A full scan takes 40–45 minutes and gives a complete assessment of the size and function of all heart structures. The British Society of Echocardiography recently introduced focal scans, lasting 20–25 minutes. It is mainly for people with suspected heart failure. If it suggests there are

Heart Matters16

Echocardiograms

TESTING TIMES

MEDICAL

An echocardiogram provides ultrasound images of your heart. Dr Rajan Sharma explains this common test to our Senior Cardiac Nurse Emily Reeve

abnormalities, a full scan will be performed.

Q I’ve heard you can get 3D ultrasound scans – is it true?

A Yes, although in the UK 2D is still more common. 3D is good at quantifying heart function and there are fewer variations in results caused by variations in investigation technique – this is particularly useful for measurements such as ejection fraction. Cost is the only reason some places have 3D scanners and not others. In the future, it’s likely we will see more 3D scans.

CV Dr Rajan Sharma≠ Consultant

Cardiologist≠ Head of Clinical

Services at St George’s Hospital, London

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A Ablation A procedure to correct or control certain

types of abnormal heart rhythms. It involves using radiofrequency waves to destroy the abnormal electrical pathways. Angina An uncomfortable feeling, tightness or pain in your chest that may also be felt in your arms, neck, jaw, back or stomach. The symptoms of angina are usually caused by coronary heart disease.Atrial fi brillation (AF) An abnormal heart rhythm in which the atria (the upper chambers of the heart) beat in an irregular pattern. People with AF have an irregular, sometimes fast, pulse.



is an education and exercise programme to help you recover from a cardiac event and get back to as full a life as possible.Cardiomyopathy Disease of the heart muscle in which it becomes weakened. It may become thickened, enlarged and/or stiff , depending on the type of cardiomyopathy. It aff ects people of all ages and is usually inherited.Cardiovascular disease (CVD) Includes all diseases of the heart and circulation, such as coronary heart disease and stroke.

Cardioversion Treatment for some abnormal heart rhythms

to help restore a normal heart rhythm. It can be done using medicines (chemical cardioversion), or by giving the heart a controlled electric shock with a defi brillator (electrical cardioversion).Coronary artery bypass surgery An operation to treat coronary heart disease. Arteries from your chest wall and arm, or veins from your leg, are used to bypass the blocked or narrowed coronary arteries, improving blood fl ow to the heart muscle.Coronary heart disease (CHD) When the walls of the coronary arteries (the arteries that supply blood to the heart muscle) become narrowed due to a gradual build-up of plaques, called atheroma.

D Diabetes A condition in which glucose (sugar)

levels in the blood are too high. There are two main types of diabetes: type 1, where your body stops producing insulin, and type 2, where your body can’t use the insulin it produces, usually because excess fat in organs prevents the insulin from working eff ectively. Diabetes increases your risk of developing cardiovascular disease.




FFamilial hypercholesterolaemia (FH) A genetic condition that results in very high cholesterol

levels. Having FH gives you a much higher risk of getting CHD.

H Heart attack Known medically as a ‘myocardial infarction’,

or ‘MI’. This describes a sudden loss of blood fl ow to part of the heart muscle. Most heart attacks are caused by atherosclerosis, the build-up of atheroma (plaque) within artery walls. If the atheroma becomes unstable, a piece may break off and lead to a blood clot. This can block a coronary artery, causing a heart attack and irreversible heart muscle damage. It is a medical emergency and can lead to a cardiac arrest.Heart failure Condition where the heart becomes less effi cient at pumping blood around the body. High blood pressure Also called ‘hypertension’. High blood pressure is when the pressure required to pump blood is consistently higher than the recommended level. This puts extra strain on your heart and blood vessels, and over time can increase your risk of having a heart attack or stroke.High cholesterol Cholesterol is a waxy substance that is mainly made in the body and plays a vital role in how every cell works. However, high cholesterol, when




I Implantable cardioverter defi brillator (ICD) A small




S Stroke An interruption of blood fl ow to part of the




DICTIONARYMedical words, identified by a small symbolD, are explained in plain English in our dictionary on page 49.

Dictionary

Q Why would I have an echocardiogram?

A An echocardiogram is an important investigation for anyone with suspected heart failureD, heart valve problems or cardiomyopathyD. It can help your doctor make an early diagnosis. You might be referred for an echocardiogram, for example, because of symptoms such as breathlessness and/or a heart murmur (an unusual sound in your heartbeat). This test is also used to diagnose patients with inherited heart disease, including cardiomyopathy.

It uses ultrasound scanning to give a picture of your heart. It is cost-effective and safe.

Q When might I have an echocardiogram?

A There are three main areas for its use: diagnosis, prognosis and follow-up. At any of these points, it can provide measures of heart function, including an ejection fraction (the amount of blood pumped out of the heart with each heartbeat – a ‘normal’ level is around 55 per cent). This helps to establish how severe the

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Q What is a TOE and why would you have one?

A A transoesophageal echo (TOE) is much more focused and less commonly used than a TTE. It’s an invasive test as the probe is on the end of a long endoscope that the patient has to swallow. The scan is taken from inside the oesophagus, which is right next to the heart.

The test provides views of the back of the heart from the left atrium, and is mostly used for patients with problems in this area, including mitral valve disease. It can give a clearer

Q Are there any after effects?A Not for the standard

echocardiogram. After a TOE you will feel like you can’t swallow for a couple of hours. If they haven’t had sedation, most people can carry on as normal in the afternoon if they have had it in the morning.

Q What will it tell me?A Either type of

echocardiogram can give a better understanding of your condition. For example, if someone has a leaky valve, it can tell you the severity of

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view as the ultrasound signal doesn’t have to travel as far.

Q Do I need to do anything to prepare for the test?

A Not for a standard echocardiogram (TTE), but for a TOE you will need to fast for four hours beforehand and two hours afterwards.

Q Will it hurt?A TOEs can be uncomfortable,

but should be tolerable. You will usually be offered anaesthetic (general or, more often, local) and/or some form of sedation.

the leak and whether it can be repaired or replaced.

Q What are the latest developments in this area?

A The most exciting development is that echocardiograms can now be used beyond hospitals. There are pocket-sized devices providing access for more patients. Image quality has also got better over the years, with clearer images.

We’re working on echocardiography for patients who don’t yet have symptoms and appear to have a normal heart, but have very early signs of disease. This can be useful for people having chemotherapy for breast cancer, for example, which can sometimes damage the heart. If damage is detected early by echocardiography, stopping chemotherapy can allow the heart to recover.

In future, I hope echos will give more information in a single scan – not just heart and valve function, but also mapping out coronary arteries.

≠ Watch our echocardiogram videos at bhf.org.uk/echo.≠ Look out for our Summer 2017 issue to learn all about angiograms. ≠ Read about ECG at bhf.org.uk/testingtimes, or call 0870 600 6566 to order our Winter 2016-17 issue.

You might be referred for an echo if you have suspected valve disease”

Heart Matters

MEDICAL

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Which numbers should I know?Weight on its own doesn’t tell us a lot, as a healthy tall person will generally weigh more than a healthy short person. This is why we use a measurement called body mass index (BMI). This is your weight (in kilos) divided by the square of your height (in metres). While this calculation isn’t perfect (it can give a misleading result for people with lots of muscle mass and pregnant women, for example), it can be a quick and useful guide to help assess whether someone is within their healthy weight range and, if not, how far outside it they are.

Another useful measurement is your waist circumference. This is important because your body shape can affect your risk of heart and circulatory disease. Visceral fat, which is stored around your abdominal organs and increases your waist size, is linked to an increased risk of heart and circulatory disease – more so than fat that is stored around the hips and thighs.

Why should I know these measurements?Your weight and body shape can make a real difference to your

weight and waist size?WHY SHOULD I KNOW MY…

VITAL STATISTICS

risk of heart disease. Obesity increases your risk of conditions that put you at risk of heart and circulatory disease and conditions, such as high blood pressureD and type 2 diabetesD. Your weight can also raise your risk of many types of cancer, such as bowel, womb, oesophagus, pancreas and some breast cancers. In fact, one in 20 cancers in the UK are linked to being overweight or obese.

Carrying extra weight puts increased strain on the joints, so there’s an increased risk of joint problems and osteoarthritis, as well as worsening arthritis if you already have it.

What should my numbers be? If you know your height and weight, you can calculate your own BMI. Online calculators allow you to put in your height and weight in either imperial or metric (use the same for both measurements). Find one on the BHF website at bhf.org.uk/BMIcalculator.

Depending on the result, this will put you into one of four groups: low weight/malnourished (BMI below 18.5), normal weight (18.5–25), overweight (25.1–30) and

obese (over 30). You can see if you are in a higher risk category, and then use BMI to calculate a target weight and monitor progress towards this over time.

For your waist circumference you just need a tape measure (like the one received in your Heart Matters welcome pack). Measure your waist at the mid-point between the bottom of your ribs and the top of your hips. For European women this should be no more than 88cm (35in) and for European men no more than 102cm (40in). People of African Caribbean, Black African or South Asian heritage should have a circumference of no more than 80cm (32in) for women and 90cm (35.5in) for men, as studies show they are at risk with a lower waist measurement than white European people.

Senior Cardiac Nurse Emily Reeve talks to the BHF Associate Medical Director Dr Mike Knapton about why it’s important to know your real size

Next issue Why should I know my blood sugar levels?

Find out more ≠ We’ve got lots of resources to help you manage your weight. These include our free booklet Facts not fads: your guide to healthy weight loss. Download or order it at bhf.org.uk/HMpublications or from 0870 6500 6566. ≠ Find all our food articles online at bhf.org.uk/nutrition, or check out our heart-healthy recipes at bhf.org.uk/recipefinder.

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

endocarditis

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Tom thought he’d caught the flu, but tests revealed

it was endocarditis

When Tom Aylott developed endocarditis, it seemed like a bout of flu. “One evening I started to come down with a flu-like

temperature and severe shivering fits,” he says. “I constantly felt cold and nothing I did could make me warm. It was a doctor friend who recommended that I went to A&E. Blood tests showed I had a staphylococcal infection, with symptoms consistent with endocarditis.”

A CT scan and a transoesophageal echocardiogramD (TOE) helped to confirm the diagnosis. Tom stayed in hospital for two weeks.

Tom was at risk of endocarditis because he’d had an aortic valve replacement nine months earlier, aged 33.

He had been fit and active, a keen surfer and rugby player, until he was diagnosed with Marfan syndrome, which can affect the connective tissues of the body. As a result, he needed urgent open heart surgery. Tom experienced heart rhythm problems following the surgery, but was back at work when he fell ill.

“The consultants believe the bacteria had attached itself to my replacement aortic arch,” he says.

20 Heart Matters

Professor Jonathan Sandoe, Associate Clinical Professor in Microbiology at the University of Leeds and Honorary Consultant Microbiologist at Leeds Teaching Hospitals NHS Trust, explains

How common is endocarditis?It affects one in 30,000 people in the UK, which is about 2,000 diagnoses each year.

Who is at risk?Your risk is increased by having:• Congenital heart disease• Previous endocarditis • Heart valve replacement• Heart valve disease – either stenosis (a narrowed valve) or regurgitation (a leaking valve)• Heart devices • Intravenous drug use.

If you have a problem with a valve or you have man-made materials in the heart, it is easier for bacteria to lodge there, and your body may not be able to fight off the infection. Intravenous drug users are at risk even if they don’t have heart problems.

What are the signs and symptoms?Feeling tired and awful, and appetite loss. Symptoms are flu-like, but flu symptoms tend to get better within 10 days, while endocarditis continues. People also experience shivers, shakes and night sweats (fever in the night, so sheets or nightclothes may be wet when you wake). This is an important symptom to tell your doctor about. Always seek medical help urgently if you think you may have endocarditis. Early diagnosis makes treatment easier and more successful.

How is it diagnosed and treated?It can be difficult to diagnose. If you have symptoms, diagnosis would be confirmed with blood samples tested in the lab to find bacteria. An echocardiogramD can show an abnormal bacterial growth on the valve. It is treated with intravenous antibiotics, usually for 4–6 weeks. Some people need valve surgery. If you have a device, it may be removed.

What are the long-term effects? A lot of people with endocarditis need surgery, due to damage to the heart valves caused by the infection. There are potential complications including stroke (see page 12). Infection can spread from the valve to places such as the joints or bones of the back, which may cause ongoing joint or back pain. One in five people die from endocarditis during a hospital stay.

Are there preventative antibiotics? NICE recommends people should not usually be given antibiotics before a medical or dental procedure. This is because these procedures are no longer thought to be the main cause of endocarditis and taking antibiotics carries some risk. Preventative antibiotics are sometimes needed, and your doctor should discuss this with you.

What advice would you give to patients who’ve had valve surgery? Look after your teeth and see the dentist regularly. If the kind of bacteria that colonise teeth enter the bloodstream, they can cause endocarditis. Try to avoid injury or cuts, and keep these clean if you do get them to reduce risk of infection.

Endocarditis: the expert’s view “Having read about endocarditis since, I realise how lucky I was, particularly in getting treated very early before the infection could develop and spread further.”

Some patients stay in hospital for the course of their intravenous antibiotics or come in for treatment as a day patient, but Tom had most of it at home. “I stayed in hospital for a week, during which time they trained me to give myself IV antibiotics at home and this continued for two months afterwards,” he says.

Tom says he is now “absolutely fine”. He’s even started surfing again, although, following advice from his cardiologist and surgeon, he no longer plays rugby because of the risk of injury. In July 2016 he cycled

from Newcastle to Paris for the BHF, riding 600 miles in a week. “It was tough,” he says. “But I am glad I did it. It felt like quite an achievement to get there.”

Tom is keen to raise awareness of endocarditis. “I was aware I might be more susceptible to infections following surgery,” he says. “But I wasn’t aware of how dangerous it could be. I would go straight to hospital if the symptoms returned. Educating people is important.”

Losing a loved one: Helen’s story Helen Moulford says her husband Bill was her “soul mate”. Together, they were raising a three-year-old daughter and two children from Helen’s previous relationship. She still misses him every day, following his death from endocarditis in February 2015.

Bill’s heart murmur was detected during a routine medical when he was 33. He had a bicuspid aortic valve – a relatively common abnormality of the heart, which often causes no problems.

“He was told his heart was otherwise fine and he’d be reviewed again when he reached 65,” says Helen.

Bill knew it was important to look after his teeth. People with any type of heart valve abnormality are at risk of endocarditis, which can be caused by dental

I wasn’t aware of how dangerous it could be”

Tom is now surfing again

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bacteria entering the bloodstream. He was rigorous about his dental hygiene and saw the dentist regularly.

In 2014, Bill fell ill. “He got a really bad cough,” Helen says. “They suspected it was whooping cough. A chest X-ray showed his lungs were clear; they gave him antibiotics and it got better; he stopped the antibiotics; they gave him steroids and blood tests. This cycle went on for five months.”

Flu-like symptoms that don’t go away can be a sign of endocarditis, but no one spotted it. “He was losing

weight and wasn’t sleeping properly,” says Helen. “I was frantic because my beloved man wasn’t getting any better. We kept going back to the doctor. The GPs were wonderful, they just weren’t aware of the risk of endocarditis. It is hard to diagnose.”

Bill got progressively worse. One day it dawned on Helen that he might actually die. “It was such an awful feeling,” she says. “We rushed him into hospital and within two hours the young man in the assessment unit said: ‘It’s his heart. There’s a massive infection in his aortic valve.’ To us, this seemed like good news, that it meant they could cure it, but it was too late.

“You never get over the trauma of holding your loved one in your arms and watching them die. I still miss him terribly.”

Now, like Tom, Helen wants to raise awareness of endocarditis in people who are at risk (see box, on page 20). She says: “I really don’t want it to happen to anyone else. We were taking all the precautions, so we didn’t think about his heart.

“If you get something that looks like flu and it doesn’t go away, seek medical attention and insist that they check your heart. If they find it, they can treat it and you have a good chance of survival.”

Research into endocarditisWe’re trying to stop people suffering from endocarditis. Professor Jennifer Potts is a BHF Senior Research Fellow at the University of York. Her lab looks at the structure and function of proteins on the surface of bacteria and how these cause endocarditis. Her team is studying how bacteria are able to form antibiotic-resistant colonies on the surfaces of heart valves and devices such as pacemaker leads. If we understand this, we may be able to prevent endocarditis in future.

Helen with late husband Bill, whofell ill with endocarditis years after adiagnosis of a bicuspid aortic valve

MY STORY

Mike Keavey faced multiple heart problems, but he’s loving life again after finding new interests and rekindling old ones, as he tells Rachael Healy

Heart Matters22

highRIDING

Mike with his bike – one of thenew hobbies he’s taken onsince his triple bypass surgery

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Mike Keavey has been on a long and often difficult journey back to health. He’s been fitted with a pacemaker, which was later replaced with an implantable cardioverter defibrillator (ICD)D, and has been

diagnosed with angina and heart failureD. He’s also undergone triple heart bypass surgery and later had a procedure to treat two more arteries.

The singer and guitarist, 69, lives in the Black Isle, near Inverness, with his wife Dianne, 46. With her support, he’s made it through the darkest days and is living life to the full, riding a new motorbike and learning to speak German.

It was during a routine GP visit in 2011 to check on his type 2 diabetesD that a nurse spotted Mike’s heartbeat was very slow. This came as a surprise. He was referred to hospital and tests revealed he needed a pacemakerD.

Once it was fitted, Mike’s heartbeat returned to a normal level. But he started experiencing symptoms, such as chest pain while he was out walking. An echocardiogram and other tests revealed Mike had anginaD, but it also showed that some of his coronary arteries were blocked. In January 2012, Mike underwent triple bypass surgery.

“I can’t describe the feeling when you’re first told you need open heart surgery – I thought it was only old men who need surgery,” Mike says. “But it changed my life.”

He noticed an immediate improvement, but after a few months felt like he was slowing down again. Mike was diagnosed with heart failure and his pacemaker was swapped for an ICD (a cardiac resynchronisation therapy defibrillator, which can be used to treat heart failure).

“Before I had the ICD fitted, I was going downhill,” says Mike. “I was disappointed because it seemed to me the bypass hadn’t worked, but then I got the new device and I’ve been great ever since.”

Living with heart failureMike’s parents both suffered from heart disease, but getting to grips with multiple health issues was still a learning experience for Mike and Dianne.

“I was pretty doom and gloom to begin with,” says Dianne. “It came as a bit of a shock the first time heart failure was mentioned, as the term is quite devastating. But you find out more about it, then pick yourself up and get on with it.”

Mike was assigned a heart failure nurse, Mandi Smith, to help him understand the condition and find ways to live with it. “It was wonderful knowing I could phone her, because I didn’t know what to expect from heart failure,” says Mike. “I might get a pain, then I could phone her up and ask if that’s OK. She does an incredible job.”

When he started experiencing numbness in his leg while out walking the dogs, Mike called Mandi. On her advice, he returned to his GP to discuss his leg trouble. He needed an endarterectomy – a procedure where the inner lining, and any fatty material (plaque), is removed from a narrowed artery to improve blood flow. Mike had treatment for two blockages in his leg.

“I’m 90 per cent back to normal now,” says Mike. “I can take the dogs out for a walk without stopping.”

Finding supportMike says he’s feeling positive and that’s thanks to family support, his healthcare professionals and a change of diet.

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≠ April 2011: During a GP visit, a nurse spots Mike’s heartbeat is slow.≠ May 2011: Hospital visit for tests.≠ July 2011: Pacemaker fitted.≠ September 2011: Mike experiences chest pains.≠ October 2011: Echocardiogram.≠ November 2011: Further tests reveal Mike has angina and blocked arteries.≠ January 2012: Triple bypass surgery.≠ Spring 2012: Cardiac rehab sessions.≠ Winter 2013–14: Mike experiences breathlessness, feels he is slowing down.≠ March 2014: Further tests lead to heart failure diagnosis. ≠ June 2014: Initial visit to Aberdeen to see surgeon for tests. Mike is told he could benefit from having an ICD fitted.≠ September 2014: Pacemaker removed and ICD fitted.≠ May 2015: After experiencing leg pain, Mike has an endarterectomy.

Mike, pictured with wife Dianne, still enjoys playing the guitar

Ups and downs: Mike’s health journey

“The family was really supportive – my daughter Gail called me every day from Australia,” says Mike. “During the bypass, Dianne was down at the hospital every day. Afterwards, she looked after me and took time off work. Dianne doesn’t like blood, so considering that, she did pretty well! She’s fantastic – the love of my life.”

Dianne adds: “He’s been very courageous through all of his illnesses – although he can be a wuss sometimes! He is very good at sharing his experiences to help other people, such as friends who have cardiac problems too.”

Beyond his family, Mike found support at cardiac rehabilitationD. Initially, he was sceptical about attending, but Dianne persuaded him to give it a go.

“I know a few friends who’d had bypass surgery and a couple of them said: ‘I don’t need to do that, I know when I’m better’,” Mike explains. “But you really get into it and you learn so much about what to work towards.”

When the course finished, Mike joined a gym, continued walking the dogs every day and does the odd workout in the house. He also changed his eating habits. He now eats fewer carbohydrates and makes sure those he does eat are wholemeal. “The weight started falling off,” he says.

Mike has now lost three and a half stone. “It’s helped with everything,” he says. “I feel better and I look better.”

New skillsExperiencing health issues made Mike realise he wants to spend more time doing the things he loves. “It’s the beginning of a new part of my life,” says Mike. “I still play wee gigs down the road, but I’m much more interested in being out with the dogs and being with Dianne.”

Back in the sixties, Mike used to ride a moped. In 2015, he decided to treat himself to a motorbike and is now working towards his full licence.

“I take it all around the Black Isle,” he says. “I even drove down to Aberdeen to meet my son Ben. I’m still a learner at the moment. Dianne doesn’t want me to pass my test yet because it means I’ll get a bigger bike!”

The couple are big Formula 1 fans and will be heading to the Belgian Grand Prix in August, combined with a holiday in Germany. They’ve made friends who live out there, and Mike is now teaching himself to speak German.

“I’ve been learning for two years and I wouldn’t have done that if I hadn’t had my bypass surgery,” he says. “I’ve got lots to look forward to. I really appreciate everything I have.”

Find out more ≠ Visit bhf.org.uk/HMpublications to download or order one of our free booklets about heart surgery, heart failure and more.

Dianne has supported Mike through the toughest times

Pacemakers and ICDsPacemakers and ICDs can both help the heart get back into a normal rhythm, so what’s the difference?

≠ ICDs monitor your heart rhythm and deliver a controlled electric shock if you have a life-threatening abnormal heart rhythm. This can be one big shock or a series of smaller ones depending on what’s needed. You may need an ICD if you had a life-threatening heart rhythm, have a condition such as cardiomyopathyD, or have heart failure, which puts you at risk of a life-threatening heart rhythm.

≠ Pacemakers monitor the heart’s electrical signals and stimulate the heart to contract if it beats too slowly. Most pacemakers just work when needed, but some send out impulses all the time to keep your heart pumping normally. You may need a pacemaker if your heart beats too slowly or too fast.

≠ Cardiac resynchronisation therapy is available in combination with either a pacemaker or ICD. It helps to treat heart failure by co-ordinating the electrical impulses in the heart’s four chambers, improving the heart’s ability to pump blood.

Heart Matters24

*Heart Matters Helpline open 9am–5pm Monday–Friday. Similar cost to 01 and 02 numbers.

How do I follow a heart-healthy diet?

What does this diagnosis mean for me?

Why have I been prescribed this medication?

Why do I need this test?

Call the Heart Matters Helpline on 0300 333 2333* or email [email protected]

Questions about your heart condition?

NUTRITION

Heart Matters26

Bored with breakfast? Senior Dietitian Victoria Taylor presents some quick and easy ideas to make you fall in love with your morning meal

Rise and shine

It’s the meal we are most likely to skip, but a healthy breakfast has huge benefits. Having a meal

first thing makes it easier to avoid unhealthy snacking, but a good breakfast can also expand the range of nutrients in your diet and help you reach your 5-a-day. What’s more, if you find that the morning sets the tone for the rest of your day, then a balanced breakfast might make it easier to make good food choices later too.

However, we often eat it in a rush, so we can fall into bad habits or just eat the same thing every day. But breakfast needn’t be boring: read on for tips on how to give a healthy, tasty boost to your mornings.

Porridge perfectionPorridge is a great choice. As well as traditional oats, it can be made with grains such as quinoa, rye, buckwheat, brown rice, or barley. Think of porridge or grains as a neutral base, then add variety with toppings. Experiment with nuts and seeds, fresh, dried or frozen

fruit, and spices such as nutmeg, cinnamon, ginger and mixed spice.

Try it savouryFor something unusual, why not experiment with savoury porridge? Using dried herbs or spices is healthier than adding salt, and you can try vegetables such as mushrooms, spinach or peas as a topping – whatever takes your fancy. Think of it as an oaty risotto!

Veg adventures For a mix of sweet and savoury, and to up your intake of fruit and veg, replace some of your porridge oats with raw grated courgette. Add it to the uncooked oats and cook as usual. The veg will bulk out your portion but is lower in energy, so it’s a good

option if you are trying to lose weight. The coloured flecks look a bit unusual, but you shouldn’t taste it so you can enjoy with your usual toppings. Grated carrot or butternut squash work well too and will add a subtle sweetness – you could even mix grated carrot, cinnamon and raisins with your oats for a ‘carrot cake’ porridge.

Toast with the mostThere are whole cafés devoted to toast, which shows the variety this breakfast staple offers. While white toast with butter and sugary jam isn’t an ideal everyday choice, the right bread and toppings can make it a nutritious start to the day.

If you like variety, then rolls, English muffins, bagels, pitta breads and even tortilla wraps can all be good choices. Be aware that salt content varies, so check food labels to choose one with the lowest salt content, and pick a wholegrain version to benefit from the fibre.

Skip butter in favour of an unsaturated fat spread, or just go straight to your main topping – ideally one that will add fruit (sliced banana or berries) or vegetables

Mix grated carrot, cinnamon and raisins with oats for a carrot cake porridge”

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(avocado, grilled mushrooms, grilled or raw tomatoes, or wilted spinach).

Add protein too so that your meal is balanced. This could be a poached egg, tinned sardines, or low-fat soft cheese. Nut butters and baked beans are protein-filled options too, but check labels and choose ones with the least sugar and salt and no added palm oil for nut butters.

Cooked breakfastsTraditional cooked breakfasts are high in saturated fat, salt and calories. But there are simple ways to make it healthier. These include:

≠ Grilling rather than frying ≠ Choosing lean back bacon rather than

streaky bacon ≠ Skipping the sausages≠ Poaching the eggs instead of frying in

butter or bacon fat ≠ Serving with wholegrain toast rather

than fried bread. If the appeal of a fry-up is the simplicity

of cooking everything in one pan, that’s still possible. Cooking your breakfast in the oven in a tray lined with greaseproof paper

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

means you don’t need to add any oil. Add eggs towards the end of the cooking time to ensure a runny yolk.

≠ Check out our simple meals infographic for an all-in-one baked breakfast at bhf.org.uk/simplemeals.

≠ Don’t miss the recipe pullout in our centre pages for interesting cooked options such as mushroom and cauliflower frittata or sweet potato rosti with poached egg.

Breakfast on the goIf you need an instant breakfast, it’s easy to rely on shop-bought breakfast bars, biscuits and muffins. Always read the nutritional information to choose those with least saturated fat, sugar and salt.

It can be better to make your own in advance. Try our recipes for banana oatmeal muffins and banana bread at bhf.org.uk/recipefinder. You can prepare these in advance and even freeze them. For grab-and-go ease in

the morning, try our bircher muesli, which you can make up in a large batch and put in airtight portion-sized boxes in the fridge to use over the week. Mix low-fat plain yoghurt with a no-added-sugar muesli and fruit such as fresh strawberries, frozen mango chunks or stewed plums for a creamier alternative. A peanut butter and banana sandwich made with wholegrain bread is another easy, filling option.

Go online≠ Find 14 delicious heart-healthy

porridge ideas to brighten up your morning at bhf.org.uk/porridge.

≠ Discover seven healthy breakfasts for busy people at bhf.org.uk/busybreakasts.

≠ See our list of popular cereals ranked best to worst at bhf.org.uk/cereal.

NUTRITION

Heart Matters28

Everyone needs protein, but it’s not all about steak. Our Heart Health Dietitian Tracy Parker explores the power of plant protein

PlantPOWER

rotein is essential for a healthy diet. You might think meat is the best way to get it, but there’s growing evidence that swapping a diet rich in animal protein (such as meat and

dairy) for one high in pulses, nuts and grains could help you live longer.

In 2016, new dietary guidelines placed greater emphasis on non-meat sources of protein. We don’t need to avoid meat and dairy entirely, but it does remind us that we need a varied diet to stay healthy.

Proteins are known as the building blocks of life as they break down into amino acids that help the body grow and repair. Our hair, skin and muscle are all made from the protein we eat.

Animal foods and three plant sources – soy protein, quinoa and Quorn – contain all the essential amino acids needed for good health. Other plant sources of protein lack one or more of the essential amino acids. Sometimes animal protein is thought of as a ‘complete protein’ for this reason. But it’s not true that vegetarians will lack protein, or that you need to eat plant-based proteins in certain combinations. Eating a variety of plant protein each day gives you all the essential amino acids you need.

Ease into meatless meals by going meat-free one day a week. Try replacing meat with foods like fish, dairy and eggs before swapping for plant-based proteins. If meat-free meals seem like a step too

far, replace some of the meat in dishes like stews, chilli or Bolognese sauce with beans or lentils.

How much protein?Most adults need around 0.75g of protein per kilo of body weight per day (for the average woman, this is 45g, or 55g for men). That’s about two portions of meat, fish, nuts or tofu per day. As a guide, a protein portion should fit into the palm of your hand.

In the UK, on average we eat almost double the protein we need. This isn’t automatically a problem, but it depends where your protein is coming from. Meat-

heavy diets have been linked to increased risks of heart disease, diabetes, some cancers and may also shorten your life. We should eat more peas, beans and lentils, two portions of fish a week, and eat no more than 70g of red and processed meat per day.

Here are 10 meat-free protein sources to get you started.

PThere are many pulses tochoose from: all containprotein and fibre

0.75gProtein you need per kilo of body weight each day

Pulses8g per three-tablespoon servingPulses are an inexpensive protein choice, are high in fibre and a source of iron. They are part of the legume family and include all beans, peas and lentils. A daily serving helps to lower your cholesterol level and counts toward your 5-a-day. If you buy tinned pulses, check the label and choose ones that have no added salt or sugar. They are easy add-ins to sauces, soups and stews, even if they’re not used in the original recipe.

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Soya beans8g per 100g serving of tofu Unlike other pulses, soya beans are a complete protein, comparable in quality with animal protein, but are low in fat and contain fibre and iron. Eating 25g of soya protein a day, instead of meat, can help lower cholesterol levels. This is equivalent to a glass of soya milk, a pot of soya yoghurt or an 80g serving of tofu.

Quinoa8g per 185g serving (five tablespoons when cooked)Quinoa is cooked and eaten like a grain, but is actually a seed of a green vegetable

related to chard and spinach. It is a good protein food, but it’s not the amount that is impressive, it’s the type. Unlike cereals, quinoa has all of the essential amino acids you find in animal protein. It is an easy substitute for rice and pasta.

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

Muscle minus meatIt’s a myth that you need lots of protein if you are active. Athletes who train more than once a day should eat twice as much protein as the average adult, but most of us already do. It’s better to spread your protein over the day, combined with carbohydrates for energy, leaving the protein for muscle repair and growth. Germany’s Strongest Man Patrik Baboumian, Ironman champion Dave Scott, and British cyclist Lizzie Armitstead all avoid meat and are very successful.

Nuts8g per 30g serving Nuts provide a good dose of protein in a handful and are packed with fibre. Although

they are high in fat, and hence calories, most of this fat is heart-healthy unsaturated

fats. But stick to a handful per day (30g).

Seeds7g per 30g serving

Like nuts, seeds contain healthy unsaturated fats

and protein. They can be easily added to salads and pasta or you can eat them plain as a

simple snack.

Heart Matters30

Find out more≠ Top 10 meatless recipes at bhf.org.uk/meatfree. ≠ Discover how much you know about protein at bhf.org.uk/proteinquiz.

Fish25g protein per 140g serving of baked fishWhite fish is a low-fat protein source. Oily fish, such as sardines, mackerel or salmon, are a little higher in fat but contain omega-3 fatty acids, which are heart healthy. Oily fish are also good sources of vitamins A and D. Aim to have two portions of fish a week, of which one should be oily.

Cereals and grains3g per slice wholemeal breadWholegrain breads, rice and pasta have more protein, fibre and iron than white versions. Brown rice with beans, or bread with hummus or nut butter, can give you as much protein as a piece of meat.

Eggs14g per two medium eggs (120g serving)It’s a myth that eggs are bad for your heart. Eggs do contain cholesterol, but it’s the saturated fat added while cooking them or on foods served with them that you may need to worry about in terms of blood cholesterol levels. Eggs are good sources of B12

and vitamin D. There is no limit to how many eggs you can eat, but if you have familial hypercholesterolemiaD then talk to your doctor or dietitian for advice about your intake.

Quorn™ 11g per 100g serving Like soya, Quorn is a complete protein. It is made from an edible fungus and has a meat-like texture. It is naturally low in saturated fat. It contains more fibre than an equivalent portion of baked beans, wholemeal bread or brown

rice. It is sold in a range of forms from mince to fillets, so can easily be swapped with meat, but take care to read labels as the salt content can vary.

Dairy8g per 30g cheeseMilk, yoghurt and cheese are great sources of protein and also contain calcium to keep our bones healthy. Choosing lower-fat dairy options will help reduce your saturated fat intake without compromising on protein or calcium.

Eating less meat doesn’t just affect your health. Going meatless once a week can help reduce your carbon footprint and save resources like fossil fuels and fresh water. Giving up meat for just one meal could save the daily water usage of nine people.

Sources of protein Portion Protein (g)Nuts Peanuts 30g 8Walnuts 30g 4Hazelnuts 30g 4

Seeds Sunflower 30g 6Pumpkin 30g 7

PulsesBaked beans 3 tbsp (120g) 6Chickpeas 3 tbsp (105g) 8Lentils 3 tbsp (120g) 9

SoyaTofu 100g 8Soya milk 200ml 6

Cereals & grainsWholegrain rice 185g cooked

(75g uncooked)7

Wholegrain bread Medium slice 3Oats (uncooked) 40g 4Wholemeal pitta 58g 5Dairy Milk 200ml 7Cheddar cheese 30g 8Yoghurt (plain) 150ml 7Quorn 100g 11Eggs (boiled) 1 medium (60g) 7

Fish 100g 21

What your daily protein intake might look likeBreakfast Egg on toast 9gLunch Salmon sandwich 27gDinner Veg and lentil chilli with brown rice 16g

Total: 52gRecommended: 45–55g

Improving your health and the environment

Call the Heart Matters Helpline on 0300 330 3300 for more information. To suggest a question, email [email protected].

How to get in touch

Our Senior Dietitian Victoria Taylor shares nutrition advice

ASK THE EXPERT

Faking itQ I keep reading that sugar

is bad for you. Are artificial sweeteners any better?

Victoria Taylor says: Health problems such as obesity and tooth decay are linked to the amount of sugar in our diets. We know from our national dietary surveys that most adults in the UK eat too much sugar.

‘Natural’ alternatives, such as honey syrups and nectars, are often seen as healthier options, but are still sugar in liquid form. For sweetness without the calories that come with sugars, you need artificial sweeteners.

Sorbitol, acesulfame K, aspartame, saccharin, sorbitol, sucralose, stevia and xylitol are the main artificial sweeteners. These are added to many foods, either on their own or in combination with sugars, as well as being available to buy in granulated or liquid forms to add to our own cooking, baking and drinks.

Some people are reluctant to use artificial sweeteners – stories linking

Enjoyed this article? Find all of our nutrition information at bhf.org.uk/nutrition.

them to health problems including cancers, liver damage

and premature births, are probably the reason for this. However, before sweeteners

can be added to food in Europe, the European

Food Safety Agency (EFSA) has to approve their use.

This is a rigorous process, so you can feel confident they

are safe to eat. Whether they

are a helpful addition to our diets

Spring cleanQ What is ‘clean eating’ and

should I be doing it?

Victoria Taylor says: ‘Clean eating’ is a term that has been used a lot over the past year or two. But what it actually means is not very clear. It is used to mean anything from making simple, healthy changes to your existing diet, to adopting a rigid diet that excludes whole food groups.

What everyone seems to broadly agree on is the benefits of eating more whole foods, such as fruit and vegetables, grains and pulses, and fewer processed foods such as cakes, biscuits and

ready meals. For most of us, these are positive changes.

However, as with all fads, there are extreme versions of clean eating and these don’t have a sound basis. It’s often recommended that dairy and wheat are excluded from the diet, even for those who have not been diagnosed with an intolerance or allergy. Coconut oil is often promoted, despite being high in saturated fat, which is linked to high cholesterolD.

Butter is avoided by some clean eaters, but not by others, while most who eat it suggest it should be organic and grass-

fed – attributes that don’t change the fact it is high in saturated fat. There is similar inconsistency over sugar. Although white sugar is definitely not viewed as ‘clean’, honey, maple syrup and juices, which are also sources of free

sugars, are usually included and even encouraged by some clean eating

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depends on your reasons for using them. They are certainly better for our teeth, and for people with diabetes they can provide a sweet taste without affecting blood glucose levels. When it comes to weight loss, the research is more mixed, as there’s some limited evidence that they may increase appetite. They might help you cut back on sugar, for example in tea or fizzy drinks. But, ultimately, you need to

reduce the total sweetness of your diet if you want to readjust your tastes in the long term.

gurus. While it’s true that there are some foods we should be eating less of and others we should eat more of, this is a world away from thinking about foods in terms of clean and dirty. Clean eating presents an image of perfection that isn’t realistic. In real life, some days may be better than others and having flexibility in your diet is important if it’s going to be a pattern of eating for the long term, rather than a continuous cycle of deprivation and guilt.

Clean eating presents an image of perfection that isn’t realistic”

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≠ See our guide to different diets at bhf.org.uk/diets.

NUTRITION

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RESEARCH

32 Heart Matters

The professor and his team usepowerful microscopes to studybone marrow cells

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no gain?Pain may not always be a bad thing, at least when it comes to a heart attack. That’s the theory Professor Paolo Madeddu is investigating, as he tells Sarah Brealey

£190,000To look at using PKCB to help heart attack patients

Pain is a common symptom of a heart attackD. Patients are usually given pain relief, often in the ambulance on the way to hospital. But what if the pain is useful? This is the theory

Professor Paolo Madeddu is investigating.“The theory we are adopting is that when

you have a heart attack, you feel pain, which is like your body’s alarm system,” says Professor Madeddu. “Symptoms described in medical textbooks 30 years ago as stressful and painful may actually have a useful function.”

Professor Madeddu has spent three decades researching ways to help people with heart and circulatory conditions, including the last 17 years trying to help the heart heal itself. He’s been at the University of Bristol since 2005 and is now Professor of Experimental Cardiovascular Medicine there.

Some people experience ‘silent’ or undiagnosed heart attacks, which may have few symptoms, if any. It’s estimated that as many as 60 per cent of all heart attacks are silent. In some cases these people may simply have a higher pain threshold, but it can also be connected with diabetesD.

Diabetes is a common cause of neuropathy (nerve damage). This can mean pain is experienced differently – it may be stronger or not felt at all. In the UK, 3.6 million adults have been diagnosed with diabetes, and it’s estimated one million may have undiagnosed type 2 diabetes. Numbers are rising fast, mostly because of increasing obesity levels. Diabetes can double the risk of heart and circulatory disease, so people with diabetes have a higher heart attack risk.

We’ve awarded Professor Madeddu and his colleagues,

including BHF Professor Costanza Emanueli, more than £700,000 over five years. They are in the third year of studying the circulatory system of the bone marrow in people and mice with diabetes. They’re using powerful microscopes and scanners to look at cells in the bone marrow and how blood flows around the bone marrow.

A further £190,000 BHF grant will allow them to see if protein kinase C beta (PKCB) could improve the outlook for those with heart attack or diabetic cardiomyopathy (changes in the heart’s structure in people with diabetes, which can lead to heart failure).

Professor Madeddu is grateful for BHF support. “The BHF is one of the biggest research funding organisations in the UK,” he says. “Many countries do not have a cardiovascular research charity like this. We are very lucky. Thank you to the BHF and all its supporters.”

BHF support

No pain,

“Sometimes people with nerve damage don’t realise they are getting injured because they don’t have pain,” Professor Madeddu explains. “If someone with diabetes has a heart attack they may not feel the pain. We know that patients who have a ‘silent’ heart attack have a worse prognosis on average than other heart attack patients. We also know there is higher mortality in heart attack patients who are given morphine for pain relief. I am not saying patients shouldn’t be given morphine, but I am saying that the pain may be serving a purpose.”

Self-repair systemSo what is this purpose? Your bone marrow is where many new cells in the body are made, including stem cells, which have the ability to restore damaged tissue.

“Normally bone marrow releases healing substances during a heart attack,” says Professor Madeddu. “We think that the pain itself is the signal to guide healing cells from the bone marrow to the heart. If pain is blocked – by diabetes or by painkillers – there’s no signal telling stem cells to travel to the heart, which will result in more damage to the heart and worse recovery.”

He’s looking at whether producing pain in heart attack patients could help them recover better, or whether there are other ways to stimulate the bone marrow to produce healing stem cells.

Professor Madeddu’s research suggests that if you have diabetes, your body’s ability to deal with a heart attack is doubly limited. If you have nerve damage, you may not feel the pain of a heart attack, so the

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body’s ‘alarm’ doesn’t go off and the bone marrow doesn’t release healing cells.

To make matters worse, bone marrow itself is less able to act as the body’s repair system, even if it does hear the ‘alarm’. This is because diabetes damages blood vessels all around the body, meaning that tissues, including bone marrow, don’t receive the oxygen they need. High glucose in the blood – a sign of diabetes – also damages stem cells.

“Normally the bone marrow contains stem cells and the network of blood vessels that supply them,” says Professor Madeddu. “But in patients with diabetes there is a lot of fatty tissue in the bone marrow. So you have less healthy bone marrow left to produce the cells; there are fewer blood vessels and fewer nerves.”

Cells in the fatty bone marrow are also more likely to be inflamed. Inflammation is a key process in the development of heart and circulatory disease.

Future treatments Professor Madeddu is researching ways to ensure bone marrow stays healthy so it can produce new cells, especially in people with diabetes.

His team is looking at protein kinase C beta (PKCB), a protein involved in several cellular processes in the body. Scientists know how to inhibit or ‘turn off’ this

protein, using drugs that are already available to treat diabetes. It looks like this could help protect bone marrow. Professor Madeddu says: “We have shown that using a PKCB inhibitor can control the processes that lead to fatty tissue.”

This would help other parts of the body as well. “What is good for the bone marrow can be good for the other organs – preventing obesity and other complications of diabetes – and can also protect the heart,” he says. “We are helped by the fact that PKCB inhibitors are already commercially available, though not for this purpose. So clinical trials could start quite soon, in a year or two, if we can prove that this can prevent inflammation and formation of fatty tissue.

“For drugs that aren’t already commercially available, we would need to test them much more rigorously for safety, so that would take a number of years longer.”

Large numbers of patients could benefit – not just those with heart attacks, but also people with complications of diabetes, such as peripheral arterial disease, which can sometimes lead to amputation.

Professor Madeddu trained in cardiology and says his work is based on problems he has seen in patients. “This is not research of an abstract hypothesis, it is research to solve patients’ needs,” he says. “We hope we will be able to bring real benefits for patients.”

Heart Matters

RESEARCH

3.6mUK adults diagnosed with diabetes

Professor Madeddu may havefound a new use for a drug thatis already safe and available

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RESEARCH

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

If you know about stroke, you probably know it’s caused by a failure of blood supply to part of the brain. You might also know that this is caused by a clot blocking the blood flow or a burst blood vessel bleeding into the brain.

But few people have heard of lacunar stroke. This type of stroke affects the small blood vessels – less than a millimetre wide – deep inside the brain. It was described in post-mortem examinations in the 1950s, when ‘lacunae’, or empty spaces, were spotted in the brain. It accounts for about a fifth of strokes – more than 25,000 a year in the UK.

Professor Joanna Wardlaw, Chair of Applied Neuroimaging at the University of Edinburgh, is an expert in brain scanning. Her internationally recognised

Watch thisSPACE

36 Heart Matters

research focuses on trying to prevent, diagnose and treat stroke more effectively. She and her team are also finding out more about what causes different types of stroke.

Little-known problem “For a long time people thought all strokes were due to blood clots or blood vessels bursting,” says Professor Wardlaw. “Only recently have we realised there is a set of strokes caused by problems with small blood vessels. These milder strokes have literally gone under the radar.” Because there has been so little recognition of the problem, our understanding remains poor. This means options for prevention and treatment are limited. Professor Wardlaw is trying to address this.

“Lacunar stroke is not usually too physically disabling, but it might stop people being able to live independently if it affects their memory or decision-making,” says Professor Wardlaw. Sometimes described as ‘small’ strokes, they can happen without the patient noticing. The more they happen, the more likely you are to develop problems with thinking or even dementia. This can be combined with mood disorders, depression or balance issues.

“Some people have symptoms that lead them to go to the doctor and some don’t,” says Professor Wardlaw. “It probably boils down to which part of the brain is affected. If it falls in a part of the brain that controls your hand or leg then you’ll go to the doctor, but if it’s in a part of your brain that controls complex decision-making, for example, you might never realise. You might think you

This is just one example of the BHF funding research to help people

affected by stroke. Many of the risk factors for stroke and heart disease are the same, and we know many of the same processes are behind both conditions.

We’ve given researchers at the University of Cambridge £1m to search for possible genetic causes of lacunar strokes. Working with researchers worldwide, as part of the International Stroke Genetics Consortium, they will look at the DNA of 5,000 people who have had a lacunar stroke to see which genes could play a role in the disease. Learning which genes can increase your

risk of lacunar stroke will shed more light on how the condition works and which medications might be helpful.

We’re currently funding more than a dozen other stroke research projects, including six with the Stroke Association. These include a project in the UK and

abroad, run by the University of Glasgow, to see whether a new clot-busting drug is better at treating stroke. A Cambridge-based trial has been looking at whether a ‘polypill’ of three different drugs is more effective at preventing further strokes in people who have already had one.

We’re funding another trial, called RIGHT-2, run by the University of Nottingham, to test if giving GTN (nitrate) patches in the ambulance on the way to hospital can help treat all types of stroke.

We’re also researching atrial fibrillation, a major cause of stroke, as well as several other projects studying causes of stroke.

BHF stroke research

have slowed down a bit or you’ve been forgetting things, but don’t necessarily spot something sudden that you would recognise as a problem.”

Even if the patient does seek help, these strokes are sometimes wrongly classified as another type of stroke or as something else entirely. “For many years, people

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have been looking at scans and calling this problem by different names,” says Professor Wardlaw. “We found there are over 150 different names for what are essentially holes in the brain.”

She has helped to establish international standards for neuroimaging to reduce this problem. She also wants to see doctors taking a more holistic view, rather than separately treating stroke, memory problems, mood disorders and high blood pressure, which all overlap in lacunar patients.

Problems with the small blood vessels of the brain contribute to around 40 per cent of dementia cases, affecting an estimated 350,000 sufferers in the UK. “There is a lot going on in the brain that we don’t understand, but treating stroke and dementia as if they are completely different is a bit artificial, and we should look at them together,” says Professor Wardlaw.

How do these strokes happen?Professor Wardlaw is studying how these strokes are caused, and in particular she’s looking at the lining of blood vessels – the endothelium. It is known to play a role in processes that lead to heart and circulatory disease, but is much less studied in the brain. “The endothelium has been studied a lot by cardiologists,” says Professor Wardlaw. “But it has been rather ignored in connection to stroke and dementia.”

The endothelium works with nerve cells and other cells in the brain. She thinks that when it becomes damaged, messages travelling around your brain slow down or don’t arrive at all.

Causes of lacunar stroke are not fully understood, but probably include the same risk factors as other strokes, including old age, smoking, high cholesterol and high blood pressure. And Professor Wardlaw’s team already have some ideas about treatments.

Future treatments They have been testing two existing drugs, which are known to have effects on the endothelium. The first is isosorbide mononitrate, part of a group of drugs called nitrates, which are used to treat angina. The other is cilostazol, which is used as an antiplatelet drug (although it’s not common in the UK), but may also help improve endothelial function.

With a team in Nottingham and Edinburgh, they are running a study, funded by the Alzheimer’s Society, which has enabled them to plan a larger trial of at least 200 people, funded by £850,000 from the BHF.

“We are testing these two drugs individually and together, because they may have increased effects when used together,” says Professor Wardlaw. “The pilot has been really helpful in telling us how to vary the dose, what kind of side effects people might get, and how well people tolerate the drugs.”

The three-year BHF-funded trial will follow people who have had a lacunar stroke. “If the theory is correct, we would hope to find they have reduced risk of another stroke of this type, and are less likely to get cognitive impairment,” she says. “We will scan their brains and measure what has changed after one year on the different drugs.”

If the trial is successful, they hope to run larger trials to establish this as a treatment. It could potentially be used for prevention too. “If it works in people who have had symptoms, it seems plausible it would work in people who haven’t had symptoms but are at high risk, perhaps due to family history,” says Professor Wardlaw. “It might be that you could use it as a treatment for people who haven’t had a stroke yet.”

≠ Discover how we’re funding research throughout the body at bhf.org.uk/beyondtheheart.

Professor Wardlaw and her teamare testing drugs that could treat

and prevent lacunar strokes

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

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

Choosing WISELY

WELLBEING

Guy had to make a quick decision about a

replacement heart valve

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Guy was only 29 when he was diagnosed with a heart valve problem. He was fit and active, training as an amateur boxer alongside his job as a logistics manager,

when he started to feel exhausted and get occasional chest pains.

Unbeknown to Guy, his aortic valve had two flaps (leaflets) instead of the normal three. This doesn’t always cause problems, but in his case the valve wasn’t working properly, putting strain on his heart. His heart valve needed to be replaced quickly.

For Guy, one of the hardest aspects was making a decision about his treatment. Agreeing to have open heart surgery was relatively simple as he was told he risked sudden death without it, but he then had to choose between a mechanical and a tissue valve.

The mechanical valve would last longer but require him to take warfarin (an anticoagulant) for the rest of his life. An animal tissue valve does not require lifelong medication, but must be replaced (typically after five to 15 years). The choice is one many people who need valve surgery must make.

“The reason why it was so hard was because you wouldn’t know until after surgery if you’d made a good decision,” Guy says. “There was no right or wrong, they both had their pluses and minuses and it was all about what life would be like.”

It’s normal to feel overwhelmed or confused when facing a big decision like this, Hilary Bekker, Professor of Medical Decision Making at Leeds University, explains. “The brain is incredibly clever and chooses what information we attend to,” she says, “and then responds to a feeling, and often chooses for us without us even being conscious of it.

“When we make a decision consciously, we have to break down and try to understand all those automatic influences on us. So when we’re put in a situation where we’re suddenly being told we need to make a decision, we think we can’t do it, but we all have the capacity to.”

Gathering informationProfessor Bekker says that there are five things you need to understand to be confident you have adequate information about your condition. These are:

1. The name of your condition.2. The symptoms and causes.3. How long it will last.4. The consequences of having it. 5. Whether it can be cured or managed. You can then look at the treatment

options and understand the decision you’re making. It can be useful to put this knowledge in the context of your lifestyle. For example, ‘Will I need to cut down my hours at work?’ or ‘Will I need to be more physically active?’

Guy was given a lot of written information to take away, as well as the number for an on-call nurse. He tried to use internet forums to help him

understand the situation better, but realised he had a lot of questions, so made an appointment to visit his surgical team.

Who to involveFor Guy, telling his family about the surgery was a difficult experience, but also a huge relief. David Spiegelhalter, Professor of the Public Understanding of Risk at the University of Cambridge, says: “It’s very good to discuss your options with family, because they have to deal with the consequences of your actions, unlike internet sites and people you don’t know very well.”

However, Guy found that it can be difficult to get frank opinions from loved ones. “At times it was frustrating,” he says. “Sometimes I felt like I was speaking to a shadow of somebody I knew, because I knew they weren’t being truthful with me. And it’s quite hard to communicate with people if they’re not being as open as you are and you don’t understand why.” Guy says his family didn’t want to impose their opinions on him and be responsible for the choice he made. He reflects: “It just made me know that ultimately I had to decide for myself.”

Guy was able to discuss his options in detail with one of his doctors. There is some debate about whether healthcare professionals should give patients a personal opinion in situations like this, but Professor Spiegelhalter argues: “It’s everyone’s right to come back and say ‘What do you think I should do?’ and to get an honest answer.”

Guy found that talking honestly with the doctor was “invaluable” and helped him come to terms with the situation. When he asked the doctor what he would do in his place, he said that because he was young, he’d have the mechanical valve to avoid having to go through the process again.

The final decisionWriting a list of pros and cons can add structure to your decision-making process, suggests Professor Bekker.

She recommends you look at the list and ask yourself: ‘What is important

If you’re presented with statistics, risks and survival rates, how do you make sense of them?

Professor Spiegelhalter says: “Numbers need to be treated with respect. They are not the first things you should be presented with after a diagnosis.” He advises that if anyone gives you statistics for, say, a survival rate for surgery, they should also explain whether it is on average or whether it has been adjusted for your age or general health. It can also be helpful to reframe the statistic – for example, a 10 per cent risk of death is also a 90 per cent chance of survival.

Heart surgery on average has a mortality risk of two per cent, which Professor Spiegelhalter says is about the same as 3,000 parachute jumps, or around 120,000 miles on a motorbike, although the risk will vary according to the procedure and the individual.

Understanding risk

40 Heart Matters

to my life at this time and what are the trade-offs?’ “Our values change over time and what is important to us now may not be important to us later,” she says. “It’s a question of whether we want to adapt our lives. Ask yourself whether something, for example climbing, is important to your life or whether it’s just something you like doing at the moment.”

After weighing up the trade-offs, about two weeks before the operation Guy realised which way he wanted to go. “And that was it, I’d made my mind up,” he says.

“I thought I could live a better quality of life on a tissue valve, though it might have a shorter life than a mechanical valve – which comes with its own restrictions. There is no right or wrong decision; it’s about personally how you look at life and what you want for the future.”

After his valve replacement, Guy has been living life to the full, going parachute jumping, snowboarding, travelling around Asia and spending quality time with his dog, Brave. However, he has had to undergo a heart valve replacement for

a second time in December 2016, after developing endocarditis (see page 19), which infected the valve. “Brave, our dog, is a great fellow and has helped me to smile and have fun so soon after my second surgery,” he says.

Guy faced the same dilemma a second time and chose a tissue valve again. He feels happy with his choice and believes he did everything he could to come to the right decision. For Guy, your right to choose is important – so much so that he’s set up a website and a Twitter account telling his story, both called Free to Choose.

Professor Spiegelhalter notes that all we can do is try to make the most informed decisions – predicting the future will never be possible. “Ultimately, none of us know what’s in store for us, or how long we will live,” he says. “Part of the joy of being human is not knowing – and being able to deal with that.”

≠ For more information see our Heart valve disease and Heart surgery booklets at bhf.org.uk/HMpublications.

Guy, with his dog Brave, whohelped keep his spirits upafter his second surgery

1 Be as knowledgeable as you can. The BHF has lots of free booklets and information on its website.

2 Speak to professionals and your family. Get more opinions so you can broaden your knowledge again.

3 Take a bit of time out. Distance yourself from people if you need to, so you can settle in with the information.

4 Use relaxation techniques. I meditated a lot at the time and that really helped me stay calm and come to terms with the situation, instead of freaking out about it.

5 Make sure you feel happy with the decision yourself, don’t feel pressured by other people, because ultimately you’re the one that has to live with it. And I think that’s one of the hardest things, doing it for yourself.

Guy’s top tips for decision-making

It’s about how you look at life and what you want for the future”

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

The psychology of RECOVERY

It was a crisp, winter morning and Jason cycled in the sunshine past the cabbage fields on his way to work. He felt very tired, but put it down to that Monday morning feeling. He chained up his bike and walked through the

factory towards his workbench, when he felt an overpowering wave of illness. He couldn’t speak but knew he needed to sit down. Just as he did, he collapsed. Luckily, his friend caught him as he fell, and called an ambulance.

It was a huge shock when Jason awoke in hospital having had a life-threatening episode of ventricular tachycardia (VT)D. He was very active and felt healthy. His heart had returned itself to a normal rhythm, and when another episode of VT struck, it again

resolved spontaneously. “The doctors were quite surprised it did that,” he says.

Jason had scar tissue on his heart, which the doctors thought was either congenital or due to a common virus that can attack heart tissue. The scar tissue disrupted the electrical signals that control the heartbeat.

Jason was fitted with an implantable cardioverter defibrillator (ICD)D to reduce his risk of another event and was discharged after two weeks. But the emotional effects lasted much longer.

Dealing with fearOn his journey to recovery, one of the first roadblocks was fear, which he describes as “an overpowering, self-protective instinct”. Both Jason and his wife, 43, had to fight the

WELLBEING

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Jason was leading an active life, so heart issues came as a huge surprise

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urge to keep him tucked up in bed, where he was safe.

“It’s like there’s a tarantula and you’ve got to pick it up,” he explains. “That’s how I felt about walking out the door. That spider’s dangerous; it could bite you; you could die. Psychologically, the first time I got out of bed felt just as scary. It’s a massive barrier.

“Walking down to town on my own was terrifying. I thought: ‘What if I don’t come back?’ Your loved ones are sitting at home, waiting, thinking that too. It’s a two-fold psychological issue.”

Dr Kelly Buttigieg, a cardiac psychologist at King’s College London, explains that it’s common after a heart event to want to withdraw to a safe place and avoid activities we previously enjoyed.

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“However, when we do this we remove some of the factors that can help with our recovery,” she says. “Avoidance can actually lead to more anxiety in the long term.” Instead, she recommends a gradual increase in activity, which may help reduce this fear and increase your confidence.

Jason started by walking up and down the garden, and gradually increased it to walking along his road. “I had to take my wife with me because I didn’t have enough guts to do it on my own,” he says. “For a big burly bloke to be all vulnerable, it’s a very strange feeling. It might sound old fashioned but I was always the man of the house. That all changed because I was relying on my wife to protect me.”

Regaining identityA cardiac event can have a huge impact on your sense of self. Jason says that during recovery, he felt like a different person. “You feel damaged and you don’t know what level you’ll recover to,” he explains. “I felt guilty. I just wanted to get back to normality – I wasn’t bothered about climbing a mountain or cycling 30 miles – I just wanted to be me again.”

Health issues can also affect how you and your partner relate to each other, explains Dr Buttigieg. You might feel your roles have changed to ‘patient’ and ‘carer’. It’s important not to let these roles take over. “The carer should try to gradually return to roles that are meaningful to them, so that their activities are not wholly focused on the carer aspect of their identity,” she says.

Pushing yourselfJason was so keen to get back to where he was – a strong, sporty man – that he pushed himself very hard during cardiac rehabilitationD sessions. His exercise specialist told him to “slow down”.

“It’s important for us to take a step back and realise that in our fast-paced

society we may have found that pushing ourselves in domains like our work has led to some benefits in the past, such as career progression,” says Dr Buttigieg. “However, this might be unhelpful for our physical and emotional health after a heart problem.”

It can be particularly hard for people who have perfectionistic traits, she says. One helpful technique is to be more aware of your thoughts, and reframe them. For example, a perfectionist might think: ‘I must push harder; everyone in my cardiac rehab group is doing more intense exercises than me.’ It could be more helpful to think: ‘Others in my exercise group may have different cardiac diagnoses and different experiences, so it’s not accurate to compare myself directly with them.’

Lack of confidenceJason went back to work part-time, eight months after the incident. But he soon sought out an office job, as he was

concerned about the effect of physical labour on his body.

Four years on from his episode, Jason says one of his biggest problems is still having the self-confidence to feel that he fits back into working life. He says: “I still have issues like: ‘Am I good enough? Can I keep the pace going like I used to do?’” When he gets into this thinking pattern, Jason says he might go into “a weird place” for an hour or a day but then he says ‘no’ to himself and makes a conscious effort to stop the thoughts and be more compassionate to himself. Psychologists recognise that consciously saying ‘no’ to yourself, or visualising a stop sign, can be helpful when you get stuck in negative thinking patterns.

In this adjustment period after a heart event, symptoms such as a lack of confidence can improve through cardiac rehab. “If you’re unsure about going, ask if there’s an opportunity for you to observe

42 Heart Matters

Jason’s family helped his recovery and he now enjoystaking his daughters climbing

1 Set yourself a timetable“I would watch the TV for an hour, have breakfast, get up, sit downstairs and do some reading, get a visitor, do a walk in the afternoon, and the day passes. You have to have a routine.”

2 Accept visitors“I think visitors, as tiring as they may be – and it is extremely tiring – are very important. You get a glimpse of normal life and this gives you hope and encouragement.”

3 Set realistic goals“You might think of making a cup of tea as a menial task. But these tasks are parts of your life that you can get back.”

4 Get a little independence“Try to physically be able to do things for yourself, such as washing yourself or walking down the garden and back. This will have a huge effect on your confidence.”

5 Go outside“Even if you don’t want to, force yourself to go out. The biggest thing you can do to get back to your life is to overcome the fear of going out again – and that’s massive.”

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a group first, to manage any nerves or misconceptions,” Dr Buttigieg says. “Or invite your loved ones to come along to a cardiac rehab session, the assessment appointment or final review. You can also ask for one-to-one support from your cardiac psychologist if you need it. The teams want to work to support you and find a way to meet your individual needs.”

Facing frustrationFor Jason, an ongoing obstacle is frustration at not being able to do the things he wants to do, or doing them slower or worse than before.

This is quite typical, Dr Buttigieg says, particularly when meaningful roles – like being a parent, grandparent or friend – are affected by the heart problem.

“Try to understand which thoughts arise during times when you are frustrated, and how they might be unhelpful,” she says. “Some examples are: ‘I shouldn’t be

I’m here, I’m watching my kids grow up... that’s wonderful”

Jason’s top tips for rebuilding confidence

this tired’ or ‘I must get back to work’. We call this ‘should-ing’ and ‘must-ing’. Try to reframe these thoughts more realistically by, for example, thinking: ‘Working half days is actually significant progress. I was on sick leave just three months ago.’”

Jason still gets frustrated, but now appreciates his level of ability and tries not to fall into negative thinking patterns. His daughters, now aged 15 and 13, both enjoy indoor climbing, which he isn’t able to do. “My pleasure now lies in seeing other people do stuff,” he says. “If you don’t twist your mind round to that way of thinking, you’re for ever going to be in a frustrated mind-set, and bitterness can creep in.

“I only asked ‘Why me?’ once, and then I felt guilty and thought: ‘Why not me?’ I refuse to get bitter and angry about what has happened to me. Now I think: ‘I’m here, I’m watching my kids grow up. If all I can do is watch them grow up, then that’s wonderful.’”

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This social sport is suitable for all levels of fitness. Rachael Healy finds out why you should try bowls

Six super reasons toBOWL

ACTIVITY

Heart Matters

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1 There’s a club near you First, you need a place to play. Many

bowls players are members of clubs, which provide facilities and opponents. There’s usually an annual fee (from £40 to £150). A lot of clubs offer free beginner sessions so you can try before you join, and then a cheaper fee for your first year.

“With more than 2,500 clubs across England, there’s bound to be one near to you,” says Tony Allcock, Chief Executive of Bowls England. Go to bowlsengland.com or call 01926 334609 to find a club in England. If you’re in Scotland, Wales or Northern Ireland, visit bowlsscotland.com (01292 294623), welshbowlingassociation.co.uk or nibabowls.co.uk.

You can also play indoors. Contact your local leisure centre to find out if they have an indoor green. Drop-in games cost around £5.

2 The rules are simple Next, you need to know the rules.

Fortunately, they’re easy to learn.Bowls is played on grass (the green).

A game starts by throwing the jack (a small white ball) down the green. Each team has different colour bowls to roll towards the jack. “The person who

gets nearest to the jack gets a point and wins what’s called the ‘end’,” explains Matt Wordingham from Bowls England. “It is added up over 18 or 21 ends.”

After each end, play is reversed and the teams bowl towards the other side of the green. Players can try to knock their opponents’ bowls away from the jack or position a bowl to block opposition shots.

You can play singles, pairs or in teams. In singles, scoring is a bit different – the first player to reach 21 points is the winner.

3 There are many varieties to tryThe most common type of bowls is flat

green bowls (represented by Bowls England), which is played outdoors on a level grass surface. But that’s not the only way to bowl. There is crown green, federation, indoor and carpet bowls. Crown green bowls is a regional variety, played on a grass surface, but with a hump in the middle of the green. Indoor and carpet are similar to flat green, but played inside. You can learn more about crown green, indoor or carpet bowls clubs at bowlsclub.org.

4 It’s a gentle way to get active“I don’t think you realise how much

walking you do until you actually play it,” says Matt. “You can walk three miles while

you’re playing. You’re only doing 30m stints at a time, but you’re doing a lot of them.”

On top of the walking, your arms will get a workout as you perfect your bowling technique and your leg muscles will develop as you lunge into the throw.

5 There’s a social sideMany bowls clubs put on regular social

functions. There are also opportunities to join the club committee or volunteer in the day-to-day running of the club. “There is a lot of socialising and you don’t have to be competitive to play,” says Matt. “If you just want to play with your friends on a Wednesday afternoon, there’s nothing stopping you.”

6 It’s perfect for all “Bowls truly is the sport for all,

regardless of age, sex or physical ability,” says Tony. The gentle pace and lack of contact means you’ll often find children playing with adults and people of different abilities and fitness levels on the same team.

Despite what you might think, it’s not just a sport for retirees. “The general bowler is over 55,” says Matt. “But in our international teams, there is barely anyone over 40. We have an under-25 and under-18 international team as well.”

Steve Bacon, 56, has played bowls since he was in his twenties, with only a short break when he needed heart surgery.

“It’s a game that can be played by everyone and you find your own level,” he says. “You can play on a casual basis or in clubs or teams with more competition.”

When Steve turned 40, he found out he needed quadruple heart bypassD surgery.

“The friendship of the people from the club [Syston BC] was great,” he says. “They would ring me up or pop round to keep

me company. The bowling club is almost an extended family.”

Steve is now Development Officer at Bowls Leicestershire and plays at least three times per week at Birstall BC. He says the friendly nature of the sport has been a real draw. “There’s a social side and camaraderie between members,” he says. “Entertainment gets put on. A lot of clubs have coffee mornings and quizzes; some clubs even have an indoor skittle alley. It is really good. We try to get local people involved. The best bowling clubs are where it becomes part of the community.”

Bowls also provided motivation for Steve during his recovery. “When you have heart problems you have to set yourself small goals,” he says. “Getting back on the bowling green was one of my targets. And in the meantime, going down to the club and seeing people would keep my spirits up.”

Once he got the go-ahead to go back to bowls, the regular activity helped Steve increase his fitness levels. “It is a good low level of activity, “ he says. “It occupies the mind and keeps the body ticking over, which is vital as people get older.”

Steve’s story

46 Heart Matters

ACTIVITY

Being active can help you prepare for surgery and improve your recovery. Rachael Healy puts common questions to two experts

surgeryFIT FOR

Waiting for surgery can be a stressful time. It can feel

like life is on hold. However, there is growing evidence that getting moving can help prepare your mind and body for an operation. Professor Mike Grocott studies the effect of physical activity on patients before they have surgery. He works with patients awaiting surgery to remove tumours. It’s hoped his research could help develop activity programmes for patients facing all kinds of surgery.

Patients in Professor Grocott’s study do two or three sessions per week on exercise bikes before surgery. So far, results are encouraging. Patients appear to get fitter and recover faster. “We’ve just done the first randomised study that shows quite clearly that you could train patients and make them fitter,” he says. “It also shows an improved surgery outcome.”

Similarly, a review of evidence in 2012 suggested heart surgery patients who undertook a course of exercise before their operation were able to leave hospital

sooner than those who didn’t. These patients were also less likely to contract pneumonia, which is a potential complication following heart surgery.

In a trial at McMaster University, Canada, bypass surgery patients exercised twice a week in the run-up to the operation. Patients did a warm-up, around 30 minutes of aerobic activity such as cycling or brisk walking, and a cool-down. These patients spent on average one day less in hospital and, six months after surgery, reported better quality of life than those outside the trial.

How could physical activity help me before surgery? Pre-surgery activity can

benefit people with a range of health conditions including coronary heart disease, COPD [chronic obstructive pulmonary disease] and heart failureD. It has psychological benefits, too.

“You can be empowered to improve your journey; therefore, thinking about improving lifestyle before surgery is important,” says Professor Grocott. As well as being a distraction from negative thoughts,

Professor Mike Grocott≠ Professor of Anaesthesia

and Critical Care Medicine, University of Southampton

≠ Consultant in Critical Care Medicine at University Hospital Southampton NHS Foundation Trust

≠ Leads the Fit-4-Surgery research consortium

Professor Rupert Pearse≠ Professor of Intensive Care

Medicine, Queen Mary University of London

≠ Leads the Critical Care and Perioperative Medicine Research Group

≠ Researches ways to improve long-term outlook for patients undergoing major surgery

47bhf.org.uk

You can be empowered to improve your journey”

48 Heart Matters

1. Know your limits It’s normal to experience mild

breathlessness during exercise, but dizziness, feeling unwell, very tired, or in pain, could be signs you’re doing too much.

2. Don’t go it alone Take someone with you or stick to

well-populated and well-lit areas if you’re doing activities outside. Knowing plenty of people are around could help exercise feel less intimidating.

3. Check with an expert If you’re feeling nervous, check in

with a medical professional before increasing your physical activity.

4. Be prepared Take your medication with you.5. Keep hydrated Drink water before, during and

after you exercise.

AT A GLANCE

physical activity makes your brain produce endorphins, which can reduce feelings of pain and help you feel more positive.

Isn’t there a risk I’ll make my condition worse?Many people with heart conditions worry that exercise will put a greater strain on their heart. It’s important to remember that for the majority of heart patients, being active is much more likely to benefit you than cause harm.

To put your mind at rest, and so you know what you’re doing is right for your condition, consult your doctor before you start. Professor Grocott says: “If you know you’ve got heart disease then it’s worth consulting someone, because activity is so important and will lengthen your life.”

You can also ask your doctor for advice on what kind of activity is best for you.

What sort of exercise would you recommend?It can be wise to start small. Even 10 minutes of walking per day is better than nothing. “Going for a good walk just once a day is likely to improve the fitness of some patients quite significantly, in a way that will benefit them when they come to have surgery,” says Professor Pearse. If you don’t currently do any physical activity, start with a slow walk. Build up speed as you start to feel more comfortable. Be aware of your breathing and get to know your limits so you can take a rest when you need it (see box, right).

Build up to a moderate intensity during activity – so you feel warmer, breathe harder and your heart beats faster, but you can still have a conversation. This is unlikely to be harmful for most people.

“Cycling is also good and has the advantage that it’s a non-load-bearing exercise,” says Professor Grocott. But the main thing is to find an activity that suits you. “You should find something that you can fit into your lifestyle and that you might even enjoy,” he says.

The best type of activity for your heart is aerobic activity – the kind that causes you to breathe a bit faster. This includes dancing, aerobics classes, brisk walking and cycling.

Generally, activities to avoid are strenuous ones such as weightlifting or heavy digging, as well as anything that brings on angina.

You may also want to avoid standing up too quickly, as this can cause light-headedness. “We don’t want people stressing their bodies in a way that means they become injured and their mobility suffers as a result,” says Professor Pearse.

Whatever you choose, warm up and cool down gradually.

Are there any conditions that mean you shouldn’t exercise?Most heart patients will be able to do moderate-intensity exercise. One

exception may be arrhythmogenic right ventricular cardiomyopathy (ARVC). For people with ARVC, it is particularly important to get individual advice from your doctor before you start. Intense exercise is usually not recommended for people with any type of cardiomyopathy. If you have an enlarged aorta (such as an abdominal aortic aneurysm), you may be advised not to do strenuous exercise.

How will I know if I’m doing too much? When you’re exercising it’s normal to experience symptoms of mild breathlessness. “That is what happens when your body is working harder, but anything more than slightly out of breath is probably a bit too much,” says Professor Pearse. “The amounts of activity people have to do to reach that threshold will be different, but feeling slightly out of breath, then recovering within a few minutes and not feeling unwell or dizzy would be the right volume.

“Pain is a bad sign. If you’re exercising and you’re getting pains in your joints and muscles, that may be a sign to be more cautious.”

Having surgery soon?≠ Read our complete guide to preparing for a hospital stay at bhf.org.uk/prepare or call 0870 600 6566 to order your copy of the Jan/Feb 2015 issue of Heart Matters.

49bhf.org.uk

AAblation A procedure to correct or control certain

types of abnormal heart rhythms. It involves using radiofrequency waves to destroy the abnormal electrical pathways. Angina An uncomfortable feeling, tightness or pain in your chest that may also be felt in your arms, neck, jaw, back or stomach. The symptoms of angina are usually caused by coronary heart disease.Atrial fibrillation (AF) An abnormal heart rhythm in which the atria (the upper chambers of the heart) beat in an irregular pattern. People with AF have an irregular, sometimes fast, pulse.



is an education and exercise programme to help you recover from a cardiac event and get back to as full a life as possible.Cardiomyopathy Disease of the heart muscle in which it becomes weakened. It may become thickened, enlarged and/or stiff, depending on the type of cardiomyopathy. It affects people of all ages and is usually inherited.Cardiovascular disease (CVD) Includes all diseases of the heart and circulation, such as coronary heart disease and stroke.Cardioversion Treatment for some abnormal heart rhythms

to help restore a normal heart rhythm. It can be done using medicines (chemical cardioversion), or by giving the heart a controlled electric shock with a defibrillator (electrical cardioversion).Coronary artery bypass surgery An operation to treat coronary heart disease. Arteries from your chest wall and arm, or veins from your leg, are used to bypass the blocked or narrowed coronary arteries, improving blood flow to the heart muscle.Coronary heart disease (CHD) When the walls of the coronary arteries (the arteries that supply blood to the heart muscle) become narrowed due to a gradual build-up of plaques, called atheroma.

DDiabetes A condition in which glucose (sugar)

levels in the blood are too high. There are two main types of diabetes: type 1, where your body stops producing insulin, and type 2, where your body can’t use the insulin it produces, usually because excess fat in organs prevents the insulin from working effectively. Diabetes increases your risk of developing cardiovascular disease.




FFamilial hypercholesterolaemia (FH) A genetic condition that

results in very high cholesterol levels. Having FH gives you a much higher risk of getting CHD.

HHeart attack Known medically as a ‘myocardial infarction’,

or ‘MI’. This describes a sudden loss of blood flow to part of the heart muscle. Most heart attacks are caused by atherosclerosis, the build-up of atheroma (plaque) within artery walls. If the atheroma becomes unstable, a piece may break off and lead to a blood clot. This can block a coronary artery, causing a heart attack and irreversible heart muscle damage. It is a medical emergency and can lead to a cardiac arrest.Heart failure Condition where the heart becomes less efficient at pumping blood around the body. High blood pressure Also called ‘hypertension’. High blood pressure is when the pressure required to pump blood is consistently higher than the recommended level. This puts extra strain on your heart and blood vessels, and over time can increase your risk of having a heart attack or stroke.High cholesterol Cholesterol is a waxy substance that is mainly made in the body and plays a vital role in how every cell works. However, high cholesterol, when




IImplantable cardioverter defibrillator (ICD) A small




S Stroke An interruption of blood flow to part of the




DICTIONARY

Order your free guides by calling 0870 600 6566 or visiting bhf.org.uk/HMpublications

Healthy eating and lifestyleBe active for life (physical activity information for over-65s) G364Cut the saturated fat M4Eating well G186Eat well. Shop smart. Save money (DVD – healthy eating on a budget) DVD31Everyday triumphs (for mental health service users) G972Facts not fads – your simple guide to healthy weight loss M2Get active, stay active G12Get up and go (DVD – physical activity for over-65s) DVD32Healthy living, healthy heart (information for African Caribbean communities) G532Healthy living, healthy heart (information for South Asian communities) G971/EKeep your heart healthy HIS25Risking it – short films designed to help you tackle risk factors bhf.org.uk/riskingit or DVD21Stop smoking G118Taste of South Asia (South Asian recipes) G606Taste of the Caribbean (African Caribbean recipes) G503Ten minutes to change your life – take time out G926Ten minutes to change your life – time to eat well G923This label could change your life G54Women and heart disease M37Your heart, our help G598 Living with a heart conditionAn everyday guide to living with heart failure G275UAngina HIS6Atrial fibrillation – your quick guide G963Blood pressure HIS4Cardiac rehabilitation – your quick guide G964Caring for someone with a heart condition HIS20Coronary angioplasty HIS10Diabetes and your heart HIS22Electrocardiogram – your quick guide G965Having heart surgery HIS12Heart attack – your quick guide G966Heart rhythms HIS14

Use our booklets, DVDs and information sheets to help you improve your heart health and get support on living with a heart condition. To see the whole range of guides, order the Take heart (G5) catalogue

50 Heart Matters

ORDER YOUR FREE GUIDES

Want to measure your blood pressure at home? Watch our short film on how to do it at bhf.org.uk/

pressure.

Heart to heart: heart disease and your emotional wellbeing G954Heart transplantation HIS13Heart valve disease HIS11Implantable cardioverter defibrillators (ICDs) HIS19Lifelines: heart surgery and after (DVD) DVD10Living with heart failure HIS8Medicines for your heart HIS17My progress record (a manual to keep important information about your medication, test dates and results) M92MOne step at a time – living with heart failure (DVD) DVD5Pacemaker – your quick guide G968Peripheral arterial disease HIS16Physical activity and your heart HIS1Primary angioplasty for a heart attack HIS26Reducing your blood cholesterol HIS3Returning to work HIS21Stroke – your quick guide G969Tests HIS9The road ahead – your guide to heart tests and treatments DVD30

BHF SUPPORT

This booklet is for people with angina and their friends and family. It explains what angina is, what causes it, how it is diagnosed, and how it is treated. It also explains what to do if you get an episode of angina or if you think you may be having a heart attack.

Printer perfectYou can also print most of our information sheets and booklets at home – go to bhf.org.uk/HMpublications.

Angina

Order code: HIS6

Angina and living life to the fullJonathan Kirkman

FREE

It’s easy to sign up. Just fill in the form attached and send it back to us at no charge.

Or visit bhf.org.uk/heartmatters to sign up online today.

Reading Heart Matters allows me to concentrate on looking after my heart”Kirsty Munn, Derby

Spring 2017

FIGHTFOR EVERYHEARTBEATbhf.org.uk Paul's back in the swing of things after a stroke

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ENJOYED READING THIS MAGAZINE?Receive your own copy and much more…Join Heart Matters – the FREE programme that can change your life.

• Kick-start your healthy lifestyle: your membership pack includes the latest issue of Heart Matters magazine, an introduction to the BHF, a tape measure and a recipe folder.

• Be inspired: Heart Matters magazine contains real-life stories, the latest research and tips for keeping healthy.

• Collect healthy recipes: in your recipe folder.• Stay up to date: fortnightly e-newsletters.• Get online: take advantage of our online

healthy eating tools and online community. • Ask the experts: call our Helpline

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*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

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.

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

For over 50 years we’ve pioneered research

that’s transformed the lives of millions of

people living with cardiovascular disease.

Our work has been central to the discoveries

of vital treatments that are changing the fight

against heart disease.

But cardiovascular disease still kills around one

in four people in the UK, stealing them away

from their families and loved ones.

From babies born with life threatening

heart problems, to the many mums, dads

and grandparents who survive a heart attack

and endure the daily battles of heart failure.

Join our fight for every heartbeat in the

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2 Heart Matters

A stroke can seem like the end of life as you know it.

It’s a feeling familiar to many people who experience a sudden health issue, whether it’s a cardiac arrest, heart attack or something else. But life can go on. Sometimes it is diff erent. Sometimes it is possible to make positive changes.

Jason Gutridge felt like his life was over when he suff ered from a sudden cardiac arrest. He explains how he learned to adjust (page 41).

In our cover story (page 11), three inspiring survivors, Paul, Mark and Margaret, explain how they’ve discovered that there is a life after a stroke and have even embraced new opportunities. We’re working to stop people suff ering from strokes, too. That’s why Professor Joanna Wardlaw is researching a type called lacunar stroke (page 35). It leaves holes in the brain that can lead to problems processing information and even dementia. She’s trying to fi nd new treatments.

All our research aims to fi nd solutions for real problems, so we can stop the devastation of heart and circulatory disease. That’s what drives Professor Paolo Madeddu, too (page 32). In a fascinating interview, he tells us how the pain that comes with a heart attack could actually help the body to heal itself.

Sarah Brealey, Editor

YOUR BHF4 Your letters6 News

BHF breakthrough in heartbeat research

8 Spotlight on... air pollutionWhy this is an invisible problem, and how you can reduce your risk

10 Behind the headlinesIs working out at the weekend enough?

49 DictionaryMedical terms explained

50 Information and support A guide to our free resources

MY STORY11 Life after stroke

Three stroke survivors share their inspiring recovery stories

22 Riding highHow pursuing new interests helped Mike through his heart problems

RESEARCH32 No pain, no gain?

How pain could help when it comes to heart attacks

35 Watch this spaceHow a little-known stroke can leave holes in the brain

MEDICAL15 Ask the experts

Are branded medicines better? Plus migraine and stroke

16 Testing times: echoHow echocardiograms can help diagnose heart problems

18 Vital statistics: weight and waistWhat these measurements can tell you about your heart risk

19 Focus on: endocarditisWe look at this rare heart infection and speak to those aff ected

NUTRITION26 Rise and shine

Start your day right with one of these must-try breakfasts

28 Plant power How to get protein without meat, and the benefi ts it can bring

31 Ask the expert‘Clean eating’ and artifi cial sweeteners

Inside the magazine of the British Heart FoundationSpring 2017

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Jason explains how he learned to adapt after a cardiac arrest Turn to page 41

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Spring 2017



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Ingredients

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225g (8oz) sweet potato, peeled and coarsely grated2 tsp olive oil3 spring onions, finely chopped3 small eggs

1 Heat the oven to 220°C/ 200°C fan/gas mark 7. Put the grated potato in a clean muslin or tea towel and squeeze out the excess liquid.

2 Heat half the oil in a small, non-stick frying pan and fry the spring onion for 3–4 minutes until soft and golden.

3 Mix the onion and sweet potato with one egg then season well with ground black pepper.

4 Shape the sweet potato mixture in four round rosti cakes and place on a foil-lined baking sheet.

Method

23%

Each portion contains:

Sugars13.1gLow

Energy1138kJ272kcal

Carbo- hydrate22.5g

Fat13gMed

Saturates4.1gLow

Salt0.42gLow7%19% 21%15%14%

% = an adult’s reference intake

BRUNCHSweet potato rosti, egg and mushrooms

Preparation time: 15 minsCooking time: 35 minsServes: TwoNot suitable for home freezing

5 Put the mushrooms and tomato halves on a second foil-lined baking sheet and brush with the remaining oil. Season with pepper and thyme.

6 Put rosti onto upper shelf of oven and mushrooms and tomatoes underneath. Roast everything for 30 minutes until rosti are golden and tomatoes and mushrooms cooked.

7 About five minutes before end of cooking time, poach eggs to your liking (see bhf.org.uk/poached). Serve on the rosti with mushrooms and tomatoes.

4 portobello mushrooms, about 115g (4oz) total weight2 large tomatoes, halved1 tbsp chopped fresh thyme (or try chives, coriander or basil)

See easy meals with just four ingredients at bhf.org.uk/simplemeals.

Moyra FraserOur resident food writer Moyra is a former Telegraph food columnist and author of numerous cookery books.

Mushroom and cauliflower frittata

Preparation time: 15 mins Cooking time: 15 mins Serves: TwoNot suitable for home freezing

BRUNCHIngredients150g (5oz) chestnut mushrooms, sliced115g (4oz) red onion, thinly sliced1 tsp olive oil150g (5oz) cooked cauliflower (or broccoli), chopped into bite-sized pieces

1 Put the mushrooms and onion in a small, non-stick frying pan and stir in the olive oil. The mixture will look too much for the pan at first, but the mushrooms and onion will cook down after a few minutes.

2 Fry together over a low heat for a good 10 minutes, or until the onion and mushrooms are soft and golden and there’s no excess liquid in the pan. Stir in the chopped cauliflower.

Method3 In a separate bowl, beat

together the eggs, milk, herb and soft cheese and pour into the pan, over the vegetable mixture.

4 Continue to cook over a low heat for a further five minutes, then sprinkle with the parmesan and pop under a hot grill for 2–3 minutes to brown the top. Serve hot or cold with a fresh salad.

2 medium eggs4 tbsp skimmed milk2 tbsp chopped fresh basil, chives or flat-leafed parsley25g (1oz) reduced-fat soft cheese1 tbsp (5g) finely grated parmesan cheese

“The cooked frittata keeps well, wrapped in foil in the fridge for two days. Serve cold with salad.

“Add any leftovers at Step 1, such as roast chicken or chopped roasted vegetables.”

Cook’s tips

These recipes are from Heart Matters magazine, Spring 2017. If you’d like to receive Heart Matters and you’re not a member, join for free by calling 0300 330 3300 (costs are similar to 01 and 02 numbers) or visit bhf.org.uk/heartmatters.

Spring 2017



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Explore easy ways to make your meals Mediterranean with our fun tool at bhf.org.uk/makeitmed.


Sugars9.9gLow

Energy988kJ

236kcal

Fat11.5gMed

Saturates3.5gLow

Salt0.46gLow8%16% 18%11%12%


Carbo- hydrate13.3g

1 Stir together all of the ingredients, except the oil, with a little ground black pepper. Cover with cling film and refrigerate for 20 minutes.

2 Wipe the base of a non-stick frying pan with a little vegetable oil and place over a medium heat.

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

115g (4oz) potato, peeled, boiled and mashed55g (2oz) frozen peas, defrosted and crushed (with a fork)55g (2oz) fresh spinach or watercress finely shredded

75g (2½oz) ricotta cheese1 medium egg yolkFinely grated rind of ½ lemon2 tsp chopped fresh mint, chives or basilA little vegetable oil

Ingredients

Method4 Carefully flip over with a

palette knife and cook the other side. Remove to a plate and keep warm. Repeat with the remaining mixture.

5 Serve warm with roasted cherry tomatoes on the vine, roasted peppers or ratatouille.

BRUNCHPea and ricotta fritters

Preparation time: 10 mins,plus 20 mins chillingCooking time: 20 minsServes: Two (four fritters)

“Like the other recipes in this issue, these would be delicious for a leisurely brunch, but good for lunch or dinner too.”

Cook’s tips

Find out how to eat more vegetables without noticing at bhf.org.uk/veg.

Moyra carefully creates and tests every recipe to make sure the dishes we share with you are both healthy and delicious. For even more meal ideas, visit bhf.org.uk/recipefinder.


Sugars2.2gLow

Energy736kJ

176kcal

Fat9.4gMed

Saturates4g

Med

Salt0.23gLow4%13% 20%2%9%


Carbo- hydrate12.5g

1 To make the compote, core and thinly slice apple (no need to peel). Put into pan with juice and ginger. Bring to the boil. Simmer until softened, about 10 minutes.

2 Mix the arrowroot with two teaspoons of water and stir into the apple mixture. Bring to the boil and bubble for one minute, until lightly thickened. Stir in the blueberries and leave to cool.

3 In a small bowl mix the first six pancake ingredients. In a large bowl, whisk the egg white until it forms stiff peaks then fold into the oat and apple mixture with a metal spoon.

4 Wipe the base of a small, non-stick frying pan with vegetable oil and place over a high heat. Drop two or three spoonfuls of mixture into the pan and reduce the heat. Leave to cook for about five minutes on each side.

Ingredients50g (3½oz) rolled oats50g (3½oz) self-raising flour¼ tsp bicarbonate of soda¼ tsp ground cinnamon or ginger1 dessert apple, about 175g (6oz), peeled and coarsely grated 150ml (¼ pint) skimmed milk1 egg whiteA little vegetable oil

For the apple and blueberry compote1 red dessert apple175ml (6fl oz) apple juiceSmall piece fresh root ginger, peeled and sliced1 tsp arrowroot55g (2oz) blueberries100g (3½oz) fat-free thick yoghurt such as fat-free Greek or skyr (creamy Icelandic-style yoghurt)

Method5 Remove to a plate and

keep warm while you cook the remaining mixture.

6 Remove the sliced ginger from the compote. Stir about two tablespoons of the compote liquid into the yoghurt. Serve the warm pancakes with the compote and flavoured yoghurt.

BRUNCHOat pancakes with fruit compote

Preparation time: 15 minsCooking time: 20 minsServes: Two (six small pancakes) Suitable for home freezing

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Are you a protein pro? Take our quiz to find out at bhf.org.uk/proteinquiz.

Want more breakfast inspiration? Check out our 14 delicious heart-healthy porridge ideas at bhf.org.uk/porridge.

Each portion contains*:

Sugars34.6gHigh

Fat4.6gLow

Saturates0.9gLow

Salt0.83gLow14%7% 5%38%

Energy1660kJ393kcal

20%% = an adult’s reference intake

*Although the total sugars in this recipe are classed as high, the only free sugars are from the apple juice. The rest is from the fruit, milk and yoghurt.

Carbo- hydrate71.6g

PULL OUT AND KEEP BRUNCH · ≠ Look inside the body in this animation and discover what happens...

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Transcript of PULL OUT AND KEEP BRUNCH · ≠ Look inside the body in this animation and discover what happens...