Firstly, I just wanted to start by saying how much I appreciate all the messages of support I have received this week in respect of my Mum and her dementia. It is humbling to read, and much appreciated. Only this morning my Dad has messaged after yet another terrible night, and many of the stories members and non-members alike have sent speak to what an awful condition dementia is.
As you likely know, I’m a big believer in preventative medicine, and taking steps to avoid problems down the line. I also practice what I preach, and this week received the results of my own blood tests. In this week’s members video, I discuss why whilst they were all in the normal range, I still wasn’t actually all that happy with them. As I said to my wife, “I don’t want normal, I want excellent”. If I am going to minimise my own chance of heart disease, cancer and dementia, it appears I’m going to have to do more. I am rigorous in my exercise regimen, I eat a whole-food diet with an abundance of fruit and vegetables, drink only modest amounts of alcohol. I do have genetic risks though, and at 46 years old, need to double down on optimising my lifestyle. Check out the video where I self-consult!
Maybe it’s because it’s the New Year, but I have received a few questions recently on alcohol. This month’s ask me anything video is on exactly that – and a little nugget of information I learnt this week that I found both interesting and a little frightening!
There are very few instances in Cardiology where I advise refraining from a good work-out, but I saw a patient this week who I had to advise just that. In fact I really felt sorry for him. He is young, sporty life-long, and clearly has paid attention to his health, yet had been seen recently in hospital with chest pain. A blood test had shown raised levels of a bio-marker which often goes up in heart attacks, but in this case the diagnosis was something else.
Myo-pericarditis. This literally means inflammation of both the lining of the heart, and the heart muscle itself. Presentations like this are not un-common to Cardiology. It is often caused by viruses, and there may be a recent history of another viral infection such as diarrhoea and vomiting, or a chest infection. It can be very painful, and often large doses of anti-inflammatory drugs are needed. Other causes include auto-immune (when the body’s immune system attacks the heart), certain toxins, adverse reaction to medications (in particular some chemotherapy drugs) and endocrine causes such as thyroid disease,
It is a condition that is frequently a ‘ diagnosis of exclusion’, ie. ruling out things like a heart attack or blood clot on the lungs then seeing what is left. Imaging scans like an MRI of the heart are very useful indeed, and we are very fortunate in Bournemouth to have a fantastic MRI service. Performed early on in these sort of cases, there are some characteristic features which can help make the diagnosis. An MRI can pick up subtle features of inflammation of the heart muscle, or indeed scarring and issues with the pumping function which can be akin to heart failure.
The outlook for this condition is usually very good, with patients making full recoveries. Fortunately there were no such complicating issues in this case, but as I alluded to above, unfortunately patients should be advised not to exercise for 6 months after the diagnosis. The rationale is that it can precipitate dangerous heart rhythms. For a young sporty person this is less than ideal, but I always take the Ted Lasso approach that one should look to turn a disadvantage into an advantage. I like to work with my patients therefore to see what they can do, if there’s a reason why something else may be off the table. For example, if you can’t do strenuous exercise for a while, could you get really into yoga or pilates which have amazing health benefits? I have used this approach many times myself when picking up sports injuries and it’s great to have another health avenue to pursue. My 11 year old daughter clearly takes after me too – she’s a competitive swimmer but has had a perforated ear drum for a couple of weeks so is out the pool. I popped into her room yesterday and she was doing an online yoga class without any prompting from me #proud
Interestingly, the American College of Cardiology have just this week issued new guidance that in some cases sports participation may be considered a little earlier (3 months) in myocarditis, provided certain conditions are met such as reassuring imaging and ambulatory ECG monitoring. It will be interesting to see if this gets incorporated into European guidelines, but nevertheless this is a promising precedent for patients who quite rightly want to get back to being active.
I also recognise that strenuous activity isn’t an option for all. A lady I saw recently had really struggled with breathing and we set some movement goals which were really rather simple, yet by reaching them and setting incrementally harder challenges, she is making much more progress than she has for some time which is great to hear.
Movement is fundamental to health. It may look very different for each of us, but what can you do this week to move more?