to build scoping strength it out · portion guide. • our online ... from lab to hospital cover...
TRANSCRIPT
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YOU USED TO BREAK HEARTS IN IT.
NOW USE IT TO HELP MEND THEM.
Organise a ‘Bag it. Beat it.’ event this September & donate yourunwanted clothes to help fund life saving heart research.
FIGHTFOR EVERYHEARTBEATbhf.org.uk
FREE
September/October 2015
How we're helping Dr Danielle Paul make amazing microscopic discoveries
it out
HERBS & SPICES
PULL OUTAND KEEP
RECIPECARDS
Scoping EXERCISES
TO BUILD STRENGTH
10PLUSWho's who in cardiac rehab
Back to work Returning to your job after a heart event
COD
MORE THAN A MAGAZINE
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Visit bhf.org.uk/heartmatters to discover what your Heart Matters membership gives you.
• An online version of Heart Matters magazine packed full of extras such as extended interviews, picture galleries and videos.
• Online tools, including a recipe search, eatwell plate and a fruit and vegetable portion guide.
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Kirsty Munn, Derby
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And don’t forget, our Heart Matters Helpline can offer help understanding your heart condition, plus healthy lifestyle support on 0300 330 3300 (lines are open 9am–5pm, Monday to Friday; costs are similar to 01 and 02 numbers).
Reading Heart Matters allows me to concentrate on looking after my heart”
Help us spread the wordIf you’re a healthcare professional, you can get multiple copies of Heart Matters magazine to distribute to your patients. Log in to your account at bhf.org.uk/heartmatters and go to the ‘My Account’ page to tell us you’re a healthcare professional and choose how many copies of each issue you’d like.
Heart Matters
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Freepost Plus RTCH–BSST–GALYHeart MattersValldata House2a Halifax RoadMELKSHAMSN12 6YY
YOUR BHF4 Your letters5 Behind the headlines
Is there a slim chance of obese people reducing their weight?
6 News Breakthrough made for rare disease, organ donation and more
8 Spotlight Good end-of-life care is vital, but not all heart patients are getting it
20 Ask your pharmacist Pharmacists are a vital source of community healthcare. What can they do to help you?
23 Join the fight Two inspirational fundraisers are using pedal power to raise funds for our research
49 Dictionary Medical terms explained
50 Information and support Free resources on tests, conditions and more
RESEARCH36 Bridging the gap
How a new centre in Bristol aims to speed up getting research from lab to hospital
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Iwan
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Sarah Kidner, Editor
Ten years on, I still remember the uncertainty I felt returning to work after a year’s maternity leave. Coming back after a long break seems challenging; much may have changed. Our cover star Dr Danielle Paul tells us how BHF funding helped her return to work after a career break, and how she benefited from a revolution in her field while she was away (page 34).
For others, ill health means an enforced break. We speak to Iain, Lisa and Andrew, who’ve gone back to their jobs following a heart event, and find out how they took on the challenge and won (page 10). You shouldn’t have to face recovery alone. We meet key members of a cardiac rehab team and discover how they can support you (page 16).
Dianne Campbell has vascular dementia and is supported by a therapist (page 30). We find out how the condition can turn everyday tasks into major challenges. That hasn’t stopped Dianne helping other dementia sufferers by telling her story.
To share your story, email me at [email protected].
MEDICAL14 Drug cabinet:
diabetes drugs An expert answers common questions about oral medications for type 2 diabetes
16 Dream team Meet the cardiac rehab professionals who can boost your recovery
22 Ask the experts Pulse checks could prevent stroke, plus a new cholesterol test
30 Focus on: vascular dementia How Dianne Campbell learned to live with vascular dementia
MY STORY10 Working wonders
Three people tell us how they made the transition back to work
34 Scoping it out Dr Danielle Paul on studying heart muscle under the microscope
Iain Lynch tells us how he got back into office life after his heart attackSEE PAGE 10
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 2015 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 2015. Heart Matters is printed on paper from sustainable forests. G204/0915
For BHFEditor: Sarah KidnerDeputy Editor: Sarah BrealeyProduction Editor: Ana BlancoMedical Editor: Maureen Talbot; Christopher AllenHead of Heart Matters: Judy O’SullivanPrint: Pindar, part of the YM Group
For WardourManaging Editor: Rachael HealyArt Director: Daniel CoupeHead of Editorial: Molly BennettPicture Editor: Johanna WardCreative Director: Ben BarrettProduction Director: John FaulknerProduction Artworker: Jack MorganAccount Director: Georgina BeachManaging Director: Claire Oldfield Chief Executive: Martin MacConnol
Inside the magazine of the British Heart FoundationSeptember/October 2015
NOT A MEMBER? JOIN TODAY!Your details1
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Sign up and order bags at bagit.bhf.org.uk
YOU USED TO BREAK HEARTS IN IT.
NOW USE IT TO HELP MEND THEM.
Organise a ‘Bag it. Beat it.’ event this September & donate yourunwanted clothes to help fund life saving heart research.
FIGHTFOR EVERYHEARTBEATbhf.org.uk
FREE
September/October 2015
How we're helping Dr Danielle Paul make amazing microscopic discoveries
it out
HERBS & SPICES
PULL OUTAND KEEP
RECIPECARDS
Scoping EXERCISES
TO BUILD STRENGTH
10PLUSWho's who in cardiac rehab
Back to work Returning to your job after a heart event
15ZM21M
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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
FIGHTFOR EVERYHEARTBEATbhf.org.uk
FREE
September/October 2015
How we're helping Dr Danielle Paul make amazing microscopic discoveries
it out
HERBS & SPICES
PULL OUTAND KEEP
RECIPECARDS
Scoping EXERCISES
TO BUILD STRENGTH
10PLUSWho's who in cardiac rehab
Back to work Returning to your job after a heart event
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 issues of Heart Matters magazine, an introduction to the BHF, a tape measure and a recipe folder.
• Be inspired: our bi-monthly 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
on 0300 330 3300* for heart health information and support.
*Lines are open 9am–5pm, Monday to Friday. Costs are similar to 01 and 02 numbers.
Heart Matters
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FIGHTFOR EVERY HEARTBEATbhf.org.uk
2
Freepost Plus RTCH–BSST–GALYHeart MattersValldata House2a Halifax RoadMELKSHAMSN12 6YY
YOUR BHF4 Your letters5 Behind the headlines
Is there a slim chance of obese people reducing their weight?
6 News Breakthrough made for rare disease, organ donation and more
8 Spotlight Good end-of-life care is vital, but not all heart patients are getting it
20 Ask your pharmacist Pharmacists are a vital source of community healthcare. What can they do to help you?
23 Join the fight Two inspirational fundraisers are using pedal power to raise funds for our research
49 Dictionary Medical terms explained
50 Information and support Free resources on tests, conditions and more
RESEARCH36 Bridging the gap
How a new centre in Bristol aims to speed up getting research from lab to hospital
Cove
r pho
togr
aphy
: Gar
eth
Iwan
Jone
s; ph
otog
raph
y: M
ark
Har
rison
Sarah Kidner, Editor
Ten years on, I still remember the uncertainty I felt returning to work after a year’s maternity leave. Coming back after a long break seems challenging; much may have changed. Our cover star Dr Danielle Paul tells us how BHF funding helped her return to work after a career break, and how she benefited from a revolution in her field while she was away (page 34).
For others, ill health means an enforced break. We speak to Iain, Lisa and Andrew, who’ve gone back to their jobs following a heart event, and find out how they took on the challenge and won (page 10). You shouldn’t have to face recovery alone. We meet key members of a cardiac rehab team and discover how they can support you (page 16).
Dianne Campbell has vascular dementia and is supported by a therapist (page 30). We find out how the condition can turn everyday tasks into major challenges. That hasn’t stopped Dianne helping other dementia sufferers by telling her story.
To share your story, email me at [email protected].
MEDICAL14 Drug cabinet:
diabetes drugs An expert answers common questions about oral medications for type 2 diabetes
16 Dream team Meet the cardiac rehab professionals who can boost your recovery
22 Ask the experts Pulse checks could prevent stroke, plus a new cholesterol test
30 Focus on: vascular dementia How Dianne Campbell learned to live with vascular dementia
MY STORY10 Working wonders
Three people tell us how they made the transition back to work
34 Scoping it out Dr Danielle Paul on studying heart muscle under the microscope
Iain Lynch tells us how he got back into office life after his heart attackSEE PAGE 10
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 2015 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 2015. Heart Matters is printed on paper from sustainable forests. G204/0915
For BHFEditor: Sarah KidnerDeputy Editor: Sarah BrealeyProduction Editor: Ana BlancoMedical Editor: Maureen Talbot; Christopher AllenHead of Heart Matters: Judy O’SullivanPrint: Pindar, part of the YM Group
For WardourManaging Editor: Rachael HealyArt Director: Daniel CoupeHead of Editorial: Molly BennettPicture Editor: Johanna WardCreative Director: Ben BarrettProduction Director: John FaulknerProduction Artworker: Jack MorganAccount Director: Georgina BeachManaging Director: Claire Oldfield Chief Executive: Martin MacConnol
Inside the magazine of the British Heart FoundationSeptember/October 2015
bhf.org.uk 3
NUTRITION24 Spice up your life
Top tips on using herbs and spices to make tasty, low-salt dishes
28 Ask the expert Pros and cons of the paleo diet, liquorice’s effect on blood pressure and whether avocado’s good for you Plus Recipe cards
ACTIVITY40 Game changer
One man tells us how the love of football helped his recovery
44 Building strength 10 simple exercises to help you build strength and flexibility
47 Paul Peacock From sharpening tools to sowing peas – the most useful autumn garden tasks
Online exclusivesbhf.org.uk/heartmattersmag
Plus more of your letters, poems about living with a heart condition, heart-healthy recipes and online community
≠ Exclusive video: Watch our expert demonstrate some strength and flexibility exercises you can try at home
≠ World flavours: Learn how to give your cooking some extra excitement – from a taste of the Mediterranean
to authentic Indian and Caribbean flavours
≠ Getting back to work: How an occupational therapist can help you return to your job
≠ Dying well: Tips for breaking bad news, how to be a good listener, and ways to start a conversation about death or dying
Our expert team
BHF Associate Medical DirectorDr Mike Knaptonhas been a GP for more than 30 years and is a non-executive director at Addenbrooke’s Hospital, Cambridge.
Physical Activity SpecialistLisa Youngis a BHF Project Manager with a focus on workplace health and wellbeing and giving expert advice on physical activity.
Senior DietitianVictoria Taylorbegan her career working for the NHS and on public health campaigns. She advises on nutrition and acts as a spokesperson for us.
Gardening ExpertPaul Peacockstudied botany at university. He has written over 20 books on gardening and food and is a regular on BBC Gardeners’ Question Time.
Senior Cardiac NurseMaureen Talbothas worked in the NHS and the private sector in general and cardiac nursing for over 25 years. She leads the BHF clinical team at head office.
Guest experts
Professor Peter Passmore is Professor of Ageing and Geriatric Care at Queen’s University Belfast and conducts research into dementia. See page 33
Professor Raimondo Ascione is Professor of Cardiac Surgery and Translational Research at the University of Bristol and head of a new research centre. See page 36
Dr Amanda Adler is Consultant Physician at Addenbrooke’s Hospital and an Associate Lecturer at the University of Cambridge. See page 14
Senior Cardiac NurseChristopher Allenhelps manage the BHF’s genetic information service and has specialist experience in cardiology and cardiac surgery.
a spa break worth £500 see page 48
WIN!
54 Heart Matters bhf.org.uk
The BHF says: Added sugar can lead to weight gain and obesity, a risk factor for both cardiovascular diseaseD and type 2 diabetesD. Replacing sugary drinks with sugar-free options is a simple swap we can make to reduce our sugar intake.
A sugar tax alone will not solve the problem of obesity. It must be combined with other policy measures, such as a reduction in the amount of sugar added to foods and drinks and restrictions on marketing unhealthy food and drink products.
“Doctors back 20 per cent sugar tax to fight obesity”A report from the British Medical Association says sugar-laden drinks should be taxed to subsidise the sale of fruit and vegetables as a way to tackle obesity and ill health.
“Heart disease plus diabetes can knock more than a decade off your life”A combination of heart disease and diabetes can shorten your life by more than a decade, research has shown.
Scientists came to the conclusion after analysing data on more than 135,000 deaths among more than a million participants.
The BHF says: Once someone has developed diabetes, or suffered a strokeD or heart attackD, it is essential to address all risk factors, such as diet and amounts of physical activity, to lower the risk of a subsequent incident and give them the best chance of a longer life.
Everyone should be aware of their personal risk of developing these conditions, and know how to reduce it. If you wait until you have developed a condition before thinking about your wider health, you will already have reduced your life expectancy.
and that a large proportion is actively attempting to reduce their weight.”
Some coverage failed to clarify that the odds of returning to normal weight were based on an annual probability, not your total chance in a lifetime. Some obese people may take longer than a year to return to a normal weight.
Victoria Taylor, our Senior Dietitian, said: “The results of this study do not mean that if you are obese you should give up trying to lose weight, but it does remind us how difficult it can be to lose excess weight once it’s been gained.
“Steady weight loss may be an achievable approach and even a modest reduction in BMI can bring important health benefits. Sticking with changes in the long term and changing food habits of a lifetime can be hard to do, especially if you have a lot of weight to lose. But remember, even if the numbers on the scales don’t change, eating healthily and being physically active will still benefit your heart health.”
“Obese men have just a ‘1 in 210’ chance of attaining a healthy body weight”
Fat chance of weight loss
The Times 13 July 2015
The Independent 17 July 2015
The Guardian 8 July 2015
BEHIND THE HEADLINES
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This study of weight changes was also covered in the Daily Mail, BBC News, ITV News and others.
Researchers from King’s College London used data from UK GPs to study 278,982 people who had their body mass index (BMI) measured more than once between 2004 and 2014. The authors described it as “one of the largest studies yet reported on body weight changes in the general population”. They classified people as normal weight, overweight, obese, severely obese, morbidly obese or super obese, based on their BMI. People who had weight loss surgery were not included.
The results showed that the annual probability of attaining normal weight was one in 210 for obese men and one in 124 for obese women, increasing to one in 1,290 for men and one in 677 for women with morbid obesity. The annual probability of achieving a five per cent weight reduction was significantly more likely – ranging from one in 12 for obese men and one in 10 for obese women, to one in eight for men and one in seven for women with morbid obesity. But many people who lost weight did put it back on later. The study authors called for more effective systems to help people with weight loss, as well as a focus on preventing obesity.
A major limitation of the study was that it did not have information on whether people were actively trying to lose weight. The authors said: “Previous studies have reported that the majority of obese individuals would like to lose weight
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
more vegan or vegetarian meals. We try to offer a variety of recipes in Heart Matters – without the yoghurt garnish, this issue’s pea soup is vegan.
Thanks for fixing my heartMy double bypass surgery has helped me to feel my old self again. I had anginaD due to two blocked arteries, which I
For the past 12 years my wife and I have lived in the south of France, enjoying an outdoor and active life with sensible diets and plenty of tennis, swimming, biking and hiking. I should admit that perhaps the temptation of delightful local wines has been a debatable advantage and that I smoked three or four cigars each day.
At the start of 2014, I found myself losing breath on the tennis court rather quickly and needing short rests.
After seeing my doctor and a cardiologist, I had a four-hour bypass operation. A week in hospital was followed by three weeks in a French cardiac rehabilitationD centre. This was an interesting time with
Next issue How to rebuild confidence after a heart event.Plus: Three women speak about the scars of heart surgery.
The writer of our star letter each issue can win a gorgeous
Radley Matinée purse worth £75, with ample room for all
your essentials. Or, if you prefer, choose this red heart-shaped
rug (about 1.5m long).
Animal-free mealsAfter entering hospital as an emergency and undergoing a triple bypassD, my husband was on 80g per day of atorvastatin. Under the supervision of our doctor he reduced the dose gradually to 20g per day by adjusting his eating habits. Now he rarely eats animal products, feels much better for it and has maintained a cholesterol level of 3mmol/L for two years. We’ve found an abundance of delicious, balanced, free recipes on the internet. The chef at a local restaurant now offers similar choices as a result of his father-in-law’s heart attackD. We’ve found many restaurants will provide ‘animal-free’ meals if you give them a couple of days’ notice. It would be a great service to readers to show some alternative recipes on your food page and the benefits of reduced saturated fat/sugar. Eve Knafler, Penrith
Our Senior Dietitian Victoria Taylor says: It’s great to hear you’re enjoying healthy diet changes, and that your husband’s adjustments to medications were made under medical supervision. People adopt a vegan diet for a variety of reasons, including health. It is fairly restrictive, so needs commitment and planning so you don’t miss out on any nutrients. Those of us who do eat animal products can benefit from
STAR LETTER
only found I had after getting a tight chest while walking up a steep hill in Devon. I went to see my doctor who sent me to a cardiologist at the local hospital. They did tests on me, including an ECGD, and I was told it showed I’d had two heart attacks!
I had my bypass at Papworth Hospital in Cambridge. My thanks to my heart surgeon
Mr Nashef, all the nurses and doctors involved in looking after me and Bedford Hospital cardiac department. I thank them from my heart for sorting me out and making me well again.Ann Robinson, Bedford
Positive changesI have been a reader of Heart Matters for several years. It is excellent in providing comprehensive information in an easily understandable format. And it’s free as well! I learn so much about heart-related matters in every issue and I follow the advice and tips.
I have been affected by heart disease as both my elder siblings have had heart attacks, but thankfully survived. Their own road to recovery and the advice contained within Heart Matters has allowed me to readjust and take on a more active, responsible and healthy lifestyle. Keep up the good work.Martin Johnston, Cambridge
daily monitoring, blood tests, stamina-building, physical therapy, talks on many subjects, and sophrology, a technique which uses physical and visualisation exercises to encourage a healthy, relaxed body and a calm, alert mind.
The centre carried out regular checks, not only on physical health but also morale and mental attitude. It would appear that maintaining a positive morale has a significant impact on recovery.
I developed a greater awareness of how we can so slowly, but undoubtedly, damage ourselves over time – I have not smoked a cigar for over 12 months now – and how important it is to appreciate the most simple and meaningful aspects of life.Nigel Cox, Seillans, France
76 Heart Matters 7
NEWS
20 September Cycle the Wight. Choose from a 50- or 70-mile route around the stunning Isle of Wight, with a choice of start locations. Visit bhf.org.uk/cyclethewight or call 0845 130 8663.
October is Free Wills Month. We are offering our supporters the chance to make or update a simple will with a local solicitor free of charge. Find out whether the offer is available in your area at freewillsmonth.org.uk.
4 October Blenheim Palace Run. Complete 2K, 10K or a half marathon in the grounds of the magnificent palace. Find out more at bhf.org.uk/blenheim or call 0845 130 8663.
4 October Autumn Ramble, Blackpool. Take a four-mile walk around Herons’ Reach and Marton Mere nature reserve. Start and finish at the Village Hotel, East Park Drive and enjoy free parking and a raffle. Contact Barbara Dunn on [email protected] or 01772 458 447.
6–10 October The Worcester Musical Theatre Company presents All You Need Is Love, an evening of singing, dancing and comedy to raise money for the BHF. Buy tickets from www.worcestermusicaltheatre.co.uk or 01905 611 427.
10 October London to Milton Keynes Bike Ride. Pedal 60 miles on- or off-road. Visit bhf.org.uk/londontomk or call 0845 130 8663.
18 October Hyde Park Run. Run 5K or 10K through beautiful autumnal parkland. Visit bhf.org.uk/hydeparkrun or call 0845 130 8663.
15 November High Peak Winter Hike. A 17-mile trek through Derbyshire’s finest countryside. Visit bhf.org.uk/highpeak or call 0845 130 8663.
5 December A Night at the Moulin Rouge. Join a black tie dinner to raise funds for the BHF at the Guildhall, Winchester. Tickets are £70. For more information, go to nightatmoulinrouge.co.uk or contact Fiona Whitehouse on 07787 514 622.
Dates for your diary
BHF supporters have helped fund a possible
cure for pulmonary arterial hypertension (PAH).
PAH is a chronic, debilitating disease that narrows the blood vessels that supply the lungs, causing breathlessness and exhaustion. A third of all
bhf.org.uk
Our annual conferences in Edinburgh, Manchester, Antrim, Cardiff and
London recognised Heart Heroes for their contribution to improving the lives of people with heart disease, both now and in years to come.
Heroes included Harry Prentice, 20, from Lanarkshire (pictured top, centre), who had a heart transplant two years ago and is helping us campaign to change Scottish law to make organ donation easier. Kirsty and Jason Morgan, from Bridgend, raised thousands of pounds after their daughter Paige (pictured below, left) was born with a complex heart condition. Geoffrey Roughton, 86, from London, has had two heart attacksD and now supports the BHF as an office volunteer, public speaker and fundraiser.
We held roundtable discussions at each event, tackling topics such as research, caring for a loved one with heart disease and the healthcare you need. Insights from these help shape our life saving work. Our audiences heard about how the money you donate and raise today funds the research discoveries of tomorrow.
Our Chief Executive, Simon Gillespie,
Our heroes
said: “Everyone brought curiosity, passion and enthusiasm and, together with our staff, created a real buzz in the room. The stars were our Heart Heroes from across the UK.”
We’ll be recognising more Heart Heroes next year. Nominations open in October. ≠ To nominate someone you feel deserves an award, visit bhf.org.uk/heartheroes.
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Breakthrough for rare heart and lung disease
BHF-funded researchhas identified a protein that
could cure PAH sufferers
People are being urged to think about their organ donation choices in the run-up to a change in the law in Wales.
On 1 December, Wales becomes the first country in the UK to make organ donation easier by introducing a soft opt-out system. If people have not registered to either become an organ donor (opt in) or to refuse donation (opt out), they will be considered as having no objection – this is called deemed consent. The family of the deceased still play a role in confirming donation after a loved one’s death.
The BHF campaigned for this to happen and is working for a similar change across the UK. An advertising and leaflet campaign from the
Welsh Government is now encouraging Welsh residents to think about their choices and explains how to opt in or opt out in advance of 1 December.
Figures published in July showed that the number of organs being donated in the UK fell last year for the first time in a decade. More than 1,200 people either died on the waiting list or were removed because of their deteriorating health.
Many families refuse organ donation if they do not know what their loved one wanted. National Transplant Week runs from 7–13 September, so why not make the time to tell your family your wishes and ask about theirs?
Time to choose in Wales Heart Support Groups provide a local lifeline for thousands of heart patients, connecting people who have had similar experiences.
There are more than 250 groups in England and Wales. They help people rebuild confidence and maintain healthy lifestyles with activities including exercise classes, hospital visits, talks and social events.
We’ve developed an online Heart Support Group Directory to help find local groups. It includes activity details and when and where groups meet. Visit bhf.org.uk/heartsupport or call our Heart Matters Helpline on 0300 330 2333.
Find support near you
On the cards Our Christmas card range is now available to buy online and from our high street shops.Prices start at £1.99 for 10 cards and 100 per cent of our profits fund world-class research. Visit bhf.org.uk/christmascards or call into your local BHF shop.
Heart of Steel We’re delighted to be the beneficiary of the Yorkshire Man of Steel, a new landmark structure that will overlook the M1 near Meadowhall in South Yorkshire.
Within the 30m-high structure is a heart, which will bear up to 150,000 names. You can support our work by becoming one of them.
Donating £20 or more lets you have your name or that of a loved one inscribed on the Man of Steel’s heart. Ten per cent of every donation goes towards our life saving work. To find out more or to donate £20, visit yorkshiremanofsteel.com.
worked in rats and mice, and human cells; it reversed
existing damage to blood vessels and also prevented arteries from narrowing.
Professor Morrell said: “The next step
for our research is studies in people with pulmonary arterial hypertension – first, safety testing to ensure
BMP9 can be given to people. We’re confident of passing this phase because it exists naturally in the body, we’re just giving patients more of it.”
If the treatment passes safety trials, larger tests to check its effectiveness in patients could start within
two to three years.
Autumn rafflePlay to win. Play to fight heart disease. A brand new car or £10,000 – which would you choose? Enter our raffle for a chance to win. Every ticket funds our life saving work. Visit raffle.bhf.org.uk or call 0300 330 3322 to request tickets.
sufferers die within three years of diagnosis.
PAH affects about 6,500 people in the UK. In May 2014, Heart Matters spoke to PAH sufferer Kath Graham (pictured), who needed a heart and lung transplant. In Kath’s case, the cause of PAH is
unknown (idiopathic). However, the condition can be inherited.
Studies we helped to fund over the past 15 years have linked PAH to the lack of a protein that is vital to the normal functioning of blood vessels in the lungs.
Nick Morrell, BHF Professor of Cardiopulmonary Medicine at Cambridge University, led a study to combat the lack of this protein by using another, related, protein (called BMP9) to reverse the effects of PAH. The study showed the treatment
98 bhf.org.uk
The end-of-life needs of people with heart disease aren’t always being met. Sarah Brealey reports on why we should talk about this important issue
SPOTLIGHT ON…
NEWS
end-of-life care
Heart disease can be devastating. It can steal loved ones away suddenly,
leaving no time to say goodbye. Thanks to our research, more people than ever survive heart attacksD, but many are left with debilitating heart failureD, for which there’s currently no cure.
Palliative care, which focuses on symptom relief and the wider needs of patients and their
families, would benefit people with chronic heart failure, says a report by Marie Curie.
Often, palliative care isn’t offered to people with heart failure because of confusion about when referral is appropriate, or because it’s not clear when they are approaching death, says the report, which is based on research from the London School of Economics.
end-of-life; controlling symptoms, including pain; providing out-of-hours services; and communication with patients, families and between health professionals.
In July, the National Institute for Health and Care Excellence (NICE) published its draft guidelines for end-of-life care.
Talking about deathThe NICE guidelines, like the Marie Curie and ombudsman reports, show the importance of communication and support for professionals talking to patients about their wishes.
But it’s equally important for patients and family members to feel comfortable talking about death and dying. Inspired by a
Swiss concept, Jon Underwood, from London, set up the Death Café movement – social events where people talk about death, over coffee and a cake. “The aim of Death Café is to raise awareness of death to help people make the most of their finite lives,” said Jon. “It is a space for people to talk about where they are at with death, their own feelings and thoughts. People join in for their own reasons, the thing they have in common is that they want to talk about this.”
Anyone can run a non-profit death café. There have been events all around the UK, both regulars and one-offs, including one on a canal boat. Jon is currently raising funds through a community share offer to set up a permanent venue in London.
Even if you do want to talk, it can be hard to find the right words, whether you’re the person with the condition or a friend or family member.
Emily McDowell, from Los Angeles, started a range of empathy cards inspired by her experience of Hodgkin lymphoma at age 24. “Most of us struggle to find the right words in the face of a friend or loved one’s major health crisis,” she said. “Whether it’s cancer, chronic illness, mental illness or anything else.”
Her cards (far left) feature messages such as, ‘I’m really sorry I haven’t been in touch. I didn’t know what to say’ and ‘Please let me punch the first person who tells you that everything happens for a reason’.
In the UK, the Dying Matters coalition (of which the BHF is a member) sells sympathy cards with messages including, ‘I don’t know what to say so I might not say much. I just want you to know I’m sorry’ and ‘We know this is going to be tough but we’re here for you’.
Preparing professionals At the University of Dundee, Lecturer in Nursing Lynn Griffin has been educating nursing students about conversations around death and dying, so they feel prepared to help patients and family members.
“From my background as a Macmillan nurse I know people have difficulty discussing death and dying – this includes healthcare professionals,” she said. “Students are often protected and excluded from difficult conversations during
their education and feel anxious about them once they graduate.”
This summer, third-year students led projects to enhance discussion about death and dying. They set up a ‘Before I die…’ display (pictured), allowing people to reflect on what would be a priority in their final months or years, and organised a death café event. Their training also includes an exercise where a specialist plays the role of a relative of a dying patient, and asks difficult questions nurses might hear in this situation.
“Communication is the key to all good practice, never more so than in end-of-life care,” said Lynn. “We only have one chance to get it right. Death is something that affects us all, so let’s stop it being the elephant in the room and talk about it.”
Encouraging people to talk about dying can result in better provision when the time comesOthers with severe strokesD,
dementia, end-stage liver disease or Parkinson’s are also missing out, while those with cancer are more likely to get specialist palliative care.
Better palliative careMike Hobday, our Director of Policy, welcomed the findings. “This report reinforces the evidence that heart failure patients are missing out on quality palliative care,” he said. “We want to see governments and healthcare bodies act now to provide better training for healthcare professionals in identifying patients with heart failure approaching the end of life and starting conversations with heart patients about their end-of-life care.”
Better end-of-life care requires professionals to spend one-to-one time with the patient and their family, and the involvement of professionals from different disciplines, including access to hospices where appropriate.
The BHF is running a pilot scheme in Glasgow with Marie Curie and NHS Greater Glasgow and Clyde to provide better end-of-life care for patients with heart failure. The Caring Together programme, praised in Marie Curie’s report, has shown that assessing patients against certain criteria allows heart failure specialist nurses to identify a significant proportion
of those nearing the end of life. Conversations about where and how patients want to be cared for can then take place, so their wishes are more likely to be met.
Marie Curie’s findings follow a damning report – Dying Without Dignity – from the Parliamentary and Health Service Ombudsman. The report said: “We see tragic cases where people’s suffering could have been avoided or lessened with the right care and treatment as they approached the end of their lives.”
The ombudsman called for the NHS to improve on: recognising when people are approaching
≠ Marie Curie: support for people affected by terminal illness mariecurie.org.uk/help, 0800 090 2309. If you are living with terminal illness and are interested in home care from a Marie Curie nurse, ask your district nurse or GP.≠ Dying Matters: dyingmatters.org, 0800 021 44 66. ≠ National Council for Palliative Care: (England, Wales, Northern Ireland) ncpc.org.uk, 020 7697 1520. ≠ Death Café: deathcafe.com.
≠ Good Life, Good Death, Good Grief: (Scotland), part of Scottish Partnership for Palliative Care goodlifedeathgrief.org.uk, 0131 272 2735.≠ Losing someone to a heart condition: get help from this free BHF booklet. Download from bhf.org.uk/HMpublications or call 0870 600 6566 to order a copy.≠ Difficult conversations: advice for professionals talking to heart failure patients bhf.org.uk/difficultconversations.
Free support
Let’s stop it being the elephant in the room and talk about it”
Death cafés, like this one inDundee, make conversations
about death easier
Heart Matters
Go online Find tips for talking about death, ways to become a good listener, and the top 10 end-of-life areas that require further research. Visit bhf.org.uk/endoflife.
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11
Another tick in the box marked ‘recovery’”
COVER STORY
WorkingWONDERS
A heart attackD, surgery or diagnosis can affect every area of your life – including work. This worries a lot of people, says Maria Davies, a Senior Occupational Therapist working in cardiac rehabD. “It’s common to be apprehensive about the
future. Often, people diagnosed with heart disease think they will never be able to go back to work,” she says. “That’s usually not the case if fears are addressed early on; this helps people begin the process.”
Maria works for Aneurin Bevan University Health Board in Gwent, Wales and has a keen interest in workplace issues. Her occupational therapy training enables her to address the physical, psychological and social difficulties people may face when returning to work. She links in with employers to explain conditions and give advice on any adjustments needed. She also works with patients, setting goals for a realistic phased return.
Employees also have legal rights and can access financial help. “Under the Equality Act 2010, employers have a duty to make reasonable adjustments to prevent an employee being at a disadvantage because of their health condition,” says Maria.
She explains that once employers are given an explanation and support, most are keen to help their staff. “Where needed, I will work with the local Disability Employment Adviser or Access to Work Advisers when issues are more complex or when financial grants are needed to adapt the workplace.”
Maria adds that getting the right support and an appropriate planned and phased return, can make getting back to work much easier. Ph
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Returning to your job can be a vital part of recovering from a heart event. Sarah Brealey meets three people who made the transition back to work
Positive steps: Iain Lynch
10
“Since my heart attack, I have tried to reduce my stress”Iain was 54 and travelling home from his job as an IT manager when he had a heart attack. He had an emergency angioplastyD procedure, then triple bypass surgeryD the following week.
Iain, from Emsworth near Southampton, returned to work three months later, following a medical check-up. He agreed to a phased return; in the first couple of weeks, he worked a quarter of his normal hours, building up to full time after eight weeks. He was also offered the chance to do some work from home, which he hadn’t done before. He had regular meetings with HR and his boss to check on progress. “I am sure not everyone in my position has the opportunity to do that, so I am very grateful for the support,” he says.
Iain found working was a positive step in returning to normal. “My overwhelming feeling was one of relief to get back to a world I know, and another tick in the box marked ‘recovery’,” he says.
At first, he felt like the centre of attention, especially as many colleagues were shocked by his heart attack – he was a non-smoker who played football, tennis, badminton and golf, and hadn’t had a day off sick in 32 years. But soon, he says: “Most people moved on to treating me as before. It seemed like people quickly forgot about it – male colleagues, in particular.”
This wasn’t a big problem, though. “I did want to be treated as normal,” he says. “There were just a few times in the first six months when someone might be giving me hassle, and I would think: ‘It’s not that long ago that I had a heart attack.’”
Iain tries to limit his working week – which used to be around 55 hours – and reduce his stress levels, for example, by not driving during rush hour. He makes a point of leaving on time once a week so he can go to walking football sessions, and he’s back playing tennis, golf and badminton.
Returning to his job in IT helped Iain feel he was
on the road to recovery
bhf.org.ukHeart Matters
13bhf.org.uk
Healthy negotiation: Lisa Brereton
Adjusting attitudes: Andrew Rae
“I have learned not to feel guilty about asking for what I need”Lisa Brereton, from south London, was diagnosed at the age of 15 with lupus, a chronic condition that can affect the skin and internal organs and carries an increased risk of cardiovascular diseaseD.
In 2011, when she was 38, she started suffering from muscle spasms and unexplained pains. Tests later showed she’d had a heart attackD. A month later, she had a second, more serious heart attack.
As a result, Lisa was away from her job as an NHS Service Manager between May and September that year. Returning to work was difficult. “Colleagues’ understanding was the problem,” she says. “I look well, so people assumed that I was well. I think employers need to know the person isn’t necessarily going to be back to normal, with the same stamina they used to have, within a few weeks.”
After some negotiation, she had a phased return to work. “I was initially asked to work 10am–4pm, five days a week,” she says. “I had to get my trade union involved and, with their help, it was agreed I could work three days a week for the first two weeks, then four days a week, and back to full time in the fifth week. After that, I was expected to be normal. But I hadn’t even finished cardiac rehabD at that point – my cardiac rehab lasted 12 weeks.”
Lisa decided to switch to interim contracts within the same field, which gave her flexibility. “I told the agency I had regular clinic appointments, and that I had to go to cardiac rehab on Thursday afternoons,” she says. “Plus, if I decide to take time off because of my health, I can.”
In 2013, she had heart bypassD and valve surgery. When she went back to work three months later, things were easier than before thanks to more understanding from her employer and flexible working arrangements. Still, Lisa’s work life was affected. “I forgot bits, tired quicker and walking to meetings took
longer,” she says. She’s adapted by writing down vital information, working at a steady pace, taking a break from work to eat rather than skipping meals and giving herself longer to reach destinations. She also had support from family members and from her cardiac nurse, who she says was “excellent”.
“Most people do want to work,” Lisa says. “It is about telling your employer what you need. Don’t feel guilty for asking.”
“Some colleagues were overprotective”Andrew Rae, from Auchterderran, Fife, has been a nurse for 30 years. Yet after his heart attack, he still lacked information. “A month after my heart attack, my GP said I could go back to work. But at cardiac rehab they told me that, because of the type of heart attack, I should wait. It was confusing.”
Give yourself a pat on the back”
In the end, he had six months off work and felt apprehensive about going back. “My ward had moved and the new one was twice the length, so it was more physically challenging,” he says.
Andrew, then 47, who specialises in medicine for the elderly, met with his managers and the HR department and had a phased return to work over eight weeks.
“It started with just one six-hour shift a week, then two in the second week,
Iain says:1. Don’t go back too early. It is one thing feeling fit and awake at home, but at work, people will expect 100 per cent concentration. 2. Go back to the job you are already doing if you
gradually increasing,” he says. “It was definitely helpful to have a phased return.”
Andrew had started to feel dizzy when bending over, which he attributes to his medications. This continues, but he’s adjusted. A bigger issue was dealing with colleagues’ attitudes. “Even if I just look a bit warm, staff on the ward will be asking if I am feeling all right and if I need to sit down,” he says. “While it is nice that they are protective of me, I need them to recognise that I can do my job.
“I am a big fellow – 6ft 4in and used to lifting weights. When I had 5ft 3in women saying: ‘You go and sit down while I move this patient for you,’ it was a bit difficult.”
Andrew no longer works night shifts, but says he’s now doing everything else he was before his heart attack.
tips for getting back to work10
Iain, Andrew and Lisa share what they have learned
12 Heart Matters
Iain benefited from BHF booklets and online information after his heart attack. “The material was uniformly excellent with very practical advice,” he says. Try our free booklets Returning to work with a heart condition and Cardiac rehabilitation. Download them from bhf.org.uk/HMpublications, call 0870 600 6566 or see page 50.≠ For details of Access to Work grants, visit gov.uk/access-to-work or call 0345 268 8489.≠ To speak to a disability employment adviser, contact your local Jobcentre. ≠ Meet the professionals who can support your return to work, on page 16.
Free help and support
can. Unless it’s your choice, changing jobs or having responsibilities taken away can be stressful. 3. Set weekly goals for a few months. Even if some of your goals are missed, set more and keep going.4. Take time to reflect. It’s very easy to forget what has happened to you. My family and I did the BHF Round the Harbours bike ride last year, and this year my daughter ran the London Marathon for the BHF. It was a useful way of remembering.
Andrew says:5. Talk to colleagues about what you can and can’t do.
6. Be honest about the state of your health.7. As long as you are sensible, you will know when you are able to do something and when you are not.
Lisa says: 8. Acknowledge how much hard work you have done to get to the stage of returning to work; give yourself a pat on the back.9. Don’t be afraid to ask for the help you need. Don’t feel guilty about your health issues.10. Talking to a counsellor can help. My cardiac nurse suggested this and it’s helpful to speak to someone outside your family who doesn’t get upset. The counsellor helped me see the positives in my situation.
Lisa switched to contract work to better
suit her health needs
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Q Why have I been given these medications?
A Type 2 diabetesD causes high levels of glucose (a type of sugar) in your blood. This is because your pancreas isn’t making enough insulin to lower your blood glucose levels, or because your body has become resistant to insulin. Insulin allows glucose in your bloodstream to move into cells, giving you energy. If you have a high blood glucose level, your cells aren’t getting enough energy to function properly.
Over time, an excess of glucose in your blood causes damage to blood vessels, which can lead to cardiovascular diseaseD. This increases your risk of having a heart attackD or strokeD. It can also lead to problems with your vision and damage your kidneys.
More than three million people in the UK have been diagnosed with type 2 diabetes, but it’s predicted that hundreds of thousands more are still undiagnosed.
Medications can help control blood glucose levels and keep them in a normal range. In the UK, the National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN) offer guidance on which drug is appropriate.
Heart Matters bhf.org.uk 1514
Oral medications to help manage type 2 diabetes
DRUG CABINET
MEDICAL
Senior Cardiac Nurse Christopher Allen talks to Dr Amanda Adler about medications that can control your blood glucose levels, which is critical to managing type 2 diabetes
49
bhf.org.uk
A Angina Angina is 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.Angiogram X-ray pictures that show whether the arteries are narrowed and, if so, how narrow they have become. A coronary angiogram examines the coronary arteries.Angioplasty Procedure to widen a narrowed artery. It involves temporarily inserting a catheter and infl ating a tiny balloon at the narrowing to widen it and improve blood fl ow.Arrhythmia An abnormal heart rhythm. 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 surgery See coronary artery bypass surgery.
Beta-blockers A medicine prescribed to reduce the amount of work the heart has to do, by slowing the heart rate and reducing blood pressure.
CCardiac arrest The ultimate medical emergency, when
a person’s heart stops pumping blood round their body and they stop breathing normally. Cardiac arrests in adults can be caused by a heart attack.Cardiac 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.Catheter lab A room in a hospital where diagnostic procedures and treatments can be carried out on the heart. These may include an angiogram and pacemaker implantation.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 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 eff ectively. Diabetes increases your risk of developing cardiovascular disease.
EEchocardiogram Sometimes called an ‘echo’. This is an
ultrasound to examine the structures within the heart, such as heart valves, and to see how well the heart is pumping.
Electrocardiogram (ECG) A simple, painless test to record the heart’s electrical activity. Small sticky patches (electrodes) are put onto your arms, legs and chest. These are connected to a machine that picks up and records the electrical signals of your heartbeat.
H HDL HDL stands for ‘high-density lipoprotein’. HDL
is commonly known as the ‘protective’ or ‘good’ type of cholesterol. It returns the extra cholesterol, that isn’t needed, from the bloodstream to the liver. So HDL removes the ‘bad’ cholesterol from the bloodstream rather than depositing it in the arteries.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 gradual build-up of atheroma (plaque) within artery walls. If the atheroma becomes
MEDICAL TERMS EXPLAINED
Call the Heart Matters Helpline on 0300 330 2333 if you want to know more
unstable, a piece may break off and lead to a blood clot forming. 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 is 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.
L LDL LDL stands for ‘low-density lipoprotein’. LDL is
commonly known as a ‘bad’ type of cholesterol. It carries cholesterol from the liver, through the bloodstream, to the cells of the body.
S Stent A short tube of expandable stainless-steel
mesh that is inserted into an artery to hold it open after an angioplasty, improving the fl ow of blood through the artery. 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.
DICTIONARYMedical words, identified by a small symbolD, are explained in plain English in our dictionary on page 49.
Dictionary
Q Are there interactions with heart medications?
A Most common heart medications are safe to take with medications for type 2 diabetes. Others are used with caution, such as beta-blockersD. They may mask the symptoms of low blood glucose, which can include shaking and sweating, caused by adrenaline trying to increase blood glucose levels. You may not get these symptoms as beta-blockers can stop the action of adrenaline. Ill
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blood glucose levels within a normal range, or is sensitive enough to insulin to use it properly, then you don’t need extra. If medications and lifestyle changes aren’t effective, your doctor may recommend insulin injections. To delay this, it’s important to be physically active and lose weight if you need to.
Q My GP says my blood glucose is normal. Can I stop the medications?
A Many cases of type 2 diabetes are caused by lifestyle factors, such as being overweight. Lifestyle factors are also risk factors for other serious conditions, such as cardiovascular disease and
some cancers. Making positive changes, like eating a healthy, balanced diet and keeping physically active, mean your blood glucose levels may return to within a normal range without medications. However, if your GP recommends you
Q Are there any foods or drinks I should avoid?
A Following a healthy, balanced diet can help prevent type 2 diabetes, or help manage blood glucose levels if you already have it. If you have diabetes, you don’t need to cut out sugar completely, but be aware of how much you consume. In the UK, most of us eat more sugar than is recommended, from foods like sugary drinks, cakes, biscuits and jam, as well as the sugar we add to food ourselves.
Q What are the possible side effects?
A Some medications, such as gliclazide, may cause low blood glucose levels. If this is the case for you, it may be best to switch to a different medication, such as pioglitazone. Low blood glucose levels can affect your thinking and cause you to lose consciousness.
You may gain some weight after starting your medication. This is because the glucose that was in your bloodstream is now being used by the body for energy, so your body is using the calories from the glucose.
Q Why haven’t I been prescribed insulin?
A If your body is making enough insulin to keep your
continue taking medications, it’s important to do so.
You will always have an increased risk of having high blood glucose levels in the future, especially if you do not maintain your positive lifestyle changes.
FIGHTFOR EVERYHEARTBEATbhf.org.uk
FREE
September/October 2015
How we're helping Dr Danielle Paul
make amazing microscopic discoveriesit out
HERBS & SPICES
PULL OUTAND KEEP
RECIPECARDS
Scoping EXERCISES
TO BUILD STRENGTH
10PLUSWho's who in cardiac rehab
Back to work Returning to your job after a heart event
Enjoyed this article?Read more:≠ Ask your pharmacist page 20≠ Benefits of pulse checks page 22
Look out for: ≠ Our Nov/Dec issue, exploring digoxin.≠ Our Jan/Feb 2016 issue on insulin. ≠ Warfarin, diuretics and more at
bhf.org.uk/drugcabinet.
CV Dr Amanda AdlerConsultant Physician at the Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge ≠ Research interests include general diabetes, cystic
fibrosis-related diabetes and diabetic complications≠ Chairs a NICE Technology Appraisal Committee≠ Trained in United States; researched diabetes in Alaskan Eskimos≠ Previously Clinical Epidemiologist for the UK Prospective
Diabetes Study (UKPDS), University of Oxford
Sometimes prescribed with metformin to help control blood glucose levels
Stimulates the pancreas to produce more insulin
GliclazideSulfonylureas
Prevents breakdown of a protein that causes the pancreas to produce less insulin
Alternative to sulfonylureas, but for those who need a large reduction in blood glucose levels, these drugs aren’t suitable
SaxagliptinSitagliptin
DPP-4 inhibitors
Stops your gut breaking down carbohydrates into glucose, which helps prevent blood glucose levels from rising
Can cause diarrhoea and flatulence
AcarboseAlpha-glucosidase inhibitors
Can be associated with weight gain
Makes your body more sensitive to its own insulin
PioglitazoneThiazolidinediones
Glucose in the urine is normally reabsorbed in the kidneys. These drugs stop this happening
May cause weight loss. Can also cause thrush of the penis or vagina
DapagliflozinCanagliflozin
SGLT2 inhibitors
Exenatide Stimulates the pancreas to produce more insulin
Slows stomach emptying, causing some people to eat less
GLP-1 agonists
Diabetes drugs and their usesDrug group Example How it works Extra informationTake Meds
Exercise daily
Don‘t forget lunch
Eat well
Take meds
Eat well
Don’t forget lunch
Exercise daily
Biguanides Metformin Makes your body more sensitive to its own insulin
Drug of choice to treat type 2 diabetes
1716 Heart Matters bhf.org.uk
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Cardiac rehab helps you recover after a heart event. Sarah Brealey visits a hospital trust to meet some of the trained professionals involved
TEAMDream
After he’d had a heart attackD in Heathrow Airport, Ian Nelson, 60, found that cardiac rehabilitationD helped him get back on his feet. Ian, who was on his
way home from the United States, was taken to Hillingdon Hospital and then had an angioplastyD at Harefield Hospital. Starting a rehabilitation course at his local leisure centre in Newcastle-under-Lyme gave him reassurance.
“Having someone to speak to about any aches and twinges you’re getting and what they might mean, to support you while you exercise, to ask questions if you need to, and to know that they’ve got your back – that is great,” he says.
Cardiac rehab schemes typically provide information and support soon after you are diagnosed or treated, followed by weekly sessions for up to 12 weeks. Each programme offers access to a range of trained professionals, such as experts in exercise, nutrition, behaviour change and
heart health, although exact roles will vary from place to place.
Ian, a hearing aid audiologist, particularly appreciated advice about how much he could safely exercise and the emotional support. “I didn’t really know what I could do, but the team helped me to push myself a bit,” he says. “Also, you are feeling a bit vulnerable – I think most people would. Having someone on hand to provide reassurance was helpful.”
The course gave Ian a structured exercise plan and also included education sessions explaining topics such as healthy eating and medications. “I had a good understanding of healthy eating, but I never really understood the impact of exercise and how it can help reduce your blood pressure,” Ian says. “I was quite fit and active before, but I now make an effort to go to the gym regularly, doing a session every Friday.”
Once cardiac rehab has finished, it’s important to maintain lifestyle changes, and you’ll get advice on how to do this. Ian was encouraged to carry on exercising in the same gym, which he does, though you can also find out about alternatives, like walking groups, too.
Ian says he is “feeling good” and is able to do everything he used to do before his heart attack. He has reduced his working hours from five days a week to three, but he is enjoying being back at work and is looking forward to a holiday with his wife in Hong Kong.
Cardiac rehabilitation begins while patients are still in hospital, explains Hayley Evans, who is part of the award-winning team that helped Ian at University Hospitals of North Midlands NHS Trust. A member of the team visits each patient on the ward and talks to them about what has happened, their medications and how to make healthy lifestyle changes. They also explain the rehab programme.
“Some people are concerned about starting to exercise, so we explain that
it is individually tailored and built around their personal goals,” Hayley says.
The ward visit is followed by an hour-long clinic session within the first month. This goes into more detail about behaviour changes, medications, wellbeing and anything else patients want to discuss. The clinic also arranges when and where people will attend exercise and education sessions.
At the first of these, staff work one-to-one with each
patient. “Some people have never been in a gym before,” says Hayley. “We show them all the machines and how they work. We go through warming up and cooling down. We reassure them that it is safe to exercise, as their main concern is normally how far it is safe to push themselves. As they progress through the course,
they learn how to use the machines on their own and we encourage them to choose their own exercises. This way, it is easier for them to continue themselves after the programme.”
Weekly sessions are run in local gyms, but patients can choose alternative activities, including an aqua aerobics
We encourage people to choose their own exercises”
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class. There’s a special class for people facing greater limitations too, helping them regain mobility for day-to-day activities.
Nicola Heath, also an exercise physiologist, explains that patients have different options. “We have a home programme of exercises for any patients who don’t want to or aren’t able to come to the sessions,” she says. “We can do a clinic over the phone if necessary, so they can tell us how they are getting on and if there are any problems.”
The course finishes with a progress review. “We review how they feel and whether they have achieved the goals set at the beginning, and what to do next,” Nicola says.
Participants can keep going to the gym, either for a small charge or sometimes funded by the local council. “We link with different walking groups as well, so if the gym isn’t their thing, they have other options,” says Nicola.
The exercise physiologists
Hayley Evans, above, and Nicola Heath, top right, helppatients make permanentlifestyle changes
Physiologist Nicola Heathexercises with a patient;
below, Ian Nelson (centre)and the cardiac rehab team
that helped him
MEDICAL
1918 Heart Matters bhf.org.uk
Depending on where you do cardiac rehab, you may encounter other roles: occupational therapists, dietitians, psychologists or cardiac rehab practitioners. Sam Jones and Andre Taylor (pictured) are cardiac rehab practitioners at the University Hospitals of North Midlands NHS Trust. They support the team and connect patients to services such as occupational therapy or stop smoking services.
Paul Stern (above) is team leader at University Hospitals of North Midlands NHS Trust. He also offers specialist physiotherapist support, because patients often have other health issues alongside their heart condition.
“Sometimes people already have a goal, such as getting back to work,” he says. “If not, we help them set specific goals, perhaps walking to the shops to get the morning paper. That goal is recorded and all the staff on the programme know what we’re working towards.”
The course includes open access to most of the gyms. “One exercise session a week isn’t really enough,” says Paul,
“but most people can exercise in the venues at other times too as they all have a cardiac rehab instructor working there.” This also makes it easier to continue exercise sessions, which most participants choose to do.
Paul pays tribute to the BHF. “We are all members of the BHF Alliance [our free membership scheme for professionals who work with people affected by heart disease],” he says. “The support from the BHF has been fantastic with regard to training opportunities. A lot of the team has done specific training funded by the BHF, and it is hard to get that kind of funding from the NHS.”
The cardiac physiotherapist
Matt Berrisford is an exercise specialist with expert knowledge of healthy eating and a degree in exercise and nutrition.
As part of the cardiac rehab course at University Hospitals of North Midlands NHS Trust, he runs a group session explaining the principles of healthy eating. He addresses common misconceptions, such as the belief eggs are bad for your heart, and explains that people don’t have to completely cut out foods they enjoy, but can have them in moderation. He explains the importance of planning ahead – being prepared with the ingredients and recipes to make healthy meals – rather than reaching for an unhealthy convenience option.
He can also work with patients one-to-one, giving advice and helping them set goals. Patients often fill in a food diary first to help identify areas for improvement.
“Some people try to change their diets completely but find it hard to stick to,” he says. “The best way is to change little bits here and there. For example, if someone doesn’t
Other members of the team “Sometimes, patients are
terrified of the word ‘rehab’,” says Sam. “When they see what we offer, that changes. Eight weeks later, they are like completely different people.
“People have perceptions of what heart disease is, sometimes from the media, that are wrong. They might think a heart attack means you are going to drop down dead. We can tackle that. I never come to work with a frown on my face.”
The nutrition adviser
The cardiac rehabilitation nurse
Andre is a cardiac rehab practitioner and supports
the rest of the team
≠ If you want to know more, order or download our free booklets, Cardiac rehabilitation, Coping with stress or Returning to work. Call 0870 600 6566 or visit bhf.org.uk/HMpublications.≠ You may also be interested in our feature on returning to work (page 10).≠ If you’re a healthcare professional, discover more about the free-to-join BHF Alliance, which helped Paul and the team, at bhf.org.uk/alliance.≠ The BHF believes all those who are eligible for cardiac rehab should have access to it. We
fund the annual National Audit of Cardiac Rehabilitation to assess how much it is offered to and taken up by patients. If you’ve had a heart event and haven’t been offered cardiac rehab, ask your GP or healthcare professional. You may also be able to contact your local hospital’s cardiac rehab team directly.
Free support from the BHF
really eat any fruit and veg, it’s quite intimidating to be told to have five portions a day. So we might start with a goal to have one portion of fruit and one of veg each day. We’ll try and find a way of making it a habit – for example, having a piece of fruit with breakfast and a portion of veg with their tea.
“When people come to the end of the course and you see it has made a real difference to their lives – that their daily tasks are much easier – it is really rewarding. It is not really a job, because you shouldn’t enjoy work as much as we enjoy our jobs.”
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Nurse Julie Atton with a patient;left, team leader Paul Sternwith cardiac rehab practitionerSarah-Lou Richards
Like every member of the cardiac rehab team, Julie Atton gives advice on lifestyle changes, but she also answers more detailed questions about medications. “We work a lot on individual goals,” she says. “It could be stopping smoking, dietary change or something as simple as eating one extra portion of fruit and veg each day. The overall goal is keeping each patient fit and well and preventing further hospital admissions.”
Julie also runs a group session on dealing with stress and anxiety. “We explain the link between physical health and stress and anxiety, and how people can recognise the signs,” she says. “We give
tips on relaxation and use BHF resources, such as the Coping with stress booklet.”
Directing people to psychological support is an important part of the team’s work. “There’s a lot of evidence to show that people can suffer from anxiety and depression following a heart event,” explains Julie. “We use a questionnaire and we have pathways for what to do next. This includes GPs, mental health services and local charities, and a telephone helpline we encourage people to use.”
We explain the link between physical health and stress”
Cardiac rehabilitation
Returning to work with a heart conditionJaney WayneSurvivor
How to manage stress and help your heart
COPING WITH STRESS
Go online Learn how occupational therapists can help your recovery, plus a guide to health professionals you may meet: bhf.org.uk/HMwho.
21Heart Matters bhf.org.uk
Are you getting the best from your community pharmacist? Sarah
Kidner discovers how they can help you manage your cardiovascular disease
THE BIG INTERVIEW
The role of the pharmacist is changing, says Helen Williams, Consultant Pharmacist for Cardiovascular Disease
(CVD) in south London. Traditionally, we’ve thought of local and community pharmacists as simply dispensing medicines. Now, there’s a realisation that they can provide support in managing long-term conditions.
“A lot of chronic disease, including cardiovascular diseaseD, is managed by repeat prescribing,” Helen explains. “The community pharmacist will usually see people every two months or so when they pick up their prescription. It’s an opportunity for people to ask questions about why they need medicines and about side effects.”
Keep taking the tabletsAn important aim is to encourage people to continue taking their medications once they’ve been prescribed. “We know that within a few months or even within days of starting a new medication, a certain proportion of patients will stop
taking them,” Helen says. “With long-term conditions, about 50 per cent of medicines are never taken, or not taken the way that the prescriber intended.”
In England, there are two initiatives that people taking medications can benefit from: the New Medicine Service and the Medicines Use Review.
The New Medicine Service is available free to people being prescribed a medicine for the first time to treat a long-term condition. This includes those receiving medications for type 2 diabetesD, high blood pressureD or to thin the blood (to reduce the risk of heart attackD or strokeD). By signing up, you’ll have the chance to find out more about your new medications and to schedule a series of follow-up appointments to ask further questions and discuss any side effects.
The Medicines Use Review is aimed at people who are taking multiple medications or people who are on particularly complex regimens – heart failureD patients, for example.
The free service offered by pharmacies throughout the UK means that, if you’re taking more than one prescription medication, you can have a confidential conversation with your pharmacist about how you’re getting on and will receive a medications action plan.
“We’ll sit down with you for 15 minutes, talk to you about the medicines you’re on, ensure you know how to take them and address any issues that you might have,” Helen explains.
20
Ask yourPHARMACIST
You can have a confidential conversation with your pharmacist”
CV Helen WilliamsConsultant Pharmacist for Cardiovascular Disease in Southwark and Lambeth ≠ Develops and
implements local cardiovascular prescribing guidance
≠ Previously an editorial board member for the British Journal of Cardiology, British Journal of Cardiac Nursing and Pharmacy Management
≠ Current spokesperson for the Royal Pharmaceutical Society
One of the biggest challenges is to encourage people to start talking about their medications to pharmacists, not just GPs. “We need to engage GPs and nurses to tell people to talk to their pharmacists when they collect their medications, especially if they have any concerns about them,” says Helen.
Pharmacists, too, must adapt. “We need to hear people’s thoughts about their
conditions and the medicines they’re using to treat them,” she says. “We need to listen.”
So, next time you have a question about your heart medications, why not ask your pharmacist?
≠ For information about cardiac medications, download our free booklet Medicines for your heart from bhf.org.uk/HMpublications or call 0870 600 6566.
Enjoyed this article? Read about diabetes drugs and possible side effects in Drug Cabinet, page 14. Find more in the same series, including articles on painkillers, statins and warfarin, at bhf.org.uk/drugcabinet.
In the communityPharmacists aren’t always found behind the counter of your local chemist, either. Helen, who has never worked in a conventional pharmacy setting, began her career dispensing medications to patients in hospital. However, she believes moving out of the hospital and into the community is a better use of her skills.
“The hospital sees a tiny snippet of a patient’s life. It seemed to me I would be better off working in a community setting looking after people with cardiovascular conditions,” she says. “I started initially running some local hypertension [high blood pressure] clinics. Now, most of my work is supporting other people to develop those roles around blood pressure and heart failure management, ensuring that not just pharmacists but GPs and practice nurses know how medicines can best be used to maximise patient outcomes.” Helen currently works with more than 90 practices across Southwark and Lambeth to pursue this aim.
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MEDICAL
Our panel of experts answer your health questions
ASK THE EXPERTS
New cholesterol guidelinesQ I just had my cholesterol
checked by my GP and was given different measurements to when I’ve had it done previously. Can you explain why this is?
Senior Cardiac Nurse Christopher Allen says: The National
Institute for Health and Care Excellence (NICE), the body that produces guidance and advice for health professionals, has recently
produced new guidance on measuring cholesterol.
Previously, the focus was on your LDLD (‘bad’) cholesterol and HDLD (‘good’) cholesterol levels, as well as the total cholesterol level. Research now tells us we also need to consider other parts of ‘bad’ cholesterol, known as IDL, VLDL and lipoprotein(a).
These parts of ‘bad’ cholesterol are collectively known as ‘non-HDL’ cholesterol, and this is the measurement you’ve probably now been given by your GP.
This measurement has been shown to help calculate your risk of developing cardiovascular disease more effectively than before.
As a guide, your non-HDL cholesterol should be lower
Need more information? Go online to bhf.org.uk/experts for more answers to our readers’ medical questions.
Call the Heart Matters Helpline on 0300 330 2333 for more information. To suggest a question, email [email protected].
How to get in touch
than 4mmol/L. If you are at risk of cardiovascular disease or you already have it, you should be aiming for no higher than 3.4mmol/L.
The good news is that there’s no need to fast before the non-HDL cholesterol test, as you may have had to do for previous cholesterol tests.
Simple stroke preventionQ Why should I have my
pulse checked?
Dr Mike Knapton says: A doctor holding a patient’s wrist to take their pulse is a classic medical image. Now we understand that this simple examination could play a significant part in strokeD prevention.
The pulse is usually taken from the radial artery, which can be felt at the wrist, where a watchstrap usually sits, in line with the base of the thumb. It should be felt with two or three fingers of the other hand. A normal pulse will have a regular rate of about 70 beats per minute but can be lower or higher. An irregular pulse can be caused by a number
of heart rhythm disturbances, but the most common is atrial fibrillation (AF)D.
The heart has a natural pacemaker. This sends out a regular electrical impulse that causes the heart to contract, creating the pulse. When someone has AF, impulses fire off from different places in the atria (the two upper heart chambers), causing chaotic electrical activity, which means an irregular, and sometimes fast, pulse.
AF can cause symptoms such as shortness of breath or palpitations, but many people have no symptoms. However, because AF is estimated to increase your risk of stroke by five times, it’s important to
know whether you have it, so you can reduce your risk.
This means it’s a good idea to check your pulse, or get your doctor or nurse to do it for you. You can have a pulse check as part of an NHS Health Check, which is available to all those over 40 who haven’t already been diagnosed with cardiovascular diseaseD or another long-term health condition.
If you have an irregular pulse, the next step is to have an electrocardiogram (ECG)D to confirm whether you have AF.
49
bhf.org.uk
A Angina Angina is 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.Angiogram X-ray pictures that show whether the arteries are narrowed and, if so, how narrow they have become. A coronary angiogram examines the coronary arteries.Angioplasty Procedure to widen a narrowed artery. It involves temporarily inserting a catheter and infl ating a tiny balloon at the narrowing to widen it and improve blood fl ow.Arrhythmia An abnormal heart rhythm. 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 surgery See coronary artery bypass surgery.
Beta-blockers A medicine prescribed to reduce the amount of work the heart has to do, by slowing the heart rate and reducing blood pressure.
CCardiac arrest The ultimate medical emergency, when
a person’s heart stops pumping blood round their body and they stop breathing normally. Cardiac arrests in adults can be caused by a heart attack.Cardiac 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.Catheter lab A room in a hospital where diagnostic procedures and treatments can be carried out on the heart. These may include an angiogram and pacemaker implantation.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 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 eff ectively. Diabetes increases your risk of developing cardiovascular disease.
EEchocardiogram Sometimes called an ‘echo’. This is an
ultrasound to examine the structures within the heart, such as heart valves, and to see how well the heart is pumping.
Electrocardiogram (ECG) A simple, painless test to record the heart’s electrical activity. Small sticky patches (electrodes) are put onto your arms, legs and chest. These are connected to a machine that picks up and records the electrical signals of your heartbeat.
H HDL HDL stands for ‘high-density lipoprotein’. HDL
is commonly known as the ‘protective’ or ‘good’ type of cholesterol. It returns the extra cholesterol, that isn’t needed, from the bloodstream to the liver. So HDL removes the ‘bad’ cholesterol from the bloodstream rather than depositing it in the arteries.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 gradual build-up of atheroma (plaque) within artery walls. If the atheroma becomes
MEDICAL TERMS EXPLAINED
Call the Heart Matters Helpline on 0300 330 2333 if you want to know more
unstable, a piece may break off and lead to a blood clot forming. 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 is 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.
L LDL LDL stands for ‘low-density lipoprotein’. LDL is
commonly known as a ‘bad’ type of cholesterol. It carries cholesterol from the liver, through the bloodstream, to the cells of the body.
S Stent A short tube of expandable stainless-steel
mesh that is inserted into an artery to hold it open after an angioplasty, improving the fl ow of blood through the artery. 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.
DICTIONARYMedical words, identified by a small symbolD are explained in plain English in our dictionary on page 49.
Dictionary
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We need to consider other parts of ‘bad’ cholesterol”
Anticoagulation medication (either warfarin or a newer
oral anticoagulant drug such as dabigatran,
rivaroxaban or apixaban) can reduce the risk of having a stroke by thinning the blood and reducing the risk
of blood clots.
≠ Learn how to check your pulse at bhf.org.uk/pulsecheck. Read about anticoagulants at bhf.org.uk/drugcabinet. Order our Sep/Oct 2014 issue to find out about newer anticoagulants by
calling 0870 600 6566.
22 Heart Matters
Aged 24, Tarik Abdel-Hady was diagnosed with a heart valve problem.
Last year, Tarik, 32, from Cambridgeshire, found he needed open heart surgery. “They told me my heart had enlarged and they were going to take me in for an operation. I was really shocked,” he says. “My wife was
five months pregnant and my first thought was: ‘Imagine if I don’t meet my baby.’ It might
sound dramatic, but a heart operation is a big deal.”
The surgery went smoothly. “As soon as I came round, I wanted to give something back to the BHF,” he says. “You’ve done so much to improve heart surgery for people like me; I wanted to ensure
other people can have the same experience.”
Tarik is a buying manager at Tesco and was inspired by its partnership with us. He and a team did our London to Brighton Bike Ride. “After I was diagnosed, I was too scared to get on a bike,” he says. “Signing up for the ride inspired me to start cycling regularly.”
≠ Sign up for a BHF bike ride at bhf.org.uk/cycle.
Cycling hundreds of miles across Vietnam and Laos in temperatures of 40°C is a challenge at the best of
times. But Clive Hills and Virginia Morris did it 16 months after Clive’s quadruple bypass surgeryD – and accompanied by their two young children.
Clive and Virginia, from south-west London, worked in Laos in the past, and had walked parts of the Ho Chi Minh Trail, a logistical supply line built during the Vietnam War. After Clive’s bypass, he was determined to return there by bike and to raise money for the BHF.
“The surgery went very well,” says Virginia, 45. “We were astonished how straightforward it was. I can remember when this was a relatively new procedure, it was major surgery and you might be in hospital for ages. Over the decades there have been important improvements that make heart surgery better and safer, thanks to funding by the BHF.”
The bike ride took two weeks over the Easter holidays. “We had to take the children with us, who were only three and six,” says Virginia. “Our biggest fear was that they would get an awful disease, but we got malaria tablets and all the injections.
JOIN THE FIGHT
“We had to share the cycling as one of us always had to be with Bluebelle and Albion. I would get up early and start cycling while Clive took them, then Clive would take over around midday while I entertained the children. Keeping the children occupied was harder than the cycling!”
The couple’s bike was damaged on the flight out to Vietnam. They had to buy a local bike with no gears, so part of the route took much longer than planned. They crossed rivers, rode steep mountain passes and remote dirt tracks, and at times cycled through the darkness, after setting out as early as 3am.
Clive, 54, says: “I wanted to do the cycle to show that you can still follow your dreams and ambitions, even after a heart bypass operation and with a young family.”
The couple have raised £1,600 so far and are still hoping for more donations.
≠ Donate online at thehochiminhtrailchallenge.com or text ‘HCMT59 £5’ to 70070 to donate £5.
Pedal power
● Set yourself a fundraising challenge● Get friends and family involved● Raise funds for our life saving work
Advances in heart surgery have given these BHF supporters a very personal reason to take to their bikes
Prosperous partnership
To help us fund more crucial research, call 0300 330 3322 or go online at bhf.org.uk/fundraise
Inspired to raise funds?
Clive and Virginia have raised nearly £2,000 for the BHF
23bhf.org.uk
25
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NUTRITION
Heart Matters24
CHILLI/CAYENNE Taste: Chillis vary quite a lot in strength, so add a little at first and taste your dish. Cayenne is a specific type of chilli.Preparation: Chilli can be bought whole (fresh or dried), as dried flakes, powder, or as hot sauce. Chilli sauce may be high in salt (or sugar in the case of sweet chilli sauce), so stick to powder, flakes or whole chillies.Uses: It works well in most dishes, including vegetable or seafood stews or vegetable
NUTMEGTaste: Sweet and pungent flavour. Works well in baked foods with cinnamon and cloves. Preparation: Freshly grated nutmeg has a much better flavour than ground.Uses: Add nutmeg with black pepper to homemade white and cheese sauces. It also adds warmth and flavour to homemade potato, cabbage and cauliflower soups.
BASIL Taste: Sweet and peppery.Preparation: Fresh basil retains more flavour and aroma than dried. Basil plants usually grow well on windowsills. As you pick the leaves, more will grow.
Uses: Perfect for pesto, marinades, dressings, sauces, sandwiches, soups and salads. Basil is traditionally used in Mediterranean cooking, in tomato-based pasta sauces, pizzas and bolognese. Use lemon, Thai and holy basil in South Asian and Thai dishes.
CARDAMOM Taste: A warm, aromatic spice.Preparation: Add whole cardamom pods to your dishes or use the seeds inside, either whole or ground.Uses: Commonly added to Asian spice mixes and curry pastes. Cardamom also works well in baked goods and sweet breads, with cloves and cinnamon, for a taste of Scandinavia.
bhf.org.uk
SPICEup your life
Herbs and spices explainedMINT Taste: A bright and refreshing herb that works in sweet and savoury dishes. Preparation: Use fresh leaves if you can. Mint is easy to grow on the windowsill or in the garden (keep in a pot as it will spread).Uses: Great in salads, on pasta or in couscous. It’s tasty with carrots, peas or broad beans.
ROSEMARYTaste: An aromatic herb with a pine-like fragrance. Use sparingly; it can overpower other flavours.Preparation: Roast whole sprigs with root vegetables (carrot, parsnip, sweet potato). If using dried rosemary, crush it first.Uses: Add to roast or grilled meats, bread, homemade pizza, tomato sauce, beans, potatoes or egg dishes. Consider growing some rosemary; it’s a hardy plant and does well outside.
Are you envious of those who throw together tasty dishes with only a few ingredients and a rifle through
the spice rack? Not any more. We’ve compiled a range of herbs and spices with instructions on how to use them with meat, fish and vegetables. Soon you’ll be mastering the flavours of the Mediterranean, North Africa, India and beyond. What’s more, using these in place of salt is better for your heart health. Our pull-out recipes offer four ideas to get you started.
Do spices have health benefits?
Mastering herbs and spices is the secret to tasty meals, and much healthier than using salt for flavour. Registered dietitian Annemarie Aburrow shows us how
soup. Add a pinch of chilli with a little mustard to spice up a cheese sauce, helping you use less cheese. Combine with cumin, coriander seeds and turmeric to give foods an
Indian twist.
CINNAMONTaste: Mostly used in sweet treats like cake and apple crumble, but works with savoury dishes too.Preparation: Sold as
cinnamon sticks (grate or add whole
to dishes like curries or stews)
or ground.Uses: Cinnamon
is an important spice in Turkish and Middle
Eastern cooking, where it is used to flavour chicken and lamb dishes. Use it to deepen the flavour of cottage pie, curries, tagines, casseroles, roast vegetables, bolognese sauce or stewed fruit.
CHIVESTaste: Onion-like but less powerful. Preparation: Snip the stems into food using a
clean pair of scissors. Add to hot dishes at the last minute, as heat destroys its flavour. Uses: Great in mashed potato, casseroles, salads, baked potatoes, low-fat cream cheese, fish and poultry. Chive flowers are edible and look good too.
CORIANDER Taste: Coriander leaves have a distinct earthy and lemony flavour, while coriander seeds have a warm, spicy, citrus flavour when crushed.Preparation: Use coriander
leaves raw or add to foods at the end of cooking.
Coriander seeds are commonly used in Indian
dishes. Fry them in a dry pan and add them whole
or crushed.Uses: Add coriander leaves to
salads, soups (eg carrot and coriander soup), salsas, curries
and fish and chicken dishes, or combine it with lime and chilli in stir fries.
Some people claim that cloves fight pain, cinnamon balances blood sugars, turmeric is anti-inflammatory and chilli increases metabolism. However, there is no firm scientific evidence to support these beliefs; most studies showing health benefits involved larger amounts of a spice than are usually eaten.
Herbs and spices can provide a source of iron, though. A teaspoon or two of dried herbs, thyme for example, can provide around 15 per cent of a woman’s daily iron requirement, while a teaspoon of garam masala provides seven per cent.
Both fresh and dried herbs and spices can addflavour to your meals
27Heart Matters26 bhf.org.uk
DILLTaste: Dill has a strong taste, often compared to fennel, star anise and celery.Preparation: Use fresh rather than dried if possible – use the leaves only and
discard the stem.Uses: Popular in
Russian, Eastern European, Greek and Scandinavian
cooking, dill is a welcome addition to cottage cheese, low-fat cream cheese, omelettes, seafood, steak, potato salad and cucumber dishes. Try adding dill to broad beans and rice and serve with koftas (made from lean minced meat), as found in Iranian cooking.
CUMINTaste: Earthy and smoky. Preparation: Fresh cumin seeds, dry roasted and then ground, provide a richer flavour than cumin powder. Uses: After black pepper, cumin is the most-used spice worldwide. It is flavoursome without too much spiciness. Cumin goes with practically any dish but particularly with lamb, game, beans and rice. Combine with oregano and chilli for a Mexican twist, or with cardamom, coriander and turmeric for a taste of India.
GINGERTaste: Peppery, lemony and slightly sweet, with a sharp aroma.Preparation: Buy ground or
fresh (as a ginger root, which can then be chopped or grated).Uses: Ginger enhances sweet and savoury dishes. Fresh ginger can be grated into stir fries and curries during cooking, or sprinkled over meat before baking or barbecuing. It can also be used in salad dressings or added to rice. Ground ginger works well with stewed fruits.
OREGANO Taste: Oregano has a warm, aromatic, slightly bitter taste and a potent aroma.Preparation: Fresh oregano leaves can be chopped into foods or added whole.Uses: Popular in Greek and Mediterranean cooking. Use it to marinate meats, poultry and seafood before grilling, in egg dishes, breads, casseroles and salads. It’s also great in spaghetti bolognese and tomato salsas. Marjoram is a good oregano substitute, but tastes milder.
PAPRIKATaste: Paprika is milder and sweeter than cayenne pepper. Preparation: Available as a red powder made from ground sweet and hot dried peppers.Uses: For a Hungarian twist, team paprika with caraway, coriander, cinnamon and dill. Combine with garlic for a Spanish flavour. Paprika goes well with lamb, chicken and fish dishes, on baked sweet potato wedges, or in beans or scrambled egg.
PARSLEYTaste: Has a mildly bitter, grassy flavour that does not overwhelm the other ingredients.Preparation: Flat-leaf parsley is favoured by chefs; it withstands heat well and is very flavoursome. Curly parsley is used for decorative garnishing.Uses: Goes with roast lamb, grilled steak, fish, chicken, veg, potato dishes, omelettes, stuffing, soft cheeses, marinades, dressings, sauces and soups.
SAGE Taste: From the Mediterranean coast, sage is like rosemary, with more lemon and eucalyptus.
Preparation: Best used fresh and in small
amounts. Unlike some herbs, sage does not lose its flavour with prolonged cooking. Uses: Sage is
traditional in Italian and French cooking,
added to meats, poultry and stuffing, and is often
chopped and stirred into pasta and gnocchi.
TARRAGONTaste: Adds a distinctive, bittersweet liquorice-like flavour to foods, and has an aroma similar to star anise.Preparation: Tarragon should be added near the end of cooking time, as heat reduces its flavour.Uses: Native to Siberia and western Asia, tarragon is a key herb in French cooking. It goes well with poultry, fish, egg dishes, beef and vegetable soups. It can also be added to salad dressings.
THYMETaste: A strong earthy, slightly minty flavour with a subtle aroma. Lemon thyme is another variety and goes well in soups and vegetable dishes.Preparation: Depending on the variety you’re using, thyme can be finely chopped or added as a whole sprig. Unlike most herbs, thyme needs a long cooking time to release its full flavour. Uses: Add whole sprigs to slow-cooked meals and casseroles
and remove at the end. Thyme works well with other herbs like rosemary, parsley, sage, savory and oregano, and is used in bouquet garni. It can flavour most meats, including chicken and game (as a marinade or in a sauce) and is a tasty addition to roast vegetables. Tuck sprigs inside a chicken, along with fresh lemon, before roasting. Pair thyme with paprika, oregano and cayenne pepper for Cajun cuisine, and with cinnamon, nutmeg and cayenne pepper for Caribbean meals.
TURMERICTaste: Has a distinctive yellow colour so is sometimes used as a cheaper alternative to saffron, although it tastes quite different.Preparation: Turmeric is an ingredient of curry powder and is in many South Asian dishes. Uses: For a hint of North Africa, use turmeric with ginger in meat and vegetable dishes, or flavour rice with it. A little turmeric goes a long way; as it cooks, its flavour intensifies.
Storing your herbs and spicesSPICES:≠ Once opened, whole spices can be kept for up to four years in an airtight container. Ground spices last for six months to two years stored in the same way.≠ Fresh ginger and turmeric last around two weeks when kept in a perforated bag in the fridge.≠ Spice racks can be a lovely addition to a kitchen, but spices last longer stored in a cool dark place, such as a cupboard or pantry area.≠ Where possible, buy whole spices and grind them yourself using a pestle and mortar or coffee grinder.HERBS:≠ Dried or fresh? Fresh herbs are best added near the end of cooking, eg in a salad or basil on a pizza, whereas dried herbs may be more convenient for day-to-day use.
≠ Generally, use one-and-a-half times the amount of fresh herbs as dried; the flavour of dried herbs is more intense.≠ Dried leafy herbs usually last between one and three years when stored in an airtight container.≠ Fresh herbs can be stored in bunches, in a jar, with the stems submerged in water. Enclose the jar in a sealable plastic bag and change the water often. They should last around a week this way. Alternatively, rinse herbs in water, wrap in a damp paper towel and place in a plastic bag in the fridge.≠ Supermarkets sell herb plants, or you could try growing your own from seed. Simply snip off as much as you need. Keep them on your windowsill or in a sheltered spot outside the kitchen door and they should last weeks or months – possibly even years in the case of perennials like thyme, mint and rosemary.
Whole spices can be kept for up to four years”
Go online Read our quick guide to bringing flavours from across the world to your cooking at bhf.org.uk/spices.
2928 bhf.org.uk
NUTRITION
Heart Matters
Our Senior Dietitian Victoria Taylor shares nutrition adviceASK THE EXPERT
Victoria Taylor says: The paleo diet was popularised by a book of the same name in 2002. In the past few years, it’s become very fashionable; according to Google, it was the most searched-for diet on the internet in 2014. Also called the ‘caveman diet’ or ‘stone age diet’, it claims we should only eat foods available to our hunter-gatherer ancestors.
It’s based on meat, fish, vegetables, nuts and seeds, and excludes grains, pulses, dairy products, refined sugar and processed foods. Compared with the average western diet, it is higher in protein, fibre and fat, and lower in sugars and starchy carbohydrates.
For those looking to eat healthily or lose weight, this diet might seem advantageous. It encourages eating fruit and vegetables and cutting out foods that are processed and high in sugar and salt. All this is positive.
However, cutting out dairy products and starchy foods, particularly wholegrains, means losing key sources of fibre, calcium and energy. This could affect your health in the long term.
As for weight loss, some people do lose weight on the paleo diet. By cutting out large food groups – especially sugary and processed foods – you’re likely to consume fewer calories (energy), but most fad diets aren’t a long-term solution because they
Read more elsewhere: Learning how the right diet can help you recover following a heart event is a key part of cardiac rehabilitation: turn to page 16 to find out more. Go online to bhf.org.uk/nutrition to read all of our nutrition articles.
Root of the problem
A fruity dilemmaQ I love avocados, but a
friend recently told me they are high in fat. Should I stop eating them?
Victoria Taylor says: Avocados are unusual among fruits because they are high in fat. This means they contain a higher amount of energy (calories) than other fruits and vegetables. At around 150kcal per half an avocado, compared with around 20kcal for a similar amount of broccoli or a small orange, their energy contribution must be taken into consideration if you are trying to reduce your weight.
levels of sodium, potassium and fluid should return to normal. However, if you have experienced any symptoms that may be triggered by liquorice, it’s important to let your doctor know, so he or she can make sure there is no other possible cause.
This doesn’t mean you should give them up, but if you want to eat avocado regularly, you will have to think about the rest of your diet a bit more carefully.
Compared with other high-fat foods, avocados are a healthy option. An 80g portion counts towards your 5-a-day and contains vitamins, minerals and fibre. The type of fat in an avocado is mainly unsaturated (specifically, monounsaturated), which, when eaten in place of high-saturated-fat foods, can help maintain healthy cholesterol levels. Olive and
rapeseed oil are other well-known sources of monounsaturated fats.
The creamy taste and texture that avocados have means they can feel indulgent to eat, but they are good substitutes for high-saturated-fat options that you might add to a salad, sandwich or toast, like cheese, butter or fatty meats. Mashed avocado works well on toast (you might like to try it with
some sliced tomato and a few fresh basil leaves, black pepper or a pinch of chilli powder). If you’re feeling adventurous, it can even be used instead of cream in puddings like chocolate mousse.
The adverse effects are due to glycyrrhizin, a compound found in liquorice root that is between 30 and 50 times sweeter than sugar and can alter your body’s levels of potassium and sodium, which help regulate body fluid. Too much glycyrrhizin can therefore lead to problems such as raised blood pressure, fluid retention, muscle weakness and heart rhythm abnormalities (arrhythmiaD).
The good news is that if liquorice has this effect on you, the changes are not normally permanent. Stop consuming liquorice and your
Call the Heart Matters Helpline on 0300 330 2333 for more information. To suggest a question, email [email protected].
How to get in touch
49
bhf.org.uk
A 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. Angioplasty A procedure used to widen a narrow artery. It involves temporarily inserting and infl ating a tiny balloon where the artery is narrowed in order to widen it and improve the blood fl ow.Atheroma Fatty material that can build up on artery walls. Sometimes called ‘plaques’.Atrial Fibrillation (AF) A common 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
C Cardiac arrest The ultimate medical
emergency, when a person’s heart stops pumping blood round their body and they stop breathing normally. Cardiac arrests in adults can be caused by a heart attack.Cardiac rehabilitation Sometimes 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.
Cardiopulmonary resuscitation (CPR) Actions performed to keep a person’s blood circulating around their body when they are in cardiac arrest. CPR consists of chest compressions (pumping the heart) and rescue breaths (infl ating the person’s lungs). Information on the Call Push Rescue programme can be found at bhf.org.uk/cpr. Cardiovascular disease (CVD) Includes all diseases of the heart and circulation, such as coronary heart disease and stroke.
Coronary artery bypass surgery An operation to treat coronary heart disease. Arteries from your chest wall and arm, or veins from your leg, can be used to bypass the blocked or narrowed coronary arteries. This helps to improve the fl ow of blood to your 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 atheroma.
D Defi brillator A life saving machine that can give the
heart a controlled electrical shock during a cardiac arrest.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. Having diabetes increases your risk of developing cardiovascular disease.
F Familial hypercholesterolaemia (FH) A genetic condition
that results in high cholesterol levels. Having FH gives you a higher risk of getting CHD.
H Heart attack The medical term for a heart attack is
a ‘myocardial infarction’, or ‘MI’ for short. This is when there is a sudden loss of blood fl ow to a part of the heart muscle. Most heart attacks are caused by atherosclerosis, which is the gradual build-up of atheroma within the artery walls. If the atheroma becomes unstable, a piece of it may break off and lead to a blood clot forming. This can block one of your coronary arteries, causing a heart attack and possibly irreversible damage to the heart muscle. A heart attack is a medical emergency and can lead to a cardiac arrest.Heart failure An inherited condition where the heart becomes less effi cient at pumping blood around. 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 there is too much in the blood, can increase your risk of getting cardiovascular disease – which
MEDICAL TERMS EXPLAINED
Call the Heart Matters Helpline on 0300 330 3300 if you want to know more
includes having a heart attack or a stroke.Hypertension The medical term for high blood pressure.
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 heart to contract and produce a heartbeat if required.
S Stent A short tube of expandable stainless-steel
mesh that is inserted into an artery to hold it open after an angioplasty, improving the fl ow of blood through the artery.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 fi brillation (VF) A life-threatening heart
rhythm that starts in the ventricles. This causes the heart to quiver or ‘fi brillate’ in a disordered way and the heart stops pumping blood around the body. This is 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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Talk to us
Heart Matters Helpline
are hard to stick to. Instead, make changes that can become everyday habits, while controlling your portion sizes.
So, while this diet is a good reminder of foods we need to eat more of, we don’t need to travel back in time to be heart-healthy. The trick is to pick the best elements and enhance these with our modern advantages.
Nowadays, our meals can be healthy without being restrictive. We can use modern grills, microwaves and non-stick pans to cook food quickly and healthily. We also have access to a wide range of foods, including healthy options like frozen fruit and vegetables, giving year-round variety.
There is still some way to go, but our diets have improved in the last 50 years. We have alternatives to saturated fats like butter and lard, such as unsaturated fats and oils, and have moved towards using lower-fat milks.
However, there are also downsides to our modern diet and lifestyle. We spend less time preparing and eating meals, and ready-to-eat products have increased in popularity. Convenience foods can save time, but they are often high in fat, salt and
sugar, and in many cases our portions of these foods have grown.
Looking at food labels can help you make healthier choices. Many manufacturers and retailers now use traffic-light labels on the front of packets, thanks in part to campaigning
by the BHF. They are easy to understand and can help you make a quick decision.
It’s important to take time to consider what we’re eating, pay attention to our
food and be conscious of how often we choose processed meals, fast foods and
snacks over healthy foods. Planning meals ahead and spending
time cooking at home, perhaps with family or friends – even just a couple of times a
week – can benefit not only our health but our overall wellbeing.
Dino dietsQ I’ve heard a lot about the ‘paleo diet’. Is it true that it’s healthier than the way we eat now and a good way to lose weight?
Q Could eating liquorice affect my blood pressure?
Victoria Taylor says: Black liquorice is one of those ‘love it or hate it’ foods. It’s available as soft and hard sweets, and liquorice root is found in some herbal teas, including chai and spice infusions and so-called detox teas.
Liquorice sweets that come dusted (or even crusted) in
salt are obviously not the best choice for your heart, but it’s generally safe to eat a small amount of liquorice every now and then. However, large and even moderate amounts of black liquorice (57g or around 2oz) can have negative physical effects when eaten daily, especially if you are aged over 40 and have a history of cardiovascular diseaseD or high blood pressureD.
Most fad diets aren’t a long-term solution”
Large amounts of liquorice can have negative effects when eaten daily”
31Heart Matters
MEDICAL
bhf.org.uk
vascular dementiaFocus on…
Tasks we take for granted, such as making tea, become a major challenge when you have vascular dementia. Dianne Campbell tells Senior Cardiac Nurse Christopher Allen about life with the condition
“It started with small things,” says Dianne Campbell, 48. “I couldn’t remember doctor’s appointments or to collect my prescription from the pharmacy. I’d be cooking and next thing
the kitchen would be filled with smoke because I’d forgotten about it. I’d take out the milk and wouldn’t put it back, then look in the fridge and it wasn’t there.”
Dianne’s moods became unpredictable too. “I was gradually becoming more aggressive and shouting at people all the time,” she says. “I’d just boil up and blare it all out. I shouted at my family members just because they were there.”
30
At first, she put her symptoms down to stress, age and fatigue. “My tiredness was through the roof and I couldn’t concentrate on anything at all,” she says. “I was so frustrated with myself. Everything I did, I just couldn’t remember. In the end, it was going from bad to worse, so I made an appointment with my GP, who did a memory test and then referred me for an MRI of my brain.”
In 2012, Dianne received a diagnosis of vascular dementia from a specialist.
Dementia diagnosisAll organs need a good blood supply. When blood vessels supplying the heart
become diseased, it leads to a heart attackD. When blood vessels in the brain are affected, this can lead to a loss of brain function either in the form of a strokeD, the symptoms of dementia or both. Dementia is an umbrella term for a group of conditions that affect how well the brain can function normally. This can include issues with memory, language and understanding. The most common forms are Alzheimer’s disease and vascular dementia, or a combination of the two.
Although Dianne is unusually young, her symptoms are typical of vascular dementia, as Peter Passmore, Professor of Ageing and Geriatric Medicine at Queen’s University Belfast, explains. “While vascular dementia can lead to issues with memory, mostly people will experience a greater challenge in what are known as ‘executive functions’,” he says. “These are tasks that involve planning what you’re going to do, how you’re going to do it, doing it
Dianne has adapted to life with dementia and gives talks to help others
Everyday tasks such as making tea can behard when you havevascular dementia
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32 Heart Matters bhf.org.uk
CV Professor Peter PassmoreProfessor of Ageing and Geriatric Care at Queen’s University Belfast≠ Research interests include neurodegeneration,
dementia, pharmacology and therapeutics in older people, and cardiovascular disease in older people
≠ Member of Portfolio Development Group at NIHR Clinical Research Network (Dementias and Neurodegeneration)
≠ Leads memory and cardiovascular disease clinics for older people in Belfast
properly and seeing the task through to the end. This could be anything as simple as making a cup of tea or dressing yourself properly and appropriately, through to more complex tasks like driving a car.”
Those who have vascular dementia resulting from a stroke may also experience personality changes. “This entirely depends on the area of the brain that’s been affected by the stroke, but in some cases it can lead to someone having little or no interest in anything at all,” explains Professor Passmore. “Some people may also have issues with central functions like bladder control or developing an abnormal gait when they’re walking.”
Living with dementiaWhile there are various treatments and medications licensed for use in people with Alzheimer’s disease, Professor Passmore says treatments for vascular dementia are currently under review. Many medications that may be of benefit aren’t specifically licensed for the condition. For Dianne, getting a diagnosis and time with an occupational therapist helped. “Finally I knew the reason why I was being so forgetful and becoming agitated with people,” she says. “My occupational therapist, Sarah, told me this was all part of the condition, but that with some support I’d be able to learn how to cope better. She was so supportive of me and helped me to get to know my brain again.”
Dianne has adapted by recognising that she can’t do lots of things at once. “I now do one thing at a time, finish it and then
start the next task,” she explains. “I’ve had to learn how to control it and try not to let myself get upset and frustrated, because that makes it worse. I have to try to relax and it will usually come back to me.
“Sometimes that’s hard, because I know there’s something I’ve forgotten and I can’t put my finger on it. That can really bug me. I’ll be cooking and forget what I’m making, or even how to make it. I even sometimes forget that I haven’t eaten.”
Supporting othersWhile Dianne’s had support from her occupational therapist, she is keen to help others living with dementia and spends much of her time providing peer support at the Kensington, Chelsea and Westminster Memory Service. “It really keeps me motivated and I find it very therapeutic,” she says. “Most of the people there have Alzheimer’s. They’re the most humorous, witty and funny people! They’re comfortable around me too, because they know I have dementia as well.
“A lot of them feel they can ask me questions they’re too ashamed or embarrassed to ask healthcare professionals. I’m more comfortable around
Vascular dementia explained
Q What is vascular dementia?
A When blood vessels supplying the brain become diseased, this can lead to a loss of brain function in the form of a strokeD, the symptoms of dementia or both.
Most people affected by vascular dementia find ‘executive functions’ more challenging. These are tasks that involve planning what you’re going to do, how you’re going to do it, doing it properly and seeing the task through to the end.
Q Is there any way to prevent vascular dementia?
A It is widely accepted that risk factors for cardiovascular diseaseD contribute towards both vascular dementia and Alzheimer’s, but we need to do more research to understand
Professor Peter Passmore answers common questions about vascular dementia
the reasons behind this (see below). Everyone who has vascular dementia will have at least one risk factor for cardiovascular disease.
Taking control of risk factors for cardiovascular disease may help to reduce your risk of developing vascular dementia, but we don’t know for certain.
Q What support is available?
A There is no reason why people with vascular dementia shouldn’t receive the same support as those with any other dementia diagnosis. Some people will need assistance or adaptations at home as their condition progresses, such as walk-in showers or grab rails.
You are entitled to an assessment to see if these services are suitable for you.
We’re co-funding a groundbreaking clinical trial of a common blood pressure medicine that, if the trial is successful, could become the first treatment for vascular dementia.
The four-year trial, which began in January 2014, will cost £2.25m. We’re funding half of that cost alongside the Alzheimer’s Society.
High blood pressure is a major risk factor for vascular dementia. Researchers think the drug amlodipine, which treats high blood
pressure, may alleviate vascular dementia symptoms.
Researchers, led by Professor Peter Passmore, hope to show that 10mg of amlodipine a day can significantly improve memory and cognitive health.
There are currently no available treatments for vascular dementia. It affects about 150,000 people in the UK, and people with coronary heart disease or related risk factors are especially at risk. It can also be triggered by a stroke.
Funding research into vascular dementia
33
them too, because when I make a mistake around other people, I think: ‘Will I be judged?’ With people who have dementia, they just laugh, because they understand.”
Recently, Dianne gave a talk to the Alzheimer’s Society in Brent, where she lives. “The chairs were packed out and I think people enjoyed it; they asked loads of questions,” she said. “It was mostly people with dementia and their carers; I think they loved it, because I could actually answer their questions because I’m going through it too. It puts them at ease. I’m not much of a speaker. I prefer it when people interview me and ask lots of questions, then you can’t stop me!”
Creating a better futureDianne also sits on the board for the Brent Dementia Strategy Group. She wants to make Brent a ‘dementia-friendly borough’ by talking about her condition. Talking has also helped Dianne come to terms with her diagnosis. “It’s good for me to talk about my vascular dementia,” she says. “I wouldn’t have it any other way. When I finally started talking about it, I accepted it wasn’t going anywhere. When I talk about it, I’m not hugging it and wrapping myself around it, I’m setting it free. I’ve learned to love my vascular dementia, and when you love something, you should set it free.
“Society needs to understand it. We can’t look at people like they’re losing their marbles anymore.”
I’ve had to learn how to control it and try not to let myself get upset and frustrated”
Information and resources on dementia and related issues are available from:≠ Alzheimer’s Society – 0300 222 11 22, alzheimers.org.uk≠ Age UK – 0800 169 6565, ageuk.org.uk≠ The Silver Line – 0800 4 70 80 90, thesilverline.org.uk≠ You can ask for support from your GP and other healthcare professionals.
Find free support
Later, you may need carers one or more times a day. Assessments are usually carried out by social services, physiotherapists and occupational therapists. You may also consider whether attending a day centre or respite care would benefit you or those caring for you.
Ask your GP or local social services department about how to access these services.
Some people will need assistance or adaptations at home”
Peer Support Project Lead
Helen, right, helps Dianne
prepare for her talks
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35bhf.org.uk
RESEARCH
34
For as long as she can remember, Dr Danielle Paul has been fascinated by science. “My mother was a research
physicist,” she says. “The thought of becoming a scientist seemed natural, but if you’d asked me back then what I wanted to be, I would probably have said a doctor.”
She discovered a passion for physics, completed a physics undergraduate degree and then began a BHF-funded PhD looking at cardiac tissue under the microscope. “It seemed an interesting application of physics and biological techniques,” she says.
Heart muscle in 3DUsing specialist microscopes that use electrons instead of light, Dr Paul examines proteins within heart muscle. “We’re looking at the molecular structure through a microscope and building a picture of how, at that level, the heart muscle is functioning in a relaxed and an active state,” she says.
Dr Paul uses these images to create 3D ‘molecular movies’ of how the heart functions normally and when it is diseased. “There are some amazing operations where a part of the heart tissue is removed to remould the heart. In cardiomyopathyD, one of the treatments has been to shave part of the heart away, because it improves the function of the heart. That is one possible source of tissue for us to examine.”
Dr Paul is specifically interested in proteins that regulate muscle contraction and attach to structures in the heart tissue called actin filaments. “The images we
obtain are used to make 3D maps of the proteins we are interested in,” she says. “We can evaluate and interpret those maps by using other available information, a bit like fitting pieces into a three-dimensional jigsaw puzzle. We use known structures of actin to help identify the proteins that we are interested in.
“Our 3D maps are deposited into online databases which are freely accessible so that any researcher can download one of our maps and see if it agrees with their research.”
A revolutionary approachImaging techniques are constantly advancing, something Dr Paul is especially conscious of, having taken a career break.
In April 2012, she decided to take time out to spend with her newborn daughter, Hadley (now three), and her son, Harrison, who was aged two at the time. “It was a big decision, but it was important to me. Although it was a long break, I was staying in touch with my colleagues, so while it was time out, it was a step to the side,” she says.
£207,979BHF Career Re-entry Research Fellowship funds three years of Dr Paul’s work
In the two-and-a-half years she’s been away, there’s been a revolution in electron microscopy. “Within the field, they had what was called the cryo-EM revolution. While I was out, I missed the revolution, but I am profiting from the advances,” says Dr Paul. “There is a whole new breed of detectors for the microscopes and advances in the processing software. This has all come about in the past two to three years and to be able to learn from that is great.”
The University of Bristol, where Dr Paul now works, is planning to apply for funding for an electron mini-microscope that uses this technology. Dr Paul’s post is funded by a BHF Career Re-entry Research Fellowship. The grant of £207,979 over three years pays for her salary and equipment.
“As I’d had two years out of science, not in an academic position, I was eligible for the re-entry fellowship,” she says. “The BHF has supported me throughout my career. My PhD was BHF-funded, and during my post-doctoral years I received project grants. It’s great to continue that relationship.”
Career aspirationsDr Paul believes building a structural picture of heart muscle at a molecular scale could help inform new drug design and would love to set up a research group to explore this further. “The beauty of looking at things through an electron microscope is that you can actually see what’s happening and where drugs bind,” she says. “I would love to have a small group of PhD students and post-docs to explore the effects of drugs on muscle tissue and see what cardiovascular drugs are doing at the molecular level.”
She’s also hoping to team up with a colleague who is being funded by the BHF through an Intermediate Research Fellowship. Together they will use her established techniques to look at the detailed structure of zebrafish hearts, a collaboration that’s come about because of their shared relationship with the BHF. Dr Paul has a message for all our supporters: “We couldn’t do it without them. Everything we do is reliant on the BHF.”
Help the BHF. Donate now. 0300 330 3322* or bhf.org.uk/donate*Cost similar to 01 or 02 numbers
Scoping it out
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Although it was a long break, I was staying in touch with my colleagues”
Heart Matters
Following a planned career break, Dr Danielle Paul is back studying heart muscle under the microscope. She talks to Sarah Kidner about her work and her ambitious plans for the future
37bhf.org.uk
RESEARCH
36
“Roughly 50 per cent of my time I’m a heart surgeon, and the other 50 per cent I’m doing research,” says Professor Raimondo Ascione. This balance makes him the ideal head of a new multimillion-pound
Translational Biomedical Research Centre (TBRC) in Langford, near Bristol. We’re funding it alongside the University of Bristol and the Medical Research Council. Its role is to get research out of the laboratory, to a point where patients worldwide can access groundbreaking treatments as quickly as possible.
Translational medicine aims to take lab science performed ‘in vitro’ – in a test tube or on cells or molecules outside of the body – and prove it has positive healing effects on a whole living organism. If so, it can be considered for human trials.
Prior to human trials, some treatments are tested in animals, but only when there’s no other way to confirm they are safe and have beneficial health outcomes. Researchers use experimental models that are relevant to human disease and anatomy, and perform the tests in state-of-the-art translational facilities, such as the TBRC. “The UK has world-class science and a strong NHS research setting but lacks a bridge between these two worlds, which the TBRC can provide,” explains Professor Ascione.
Welfare stateWhile animal research is critical to the centre, animal welfare and full adherence to Home Office
£998,912from the BHF will fund the TBRC and a catheter lab
regulations are fundamental considerations. The TBRC is strategically housed at the University of Bristol Langford Campus to benefit from its world-renowned expertise for research on animal welfare. The centre will also benefit from clinical and academic veterinary expertise on site and a state-of-the-art imaging scanner and catheter labD, allowing researchers to take repeated scans of living animals. This will help scientists test new treatments to NHS standards and significantly reduce the number of animals required.
“It is no longer necessary to perform experiments on multiple animals that would be put to sleep at different stages to see the effect of an intervention,” says Professor Ascione. “In our centre, a procedure done on a single animal can be tracked, non-invasively, over time, just as we do in NHS patients, using sophisticated scanning techniques. Given the on-site veterinary and animal welfare expertise, we can be sure that the animals are treated with the same care and sensitivity as human patients.”
There’ll also be a biobank on site – a long-term store for cells collected post-mortem that will reduce future need for animal tissue samples. “We’ll keep stem cells, spare eggs and tissues alive for 20 years or longer, just as it is done in the NHS,” says Professor Ascione. “By storing them in this way, we can reduce the number of animals necessary for our research.”
Bridgingthe gapA new centre will take lab research into hospitals, where it benefits patients. Professor Raimondo Ascione talks translational science with Sarah Kidner
Heart Matters
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Professor Ascione will leada new translationalresearch centre in Bristol
Often, we share the same problems as animals”
39bhf.org.uk38
≠ Living with heart failure≠ One step at a time – living with heart failure (DVD)≠ Inherited heart conditions: Arrhythmogenic right ventricular cardiomyopathy
≠ Inherited heart conditions: Hypertrophic cardiomyopathyVisit bhf.org.uk/HMpublications or call 0870 600 6566.
Free support from the BHF
The TBRC will follow the One Health initiative to benefit people, animals and the environment. Research done here will improve the lives of many animals. “Often, we share the same problems as animals –
tumours, clots and blockages. Veterinary clinicians and scientists, with NHS doctors, will undertake research at the TBRC to develop new methods to treat pets,” says Professor Ascione. “Often, this is a simple case of adapting treatments already established in humans.”
Deep impactProfessor Ascione moved from Italy to the UK in the 1990s and has since experienced moving his own research into practice. In 1998, he and BHF Professor Gianni Angelini explored the benefits of conducting heart surgery without a heart-lung machine. This is now a routine procedure in the NHS and worldwide.
By studying new medicines and techniques in human
cells in the lab first, before carefully trialling the most successful ones in animals, we’ve done all we can to make sure they’re going to be effective and safe for treating patients. For example:≠ Potential new heart medicines that work on human cells in the lab must be assessed in a living system before trials in patients can be carried out.≠ Animal studies can reveal problems with new treatments, allowing
dangerous side effects to be spotted before clinical trials.≠ Current research includes studying how the heart develops in mice and fish, so we can better understand why babies are born with heart defects.
The research community is constantly developing new techniques to reduce the number of animals needed. Scientists we fund carry out as much research as possible on human volunteers, cells or computer models.
However, until we find an alternative method that can
reproduce the complicated working of our hearts and circulatory systems, replacing all animals in research is not yet possible.
The three RsWhen deciding what research to fund, every grant application we receive goes through an exhaustive independent peer review system. This ensures all BHF-funded scientists follow a clear set of principles – the three Rs – to reduce the number of animals used and to maximise their welfare:
≠ Replace with non-animal alternatives where possible.≠ Reduce the number of animals used.≠ Refine the care of animals to achieve the highest welfare standards.
When researchers we fund carry out studies in animals, they are done in line with strict Home Office guidelines. Our research has led to life saving medical advances for heart patients over the past half-century. But we can do even more and, for the foreseeable future, that will involve animal research.
Research involving animals
Currently, Professor Ascione is working on two world-first trials (funded by the BHF and the National Institute for Health Research) exploring the use of stem cells derived from the patient’s own bone marrow to repair hearts after a heart attackD. Results are being analysed and will be made public soon. This type of work will be helped greatly by the Bristol facility.
Others at the centre are making great strides too. “I’m the TBRC Director, but there is a national network of about 120 scientists spanning NHS trusts, academic institutions and veterinary science and practices, many with a strong cardiovascular interest,” he says. “There is cardiovascular research work already funded by the BHF, Medical Research Council and other top UK charities waiting to be undertaken at the TBRC.
“I regard myself as lucky to sit as the interface between the university, the NHS and the veterinary worlds, acting both as a researcher and as a facilitator of new cross-fertilising academic partnerships. Ultimately, I like to do heart operations that make a difference to people’s life expectancy and quality of life. That’s what this centre is all about.”
Troubled by constant exhaustion, Richard Mindham put it down to the pressures of work. His job selling
and managing for a software organisation demanded extensive travel to the Middle East and Africa. He was spending more than 240 days of the year abroad. “My private life had been subsumed by my job,” says Richard, 58. “I decided to make a change.”
At the same time, Richard’s wife Bridget, 53, took a sabbatical. Observing a lethargic Richard sitting at the kitchen table “day after day”, she asked him to see a doctor. Richard’s GP referred him to a cardiologist in September 2007, who performed an echocardiogramD. This showed that Richard had heart failureD as a result of a previously undiagnosed underlying condition, dilated cardiomyopathyD.
Knowledge is powerRichard describes his diagnosis as devastating. “We were going to go cycling in Argentina and Chile over Christmas, but the cardiologist told me: ‘You’re not going on that holiday; you’re not going very far from this hospital until I see some significant improvement,’” he says. “It seemed everything had changed. It hit me that I might need a heart transplant and that I’ll be on drugs for the rest of my life.”
Part of Richard’s way of coping was to arm himself with as much information as possible about his condition. He put himself forward as a patient representative for the NICE guideline for chronic heart failure and joined a patient group of people living with heart failure at Royal Brompton Hospital’s research centre.
“We are introduced to trials and review them and make any recommendations that may have a bearing on a patient’s involvement in a trial or similar. For example, we recommended that where people are invited to multiple sessions at the hospital, they try and structure the
Trials and tribulationsA heart failure diagnosis led vegan Richard Mindham to question his attitudes to animal research
sessions in a sequence so that people go straight from one to another and aren’t waiting around in corridors.”
Clinical trialThe Royal Brompton asked Richard to sit in on a clinical trial it is running jointly with the BHF, exploring how chronically weakened heart muscle may be improved in people with heart failure. Through this, Richard learnt that previous investigations, which had made this trial possible, involved animal testing. It prompted him to consider his attitudes.
“I come down on the side of it being acceptable to use animals in research, providing their treatment is compassionate and seeks to avoid suffering and where the use of higher species is minimised,” he says. “I can accept the use of animals where remedies are sought for diseases that cause considerable distress to humankind.”
Recently, Richard spoke about his concerns at an open day at Imperial College London, where he says he learned more about animal testing. Richard believes research is fundamental to the fight against heart disease. “It challenges your view of things if you’re taking a tablet and, potentially, research involving animals has been involved in the preparation of that tablet,” he says. “If I’d been born 15 years earlier, I might
not be benefiting from the medicines I’m on now.”
The medications he takes allow Richard to manage his condition well. “I did go on that cycling holiday, five years later, and I go skiing,” he says.
He’s also completed a cycle ride from Land’s End to John O’Groats with Bridget and describes his current life as “great”.
It is no longer necessary to perform experiments on multiple animals”
Richard recently cycled from Land’s End
to John O’Groats
Heart Matters
41
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Chris, centre, is 50 yearsolder than the youngest member of his team
Game
bhf.org.uk
Chris Courtenay Williams, 71, is a dedicated football player. Since 1977 he’s played up to three games a week. Every Wednesday evening, you can find him engaged in some serious five-a-
side at the Northgate Arena in Chester. “I used to play upfront because I was
quite a prolific goal scorer, but as I’ve got older I’ve moved further back,” says Chris. “I’m happy to play at the back – I’m quite a good goalkeeper – but I like to sneak up front now and again.”
He plays all year round, and has only had two significant absences in 38 years. One was for eight weeks, while he waited for a cracked rib to heal. More recently, Chris had a six-week break following a heart attackD in March 2011.
“The one thing I was most bothered about when I had the heart attack was that I wanted to get back to playing football,” says Chris. “I knew that once I returned to football, my life was back to normal.”
Time outBack in early 2011, Chris was putting in long hours working from home; the demands of his job were causing him stress. When he started experiencing chest pain one afternoon, he feared he knew what was happening. He called an ambulance for himself and was taken to the Countess of Chester Hospital, before being transferred to Liverpool Heart and Chest Hospital to have a stentD fitted.
Chris began attending cardiac rehabilitationD, consisting of a weekly physical activity class and talks about heart health (read more about cardiac rehabilitation on page 16). The classes started gently, with activities including 10 minutes of slow walking on a treadmill.
Chris began to feel frustrated with the pace. “I felt like I wasn’t testing myself. I started to do, say, half an hour on the rowing machine,” he says. “I didn’t really want to wait the 12 weeks before going back to football because of my age. I felt I would just stiffen up and it would be harder for me.”
Staff at the rehab programme monitored Chris closely and promised to let him know when he could return to the pitch. “I can’t complain about the treatment I got,” he says. “It was absolutely brilliant; I really can’t fault it.”
Although Chris was keen to push himself physically, he found that the loss of confidence that can often accompany a heart event was challenging. “When you’ve
All the lads celebrated with me... it was a bit emotional”
ACTIVITY
When Chris Courtenay Williams had a heart attack, he feared he’d have to quit his favourite game. He tells Rachael Healy how he got back on the pitch
CHANGER
had a heart attack, the first thing about it is that it’s very inconvenient. It gets in the way of your life, and I really wanted to get back to doing everything I normally do. I didn’t want to be sat in a chair, thinking: ‘I’ve had a heart attack; that’s the end of my life.’”
Once he’d been discharged, Chris had tried to resume everyday activities. “Less than a week after I’d got out of hospital, I went into the garden, started digging and, I must admit, I felt like I’d overdone it,” he says. “I came in the house and sat down; my wife wasn’t very happy. I did realise I’d have to take it a bit easier.”
He was still determined though, and began working on his fitness with the help of his friend John Danby, a fellow footballer and personal trainer. “I used to see him once or twice a week and he was brilliant with me,” Chris says. “I was with him a year and he was so much help to me. He would get me doing exercises, weights, running – I’d do a bit of everything and it really helped me get my confidence back.”
40 Heart Matters
≠ Have you been prescribed statins? Our experts answer some common questions about different types and their benefits, uses and potential side effects at bhf.org.uk/drugcabinet.≠ To order one of our free booklets, call 0870 600 6566, or visit bhf.org.uk/HMpublications. Heart attack tells you all about this heart event, while Keep your heart healthy offers advice on positive changes you can make to your lifestyle to reduce your risk of developing certain heart conditions.
Free help from the BHF
“I’d like to thank my wife and family, and the BHF for their support, the NHS for the wonderful treatment I had, and John, my friend and personal trainer, who did help me such a lot,” Chris says. “My advice to anybody who has had a heart attack is not to simply think that that’s the end. Life can continue on normally afterwards.”
With thanks to Chester Football Club and the Northgate Arena.
I wanted to get back to doing everything I normally do”
0300 333 2333Call the Heart Matters Helpline
Talk to us
Heart health questions?Heart Matters Helpline
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Call rates are similar to 01 and 02 numbers. Lines are open 9am to 5pm, Monday to Friday
I think I even scored two or three goals as well,” he says. “I celebrated and all the lads celebrated with me, which was nice because they knew how much I loved it. They all said they’d missed me, so it was a bit emotional.
“I’m the oldest on the team now, and I’ve seen lots of players come and go. Currently we have two players who are 50 years younger than me.
“We’re just a group of lads who organise a game every Wednesday. We turn up, pick two teams and play. There’s no larking about, though; we do play very seriously. We get some good games and I don’t get any special treatment, I can tell you!”
Chris is playing football weekly again. He’s still working from home too, but now he gives himself a break and fits in some physical activity every day, strolling uphill to the local shop at lunchtime.
He’s grateful to everybody who helped his recovery and wants to let others know that life doesn’t always get worse after a heart attack.
Chris’s risk of heart attack had been increased by raised cholesterol levels, so he began a new medication regime and planned a new, heart-healthy diet. “At the time of my heart attack, my cholesterol was above the normal level, at 8mmol/L, so I have to take statins every day,” explains Chris. “I don’t like having to take them because of the side effects – they give you bad dreams and interfere with your bowel movements – but it is one of the hazards of having high cholesterol.
“I was on quite a lot of tablets just after I’d had the heart attack, but now I’m just down to statins and an aspirin a day. I’m also more conscious of my diet now. I’m very careful with what I eat – I don’t eat as many crisps and I’m very wary of eating too many fatty things.”
Back in the gameBefore long, Chris’s efforts were paying off and he was told he could return to his weekly five-a-side game. “After six weeks, I played with no side effects and
Go online Inspired to get moving? Read more stories at bhf.org.uk/activity.
42 Heart Matters
4544 Heart Matters bhf.org.uk
ACTIVITY
Moving more often can help you avoid a range of health conditions, including
coronary heart disease (CHD)D. Regular movement helps control weight and reduce your blood pressure and cholesterol. If you have a condition already, it can help you manage it.
As you age, being active helps maintain independence, prevent falls and delay onset of conditions such as osteoporosis. It also lowers risk of dementia, can improve quality and quantity of sleep, how you look and feel, and ability to cope with stress. The more active you are, the bigger the benefits.
There are simple steps we can all take to gain these benefits. The first is to move more every day; any amount of activity is better than none. Start by being active for at least 10 minutes per day at a moderate intensity. Try walking, dancing, swimming or gardening. If you are progressing well, build up to 150 active minutes a week.
Activities involving strength and balance will help improve mobility. Doing simple activities, like the ones in this article, at least twice a week in addition to your daily physical activity, can help you stay strong and balanced. They can be incorporated into your daily routine. For example, try some Ill
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Lisa Young’s
Keeping active will help you maintain your independence. Try these 10 simple activities to improve your strength and balance
STRENGTH BUILDING
knee bends while waiting for the kettle to boil.
Muscle-strengthening activities usually make muscles feel warmer and you may get a ‘shake’ or ‘wobble’ during the activity. The next day, you will feel as if the muscles have been used. Strength activities include climbing stairs, tai chi, heavy housework or gardening.
Balancing activities usually make you concentrate on staying upright. They include dancing, tai chi, bowls and exercise classes that include standing and moving.
≠ Paths for All These exercises were adapted from the Otago exercise programme by Paths for All, a Scottish charity promoting everyday walking as a way to a happier, healthier nation. It delivers community health walks, workplace walking and improvements to the walking environment. Visit pathsforall.org.uk/strength.
10 activities to try at home4 Knee bends
Facing a bench or table, place your feet shoulder-width apart. Squat down about 10cm (4in) by slowly bending your knees. Return to starting position. Keep your back straight and don’t push your knees out beyond your toes. Again, repeat five times, building up to 10. Hold each squat for longer as you become stronger. Knee bends strengthen muscles in your hips and thighs, improving balance. This will help you climb stairs, bend and walk.
5Calf raises with supportStand tall facing a bench or
table with your feet hip-width apart. Slowly and with control, raise your heels off the ground. Hold for a slow count of three, then lower your heels back to the ground. Repeat five times, building to 10. As your balance improves, try this activity without holding onto the table. This exercise strengthens calf muscles and toe joints, making activities such as reaching high cupboards and hanging out washing easier.
3Sit to standSit on the front third of
a chair. Put your feet flat on the floor and then slide them back slightly. Lean forward over your knees, keeping your head and shoulders high, and push up through your heels into a standing position. Try not to use your arms. Sit back down slowly. Repeat five times, building to 10. This exercise will help you to get in and out of chairs more easily.
6Toe raises with supportStand tall facing a bench
or table with your feet hip-width apart. Hold onto the bench and come back onto your heels, raising the front of your feet off the floor. Lower your toes back down. Keep your body as straight as possible throughout. Repeat five times, building to 10. As your balance improves, try this activity without holding onto the table. This activity strengthens your lower leg muscles, making it easier for you to step backwards.
2 Back-knee strengthenerStand up straight in front
of a bench or table. Bend one knee, bringing your foot slowly towards your bottom and hold for a slow count of three. Keep the knee of your bent leg slightly behind the knee of the straight leg. Slowly return to starting position. Repeat five times with each leg. Build up to 10 times per leg. Both of these knee exercises strengthen the large muscles in your thigh that help you stand up and sit down. Developing these muscles will help with walking and climbing stairs.
1Front-knee strengthenerYou can do this activity while
watching TV or listening to the radio. Straighten your leg out, lift it an inch, hold for a slow count of three, and then slowly lower it. Repeat five times with each leg. Build up to 10 times per leg. If you want to test yourself further, try sitting away from the back of the chair, keeping a straight back.
Being more active helps you maintain independence”
Watch now Our expert demonstrates strength activities, at bhf.org.uk/strengthexercises.
Maintaining yourtools will make
gardening easier
4746 Heart Matters bhf.org.uk
ACTIVITY
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Autumn can be a tricky time in the garden, but there’s still plenty to do to keep you ticking over
One day it is August and still summer, the next brings deep earthy
aromas, mists and silver light. All the seasons come in a day. Those of us with heart failureD need to wrap up warm, keep covered from the rain and stay inside when the north wind blows – but I’ll still be tending the garden.
Paul’s autumn tips1 Roll out the barrow
Now is a good time to start the long job of moving plants in pots to their overwintering point. What I do is get someone to bring the wheelbarrow to the patio, and slowly – even if it is only one plant a day – pop them into the barrow. I start with those destined for the greenhouse. When the wheelbarrow is full, I get
help moving them to the greenhouse and arrange them by the door ready for October (or later), when I will pop them inside for the winter.
2 Life is sweetI always sow sweet peas in October, so September is spent searching the seed catalogues. They are sown in modules and then left in an unheated greenhouse or a cold frame until they are planted out in
April. You always get the best sweet peas this way.
3 Crop clearanceClearing crops such as potatoes can be tricky, especially if you have trouble digging. You can prepare far in advance to make this task easier. When planting out (next year now), simply create a shallow scratch in the soil by hoeing, lay your seed potatoes in this and then cover them with straw. On top of the straw, add more soil. As
the plants grow, add a little more straw and cover with soil again. Then, when it comes to harvesting, you just need to rake the soil down and collect your potatoes.
If your potatoes are in the ground, as mine are, I tend to dig them up while sitting down. I use a good stout trowel, and scrape in a circle around the plant until my trowel won’t go any further. I then chip away at the central mass, exposing the potatoes.
9 Toe walking with no supportStand tall and look ahead.
Slowly come up onto your toes. Walk 10 steps forward while up on your toes. Lower your heels and turn around. Stand up on your toes again and walk 10 more steps. You can use a wall or railing to support yourself, if necessary. This activity can improve balance, making tasks such as reaching high shelves easier.
8 Sideways walkingStand up tall with
your hands on your hips. Take 10 steps to the right, pause, then take 10 steps to the left. You can use a wall or railing to support yourself, if necessary. This activity will improve your sideways movements.
10Heel walking with no support
Stand tall and look ahead. Come back onto your heels (as in activity six). Make sure your body stays straight; do not stick your bottom out. Slowly walk 10 steps on your heels. Lower your toes and turn around. Come back onto your heels and take 10 more steps. You can use a wall or railing to support yourself, if necessary.
7 Side hip strengthenerStand side-on to a bench or
table. Place the nearest hand on the bench and slowly lift the opposite leg out to the side. Hold for a slow count of three and then return to starting position. Keep your body upright and only move your leg. Repeat five times for each leg, eventually building to 10. This strengthens hip muscles, helping with stepping up onto kerbs and steps.
For more information on staying active, download or order one of our free resources:≠ Be active for life≠ 10 minutes to change your life – time to get moving≠ Get up and go (DVD)Visit bhf.org.uk/HMpublications or call 0870 600 6566.
Free help from the BHF
The more active you are, the bigger the benefits”
Top tipI have a cultivator on a long pole. It has a rotating series of heavy-duty spikes at the end. You roll this back and forth over the soil and it creates a good tilt. It’s a bit like a hoe, only it takes less out of the arms as you are not doing any lifting, just rolling. Sometimes I don’t move my arms at all, I just sort of wobble!
It takes longer, but I only do one plant’s worth at a time.
4 Show moss who’s bossYou can do some preparatory jobs for the winter now. Clearing your greenhouse of moss is a good start. Moss grows in the cracks, between the glazing and in the gutters. It isn’t a problem until it dries out, then on the first downpour it swells enough to crack glass and even bend the frame.
5 Ace of spadesNow’s a good time to sharpen the tools you won’t need again until spring. Spades in particular must be sharp – it is amazing how much more effort is needed to dig with a blunt spade. Give it a clean, a coating of oil using a rag and a bit of three-in-one, then sharpen the cutting edge with a metal file. You don’t want it to be razor-sharp, but you do need a definite edge.
Clearing your greenhouse of moss is a good start”
Paul Peacock’sCHANGINGTIMES
4948 Heart Matters bhf.org.uk
AAngina Angina is 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.Angiogram X-ray pictures that show whether the arteries are narrowed and, if so, how narrow they have become. A coronary angiogram examines the coronary arteries.Angioplasty Procedure to widen a narrowed artery. It involves temporarily inserting a catheter and inflating a tiny balloon at the narrowing to widen it and improve blood flow.Arrhythmia An abnormal heart rhythm. 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.
B Bypass surgery See coronary artery bypass surgery.
Beta-blockers A medicine prescribed to reduce the amount of work the heart has to do, by slowing the heart rate and reducing blood pressure.
CCardiac arrest The ultimate medical emergency, when
a person’s heart stops pumping blood round their body and they stop breathing normally. Cardiac arrests in adults can be caused by a heart attack.Cardiac 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 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.Catheter lab A room in a hospital where diagnostic procedures and treatments can be carried out on the heart. These may include an angiogram and pacemaker implantation.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 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.
EEchocardiogram Sometimes called an ‘echo’. This is an
ultrasound to examine the structures within the heart, such as heart valves, and to see how well the heart is pumping.Electrocardiogram (ECG) A simple, painless test to record the heart’s electrical activity. Small sticky patches (electrodes) are put onto your arms, legs and chest. These are connected to a machine that picks up and records the electrical signals of your heartbeat.
H HDL HDL stands for ‘high-density lipoprotein’. HDL
is commonly known as the ‘protective’ or ‘good’ type of cholesterol. It returns the extra cholesterol, that isn’t needed, from the bloodstream to the liver. So HDL removes the ‘bad’ cholesterol from the bloodstream rather than depositing it in the arteries.Heart 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 gradual build-up of atheroma (plaque) within artery walls. If the atheroma becomes
MEDICAL TERMS EXPLAINED
Call the Heart Matters Helpline on 0300 330 2333 if you want to know more
unstable, a piece may break off and lead to a blood clot forming. 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 is 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.
L LDL LDL stands for ‘low-density lipoprotein’. LDL is
commonly known as a ‘bad’ type of cholesterol. It carries cholesterol from the liver, through the bloodstream, to the cells of the body.
S Stent A short tube of expandable stainless-steel
mesh that is inserted into an artery to hold it open after an angioplasty, improving the flow of blood through the artery. Stroke An interruption of blood flow 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.
DICTIONARY
Terms and conditions All entries must be received by midnight on 30 October 2015. The promoter is St Mellion International Resort. Entrants must be UK residents, aged 18 or over. Only one entry per person. All BHF and St Mellion International Resort employees, associates and direct suppliers are ineligible to enter. Only the winners will be notified. There are two prizes. The prize is based on two adults sharing a standard double/twin room, must be taken by 30 May 2016 and is subject to availability. The prize is non-transferable and non-refundable and there is no cash alternative. The promoter reserves the right to change the prize or cancel the draw at any time. Entry denotes acceptance of these terms and conditions.
St Mellion International Resort is set in 450 acres of beautiful Cornish
countryside, near the seaside towns of Looe and Polperro.
This four-star hotel has a fabulous indoor leisure complex, featuring three pools, spa facilities and a full-scale health club. Outdoors there are tennis courts and two championship golf courses, including the UK’s first Jack Nicklaus-designed signature course. Whether you prefer swimming, tennis, golfing, keeping fit in the gym or a bit of everything, this is the perfect active break in luxurious surroundings.
We’ve got two superb two-night breaks for two people to give away, each worth £500.
The lucky competition winners will receive:≠ luxurious accommodation in a superior room
How to enterTo be in with a chance of winning, send your name, address and telephone number to Heart Matters/St Mellion International Resort prize draw, Freepost RTCH-BXUB-XCTU, 2A Halifax Road, Melksham SN12 6YY or email [email protected] by midnight on 30 October 2015.To find out more about the hotel, visit st-mellion.co.uk.
WIN!
Reader offerEven if you are not one of our lucky winners, you could still save 30 per cent on a relaxing break at the St Mellion International Resort.
You will pay just £108 per person for a two-night stay in standard accommodation, based on double occupancy. This includes breakfast and one evening’s dinner at the resort’s brasserie restaurant (excluding drinks).
You’ll get complimentary use of all of the excellent health and leisure facilities.
Plus, enjoy a 15 per cent discount on spa treatments when you book them in advance.
This offer is based on two adults sharing a double/twin Resort Room, is valid for stays before 23 December 2015 and is subject to availability of allocated rooms at time of booking. Guests must be 18 or over. A single supplement applies.
To book your stay, call 01579 352 001 and quote ‘Heart Matters’.
≠ full English breakfast each morning≠ dinner in the brasserie each evening ≠ full use of the leisure facilities, including the pool complex, gym and tennis courts≠ a choice of two personal training sessions, with a health check before you start, or two individual spa treatments.
The hotel provides a fresh alternative to more traditional resort accommodation in the West Country, with a unique blend of contemporary style, exceptional facilities, true golfing heritage and wonderful Cornish hospitality.
The highly skilled spa team works with luxurious Elemis treatments and offers a complete range of products to complement your experience.
The resort, within easy reach of the A38, is perfect for a relaxing break or exploring
AN ACTIVE SPA BREAKIN CORNWALL
the dramatic and stunning Whitsand Bay and the famous Cornish north coast surfing beaches. The world-famous Eden Project and the culinary delights of Padstow and Rock are also nearby.
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 (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 who want to know more about high blood pressure. It explains what high blood pressure is, why it is so important to control high blood pressure, what you can do to help and what medicines are used to treat it. Includes case studies throughout. Order code: HIS4
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Blood pressure
40g (1½oz) fresh wholemeal breadcrumbs2 tbsp chopped fresh mixed herbs, such as parsley, chives and tarragonFinely grated zest of ½ small lemon
Freshly ground black pepper, to taste4½ tsp olive oil2 fairly thick-cut sustainable skinless white fish fillets (about 140–175g/5–6oz each)Lemon wedges, to serve
Baked fish with herby lemon crust
Preparation time: 15 minutesCooking time: 12–15 minutesServes 2
1 Preheat oven to 220°C/200°C fan/gas mark 7. Put breadcrumbs, herbs, lemon zest, black pepper and 4 teaspoons of the oil in a bowl and mix together well.
2 Arrange fish fillets in a shallow ovenproof dish. Divide the breadcrumb mixture between the fillets; gently press
mixture over top of each fillet to form a tightly packed crust. Drizzle over remaining oil.
3 Bake in oven for 12–15 minutes or until fish is cooked and crust is deep golden and crisp. Serve immediately with lemon wedges, new potatoes, carrots and green beans or peas.
Ingredients
Method
“Swap fresh white breadcrumbs for the wholemeal breadcrumbs.”
Anne SheasbyOur resident food writer Anne has had more than 26 cookery books published covering bread, soup, vegetarian meals and more.
Anne’s tip
23%
Each portion contains:
Sugars0.7gLow
Energy1220kJ291kcal
Fat13.3gMed
Saturates1.9gLow
Salt0.62gMed10%19% 10%1%15%
% = an adult’s reference intake
HERBS AND SPICES
Fan of fish? Try our grilled mackerel (Mar/Apr 2013). Call 0870 600 6566 or go to bhf.org.uk/recipesearch.
IngredientsRecipes: Anne Sheasby; food styling: Sara Lew
is; prop styling: Tony Hutchinson; photography: W
illiam Shaw
1 small onion, chopped1 baking potato (about 225g/8oz), peeled and diced500ml (18fl oz) homemade or reduced-salt vegetable stock225g (8oz) frozen peas2 tbsp finely chopped fresh mint leaves, plus extra to garnish
Freshly ground black pepper, to taste2 tbsp natural yoghurt, to garnish (optional)
1 Put the onion, potato and stock in a saucepan. Bring to the boil; cover, reduce heat and simmer for about 15 minutes or until potato is tender, stirring occasionally.
2 Stir in peas, mint and black pepper. Cover and bring back to the boil; simmer for 5 minutes.
Method3 Remove from heat; cool
slightly. Blend in pan until smooth using hand-held stick blender (or transfer to a food processor or blender, blend until smooth, then return to pan). Reheat gently until hot.
4 Serve in soup bowls, garnished with a swirl of yoghurt (if using) and a sprinkling of chopped mint.
These recipes are from Heart Matters magazine, Sep/Oct 2015. 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.
“This soup is suitable for freezing (once cooled and without the yoghurt garnish) for up to three months. Defrost, then reheat gently until piping hot before serving.”
Anne’s tip
23%
Each portion contains:
Sugars5.3gLow
Energy884kJ
210kcal
Fat3.1gLow
Saturates1.2gLow
Salt0.28gLow5%4% 6%6%11%
% = an adult’s reference intake
HERBS AND SPICES
Easy peasy minted pea soup
Preparation time: 15 minutesCooking time: 30 minutesServes 2 (generously) for supper or lunch
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Knock up some roasted red onion soup (Jan/Feb 2013). Call 0870 600 6566 or go to bhf.org.uk/recipesearch.
1 Heat oil in a non-stick saucepan. Add onion and red pepper; sauté over a medium heat for 5 minutes or until softened. Add chilli, garlic and ginger; cook for 1 minute. Add chicken; cook until sealed all over, turning occasionally.
2 Stir in flour and ground spices; cook gently for 1 minute, stirring. Stir in stock; add
Ingredients2 tsp rapeseed oil1 onion, sliced1 small red pepper, deseeded and sliced1 small fresh red chilli, deseeded and finely chopped1 clove garlic, crushed1cm (½in) piece fresh root ginger, peeled and finely chopped3 skinless, boneless chicken thigh fillets (about 225g/8oz trimmed weight), trimmed of fat, each cut into 4
1 tbsp plain flour1 tsp each of ground coriander, ground cumin and turmeric powder150ml (¼ pint) homemade or reduced-salt vegetable stock227g (8oz) can chopped tomatoes in rich natural juice1 tbsp tomato purée300g (10½oz) can chickpeas in water, drained and rinsed85g (3oz) small fresh spinach leaves
Method
“Swap skinless and boneless turkey or lean pork (cut into small chunks) for the chicken.”
tomatoes, tomato purée and chickpeas, mixing well.
3 Bring to the boil, stirring; cover, reduce heat and simmer for about 25 minutes or until chicken is cooked and tender, stirring occasionally. Stir in spinach; cook briefly until wilted. Serve immediately with boiled brown basmati rice or a jacket potato (these are not included in the nutritional analysis).
Anne’s tip
23%
Each portion contains:
Sugars14.3gLow
Energy1784kJ425kcal
Fat11.4gLow
Saturates2.0gLow
Salt0.68gLow11%16% 10%16%21%
% = an adult’s reference intake
Anne cooks each recipe for us twice (at least!) to ensure everything we recommend is healthy and delicious. For even more meal ideas, visit bhf.org.uk/recipesearch.
HERBS AND SPICES
Chicken and chickpea curry
Preparation time: 20–25 minutesCooking time: 45 minutesServes 2 (generously)
1 Preheat oven to 170°C/150°C fan/gas mark 3. Put milk in a saucepan; heat gently until hot but do not boil. Remove from heat. Lightly whisk eggs, sugar and vanilla extract together in a heatproof bowl; pour on hot milk, stirring.
2 Strain mixture through a sieve into a 600ml (1 pint) ovenproof dish. Sprinkle a little nutmeg all over top.
Recipes: Anne Sheasby; food styling: Sara Lewis; prop styling: Tony H
utchinson; photography: William
Shaw
300ml (½ pint) semi-skimmed milk2 medium eggs25g (1oz) caster sugarFew drops of vanilla extractFreshly grated nutmeg, to taste
Ingredients
Method3 Bake in oven for about
45 minutes or until set. Serve hot, cold or chilled with canned, stewed or fresh fruit or with the red plum compote from our lemon-scented rice pudding recipe (see below). If serving hot, let baked pudding stand for 20 minutes or so before serving.
≠ To find out more about maintaining a healthy diet, read our free booklet Time to eat well. Visit bhf.org.uk/HMpublications or call 0870 600 6566.
23%
Each portion contains:
Sugars19.8gMed
Energy828kJ
197kcal
Fat8.1gMed
Saturates3.1gMed
Salt0.39gLow7%12% 16%22%10%
% = an adult’s reference intake
10 MINUTES TO CHANGE YOUR LIFE Time to eat well
HERBS AND SPICES
Baked egg custard with nutmeg
Preparation time: 10 minutesCooking time: 45 minutesServes 2
Try our lemon-scented rice pudding (Sep/Oct 2013). Call 0870 600 6566 or go to bhf.org.uk/recipesearch.