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NO SMOKING DAY 11 March 2015

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PLUS One man on his ICD and his passion for spiders

Exclusive interview with pioneering heart surgeon

Professor Magdi Yacoub

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Facing heart disease as a family

“Thanks for being my mum”

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The name Magdi Yacoub is world-renowned. His cardiac career began with the BHF and he pioneered operations that save countless lives. He tells us about his heroic career (page 4).

For many, their personal hero is closer to home. As we celebrate Mother’s Day, Leanne Clarke, born with a congenitalD heart condition, speaks about the support of her mum and her struggle to become a mother herself (page 12).

Becoming a parent is life-changing. While welcome, change can be unsettling. We offer tips on coping with change (page 34) and hear how an ICDD didn’t stop one man’s passion for spiders (page 31).

By now, the New Year changes we promised to make may be a dim memory, so there’s no better time to ditch the excuses and get active (page 41). Plus, read the five big lies we tell ourselves about weight gain (page 28) and our myths about fat (page 29).

Sarah Kidner, Editor

Discover how, with the support of her mum, Leanne beat the odds to become a parent herself, page 12

It’s Mother’s Day…

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Proud Quitter, Ria© British Heart Foundation 2015. Registered charity in England and Wales (225971) and in Scotland (SC039426).

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The name Magdi Yacoub is world-renowned. His cardiac career began with the BHF and he pioneered operations that save countless lives. He tells us about his heroic career (page 4).

For many, their personal hero is closer to home. As we celebrate Mother’s Day, Leanne Clarke, born with a congenitalD heart condition, speaks about the support of her mum and her struggle to become a mother herself (page 12).

Becoming a parent is life-changing. While welcome, change can be unsettling. We offer tips on coping with change (page 34) and hear how an ICDD didn’t stop one man’s passion for spiders (page 31).

By now, the New Year changes we promised to make may be a dim memory, so there’s no better time to ditch the excuses and get active (page 41). Plus, read the five big lies we tell ourselves about weight gain (page 28) and our myths about fat (page 29).

Sarah Kidner, Editor

Discover how, with the support of her mum, Leanne beat the odds to become a parent herself, page 12

It’s Mother’s Day…

bhf.org.uk 3

YOUR BHF8 News

Heart-related research, plus dates for your diary

10 Spotlight The types of support available to UK carers

11 Behind the headlines The facts behind media health stories

15 Your letters Readers’ thoughts

25 Our new website Discover our exciting online makeover

49 Dictionary Medical terms explained

50 Information and support A guide to our free resources

MY STORY12 Thanks, mum

How three generations came together to face heart disease

31 Amazing spider man Carl Portman’s passion for spiders won’t be stopped by an ICD

NUTRITION26 The story of O

What does it mean to be obese and are we in the middle of a crisis?

29 The truth about fat We clarify some common myths about the fats in your food Plus Healthy recipes

38 Dechox Chocolate lies exposed and how giving it up can help the BHF

WELLBEING34 Coping with change

A heart diagnosis can mean big life changes

MEDICAL16 Drug cabinet: over-

the-counter pain relief Different types of painkillers explained

18 Focus on: ablation Find out how it can help treat abnormal heart rhythms

21 Ask the experts BHF experts answer your heart queries

RESEARCH4 Heart of gold

Professor Magdi Yacoub tells us about his inspirational career

22 100k Genomes Project Genetic information may help us identify and treat rare diseases

ACTIVITY40 Seven top tips from

our activity expert Lisa Young helps you get moving this spring

41 Ditch the excuses No. You’re not too old, too tired or too busy...

44 Up and running Cardiac rehab helped one man discover a passion for running

47 Spring into action Our resident gardener Paul Peacock’s tips for the new season

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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. G204/0315

For BHFEditor: Sarah KidnerDeputy Editor: Sarah BrealeyProduction Editor: Amily ChangMedical Editor: Maureen Talbot; Amy ThompsonHead of Heart Matters: Judy O’SullivanPrint: The Artisan Press Ltd

For WardourManaging Editor: Rachael HealyArt Director: Daniel CoupePicture Editor: Johanna WardCreative Director: Ben BarrettProduction Director: John FaulknerProduction Artworker: Jack MorganSenior Account Manager: Georgina BeachManaging Director: Claire Oldfield Chief Executive: Martin MacConnol

In this issue…March/April 2015

Online exclusivesbhf.org.uk/heartmattersmag

Our expert team

Chief Scientist, Genomics EnglandMark Caulfieldis a clinical pharmacology professor at Barts and the London School of Medicine.

Physical Activity SpecialistLisa Youngis a BHF Project Manager with a focus on workplace health and physical activity advice.

Consultant CardiologistDr Guy Haywoodis a specialist in adult heart rhythm problems and coronary artery disease.

Professor of Health PsychologyKaren Rodhamfrom Staffordshire University, specialises in the experience of living with a chronic condition.

Senior Cardiac NurseMaureen Talbothas worked in the NHS and private sector in general and cardiac nursing. She is also a BHF Nurse Manager.

Senior Cardiac NurseAmy Thompsonhelps manage the BHF’s Genetic Information Service and also has a specialist interest in heart failure.

≠ Exclusive video: The amazing spider man shows us his creepy crawlies and shares advice on living with an ICD

≠ Real stories: Meet some people who owe their lives to Professor Yacoub

≠ Video: Leanne Clarke’s touching thank you to her special mum

≠ Fast facts: Frequently asked questions about common painkillers

≠ Your poems: Reflections from our readers on life, love and heart conditions. Find out how to submit yours too

≠ Drug cabinet: From statins to warfarin and beyond, heart medications explained and common questions answered

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RESEARCH

The name Magdi Yacoub is known worldwide. The professor, knighted for services to medicine and surgery in 1991, has developed a number of operations to correct congenitalD heart conditions, and was appointed the first BHF Professor

of Cardiothoracic Surgery. In person, he’s modest, unassuming and, by his own admission, shy – especially when it comes to giving interviews.

His illustrious cardiac career began with the BHF. “I started as a practising cardiac surgeon, doing clinical research looking at the results of certain operations. Early on, I realised the BHF was interested in research and could help with funding some of these studies,” he says. “I was asked to consider joining the National Heart and Lung Institute as the first professor of cardiothoracic surgery. I wondered whether I should be doing it, because I was very busy being a surgeon but I had an innate desire to know new things, to perfect what we were doing, to evaluate new forms of treatment and to study and improve surgical techniques.”

The driving force, however, was to stop suffering. “We were swamped and couldn’t cope with what was going on, but we found cardiac surgery provided material for studying the basic elements of cardiovascular diseaseD (CVD). We saw that we could prevent disease as well

as treat it, and if we put ourselves out of a job, great – really, you felt if you could do that, you could go and grow oranges and be very happy.”

Lifetime achievementsAs well as developing pioneering surgical techniques, the Egyptian professor established what was at the time the world’s largest heart and lung transplantation centre. He also led research into myocardial regeneration – a way of using stem cells to repair the heart. So what’s his proudest achievement? “I find the answer to this question difficult,” he says. “I have children and grandchildren and if you asked who

my favourite is, I would say I love them all. I feel the same about my research. Is it operations for children with congenital heart disease? Yes, of course. Is it new methods in transplantation and immunosuppressants, seeing people survive longer? Of course. Is it tissue engineering and regenerative therapy? Of course. But it’s all related and to pick one of them and say ‘this is my favourite’... I am not going to do it.”

Besides, there’s plenty more to be done. “Seeing people of all ages developing severe heart failureD, and seeing them die unless you do drastic things such as transplantation or artificial hearts... We really have to discover what causes that at a molecular level.” Using

advanced surgery provides opportunities, he explains. “For example, if you put a left ventricular assist device [used to support a failing heart] into a patient, you show so-called terminal heart failure is slowing. It’s very, very exciting to think what we learn from this could help us to find a way to reverse heart failure and to stop people dying. A cure for heart failure is something I would love to see before I die.”

Professor Yacoub is optimistic that advances in regenerative medicine will lead to positive results, but says it’s important to be realistic about how long it will take until this can benefit patients. “It is extremely promising but that doesn’t mean we are ready to give

HeartOF GOLD

Heart Matters bhf.org.uk

Professor Magdi Yacoub is one of the world’s leading heart surgeons, and his pioneering operations

have saved countless lives. In a rare interview, he speaks to Sarah Kidner

Professor Yacoub’s distinguished career has been supported by the BHF

CV 1957 Graduated from the Cairo University Medical School

1969–2001 Consultant Cardiothoracic Surgeon at Harefield Hospital

1986–2006 BHF Professor of Cardiothoracic Surgery

1991 Knighted for his services to medicine and surgery

2013 Awarded the Order of Merit

I don’t want to slow down, because it’s a way of life, it’s something I enjoy”

4

Help the BHF. Donate now. Call 0300 330 3322*. Go to bhf.org.uk/donate. Or visit your local BHF shop.*Cost similar to 01 or 02 numbers

76

it to the public.” That said, he believes we could see therapies being used in three to 10 years’ time. “It partly depends on the BHF and the generosity of the public that supports it. How long it is going to take depends on how much investment you put in. What I do know is that there are keen people, young and old, who will work day and night to bring it sooner rather than later.”

Congenital heart conditionsProfessor Yacoub maintains a keen interest in congenital heart conditions, and is excited by our expanding understanding of what causes them. “What’s so exciting is developmental biology, getting to see how the heart formed in the first place, the molecules that are responsible, and what goes wrong to produce congenital heart disease,” he says.

He has a keen interest in all forms of inherited heart muscle disease (cardiomyopathies). “We began by describing what we saw in structure, and changes in function,” he says. “A lot of it is inherited, so there has to be a genetic mechanism behind it, and that stimulated more research. Now we know more than 100 genes are responsible for the different types [of cardiomyopathy]. The next thing is to understand how the genetic abnormalities translate into the disease and then treat it or prevent it molecularly. This is already happening.”

Caring for freeHis interest in helping children born with heart conditions led him to establish the charity Chain of

Professor Yacoubreceived the Orderof Merit in 2013 not to ourselves, it is to the community. What is the

community? It is the local community, obviously, but also the global community. It is down to professionals like us who see the problem first-hand, who see them dying in front of us, who have to do something.

“We collect a lot of donations locally, and say it is a present from the people, to the people. The surgery is provided for free with priority to the poor and those who need complex operations.”

He is a staunch supporter of the NHS and says his work overseas benefits his work here, too. “It is a two-way system. I am teaching but also I am learning from people and from the system. You realise that you must get the best for your money. We take that back to the hospitals in this country and allow them to be cost-effective, which is essential because not even the richest country can afford everything all the time.”

Future aspirationsNow aged 79, Professor Yacoub shows little sign of slowing down. He has academic groups at Imperial College London and at Harefield Hospital, which he “cherishes”, as well as helping with projects in Aswan. In Qatar, Professor Yacoub has a growing cardiovascular research centre (QCRC) working on basic science and translational research. He also continues to supervise PhD students, teaching the next generation of researchers.

“They are very intelligent, responsive, enthusiastic, and have endless energy, which I do not have now, so it’s a very exciting thing to work with students, and particularly PhD students and trainees in both these countries and abroad, because I think this is a fantastic legacy to leave behind. I am happiest when I meet people saying – and it shows my age as well – ‘I went


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Hope, which flies surgeons across the globe to operate on sick children. It also brings children to the UK so they can access the medical care they need. “It began a long time ago when I was in Egypt as a medical student. I saw children dying because their hearts were improperly formed.” When he finished his training, Professor Yacoub and some of his colleagues began travelling to South America and Africa to operate. He quickly realised this work needed an organisation behind it to ensure its longevity and so set up Chain of Hope, of which he remains president today.

The charity performs heart operations in 28 countries including Brazil, Egypt, Ethiopia and Zimbabwe, but also aims to leave a legacy of infrastructure and expertise. “We work with them to create a sustainable service, including building a unit and providing human resources. In Aswan, Egypt, for

example, the unit performs all types of operations on small babies, newborns, [including] the switch operation, [carried out] by local staff, day and night and all for free.”

Providing care free of charge is something that’s close to Professor Yacoub’s heart. “You are not being generous, you are doing your duty, which is global medicine. We should have been taught that before, our responsibility is not to the hospital, it is

to medical school because I heard about you’. I think ‘Wow’ – that’s something I cherish because I have seen and continue to see how much suffering is caused by heart disease, and to think that these young people are let loose on this big enemy is a fantastic thing.”

He’s also spending time with his grandchildren and, at the time of our interview, has just returned from visiting some of them in Vietnam. “It is the happiest time of my life,” he says. “It is like magic. They seem to greet you with unlimited happiness and love.”

But he continues to throw himself into his research: “I don’t want to slow down, because it’s a way of life, it’s something I enjoy thoroughly. I wake up at 3am thinking about writing a grant to the EU or reading the latest scientific journal.”

I had an innate desire to know new things, to perfect what we were doing”

Online exclusive For more information about Professor Sir Magdi Yacoub and his work with the BHF and Chain of Hope, and to read the stories of the people he has operated on, go to bhf.org.uk/magdi.

Clockwise from above: some of Professor Yacoub’s recovered patientscelebrate with him; the professor at work; Chain of Hope has saved thelives of countless children

98 Heart Matters 9

NEWS

11 March No Smoking Day. This year’s theme is Proud to be a Quitter. We know stopping smoking isn’t easy, so No Smoking Day helps smokers who are planning to quit feel solidarity and gain support in quitting for good. If you’re a smoker or have a loved one who smokes, join in and make 11 March the day to become a proud quitter. Visit nosmokingday.org.uk or call 0800 434 6677.

29 March London to Reading Bike Ride. A 40-mile spring bike ride, ideal for all. Visit bhf.org.uk/londontoreading or call 0845 130 8663.

26 April Dorset Bike Ride. A 25-, 50- or 66-mile circular route through stunning countryside. Visit bhf.org.uk/dorset or call 0845 130 8663.

6 May Tower of London Run. Walk, jog or run up to 10k. Visit bhf.org.uk/towerrun or call 0845 130 8663.

16 May BHF Midlands Supporter Conference. This interactive, informal and engaging visit to the University of Birmingham’s Medical School is your opportunity to meet some BHF-funded researchers and learn more about the work of the BHF in the Midlands. To register, contact Donna Stokes on 0121 353 2087 or email [email protected].

17 May Cotswolds Bike Ride. New 30- or 50-mile countryside routes. Visit bhf.org.uk/cotswoldsbikeride or call 0845 130 8663.

12 July Bournemouth Pier to Pier Swim. Brave the English Channel in this 1.4-mile open-water swim. Visit bhf.org.uk/swim or call 0845 130 8663.

19 July Heart of England Bike Ride, Solihull. Explore rural Warwickshire by biking 13, 19 or 31 miles. A great family day out organised by the Knowle and Dorridge Lions to raise funds for our Mending Broken Hearts appeal. Contact Donna Stokes on 0121 353 2087 or email [email protected].

Dates for your diary

Scientists you’ve helped fund have identified chemicals

that could prevent long-term damage following a heart attackD or strokeD.

Researchers, led by teams at the University of Cambridge and two Medical Research Council units, found long-term damage to the heart after a heart attack, and to the brain

after a stroke, is caused by a build-up of a chemical called succinate. Succinate occurs naturally in the body when sugar and fat are broken down to release energy.

Scientists discovered simple chemicals, called malonate esters, significantly limit the build-up of succinate, and thus long-term organ damage, in

mice and rats. Malonate esters are found in fruits including strawberries and apples, but not in high enough amounts to be beneficial.

Researchers hope to develop injectable drugs to prevent some of the long-term damage, such as heart failureD or disability, that can be caused by heart attack and stroke.

Fruit chemical may limit heart attack harm

Time for a spring clean

WIN the latest BHF charm from Pandora

Whether you sift through one cupboard or the whole house, your spring clearout could help the BHF beat cardiovascular disease. Our shops and Furniture & Electrical stores value donations so much that they offer a free collection service. You’ll not only help fund life saving research, but

also stop millions of items ending up in landfill.

BHF Retail Director Mike Taylor says: “We hope everyone will keep up the tradition of having a spring clearout. If everyone spent just half an hour clearing out and donating unwanted items to BHF shops, it would make a huge difference.”

BHF shops accept clothes, books, CDs, DVDs, etc. Furniture & Electrical stores accept beds, sofas, TVs and more. Call our free collection service on 0800 915 3000. Book a Furniture & Electrical collection at bhf.org.uk/free. Find your nearest shop at bhf.org.uk/shops or call 0844 412 5000.

Get your BHF events calendar Our 2015 Events Calendar is out now and full of local, national and overseas challenges for all fitness levels and ages. Choose from our wide range of bike rides, runs, walks, treks, swimming and triathlon events and help us raise money for our life saving research. Pick your event, sign up and spread the word. Order your free copy by calling 0870 600 6566 or see all our events at bhf.org.uk/events.

bhf.org.uk

The next general election takes place on 7 May. Amid the election fever, we are

calling for the next government to:≠ Maintain current protection of the government science budget, ensuring our life saving research can go further.≠ Stop junk food advertising on television before the 9pm watershed to help the country’s next generation make healthier food choices.≠ Ensure CPRD is a mandatory part of the secondary school curriculum, so that every child leaves school knowing how to save a life.

Our hopes for the next government

≠ Introduce measures to give people with CVD access to the integrated health and social care support they need.

You can help our campaign by visiting bhf.org.uk/get-involved/campaigning.

Malonate esters are found in strawberries,

apples and other fruits

After an overwhelming response to our two BHF charms in 2014, we are delighted to work with Pandora again. Pandora has pledged £50,000 to our fight for every heartbeat in 2015, and has launched a new BHF charm. Made from silver and cubic zirconia, it’s available at Pandora stores or pandora.net for £55. Find your nearest store online.

Pandora is giving two readers the chance to win a BHF charm. Enter by emailing your name to Pandora at [email protected] or write to Pandora at: Press Office, Pandora Jewellery UK Ltd, 33 George Street, London W1U 3BH before 30 April 2015. For full terms and conditions, visit bhf.org.uk/HMtandcs.

BHF thanks volunteersWe’d like to say a huge thank you to the hundreds of volunteers who joined the national supermarket collection this Valentine’s Day. We were at more than 500 Tesco stores to kick-start fundraising for the groundbreaking partnership between the BHF, Tesco and Diabetes UK. This three-year collaboration aims to raise millions of pounds. A wonderful turnout from BHF volunteers helped us raise thousands towards this goal.

Tesco, Diabetes UK and the BHF want to reduce the number of people at risk of cardiovascular diseaseD (CVD) and type 2 diabetesD. Our partnership aims to help millions of people eat better, get active and make healthier choices.

There are 3.5 million people in the UK who have type 2 diabetes and seven million living with CVD. Yet these conditions are largely preventable.

To find out more or get involved, call Michelle on 020 7554 0520 or visit tescocharitypartnership.org.uk.

We want kidsto learn CPRat school

Looking for a new T-shirt? Why not support the BHF by buying one like these from our latest online range? There are many styles and designs available for men, women and children. Prices start from £10.Visit giftshop.bhf.org.uk or call 0116 232 4195.

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1110 Heart Matters bhf.org.uk

One in 10 people in the UK are unpaid carers – that’s nearly seven million, and the figure keeps rising. Of those,

1.2 million people spend more than 50 hours a week caring and 60 per cent of us will care for another person at some point in our lives. It’s vital that carers get the support they need.

Over the past five years, the Royal College of General Practitioners (RCGP) has been working to increase the recognition and support that GPs give to carers, with funding from the Department of Health. More recently, nine GP carers’ champions were appointed in different regions to

work with GPs, practice nurses and the bodies that commission local healthcare services. An online platform, the Caring for Carers Hub, has been set up to help GPs find local information for carers, including details of nearby Heart Support Groups (BHF-affiliated meetings for heart patients and carers). The hub is growing as more groups join.

Dr Ann Mulroy, RCGP champion for London, said: “We realise that being a carer can have a big impact on mental and physical health and we want to prevent problems occurring. A lot of mental

Being a carer can affect your mental and physical health, but as Sarah Brealey discovers, support is out there

SPOTLIGHT ON…

NEWS

Support for carers

Unpaid carers save the NHS a lot of money. They deserve support”

The BHF says: The researchers looked at the total amounts of wholegrains eaten, not porridge (or even oats) specifically. But it’s an interesting study and reinforces existing dietary recommendations to eat more high-fibre foods. If you want to eat better, switching to wholegrain versions of bread, breakfast cereals, pasta and rice is a simple change to make.

“Get your oats! Porridge helps to protect against heart disease”Porridge could actually save your life, according to new research.

A 25-year study of 100,000 people in the US found people who ate the cereal regularly had been protected from heart disease.

“Happy kids are healthier adults”

A happy childhood means healthier hearts and circulation in adulthood, new research found. Children brought up in a loving home who do not go without, eat healthier foods, have friends and have learnt to control their aggression and impulsiveness have better cardiovascular health in later life than deprived children.

The BHF says: The earlier you adopt a healthy lifestyle, the more you reduce the risk of developing cardiovascular disease. This study makes interesting observations, but further research is needed. In the meantime, positive changes, such as eating a healthy diet and doing regular physical activity, can reduce your risk of cardiovascular disease, whatever your age.

diet with other healthy diets, such as the Mediterranean diet, so it couldn’t show whether the Nordic diet is better.

The Nordic diet has made headlines in the past. In September 2014, researchers in Denmark found that overweight people who followed a diet that included local and seasonal meals, based on traditional Danish foods such as berries, nuts, grains and fish, lost more weight than those who ate a more Westernised diet.

Victoria Taylor, our Senior Dietitian, said: “A healthy Nordic diet rich in fruit and vegetables, oily fish and wholegrain cereals, is consistent with a heart-healthy diet. Additionally, healthier, unsaturated fats such as rapeseed oil are a good choice, as are low-fat dairy products.

“There are certainly characteristics of the Nordic diet that we can apply to our own style of eating, such as cutting down on saturated fat and eating more fish instead of meat. But this doesn’t mean you have to start buying rollmops and sauerkraut – and this definitely isn’t an excuse to start indulging in Danish pastries on a regular basis.”

≠ Turn to page 40 to read Lisa Young’s analysis of how Finland improved its public health.

“High blood pressure? Eat like a Viking. A Nordic diet could reduce the dangers of being overweight, a study suggests.”

Nordic but niceDaily Express 8 January 2015The Telegraph 7 January 2015

Daily Mail 13 January 2015

BEHIND THE HEADLINES

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This study compared a healthy Nordic diet based on wholegrains, vegetables, berries, fish and low-fat dairy products with a less-healthy diet based on low-fibre foods, butter-based spreads and only a small amount of fish. The participants in the study were obese adults with features of metabolic syndrome. This is a cluster of linked risk factors – including high cholesterol, high blood pressureD and raised blood sugar levels – that dramatically increase the risk of developing diabetesD and cardiovascular diseaseD.

After participants had been following the diets for 18 to 24 weeks, researchers from the University of Eastern Finland noted differences in the activity of 128 genes, mostly in those connected to immune response. However, they didn’t find clear differences in any clinical measurements, such as blood pressure, cholesterol levels or weight. It’s a big leap to suggest that (as the Daily Mail put it) “eating like a Viking can reduce the damaging effects of being overweight”.

The Telegraph’s website also featured tips on ‘How to eat like a Viking’, which included some unconventional (although probably tongue-in-cheek) advice such as “Embrace the rollmop” and “Fry an egg… DI Sarah Lund survived on little else through three series of The Killing.” Rollmops, like many pickled foods, are high in salt, and while eggs can be part of a healthy diet, poached or boiled are healthier choices.

This was a relatively small study, with 56 people included in the final analysis – 31 from the Nordic diet group and 25 from the control group. It didn’t compare the Nordic

If you are a carer, let your GP know so they can offer you relevant information and support, including a free flu jab every year. They may also be able to put you in touch with your local carers’ service. The assistance these services offer varies around the country but can include help with claiming benefits, coffee mornings, personal training sessions and massages.≠ The Carers Direct helpline offers confidential information and advice. Call 0300 123 1053 or visit nhs.uk/carersdirect.

≠ The Carers Trust has a directory of local carers’ services and more, at carers.org. You can also email [email protected] or call 0844 800 4361.≠ Download or order our free booklet, Caring for someone with a heart condition, from bhf.org.uk/HMpublications or by calling 0870 600 6566. ≠ Find your local Heart Support Group at bhf.org.uk/heartsupport or call the Heart Matters Helpline on 0300 330 3300.≠ Find RCGP information on carer support (aimed at healthcare professionals) at www.rcgp.org.uk/carers.

Where to get help?

health problems, such as depression and anxiety, and feelings of isolation, are more common among carers. There are also physical issues such as back problems linked to lifting, or carers may neglect their own health because of their caring role.

“If by giving extra support to carers we can deal with an issue before it becomes a problem, that can help a lot. It can reduce hospital admissions and prevent breakdown of the caring relationship.”

Dr Mulroy said people may not always identify themselves as carers, but their roles are vital. “Unpaid carers save the NHS and social services a lot of money, and they provide a better service to the person being cared for. They deserve support.”

≠ Read more about our survey of heart conditions and mental health at bhf.org.uk/emotional, or order the Jan/Feb 2015 issue on 0870 600 6566.

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COVER STORY

Leanne Clarke was born with a heart condition, but always had support from her mum. Sarah Brealey hears how she beat the odds to become a mum herself

Leanne Clarke

Ann Danks

There are few things as powerful as a mother’s love, and Leanne Clarke understands this better than most. Leanne, 33, was born with a complex congenitalD heart defect. She’s always had health problems and was told she may never have

children. But her mother, Ann Danks, has supported her at every difficult moment.

On Mother’s Day this March, Leanne wants to say thank you to her very special mum. “She means the world to me. She keeps me going through all the bad times I’ve had; she always keeps me smiling. I’d just like to say thanks for being there.”

Leanne, from Redditch, Worcestershire, had her heart problems diagnosed as a toddler, when her mum noticed that her lips and fingers were turning blue. Tests showed she had an atrial septal defect, also known as a hole in the heart. Aged five, she had open heart surgery to repair the hole.

Ann, 51, a jewellery maker and mother of four, says: “We’ve had some scary times. I think the worst part was handing her over to the surgeon. I was crying. You worry they might not come back.”

Leanne’s health problems didn’t end there. She also has a disorder of the connective tissue that affects her heart valves, joints and skin. As a result, she was born ‘floppy’ and couldn’t walk until she was four. Doctors think this might be Ehlers-Danlos syndrome, a group of inherited conditions affecting the connective tissue, which can manifest in a number of different ways.

As Leanne grew up, she experienced regular chest pains and migraines, as well as breathlessness when

she played sport. Her mum was always there though, through the hospital visits and days off school.

When she was 23, she was admitted to hospital with crushing chest pains and, again, her mum raced to be with her. Leanne was told she’d had a heart attackD, which was linked to her existing heart condition. During her 20s, she also had three transient ischaemic attacks (TIAs, also called mini strokesD), which are caused when a blood clot temporarily blocks the blood supply to the brain. The first time it happened, Leanne and her mother thought it was a full stroke, so it was a frightening experience for them. Since then, Leanne takes warfarin to reduce the chances of further clots.

Beating the oddsLeanne always hoped to have a family, but her cardiologist warned there would be risks to her and the unborn baby, because pregnancy puts extra strain on the heart. She would need regular monitoring and might even be kept in hospital for the full nine months. There was also the chance that her baby might be born with the same condition.

On top of that, Leanne had fertility problems. She and her fiancé, Joseph Daly, were approved for NHS IVF treatment, but six weeks before it was scheduled, she fell pregnant naturally.

Leanne had to stop most of her medications during pregnancy to protect her unborn baby. No longer able to take warfarin tablets, she injected herself with an anticoagulant every day to reduce risk of blood clots.

Yet she felt fit and well, and regular scans showed she and her baby seemed healthy. During labour, her

Harley is an absolute gift to me”

We’ve helped each other through difficult times”

Heart Matters bhf.org.uk12


The love of Ann, farright, and now Harley,far left, helpedLeanne stay positive


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

telling my story in the media. My wife and I also featured in Heart Matters after I nominated her as ‘the person I could not do without’. I am deafblind.

As a result, I was contacted by the BHF advising me that Sarah Hanson was trying to contact me after she saw me in the newspaper. Sarah is the daughter of my best friend Mike, who I grew up with. I was best man at his wedding, but we had lost touch.

We got in touch again through the BHF and Sarah arranged for me to be the surprise guest at her parents’ 30th wedding anniversary. It was so nice to be reunited with Mike and Suzanne and their

Fit and well after bypassThree years ago I was told I needed a heart bypassD. I was shocked and in a terrible state.

I attended Castle Hill Hospital and met the most wonderful specialist, Mr Chaudhry, and his staff. He explained what would happen and reassured me. After a seven-hour operation and a quadruple bypass I am fit and well.

I send my unwanted items and give donations to the BHF as a thank you, knowing it will help others in my position.Linda Staves, Hull

STAR LETTER

Next issue How to prepare for a hospital stay.Plus: We take a detailed look at heart failure, find easy ways to get your 5-a-day and discover the joys of tennis.

The writer of our star letter each issue can win a gorgeous

Radley Matinee purse worth £75, with ample room for all

your essentials. Or if you prefer, choose this red heart-shaped

rug (about 1.5m long).

READER’S TIP My husband and I sleep in separate rooms as he has Parkinson’s and can be quite restless.

As we both have health problems, we were worried about being able to hear each other in the night if either of us called out for help. So we bought a cheap battery-operated doorbell. We put the bell push in my room and the receiver in his. As it is portable, he could take it into the garden or garage and could still hear it if I rang.

Now we have a bell each, so we are always just a ring away from each other. The doorbells can be under £10 – a small price for peace of mind.

Thank you for a great magazine. We both read it from cover to cover and find it very helpful.Jill Luter, Waterlooville, Hampshire

Heart Matters editor Sarah Kidner says: We love to get tips from readers that might help others. Another device that could be useful is a baby monitor – these are available from about £20 and will allow you to hear what’s happening in another room.

children. Sarah gave birth to a son, Riley, in August and she asked me to be his godfather. I was so honoured and privileged.

If it wasn’t for my illness, my involvement with the BHF and its work, this story would not have unfolded. I feel deep gratitude and I have a special place in my heart for Sarah and the BHF.Alan Sloman, Petersfield, Hampshire

Blood pressure helpI always look forward to reading Heart Matters and hearing about other people’s experiences.

My husband has just visited his GP, who told him his blood pressure was high and gave him pills to bring it down. By chance, I had just read your excellent article on blood pressure in the Jan/Feb 2015 issue and gave it to him to read. I know too much salt is a factor so try to restrict our intake.

It is 16 years since my own heart attackD and I thank God every day that I am still here. We should all be thankful for what we have and not take anything for granted.Mrs J Darwin, Chesterfield, Derbyshire

Deputy editor Sarah Brealey replies: We’re pleased you found the article useful. To watch our video on measuring your blood pressure at home, visit bhf.org.uk/pressure.

Reunited through the BHFI have had anginaD, a heart bypass and an angioplastyD, and a few years ago, I promoted the work of the BHF through

fingers and lips went blue as the oxygen levels in her blood dropped. She was kept in hospital for a week to make sure she and baby Harley were alright.

Harley is now nearly five. Leanne says: “He’s an absolute gift to me.”

Ann adds: “Having Harley has been the dream for her; she’s always wanted a child of her own, even though we were told that might never happen.”

Second chanceWhen Harley was a toddler, Leanne’s heart valve problem worsened. By 2013, she needed surgery again to fix the mitral valve.

Leanne says: “My mum took me to hospital and I said goodbye to my son and my fiancé. It was the hardest thing I ever had to do, as I was frightened I might never see them again. But I had to look at the bright side and think: ‘This will make me better, and nothing is going to go wrong.’

“When I opened my eyes after the surgery, I heard my mum’s voice and I was so happy.”

Leanne’s mum looked after her for three weeks, then her fiancé took over care for another six weeks, by which time she was back on her feet.

Leanne’s scar has faded and she rarely thinks about it, although her first scar, from childhood surgery, used

to bother her. “I hid it all the time,” she says. “When I got older I thought: ‘You know what, it’s a part of me and if people don’t like it, it’s their problem.’”

Overcoming health challenges has inspired Leanne to make the most of her life. She lost weight before the operation to reduce strain on her heart and still follows a healthy diet. She works full time in a department-store warehouse and hopes to go back to college to train as a hairdresser. She says: “I want to learn things. I feel I’ve been given a second chance at life.”

Ann says her daughter has always been positive and determined: “Leanne’s such a happy person. She always has a smile on her face, even when she’s having tests and scans. We’ve helped each other through difficult times. I’m really proud of her.”

Watch our exclusive video of Leanne’s emotional thank you to her mum at bhf.org.uk/leanne. Order or download BHF publications such as Having heart surgery or Caring for someone with a heart condition at bhf.org.uk/HMpublications.

More online

Pregnancy and heart disease

Most babies born with a complex heart defect used to die in childhood, but, partly thanks

to BHF-funded research, most now survive to adulthood. This means issues of pregnancy and childbirth in women with complex congenital heart disease are more common.

Pregnancy puts extra strain on your heart, so if you have a complex congenital heart condition, ask to be referred to a cardiologist with experience of treating pregnant women. Do this if you’re trying to become pregnant, or soon after you get pregnant. This applies even if you have no symptoms, as you might have scarring on the heart from surgery as a child.

Depending on the type of heart condition you have, there is a chance your baby could inherit it. Ask your medical team whether this is possible and find out which tests can be done during pregnancy.

If you have coronary heart diseaseD, visit your GP or specialist before you start trying for a baby. Making lifestyle changes, such as losing weight, taking regular exercise and stopping smoking, can also reduce the risk to you and your baby.

I feel I’ve been given a second chance at life”

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Q What painkillers can I buy? A Paracetamol is the most

common analgesic (painkiller) you can buy. It is recommended for the treatment of mild pain and comes in tablet, capsule, syrup and soluble forms.

Another option is a non-steroidal anti-inflammatory (NSAID) preparation, such as ibuprofen. NSAIDs relieve mild pain and reduce swelling. Often, they’re taken as a one-

off dose, or more regularly for persistent pain, although it is important you don’t exceed the daily recommended dose. Ibuprofen can be taken alongside paracetamol.

If you have mild to moderate pain and paracetamol alone is ineffective, you can take a compound analgesic. These contain paracetamol and a mild opioid, usually codeine or dihydrocodeine. Examples are co-dydramol and co-codamol.

Q Which different conditions do these treat?

A Over-the-counter analgesia can treat both acute and chronic pain. Acute pain comes on suddenly, resolving once the underlying cause is treated. Generally, it lasts no longer

than six months and is often present as a warning, such as toothache or a sprained ankle. Unresolved acute pain can become chronic pain. This continues after the original cause has been treated, such as leg pain following DVT, or rheumatic pain following a fracture. Chronic pain can last for long periods and be challenging to manage.

Q Is it true that different painkillers work better for different types of pain?

A Yes. Pain associated with inflammation usually responds well to NSAIDs. However, you are limited by what can be bought over the counter.

Certain pain, such as that caused by nerve damage,

Heart Matters bhf.org.uk 1716

Over-the-counter pain relief

DRUG CABINET

MEDICAL

Pain relief medicines belong to the drug group ‘analgesia’ and you can buy several types without prescription. Amy Thompson talks to Janine Beezer, Advanced Clinical Pharmacist for City Hospitals Sunderland

49

bhf.org.uk

A Ablation A procedure to correct types of arrhythmias. It involves using radio-

frequency waves to destroy the abnormal electrical pathways.Angina An uncomfortable feeling, tightness or pain in your chest. May also be felt in arms, neck, jaw or stomach. Symptoms 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. Atheroma Fatty material that can build up within the walls of the arteries. Sometimes called ‘plaques’. Atrial fi brillation (AF) An abnormal heart rhythm in which the atria (the upper chambers of the heart) beat in an irregular pattern. People with AF have an irregular, sometimes fast, pulse.

B Bypass See coronary artery bypass surgery.

C Cardiac rehabilitation Also called ‘cardiac rehab’,

this education and exercise programme helps you recover from a cardiac event and get back to as full a life as possible.Cardiomyopathies Diseases of the heart muscle that cause it to work less eff ectively. It may become thickened, enlarged and/or stiff . It aff ects people of all ages and is usually inherited.

Cardiovascular disease (CVD) All diseases of the heart and circulation – for example, coronary heart disease or stroke.Congenital See below.Congenital heart disease A heart abnormality that a person is born with, such as, a hole between heart chambers (‘hole in the heart’). There are many types; some are due to faulty genes or chromosomes.Coronary artery bypass surgery An operation to treat coronary heart disease. Arteries from your chest wall or arms, or veins from your leg, are used to bypass 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.Cardiopulmonary resuscitation (CPR) Actions performed to keep blood circulating around the body when a person is in cardiac arrest. CPR consists of chest compressions (pumping the heart) and rescue breaths (infl ating the person’s lungs).CT angiogram A type of scan to show the blood fl ow through the coronary arteries.

D Diabetes A condition in which glucose (sugar) levels in the blood are too high. There are two main types: in type 1,

your body stops producing insulin; in type 2, your body can’t properly use the insulin it produces, usually because excess fat in organs prevents the insulin from working. Diabetes increases your risk of developing CVD.

E 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 then connected to a machine that picks up and records the electrical signals of your heartbeat.Echocardiogram Sometimes called an ‘echo’. An ultrasound to examine the structures within the heart, such as the heart valves, and to see how well the heart is pumping.

F Familial hypercholesterolaemia (FH) A genetic condition

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

G GTN spray A nitrate medicine that helps relax blood

vessel walls, improving blood supply to the heart muscle. GTN provides quick relief from angina pain and symptoms. For some, GTN can prevent ‘predictable’ angina attacks, but you should only use it in this way if your doctor or nurse has advised it.

H Heart attack Known medically as a ‘myocardial

infarction’, or ‘MI’. This describes a sudden loss of blood fl ow to part of the heart muscle. Most heart attacks are caused by atherosclerosis, the gradual build-up of atheroma within artery walls. If the atheroma becomes 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.

MEDICAL TERMS EXPLAINED

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

Heart failure Condition where the heart is less effi cient at pumping blood around the body.High blood pressure This is when your blood pressure 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.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 rhythm.

P Pacemaker A small device implanted under the skin

on the chest and connected to your heart by one or more wires (leads). It monitors the heart’s electrical signals and can stimulate the heart to contract and produce a heartbeat.

S Stent A short tube of expandable stainless-

steel mesh, inserted into an artery to hold it open after an angioplasty, improving the fl ow of blood through the artery.Stroke Interruption of blood fl ow to part of the brain, damaging or killing cells. This happens if an artery carrying blood to your brain becomes blocked or bleeds into your brain. It is a medical emergency.

V Ventricular tachycardia A very fast abnormal heart rhythm that starts at the ventricles. If

it doesn’t resolve quickly, it’s a medical emergency. It can lead to collapse and cardiac arrest.

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

Dictionary

may respond better to antidepressant or anti-epileptic medicines, for example, which require a prescription and assessment by a doctor.

Q Will any of these help relieve the discomfort caused by my heart condition?

A They may help, but masking the pain with analgesia could be dangerous. Chest pain in particular can be very serious and shouldn’t be ignored. If you’re worried about your heart condition, or your symptoms have worsened, see your GP. If you have been diagnosed with anginaD, use your GTND spray to relieve the symptoms; make sure it is in date and keep it nearby at all times.

Q Why do they come in different strengths? And what do these mean?

A Strength is the amount of the active ingredient a medicine contains. All medicines come in different

Over-the-counter analgesia can treat both acute and chronic pain”

All analgesia are available on prescription, but your GP will determine if that is appropriate for you. If you pay for prescriptions, it may be cheaper to buy them than to pay the fee.

Q I’ve been taking painkillers

for more than six months. Is this too long?

A Analgesia are generally safe if taken as intended, and it’s sometimes necessary to take them for prolonged periods, especially for chronic pain. Never take more than the recommended or prescribed dose, as this can have serious health implications. For example, an overdose of paracetamol can cause liver damage. Effervescent (dissolvable) analgesia contain a lot of salt, so it may be better to change to a non-effervescent equivalent if you are taking these regularly.

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strengths and doses; the usual dose of paracetamol is 1,000mg, whereas for ibuprofen it is 400mg. Effectiveness cannot be judged on strength (numerically), as each

medicine works differently. It’s like comparing apples with oranges. Always follow the instructions on the packet; they tell you how much you can take and how often. If you are unsure, ask a pharmacist or check with your GP.

Q Are non-branded painkillers as effective?

A All medicines are made to a recommended standard using the same amount of active ingredient. The efficacy (how well they work) should always be the same. Occasionally, the other, non-active, components of the medicine may differ slightly, but this shouldn’t affect the way they work.

Q I’m taking regular painkillers; can I get them on prescription?

A If you take over-the-counter analgesia regularly, see your GP to make sure you’re on the best one. This is vital if you’ve been taking them for an acute problem for 48 hours or more, and the pain remains.

Paracetamol

Uses

Alternative uses

Interactionswith other medication

Possible side effects

Aspirin Compound Ibuprofen

Mild pain (acute or chronic)

To reduce temperature

None

Rarely, a rash or swelling

• Bleeding in the stomach

• Indigestion• Vomiting

• Constipation• Nausea• Diarrhoea

• Indigestion• Heartburn• Stomach ulcers/

gastrointestinal tract bleeding

Antidepressants • Aspirin• Anticoagulants

(both warfarin and NOACs)

• Ibuprofen• Some diuretics

(water tablets)• Antidepressants

To prevent blood clots forming

• To reduce raised temperature

• To reduce inflammation

Mild pain associated with inflammation (acute or chronic)

Mild to moderate pain (acute or chronic)

Mild pain (acute or chronic)

None

More online See our guide to the different types of medications at bhf.org.uk/drugcabinet.

1918

Ablation explainedCatheters (small tubes) enter your heart via a vein or artery in your groin or neck. The arrhythmia trigger site is identified and radiofrequency energy is then used to inactivate or cordon off the affected area.

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Heart Matters

MEDICAL

anticoagulant medicine (such as warfarin) for a few weeks before and after their ablation.

Q How long does the procedure take?A The shortest ablation can take as little as

15 minutes, whereas a more difficult and complex procedure can take three or four hours. However, this usually includes preparation before and a recovery period afterwards.

We closely monitor each patient for 15 to 30 minutes after the procedure to make sure it has been a success. Once on the ward, each patient continues to be observed for a few hours before they are allowed home, although some people may need to stay in hospital overnight.

Q Will I need a general anaesthetic?A For simpler, shorter ablation procedures, a general

anaesthetic is unnecessary. A mild sedative is usually enough to keep you relaxed. However, for prolonged procedures or ones where other treatments are needed – for example, when the heart needs controlled electrical shocks – a general anaesthetic will be given. You are also likely to be given painkillers.

Q How risky is it?A Complications are extremely infrequent and for

around 90 per cent of those who have it, catheter ablation is successful. However, some patients may experience pain or bleeding at the sites where the catheters have been inserted or an allergic reaction to medications, although this is rare. Theoretically, high doses of radiation from the X-rays can burn the skin, but this is extremely rare and usually only affects people who are very overweight or obese. The risk of a disabling stroke is around one in 500, and the chance of a bleed around the heart needing to be drained is about one in 200. The risk of death is around one in 1,000.

Because of these risks, some patients refuse to undergo catheter ablation. A stroke, for example, can cause lifelong disability; that’s a frightening thought. Having these risks and alternative treatment options

bhf.org.uk

explained by your cardiologist in the right context and in the correct manner and tone, can make all the difference and offer reassurance.

Q How long is the recovery period after a catheter ablation?

A Once you are able to go home, you’re usually advised to rest for the remainder of the week and the weekend. This may mean taking a couple of days off work, particularly if you do a physical or demanding

job. You may also need to gradually increase the amount of exercise you do, especially if you hadn’t been doing much prior to the ablation procedure. Brisk walking by the second week is the norm.

Q What are the alternatives?A Treatment will depend on the type of arrhythmia

you have. Sometimes, simply finding out what you are feeling and why is enough. For example, lots of us get extra heartbeats (ectopics) from time to time and, although these can be a nuisance, they are usually harmless and require no treatment. Knowing they are not dangerous and trying not to focus on them can help you feel better.

There are also a number of medicines that can help to keep your symptoms under control.

If you feel your heart beating abnormally, you may need a catheter ablation. Dr Guy Haywood, Consultant Cardiologist in Plymouth, explains

Q What is a catheter ablation and why might I need one?

A Catheter ablationD is a drug-free solution for a wide range of abnormal heart rhythms (arrhythmiasD). An ablation is usually performed when the arrhythmia is causing symptoms that interfere with the person’s quality of life, such as stopping them from doing their job or normal daily activities, and when they haven’t responded to other treatments, such as medicines.

A catheter ablation involves passing thin, flexible tubes, called catheters, through the blood vessels to the heart. The catheters record the heart’s electrical activity and can pinpoint where the arrhythmia is coming from. The area of heart

Dr Guy HaywoodDr Guy Haywood is a specialist in adult cardiology, focusing on heart rhythm problems and coronary artery disease. Based in Devon, he helped set up the South West Cardiothoracic Centre.ablation

Focus on…

Undergoing a catheter ablation Turn over to discover what happens in the cath lab and read Frank’s experience of an ablation.

For around 90 per cent of those who have it, catheter ablation is successful”

muscle at the affected site is then destroyed using either heat (radiofrequency ablation) or by freezing (cryoablation). This creates scar tissue, which doesn’t conduct electricity and so knocks out a trouble spot or acts as a fence around the problem area to prevent the electrical signals from reaching the rest of the heart and causing the arrhythmia.

Q How does my doctor know what type of arrhythmia I have?

A For many people, their arrhythmia is paroxysmal, which simply means it comes and goes. This often makes capturing it on an ECGD recording very difficult. You will probably need to have a series of tests to show how your heart functions and determine what type of arrhythmia you have, so the doctor can decide the best treatment for you. These tests can include a chest X-ray, ambulatory ECG monitor (or Holter monitor), CT angiogramD, an echocardiogramD and MRI.

Sometimes, an event recorder that the patient can keep with them and activate when they feel they are in the arrhythmia is helpful. These are starting to appear as mobile phone attachments. In the most difficult

cases, where the arrhythmia causes bad symptoms but occurs only once or twice a year, a device like a computer memory stick can be implanted under the skin to record any arrhythmias automatically. This is called an implantable loop recorder.

Q What happens once I agree to have a catheter ablation?

A Your doctor will check if you need any preparation before your procedure. For example, you may need certain blood tests, and some patients must take an

Arrhythmiatrigger site

Ablationcatheter

Coronarysinus catheter

Diagnosticcatheter

Brisk walking by the second week is the norm”


MEDICAL

Our panel of experts answer your health questions

ASK THE EXPERTS

Rapid rate

Q My nine-year-old daughter has a fast resting heart rate – sometimes around 140 beats per minute. Should I be concerned? She’s a normal weight and stays active every day, at home and at school.

Dr Mike Knapton says:The resting heart rate in adults should be between 60 and 100 beats per minute (bpm), sometimes a little less for those who are very physically fit. In children, these values tend to be higher depending on their age. There are a large number

of reasons for the heart to beat faster than expected, from simple physiological causes, such as excitement or physical activity, to illness, such as a fever, and a range of diseases of the heart or metabolism.

It is worth making an appointment to see your child’s GP, as 140bpm is a little

fast for a child of her age. The key here is to find out if there is an underlying problem causing the rapid heartbeat. Her GP may wish to listen to her heart using a stethoscope and perhaps take an

electrocardiogram (ECG)D of her heart to check not only the rate but the rhythm too. It’s possible a blood test to check for common problems, such as anaemia or an overactive thyroid

gland may be helpful.

Read more elsewhere: To find out about the 100,000 Genomes Project, which is compiling vast stores of genetic information to help us identify and cure rare diseases, turn to page 22.

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

How to get in touch

A harmless heart hole?

Q I’m 73 years old and my doctor just told me I have a hole in the heart called a PFO, but he doesn’t want to do any surgery to close it. Is this normal and why hasn’t it been picked up sooner?

Professor Peter Weissberg says:A patent foramen ovale (PFO) is a small flap-like opening between the

top two chambers of the heart. This is part of the foetal circulation

when you’re in the womb, allowing

blood to bypass the lungs and take oxygen straight to the brain and body.

In most people, this

closes when they’re very young, but for some, it stays fully or partially open. This usually doesn’t cause any symptoms or problems with the function of your heart, so it often isn’t picked up until you have tests for other conditions. Most people will not require surgery to close it or medications, unless you have other conditions, such as a history of strokeD, or have a high risk of developing blood clots. Some

research shows a possible link between PFO and suffering with certain types of migraine, but more studies are needed before we can confirm this.

49

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Dictionary

When it comes to anything heart related, we’re here to help. Call or email our Helpline for support and information on:

Heart conditionsHealthy eatingHeart medicationsHeart Support GroupsKeeping your heart healthyLowering your risk factors, such as high blood pressure

Call the helpline on 0300 330 3300* or email [email protected]*Call rates are similar to 01 and 02 numbers. Lines are open 9am–5pm, Monday to Friday.

Heart Matters Helpline

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On the morning of your procedure, you will be admitted to the cardiac unit and then prepped.

1 Getting readyYou will change into a gown and a small plastic tube will be inserted into your arm. This tube – a cannula – is there in case you need any medicines during the procedure.

You will discuss the procedure with your doctor and sign your consent form, before being taken to the cath lab and asked to lie on an X-ray table. The table has a mattress for your comfort, as you may be there for a few hours, depending how long the procedure takes.

You will be connected to an ECG machine so your heart rhythm can be closely monitored. Your vital signs, including blood pressure and blood oxygen levels, will be monitored too.

Sterile paper towels will be draped over you to create a clean environment and reduce the risk of infection. If you are having a general anaesthetic so you are asleep during the procedure, an anaesthetist will administer this.

2 The procedure beginsThe skin at either your groin, collarbone or neck will be cleaned using a special solution, before a local anaesthetic is administered by injection to numb the site. The cannula is then inserted, and the catheters are passed through the vein or artery to your heart, using X-ray guidance.

Once the tips of the catheters are in place, the electrical activity in your heart can be recorded. Sometimes it is necessary to trigger the arrhythmia to identify what the problem is and where it is coming from, so the cardiologist knows which area to ablate. This process is called an electrophysiology study, or EPS. The ablation catheter is then passed into the heart to deliver the treatment.

3 Testing for successAfter the area has been ablated, the cardiologist will check to see if the arrhythmia can still be triggered. If it can, they will continue finding and ablating problematic tissue. In AF procedures, the goal is to build a ‘fence’ around the trouble spots in the heart, so the fence is tested to check if it’s intact at the end of the procedure.

Frank, now 75, had always kept active and enjoyed playing sport, particularly golf. In 2007, while

he was out on the golf course, Frank started to feel short of breath.

“I suddenly began puffing and panting,” he says. “Over the next few days, the same thing kept happening, several times a day. I took my own pulse during one episode and it was around 160 beats per minute, so I made an appointment to see my GP.”

Frank underwent an ECG and this showed that he had a common abnormal heart rhythm, similar to atrial fibrillationD (AF), called atrial flutter. Frank’s GP referred him to a local cardiologist, where he had a series of further tests. After the results of these had been assessed, Frank was referred to the John Radcliffe Hospital in Oxford for a catheter ablation.

“I was worried, but the cardiologist and his team were very reassuring. I remember I was awake for the whole procedure and was able to watch what they were doing on a TV screen. I didn’t feel any discomfort, except for when the cannula was put into my groin at the start, although I was told it would feel like a small, sharp scratch.”

Frank recovered well from the procedure and was allowed to return

home within two days. “I am fully fit again, am back to playing golf four times a week and go to the gym twice a week,” he says.

“It is seven years since I had the ablation and there has been no sign of the atrial flutter returning,” says Frank. “I was discharged by my cardiologist in 2012.”

Cath lab: what to expect

Online exclusives Meet Dr Gallagher as he treats Anne, a keen walker who had a cardiac ablation to treat atrial fibrillation. Find out what to expect during the procedure. Visit bhf.org.uk/heart-health/treatments/ablation.

I was worried, but the cardiologist and his team were very reassuring”

Frank’s story

Keen golfer Frank Lucock had a catheter ablation. Despite initial concerns, he recovered well and is back playing twice a week

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“The human genome is the blueprint for the people that we are,” says Professor Mark Caulfield, Chief Scientist for Genomics England. More importantly, our genomes

contain vital information about our susceptibility to certain conditions, including cardiovascular diseaseD, cancer and rare diseases.

“The genome contains about 3.3 billion ‘letters’, and in every 300 or so there’s a change to one that can make us more susceptible to a disease or, if passed on from generation to generation, can cause us to inherit

specific diseases,” explains the professor. “Sometimes there will be extra bits, or bits missing, and periodically bits will be moved around or not in the right place.”

Professor Caulfield is advising on an ambitious programme that will sequence 100,000 genomes by 2017. The aim is to identify the specific changes responsible for triggering both rare diseases and more common ones, such as cancer and heart disease. This information could allow us to tell thousands of families why their loved ones are susceptible to as-yet-undiagnosed conditions. “It’s about getting information to patients, mums and dads, and families

RESEARCH

Professor Mark CaulfieldProfessor Caulfield is Chief Scientist at Genomics England, Professor of Clinical Pharmacology at Barts and the London

School of Medicine and Dentistry, and Director of the William Harvey Research Institute. He specialises in cardiovascular genomics and has led a number of studies into hypertension.

A world-leading project to sequence 100,000 human genomes could get thousands of families the diagnosis they need. Genomics England’s Chief Scientist tells Sarah Kidner more

who can’t get it right now from currently available technologies in the health service,” says Professor Caulfield.

The UK is uniquely placed to lead on a project of this scale. “There is an opportunity for Britain, with a unified healthcare system, free at the point of delivery, to transform the application of genomics in medicine,” says Professor Caulfield.

“We have reached a point where developments in technology and chemistry allow us to sequence an entire human genome in a few days for the relatively low cost of circa £1,000. The Human Genome Project revealed there were only about 20,000 genes that code for the proteins that make us who we are – about the same as a starfish. The role of the remainder, around 95 per cent of it, was a mystery. We now know that the remaining DNA plays a critical role in determining how and when these proteins are produced, which is why it’s important to sequence the entire genome.”

Rare discoveriesSequencing the whole genome of people with a rare disease could help us identify atypical variants in the genetic code that actually cause diseases. But these rare variants are hard to find.

“By a rare variant, we mean a genetic variant in your genome that occurs in less than one per cent of the population, and sometimes even more rarely than that,” says Professor Caulfield. “Each of us has many, many rare variants. Getting a clear line of sight on the ones that cause rare inherited heart conditions, for example, can be very challenging, so we need some help.”

That help will come from families who have a rare and undiagnosed disease, ideally two parents with an affected child, allowing us to track the rare variant through generations. Participants will come via the NHS and enrol in the programme through NHS Genomic Medicine Centres. The first wave of these was announced in December 2014.

“These centres will offer whole genome sequence to patients with rare inherited diseases who have not obtained genetic diagnoses from existing tests in the NHS. They will have time to think about it before

they enrol, with informed consent,” says Professor Caulfield.

Typically, the definition of a rare, inherited disorder is one that affects five people per 10,000. For the 100,000 Genomes Project, the definition will be broader. “I decided when we started that we wouldn’t confine rare diseases to that definition, because it wouldn’t include less rare but very important disorders such as familial hypercholesterolaemiaD (FH),” says Professor Caulfield. “FH affects about one in 200 and is a major cause of premature heart attacks.”

The project will also observe disorders that affect the heart muscle, including cardiomyopathiesD and rare disorders of heart rhythm. Professor Caulfield explains: “The mums and dads that are enrolling their children in this programme know that only by understanding the genetic basis of rare diseases do we have much hope of designing better treatments for them.”

100,000 sequencesSome parts of the genetic code can be difficult to read, so they’ll read each one 30 times. “Reading the genome once is not enough, because you might miss bits,” says Professor Caulfield. “It’s like reading a book periodically; you get to a sentence and think,‘How did I get there?’ You have to go back and read a bit again because what you’re reading now doesn’t make sense. You realise you have missed a bit. It’s the same reading a gene sequence.”

Once read, the genomes will be added to a databank. Each genome generates around 220GB of data (the storage capacity of 14 average iPhones), so a special data centre is being built to store them, using a £24m investment from the Medical Research Council. The data, Professor Caulfield explains, will be in two parts. “One will retain an identity, because it’s important we can feed back to patients. A second data centre will store data in a non-identifiable format. We often call this anonymised or pseudonymised data. That data store will be 30 petabytes in size and will have about 30,000 dual processors.”

Scientists and clinicians will be able to access the raw data, or the genome sequence, as it comes out of the machine that captured it. The newly captured

100,000 whole genomes from NHS patients will be sequenced by 2017

4 base components make up our DNA

220GB the amount of data occupied by a single genome

3.3 billion letters in a single human genome

Have you seen our new-look website, bhf.org.uk/heartmattersmag?

If you’ve visited our website recently, you may have noticed its new look. We’ve made it brighter, bigger and more engaging, with videos, interactive infographics and helpful tips for a healthy lifestyle.

Just go to bhf.org.uk/heartmattersmag, where you’ll see our editor’s picks from the latest issue. If you’re interested in a particular topic, such as Nutrition, Research, News or Medical, you can use the handy tabs to take you straight there. If you want to find something specific, you can use the search box at the top right of the screen.

The website is the perfect partner to the print magazine, but if you want to save paper and make your Heart Matters membership online-only, you can do this by logging in to your account at bhf.org.uk/heartmatters or by calling 0300 330 3300.

WHAT’S TRENDING?Readers can’t get enough of these features:

Surprisingly salty foods

How much sugar is in different foods?

onlineFocus on…

Members-only toolsAs a Heart Matters member, you have access to exclusive tools. Try our recipe finder (bhf.org.uk/recipefinder), which contains hundreds of healthy recipes, all with nutritional analysis and a fruit and veg portion guide, or chat to other people with heart conditions on our online community (community.bhf.org.uk).

Poetry cornerOur new poetry section, only available online, contains readers’ poems about all aspects of living with a heart condition or caring for someone, ranging from the humorous to the touching. Find the poems at bhf.org.uk/poems. If you’d like to submit one of your own poems, email it to [email protected].

Heart Matters at a glance≠ Browse our healthy eating and nutrition features:bhf.org.uk/nutrition.≠ Find Drug Cabinet articles covering many different heart medications, as well as painkillers and antidepressants:bhf.org.uk/drugcabinet.≠ Discover readers’ medical questions, answered by our team of experts:bhf.org.uk/experts.≠ Explore every healthy-eating question our Senior Dietitian has answered:bhf.org.uk/foodquestions.≠ Use our recipe finder (it’s a Heart Matters member exclusive, so you’ll need to log in): bhf.org.uk/recipefinder.

A medical who’s who

Video: exercising with resistance bands

Chair-based exercises

Video: how to measure your blood pressure

at home

Find them all at bhf.org.uk/heartmattersmag.

bhf.org.ukHeart Matters24 25

genomes will be aligned to a control genome, ensuring the genome is reassembled in the right order.

Researchers can compare the genome of someone with a rare disease to those of others without it, to find potentially noteworthy variants. Work will be divided into areas. “There’ll be a cardiovascular domain, with UK leadership,” says Professor Caulfield. “Within each domain, a series of subsets will focus on specific diseases. Some researchers might work on Marfan syndrome, some on FH, some on familial hypertrophic cardiomyopathy, and other disorders as well.”

Go online for more…Our research saves lives We’re the biggest funder of heart research in the UK. To find out more, visit bhf.org.uk/research.

Beyond the horizon To hear the BHF’s Medical Director, Professor Peter Weissberg, talk about new areas of research and past successes, go to bhf.org.uk/horizon.

Call the BHF Genetic Information Service on 0300 456 8383. The BHF provides a number of helpful booklets, including our booklet Life with familial hypercholesterolaemia. See page 50 for more details, or visit bhf.org.uk/HMpublications to download or order.

Support from the BHF

By giving experts access to the data store, they can compare characteristics across genomes, enabling them to say – with greater confidence – whether these are likely to be characteristics of a rare disease.

Lifelong screeningResearchers plan to follow project participants through the course of their lives. This will, says Professor Caulfield, give us a clearer picture of how rare disorders progress through middle and later life, providing further clues about treatment.

Already, a rare disease pilot has screened 2,000 people with rare diseases. This has covered 85 diseases, of which many relate to the cardiovascular system. Professor Caulfield believes they’re on track to sequence an initial 10,000 genomes.

The remaining 90,000 will be sequenced by 2017, leaving a legacy of Genomic Medicine Centres and a state-of-the-art sequencing centre. In addition, the project has allocated £25m to provide 700 person-years of education in the form of short courses, PhDs and master’s degrees. These will “drive up the cadre of people able

people are affected by familial hypercholesterolaemia

1 in 200

the estimated number of rare diseases

5,000 8,000

to use this technology in the healthcare system,” says Professor Caulfield. The first master’s courses will begin in 2015.

While it’s early days, hopes are high that the project can deliver much-needed answers. The impact could be far-reaching. “You might ask – why invest in these diseases if they’re rare?” says Professor Caulfield. “But each individual disease affects five in 10,000 people, and there are 7,000 of these rare diseases, so collectively they affect around three million people in the UK. This programme is designed to get all of them a genomic diagnosis for the first time.”

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NUTRITION

Heart Matters

of

Thestory

2001 National Audit Office confirms

that obesity in England has tripled since 1981, with one in five people now overweight or obese

2004 Health Select Committee

report on obesity links 8.7 per cent of all UK deaths to excess weight

2008 World Health

Organisation warns 2.8 million will die worldwide each year as a result of excess weight

2011 Government policy paper Healthy lives,

healthy people: a call to action on obesity in England shows England is one of the most obese countries in Europe

2012 Health Survey for

England shows mean waistline has grown 6cm (2.4in) since 1993

1980 Six per cent

of men and eight per cent of women are obese in the UK

2007 The Foresight Report on UK

obesity says if no action is taken, more than half of UK adults and a quarter of children will be obese by 2050

Amid popular panic about an obesity epidemic, Heart Matters asks Paul Aveyard: how did we get here, and is it really a crisis?

It’s always been the case that some people are bigger than others, as Holbein’s portrait of Henry VIII (below) shows. At the time this was painted, carrying weight showed wealth and status, a visual reminder that you were

rich enough to eat well and important enough to avoid manual labour.

Today, we recognise that excess weight contributes to health problems, but how do we define obesity now? And is there really an obesity ‘epidemic’?

Health experts use body mass index (BMI), which is a measure of weight adjusted for height, to assess whether someone is a healthy weight, overweight or obese (see box, right). Obesity refers to a BMI of over 30 or, for those of South Asian descent, over 27.5.

Talking about obesity can be tricky, because the general public’s perception of it often differs from that of healthcare professionals. Paul Aveyard, Professor of Behavioural Medicine at Oxford University, explains: “The lay understanding of the term obese is really grossly overweight. A person with a BMI of 30 who does indeed have damaging levels of body fat won’t look at all remarkable.

“This is a problem, because when we talk about obesity and its risks on the news, in TV programmes or even in Heart Matters, many people just

Paul Aveyard is Professor of Behavioural Medicine at Oxford University. He helps people change behaviour to prevent or treat

serious disease. He is president of the UK Society of Behavioural Medicine, a trustee for the Association for the Study of Obesity, editor of Addiction and obesity adviser to the Department of Health.

Calculate your BMI by dividing your weight in kilograms by your height in metres squared. A BMI of over 25 may mean you are overweight. If it’s over 30, you may be obese (see point three, overleaf ). The exception is for people of South Asian descent, who are at increased risk of cardiovascular disease at a lower BMI than the rest of the population. The healthy BMI range for South Asian people is narrower. A BMI over 23 indicates they may be overweight, and over 27.5, obese, such as the 12st, 5ft 3in person below.

What is BMI?

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1993 The average

UK waistline reaches 32.3in (83cm) for women and 36.6in (93cm) for men

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assume those risks apply only to the extremely overweight.”

Any excess adipose (fatty) tissue upsets our metabolic processes, puts up blood pressure and worsens our blood cholesterol pattern, which make cardiovascular diseaseD (CVD) more likely. It also affects the way our body deals with glucose, the main sugar we use as fuel for our cells. This causes type 2 diabetesD, a major risk factor for cardiovascular disease.

Most people with a BMI above 30 have too much adipose tissue in their body, but not all. “BMI is an imperfect measure of health risk. It is an approximate measure of a damaging level of body fatness,” explains Professor Aveyard.

Is obesity a problem?According to Professor Aveyard, there

are two ways to answer this question, depending on whether we look

at individuals or societies. For individuals, excess fatty tissue has always been a problem, because it causes high blood pressureD, high cholesterol and diabetes and is one of the main causes of cardiovascular disease.

In societies like ours, where many people are

obese, it has become a major problem.

“It’s not just that there are more obese people in 2015 than there

were in 1980,” says Professor Aveyard. “It’s as if we’ve all had

a few kilograms of fat added to our bodies.” In England, we have had good records of the prevalence of obesity since 1980. Then, it was relatively rare, with six per cent of men and eight per cent of women classed as obese. Two decades later, in 2001, those rates had tripled. In the UK, obesity rates are rising faster than in the rest of Europe, as revealed in the 2004 Health Select Committee Report on obesity, which also linked 8.7 per cent of all UK deaths to excess weight.

If we don’t act, more than half of all UK adults and a quarter of all children will be obese by 2050, according to

2928 Heart Matters

There’s a lot written about fat in the press, not all of it accurate. Pascale Varley clarifies those fat myths

The truth about

FATNUTRITION

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Online exclusives Find out more with our list of surprisingly fatty foods: bhf.org.uk/fattyfoods.

bhf.org.uk

the Foresight Report. Lately, the rise in prevalence of obesity has slowed and the latest projection is not as dire, but it is still predicted that 40 per cent of adults will be obese by 2030. The direct healthcare costs linked to excess weight and obesity have reached an estimated £4.2bn, and the total cost to the UK economy around £16bn.

Too late to change?Governments, the NHS and other health organisations are working together to help stem the tide. In 2013, the Department of Health released a policy stating its intention to reduce obesity levels by 2020. But we all have a part to play by eating a balanced diet and getting regular physical activity.

Professor Aveyard says: “Shedding a kilogram of excess adipose tissue does your health as much good if you are only a little overweight, as it does if you are grossly overweight, or obese. The risks from a kilo of extra fat are the same, regardless of how many other kilos you are carrying.”

≠ Extra research by Pascale Varley, edited by Senior BHF Dietitian Victoria Taylor.

Monounsaturated fats: Unsaturated fats that protect our hearts by maintaining levels of good HDL cholesterol while reducing levels of bad LDL cholesterol. Polyunsaturated fats: Unsaturated fats that reduce blood cholesterol, including triglycerides. Omega-3 and omega-6 are the two main types of polyunsaturated fats. Saturated fats: Our body uses these to produce bad LDL cholesterol. Saturated fats can increase both total cholesterol and LDL cholesterol levels. Most saturated fats are identified easily, as they are solid at room temperature, except for palm oil. Trans fats: These occur when oils are transformed into solid fats during a process called hydrogenation. Foods that list ‘hydrogenated oils/fats’ or ‘partially hydrogenated oils/fats’ as ingredients are likely to contain trans fats. Very small amounts of trans fats occur naturally in dairy products and meat, but not in sufficient quantities to be harmful to your health.

Glossary

MYTH: All fats are the sameREALITY: All fats are high in energy and have an identical calorie value (9kcal per gram), so their effect on your waistline is the same. The big difference is their effect on your cholesterolD levels, so it’s important to consider the type as well as the amount of fat you are eating.

Industrially produced trans fats and too much saturated fat can increase the risk of coronary MYTH: Any kind of meat is

bad for my heartREALITY: Lean meats such as chicken or turkey, without the skin, are healthier options, as they are lower in saturated fat. Red and processed meats can be high in saturated fats and may also have added salt. Watch out for the white bits of fat in ham, steaks and bacon, and trim them off where possible.

heart diseaseD by raising the level of harmful LDL cholesterol, which can contribute to blood vessel blockage. Trans fats have largely been removed from UK food; average intakes are now below recommended maximums. However, we’re still exceeding recommended amounts of saturated fats. These include butter, lard and ghee, plus coconut and palm oil (often found in confectionery and biscuits). Saturated fats are also in whole milk, cream, cheese, cakes and chocolate.

Swapping saturated fats in your diet for unsaturated fats (monounsaturated and polyunsaturated) can help lower cholesterol levels. Find unsaturated fats in avocados, olive, rapeseed and sunflower oils, oily fish, seeds and nuts.

MYTH: I need to eat a low-fat diet to look after my heartREALITY: As our understanding develops, it’s clear we need to consider the overall balance of our diets.

A Mediterranean-style diet is famously associated with lower

rates of cardiovascular diseaseD, attributed to the inclusion of

olive oil, grains, beans, lentils, fruit, vegetables, oily fish and nuts. This is

not a low-fat diet, but the fats are mostly unsaturated. It seems to be the overall

combination that makes it so successful.

MYTH: Cutting out all fat is good for my heartREALITY: Such a drastic approach isn’t necessary, and excluding fat can mean missing out on nutrients and fatty acids that our bodies need, such as omega-3 and omega-6 fats. These polyunsaturated fats are found in oily fish, nuts, seeds and the oils made from them.

MYTH: Butter is better REALITY: Butter is high in saturated fat, so restrict yourself to small amounts and use alternatives for everyday eating. Try mono or polyunsaturated spreads, such as olive oil or sunflower spreads (a new manufacturing process solved past concerns about their trans fat content). Liquid oils can also be used for cooking and baking instead of butter.

51 We’re all getting bigger; it’s natural

With so many larger people around, we now perceive being bigger as ‘normal’. Based on BMI, healthcare professionals believe more than half the UK adult population (64%) is overweight and about a quarter is obese.

2 I have a bit of a belly, but what’s the problem?A person with a waistline above the recommended measurement is still at risk, because storing excess fatty tissue around your stomach increases the risk of high blood pressure and type 2 diabetes, which both increase your risk of cardiovascular disease.

To check your waistline, measure around the mid-point between your lower rib and the top of your hip bone. This measurement should be less than 102cm (40in) in men or less than 88cm (34.6in) in women. Anything above this indicates greater risk of complications. In South Asians, this can happen at an earlier stage, so we use a lower waistline measurement of 90cm (35in) for men and 80cm (31.5in) for women.

2020 A third of everyone in the UK aged 16 and

over will be obese, and two-thirds worldwide will be overweight or obese if current trends continue

2050 Total cost of excess weight and obesity

to the UK economy is estimated to reach £50bn per year by 2050 if nothing changes (Foresight Report)

2013 42 million children

aged five and below are overweight or obese worldwide

Weight through the ages

3 It’s not fat, it’s muscleBMI alone doesn’t tell you how much fat and muscle your body is made up of, or where that fat is stored. It’s true, a muscular athlete may have a high BMI without excess body fat, but it’s usually easy to spot such people. Even if your BMI is in the healthy range, measure waist circumference for a better picture of how your weight may affect your risk. An ‘apple’ body shape, where more fat is stored around the belly, puts you at higher risk of coronary heart diseaseD and diabetes than a ‘pear’ shape where fat is stored around the hips.

4 The odd biscuit won’t make me obeseEating biscuits occasionally might not hurt, but it’s easy to consume too many of them without realising. Having two custard creams per day (an extra 120kcal) on top of your normal diet can increase body fat by 2–4kg (4.4–8.8lb) over one year. If your clothes or jewellery feel tighter, or you get more out of breath when you are active, you may be putting on weight.

5 I need to crash diet to lose the excess weightLosing as little as five to 10 per cent of your body weight can significantly reduce your risk. For a 5ft 3in (160cm) woman weighing 12st (77kg), this means losing 9lb to 1st 3lb (4–7.5kg). There is no shortcut to healthy eating, so don’t fall for the fad diets. Instead, consider gradual changes to your eating habits. Trying to change too much, too quickly usually fails. You could also focus on preventing further weight gain if you feel losing weight is too hard.

Our free booklet Facts not fads can help you control your weight. You’ll find tips on portion sizes and changing your behaviour towards food, and a progress chart to track improvements. Our heart-friendly recipes provide healthy cooking ideas, while our resources, Be active for life and Put your heart into walking, hold tips on getting active. See page 50 for details of how to order.


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A heart condition hasn’t stopped Carl Portman’s jungle adventures. Sarah Brealey meets him and his eight-legged friends

30 Heart Matters

NUTRITION

Our Senior Dietitian Victoria Taylor answers your nutrition questions

ASK THE EXPERT

Eating for exerciseQ What do I need to eat and

drink while I’m training for a 10km run?

Victoria Taylor says: When you’re training for an event such as a 10km run, it is unlikely that you will need to buy any special foods or drinks. Enjoy the activity and the feeling of getting fitter without worrying about specialist sports nutrition. When it comes to drinks, if your exercise session is up to an hour, then you only need to drink water. This is especially important if you are trying to lose weight, as drinking sugary sport or energy drinks during or after your

training can mean you consume more calories than you have expended.

Similarly, it can be easy to overcompensate for the exercise you have done by treating yourself to more indulgent meals or additional snacks. If you have a healthy diet, then you should already be getting all the energy and nutrients you need.

However, if you move on to training for endurance events, such as a marathon or our 54-mile London to Brighton bike ride,

this could require a bit

more thought. Nevertheless, the basis of your eating should still be a healthy

balanced diet. Although protein requirements do

increase slightly with regular exercise, because

most of us are already eating more protein than our bodies need, this should be enough to compensate for the extra

activity you are doing. This means there is no need to top

Read more elsewhere: Turn to page 38 and discover some tasty snacks to replace a chocolate bar, or visit our website for more great tips on eating and exercise: bhf.org.uk/trainingtips.

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

How to get in touch

yourself up with protein shakes or similar. Staying hydrated is, however, extremely important. If your exercise sessions last for longer than 90 minutes, then eating a snack to sustain your energy is a good idea. Good options would be a piece of fruit, such as a banana, or a handful of dried fruit.

A sweet dilemmaQ Can I be addicted

to sugar? Victoria Taylor says: Many of the foods and drinks that people regularly consume are high in sugar. While eating a little bit of sugar is fine, on average, we are eating more than is recommended, so it’s something that we do need to be aware of. We naturally like the taste of sweet foods and it is therefore easy for the occasional sweet or a

sugary drink to become part of our daily routine without us noticing. We often use sweets, cakes and sugary drinks as a reward, or to pick us up if we’ve had a bad day. Because of this, we can start to feel reliant on sugary foods and drinks, and some people feel as though they’ve developed an addiction.

In reality, while we might have developed hard-to-break habits, there is little evidence to

suggest that sugar is addictive in the same way as tobacco, alcohol and other drugs. The theory that sugar is addictive is largely based on evidence from feeding studies conducted in animals. These findings cannot be directly applied to the eating patterns of humans,

which are much more complex than those of

most animals.While that’s

reassuring, it can still be hard to change

the way you think about your favourite sweet treats and when or how often you want to eat them. To help break your old habits and create new ones, try removing temptation and changing your environment, by sitting in a different room or going for a walk, when the urge to eat strikes. You can still reward yourself, but consider non-food options that will be equally satisfying, such as a magazine or a trip to the cinema.

49

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Carl has been all over thesouthern hemisphere insearch of spiders

The

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amazing


Carl Portman isn’t your typical tourist. He’s travelled thousands of miles, but not to visit beach resorts or capital cities. Instead, Carl, 51, has crossed the southern hemisphere

and trekked through remote jungles to pursue his passion for creatures that many of us find terrifying.

Carl loves spiders, and observing them in their natural habitat is his favourite hobby. “When I get into the rainforest and I hear the cicadas in the trees, it is my idea of heaven,” he says. “I feel totally at home there.”

Carl carries out his quest in spite of his heart condition, which is controlled by an implantable cardioverter defibrillatorD (ICD). “I want to show that anything is possible,” he says. “My motto is ‘Get up, get dressed and get out there’, and I know this attitude helps me cope with my heart disease and the ICD.”

Carl was diagnosed with arrhythmogenic right ventricular cardiomyopathy (ARVC), a rare disease of the heart muscle, when he was 29. It can affect the pumping ability of the heart and can cause abnormal heart rhythms. Carl has had two ablationD procedures (see page 18 for more information) to try to correct the heart-rhythm issue, and also takes medication.

When he was offered an ICD, which can restore a normal heart rhythm if he suffers a life-threatening ventricular tachycardiaD, he was initially reluctant. “I didn’t want any foreign objects inside me,” he says. “Even the fear of sudden death couldn’t change my mind. But Tim Betts, my brilliant cardiologist, convinced me. He treated me as a person, not just as a patient – that was really important. It was his words, ‘You enjoy life so much, why not extend it?’, that I thought were really logical.”

Life saverCarl says he sometimes finds his ICD uncomfortable, such as when he lies on his left side in bed, and he found it difficult

psychologically at first. “It is strange to have a piece of machinery inside you. You almost don’t feel like a person. But you might argue it’s a small price to pay for my life.”

Having the ICD has almost certainly saved his life twice. When it delivered its first shock, in March 2010, Carl was on a fishing boat in the Arctic trying to spot the aurora borealis (northern lights). There was no medical help on board, but the ICD restored Carl’s normal heart rhythm. He was able

to fly home the next day and went for a check-up at the cardiology clinic. He knows the device is helping to protect him and allowing him to do the things he loves.

Carl, from Banbury, Oxfordshire, worked in logistics for the Ministry of Defence for 30 years and now works for a chess magazine and as a chess coach. Studying spiders is his hobby. Since his ICD was fitted, he’s been on natural history trips to Australia, Costa Rica, Guatemala and Belize. He also married his partner Susan, an IT consultant. He says: “I have done all this, followed my hopes and dreams, because of my ICD.”

Being in remote places can be frightening. Carl worries about having a life-threatening heart rhythm, his ICD delivering a shock when it’s not supposed to, or getting bitten by a venomous spider (fortunately, he hasn’t been bitten yet). “It is always on your mind,” he says. “You think, ‘There is no medical help here.’ Some of the places I go to have no facilities at all. It is good that the ICD is there to protect me.”

Online exclusives Watch Carl with his spiders and this cockroach and see him talking about his ICD. Visit bhf.org.uk/spiders.

You might be interested in our free booklet, Implantable cardioverter defibrillators (ICDs). Download or order from bhf.org.uk/HMpublications or call 0870 600 6566. Our Heart Matters Helpline offers information and support if you have a heart condition. We also have a Genetics Information Service if you or a family member have been diagnosed with an inherited heart condition. Call 0300 330 3300. To share experiences with other people with heart conditions, join our online community at community.bhf.org.uk.


Travelling through airports has only posed minor challenges. “I have had a few issues at airports, but generally it is OK. I just tell them I need a pat down instead of walking through the scanner.”

Awesome arachnidsCarl believes in the importance of staying positive. Pursuing his interests and having a can-do attitude helps him do that. “The thrill of seeing a big tarantula in its natural habitat is one of the highlights of my life,” he says. “I want to go out and see these things. Why should this stop me?”

He has been interested in spiders for about 20 years, ever since he got a pet tarantula to try and cure his fierce hatred of spiders. “I got the biggest tarantula I could find, and the next thing I knew, I was travelling to Ecuador to see them.”

At one point, Carl was breeding endangered spiders and had more than 1,500 of them in his house. His wife is less keen, so he’s now down to 17 – plus a scorpion and a Madagascan hissing cockroach. But his passion for spiders hasn’t diminished.

“Spiders are interesting,” he says. “They are different. They go back 400 million years. They have to moult their whole skin to grow. They are creative; they set traps to catch prey. They can produce silk. Some can go without food for 12 to 13 months, and some have incredible camouflage. Without spiders, we would probably be overrun with insects.”

Carl hasn’t let his ICD stop him from living a full life, and he wants to encourage others

to do the same. “I am not afraid to die, but I am afraid of not living. I want to show that anything is possible.”

≠ Find out how long ICDs like Carl’s usually last in our Jul/Aug 2015 issue.

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I have done all this, followed my hopes and dreams, because of my ICD”

DO live a normal life. Most household items, including microwaves and drills, shouldn’t affect your ICD.

DON’T dangle headphones round your neck or within 3cm (1in) of your ICD.

DO tell the DVLA you have an ICD. You won’t be able to drive for six months, but can restart if you’ve had no shocks. A few people can drive after a month. Check with your doctor.

DON’T put mobile or cordless phones, or MP3 players within 15cm (6in) of your ICD.

DO always carry your device ID card.

DON’T wear magnetic fasteners near your ICD. Don’t use a TENS machine for pain relief, and keep electric-pulse body-toning tools below your stomach.

DO tell staff you have an ICD when you go through airport security, as it will set off the alarm. Walking through quickly shouldn’t be a problem, but you can ask for a hand search or hand-held metal detector check instead. The detector should not be placed directly over your ICD.

Carl bought his firstspider to cure a

hatred of arachnids

ICDs: dos and don’ts

34 Heart Matters

WELLBEING

35

When Trevor Munkenbeck had a heart attackD, he felt his world had changed. “Suddenly I had to take medications,” he says. “I felt my friends saw me differently, not as a fit and healthy person. I felt flawed.

And I’d lost my hopes and dreams: the vision I had of attending my five-year-old granddaughter’s wedding one day no longer seemed a certainty.”

As Trevor found out, a heart attack, surgery or being diagnosed with a health condition can change your life. But even if you are in good health, we all have to deal with change. Whether it’s the breakdown of a relationship, bereavement, moving house, losing your job or retirement, it can be hard to adjust to a new scenario.

A retired psychological therapist, Trevor was surprised to feel anxious and tearful in the weeks after his heart attack. “I thought I knew how to deal with stuff like this, but when it came to me, I didn’t.”

Normal reactionKaren Rodham, Professor of Health Psychology at Staffordshire University, says changes often create a sense of uncertainty that we naturally find difficult. “As human beings, we like to feel life is ordered and will go in the way we expect,” she says. “When something happens to change that, such as a heart condition, it can make your future seem uncertain and scary.”

bhf.org.uk

COPING WITH

changeNot surprisingly, this can lead to feelings of anxiety,

depression or both. Our survey of Heart Matters readers in our Jan/Feb 2015 issue showed this affects numerous people with heart conditions, and many of you asked for tips on coping with change.

Understanding that these feelings are normal can help you to deal with them. Professor Rodham says: “Feeling depression after something like a heart attack is very normal. It is a life-changing event; it is normal to feel down and fed up. It takes time to process it. You can allow yourself to feel it – no one has to be chipper all the time.”

Trevor, too, wants people to know these feelings are common. “This is something that does affect us. You

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Trevor had to find waysto cope when a heartattack changed his life

Going through change can be unsettling, especially when it’s caused by a heart condition. Sarah Brealey discovers how Trevor Munkenbeck coped with life after a heart attack

Just to be able to voice your fears and feelings is helpful”

Having to take medicationafter his heart attackmade Trevor feel flawed


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Read our free booklet Heart to Heart: heart disease and your emotional wellbeing. You can download or order it at bhf.org.uk/HMpublications, or call 0870 600 6566. You can also find support from other people with a heart condition

on our online community at community.bhf.org.uk.Heart Support Groups are groups run by patients, for patients. To find your nearest group, call our Heart Matters Helpline on 0300 330 3300 or visit bhf.org.uk/heartsupport.


5ways to cope with change

1 Learn to accept what has happened to youAcceptance is a big word, but it can really help. Some people see it as giving in, but I see it as coming to terms with how things are now.

2 Pace yourselfIf you have a heart condition or are recovering from a procedure, you may not be able to do as much as you used to. This can be hard to adjust to, but pacing yourself may actually help you do more, rather than rushing to do lots of things and having a setback because you’ve done too much.

3 Ask for help from loved onesIt can be hard to ask for help, especially if you think you are already a burden on loved ones because of your condition. But often they want to help you and they won’t know how until you tell them what you need. Try not to think: ‘If he/she really loved me, they would know what I need.’ Our loved ones are not mind readers, after all. Tell people if the support you’re getting isn’t what you need. For example, your friends and family may want to wrap you up in cotton wool and do everything for you, but it can be an important part of your recovery to do things for yourself.

4 Look for new opportunitiesThere may be things you can’t do any more, and it’s normal to mourn the loss of this. Ask yourself: ‘What can I do instead?’ It might be taking up cycling if a heart condition means you can’t run any more, or volunteering instead of doing the job you used to.

5 Carry a self-help reminderGet a small card that you can carry with you, and write down a strategy that works for you when you’re feeling down. It might be ‘Go for a walk’, ‘Phone my sister’ or ‘Make an appointment with my GP’. Write down useful phone numbers too, because when you are in crisis, you don’t think straight. If you feel yourself slipping into crisis, get out the card and do what it says. You’ll be reassured by having a successful strategy at your fingertips.

Talking to his wife and children helped Trevor stay positive

are not being silly in thinking these things,” he says. “Find someone around you to listen, but if you need to, you can get professional help.”

Talking cure“The way I have come to terms with it is by talking through it. Just to be able to voice your fears and feelings is helpful,” says Trevor. He found talking to people who’d been through the same thing particularly useful, whether at cardiac rehabilitation, or chatting to friends and acquaintances who’d experienced heart attacks. He also found talking to loved ones, such as his wife and children, helped a lot.

Heart Matters has also been a source of support. “Reading things like Heart Matters is very useful,” he says. “The article about Dr Richard Gale [Nov/Dec 2014] and how he felt after his heart bypass was wonderful – to read that and think someone else has gone through the same thing and feels the same way.”

Karen Rodham, Professor of Health Psychology at Staffordshire University, gives her expert advice:

Not everyone needs professional help to cope with change, but if you feel you would benefit from it, your GP is a good place to start. They may refer you for psychological support to help you come to terms with what has happened. Health psychologists are particularly useful because they understand how physical health affects your psychological health and vice versa.

You also have the option to pay to see a counsellor or a health psychologist privately.

Find a directory of chartered psychologists at bps.org.uk or counsellors at bacp.co.uk.

To speak to someone at the BHF, call the Heart Matters Helpline on 0300 330 3300. If you’re finding it difficult to talk to your family, you might want to consider Relate. Visit relate.org.uk or call 0300 100 1234.

The Samaritans are not just for people who feel suicidal; they are also there if you are feeling really fed up. Visit samaritans.org or call 08457 90 90 90.

Where to find help

As the months passed after his heart attack in March 2014, Trevor found coping got easier. “Time is a great healer,” he says. “At first I kept worrying that I was going to have another heart attack, but I don’t now. I think what hit me at first is that everything happened so quickly. It takes time to adjust to it.”

Like Dr Gale, Trevor thinks there needs to be more focus on the psychological side of heart problems. “The physical side is sometimes seen as more

important, maybe because it is easier for someone to fix. But the psychological side is important too.”

Trevor feels fortunate that his heart didn’t suffer much damage and says many of his fears, such as being unable to go walking on Dartmoor, have not been realised. He’s now focusing on the positives; he’s improved his diet and lost a stone-and-a-half in weight. “I can now join in with my grandchildren’s games, which I couldn’t before,” he says.

“It was a massive kick in the teeth, but it has been a turnaround. It’s as if someone said: ‘This is a warning, it is a little knock, but you have the chance to sort things out.’ I feel grateful.”

≠ Read more about the psychological effects of living with a heart condition at bhf.org.uk/emotional.

It was a massive kick in the teeth, but it has been a turnaround”

Go online Find 7 extra ways to cope with change at bhf.org.uk/copingwithchange

NUTRITION

38

1Chocolate is good for meCocoa beans, the main ingredient in

chocolate, contain naturally occurring polyphenols. There is some evidence that polyphenols help reduce blood pressure and have antioxidant properties. However, chocolate is high in sugar and saturated fat. It is a high-energy (calorie) food, and too much can result in excess weight, a risk factor for cardiovascular diseaseD. Healthier sources of polyphenols include beans, pulses, fruit and vegetables.

2Chocolate gives me energy Chocolate contains small amounts of

caffeine, which may contribute to the idea that it makes us energetic. When you’re hungry, it’s better to eat a snack that provides sustained energy release. Choose foods with less sugar and fat and more fibre, such as a small sandwich, a piece of toast, an apple or a small bowl of unsweetened cereal.

3Dark chocolate is better for meDark chocolate contains more cocoa

solids and cocoa butter than milk chocolate, but the amount of polyphenols depends on how the chocolate is processed, so it’s not necessarily better. During the manufacturing process, cleaning, fermentation, roasting time and temperature, ‘dutching’ (alkalising) and the addition of extra ingredients to the cocoa (emulsifier or sugar, for example)

can almost completely remove polyphenols from the dark chocolate.

4Hot chocolate doesn’t countCocoa powder used to make hot

chocolate contains less fat because it doesn’t include the cocoa butter and other fats found in a chocolate bar. However, depending on what you mix the cocoa powder with, your hot chocolate drink can contain as much energy (calories), fat and sugar as between one and two-and-a-half average chocolate bars. Be wary of hot chocolates made with full-fat milk and served with high-energy toppings (whipped cream, marshmallows, cocoa

sprinkles). However, switching a chocolate bar for a drink made with semi-skimmed, one per cent or skimmed milk and cocoa powder, with just a little sugar or sweetener, could save you 100kcal and will be a more nutritious option.

5Chocolate is addictiveThere is no evidence that chocolate

causes physical addiction. Instead, our feelings about chocolate tend to dictate our behaviour, as we associate it with comfort, reward and celebration. This connection means we might feel that we ‘need’ it, which can make it hard to control how much we eat. Instead, try to obtain pleasurable feelings in other ways; walk in beautiful surroundings, call a friend or indulge in hobbies you love.

6Chocolate with bubbles in is ‘lighter’

The energy, fat and sugar content per 100g are similar to other chocolates. Added air makes it less dense than solid chocolate, so eating

chocolate with bubbles can be like eating a slightly smaller bar, and therefore you are getting less fat, saturated fat and sugar per portion. But always check the portion size. Some bubbly chocolates are sold in larger bars than your usual solid chocolate bar, eliminating any health benefits.

7A chocolate bar is the perfect portionAny excess energy you consume will

lead to weight gain. One chocolate bar

averages 250kcal. This is equivalent to 10 per cent of a man’s and 12 per cent of a woman’s recommended daily intake, and it’s often gobbled down in a few minutes. In order to lose the energy obtained from a chocolate bar, a 50-year-old person needs to walk for 45–55 minutes.

8I can’t eat chocolate, I have diabetes Most people who have diabetesD can

usually consume chocolate in moderation and as part of a healthy lifestyle and diet. There is no need for special diabetic chocolate products that are often higher in energy and fat, and may still raise your blood glucose levels. Instead, if you do decide to eat chocolate, stick to a small amount of it and try to have it at the end of your meal, so that your body absorbs it more slowly.

MYTHS about

It’s tempting to swallow the hype about chocolate’s supposed benefits, but don’t believe all you read. Pascale Varley debunks some common myths

CHOCOLATE

39

Time for a Dechox?Join the UK’s first DECHOX, a nationwide, sponsored challenge to give up chocolate for March and raise money for our life saving heart research. Any cocoa is a no-no, which means chocolate bars, biscuits, ice cream, cake – even cappuccino chocolate sprinkles – are off limits. Whether you’re an undercover eater, a crafty nibbler or a midnight fridge-raider, why not sign up. Although March has begun, you can still sign up at bhf.org.uk/dechox or call 0300 330 3322.

DECHOX?Time for a

Challenge yourself to give up chocolate for March

Help raise money for lifesaving heart research Sign up by 28 Feb at bhf.org.uk/dechox

FIGHTFOR EVERYHEARTBEAT

Chocolate swapsAn average 50g chocolate bar contains 250kcal. Swap it for a nutritious snack and see how many calories you save.

SWAP FOR

3 dried apricots

Plain popcorn (20g)

Skinny latte rather than hot chocolate125g fruit yoghurt pot (fat free)Small bowl of fresh berries

194kcal

131kcal

145kcal

176kcal

212kcal

SAVE

There is no evidence that chocolate causes physical addiction”

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ACTIVITY

Improving your health with physical activity and a balanced diet is a great idea, but we often avoid it. Rachael Healy finds out why

Ditch theEXCUSES

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Every New Year, we vow to start that diet or join the gym. But by now, many of us will have slipped back into our old ways. Committing to long-term lifestyle change can be challenging,

and it’s often easy to make excuses at the end of a long day or when the weather is bad. However, excuses rarely stand up to scrutiny, and not being physically active can have serious consequences for our health. We’ve tackled the most common excuses and suggested ways to ditch them.

1I’m too tired to do physical activityStudies show being active gives you more

energy. A University of Georgia study, for example, claimed exercising three times a week at low and moderate intensities made

ACTIVITY

World Health Day (7 April) reminds us of the health challenges

we face as a nation. In the UK, 64 per cent of adults are overweight or obese and inactivity causes one in six deaths. More than 25 per cent of us are inactive, getting less than 30 minutes of moderate-intensity activity a week. Inactive people are at a much greater risk of 20 common health conditions, including cardiovascular diseaseD

(CVD), type 2 diabetesD, hypertensionD, obesity, dementia and other mental health conditions.

Inactivity levels in the UK are double those of Germany and France and more than 20 per cent higher than in the United States. Once world record holder for CVD, Finland tackled this with a nationwide campaign focusing on all ages and a shift of money to local authorities. Similarly, a transfer of public health responsibilities to a local level has begun in England, but will need all sectors involved and a redirection of public funding, to encourage everyone to be more active, every day. Ph

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More than 25 per cent of us are inactive”

Top tips for being active every day

3 If you enjoy walking, add some variety and push yourself further with Nordic walking poles. Using two poles while you walk gets your arms and core involved, making your physical activity more well-rounded. To challenge yourself even more, incorporate a small hill into the route of your walk, or try carrying small weights.

2 Everyday activity, such as walking or cycling to the shops or to work, is a great way to get your heart pumping. There is a greater chance of success if you build physical activity into your daily routine.

1 Find an activity you enjoy and make it even more fun; listen to music while you do it or attend a class with a friend or family member.

4 Use tools to support you, such as the NHS Choices’ Couch to 5k plan.

5 Set yourself a goal or challenge. Why not take part in a mass participation challenge, such as a BHF walk, run or bike ride?

6 Take advantage of the great outdoors – meet friends for a walk at your local park, or take your children or grandchildren for a kick-about.

7 Encourage young children to be active through the games they play.

8 Take the stairs instead of the lift or escalator, whenever possible.

Lisa’s top

As we celebrate World Health Day, we’re reminded of the link between diet and activity, and Lisa Young explores how we can make the UK more active

TIPS


people feel less lethargic. Physical activity helps you make more energy and can increase the number of mitochondria in your cells. Mitochondria turn glucose and fat into ATP, the chemical your body uses as energy.

2I’m not putting on weight, so I don’t need to do any physical activity

Visceral fat is found between your organs, so you may not know it’s there, but a lack of physical activity and a diet high in saturated fat can encourage its growth. Visceral fat has been linked to a higher risk of cardiovascular diseaseD, so where your fat is may be more important than how much of it there is.

Physical activity also has benefits beyond weight loss. It can make you stronger, more flexible and help you cope with stress. Physical activity changes skeletal muscles, helping them rid your body of a chemical created when you’re stressed that in high quantities can cause depression.

3I’m too old to start being activeTaking up physical activity at any age

can improve your health. Those who exercise regularly have a 30 per cent lower risk of early death, around 68 per cent lower risk of hip fracture, 30 per cent

allow you to find others interested in both a specific activity and meeting new people. Team sports, walking groups and class-based activities are also a good option.

6 I’ve never liked sportModerate-intensity activity doesn’t

necessarily mean traditional sport. As well as brisk walks and riding a bike, you could try ballroom dancing, gardening, housework, walking a dog or painting a room. Look up active hobbies in your area at tinyurl.com/activehobbies or visit your local sports centre or community centre and check the noticeboards.

7Getting active is too expensiveRun, jog or walk in your neighbourhood

or a nearby park. Or try tricep dips on a park bench: face away from the bench; place hands, with arms straight, on the

bench on either side of you, feet flat on floor and bum off the bench. Bend arms and lower yourself down. Pause, then push back up. In your home, use the stairs for step-ups, practise yoga in your front room, or use household items such as tins of beans as small weights.

Although zero activity may seem like the cheap option, our collective lack of physical activity costs the NHS an estimated £900m per year. The Department of Health also predicted the cost of elevated BMI, covering treatment of obesity and related conditions, may rise to £6.4bn this year.

8I don’t have timeMake activity part of your daily routine.

The journey to work or to the shops is a great opportunity to walk or cycle. If you’ve got a long trip, get off the bus or train a stop early and walk. You could also replace

Jerome Carson, 57, is Professor of Psychology at the University

of Bolton. He used his ‘good genes’ as an excuse to live the life he wanted, avoiding exercise and often indulging in fine wines and rich foods. But on a business trip to Athens in 2013, he was taking a walk when his chest began to hurt.

“I tried to control my breathing, but the only thing that stopped the pain was sitting down,” says Jerome. “The pains came on intermittently after this, generally when I was exerting myself – carrying Christmas shopping or carrying heavy briefcases.”

Yet Jerome put off seeing a doctor until a night of particularly bad pain ended in A&E. He had an exercise ECGD test and then an angiogramD. This revealed a blockage in one of his coronary arteries, and in March 2014, Jerome had three stentsD inserted.

“I had the procedure in the morning and in the evening I felt perfectly fit,” says Jerome. “It was absolutely unbelievable that there was such a difference so quickly.”

Jerome’s procedure was a success, but he now takes a number of medications, including a beta-blocker and statins.

Jerome now realises that, despite being a professor of psychology, he was making excuses to himself. Since the operation, he has made some lifestyle changes, losing 5kg (11lb) and transforming his diet. He says occupational stress is a factor people should also be aware of.

“Genes are important, but they’re only part of the story,” he says. “My cholesterol wasn’t high, I’d never smoked, but my diet wasn’t great and I had been a binge drinker. In my case, lifestyle no doubt contributed to the early onset of this problem.”

“I felt that I was invincible: I have good genes, it’ll never happen to me”

Physical activity at any age can improve your health”

lower risk of dementia and a 30 per cent lower risk of falls. To reap these benefits, a minimum 150 minutes of moderate-intensity activity is recommended per week. Everyday tasks such as mowing a lawn, shopping and housework all count.

4 I am active every day, so it doesn’t matter if I eat unhealthily

Bad habits, such as drinking in excess or eating unhealthily, have a negative impact on your coronary arteries, even if you are physically active.

5 I don’t have anyone to exercise withAsk friends or family if they want to do

activities with you. Set a regular time to take a walk or attend a class together to keep one another motivated. Activities can also be a great way to make new friends. Websites such as Meet Up (meetup.com)

On the run Mark Harrison used to avoid exercise, but after a heart attack, he’s made positive lifestyle changes.

lift or escalator journeys with the stairs, and if you have to sit down most of the day, make an effort to stand up and walk around regularly.

9I’ve had a heart attack/surgeryRegular activity can aid your recovery

and confidence. Cardiac rehabilitationD can help you get active again after a heart event and has been shown to increase the proportion of patients reaching the 150-minute goal. You’ll also learn about different types of physical activity. The programme usually recommends starting with gentle walks on flat terrain, gradually building up to more intense activities.

10I have good genesSo-called good genes are not an

excuse to pick up bad eating habits or avoid physical activity. Lifestyle factors

have a big influence on your health, so even if there’s no history of heart disease in your family, you may still be at risk. Jerome Carson, a professor from Bolton, recently discovered this the hard way, when he was diagnosed with a heart condition (see above).

Lifestyle factors have a big influence on health”

Doing weekly activitycan reduce your

chance of early death

Joining an exerciseclass is a good way to

make new friends

Cardiac rehab can

help you find an

activity that suits you

4544

After suffering a heart attack, Mark Harrison found solace in running. He tells Rachael Healy about discovering the ‘runner’s high’, and why he’s raising money for the BHF

ACTIVITY

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running “I

t was just a lazy Saturday. The day before, I’d had fluttery feelings in my chest and put it down to indigestion, but the next morning the pain started and got worse and worse.”

Mark Harrison, a teaching assistant from Staffordshire, was just 39 when his quiet weekend became a health emergency. As the pain in his chest intensified, he knew something was wrong, but he never expected it could be a serious heart event. “I’ve always been really slim, so I never really exercised or worried about what I ate. This was completely out of the blue.”

Kate, Mark’s partner, rang an ambulance and 10 minutes later paramedics had arrived and were administering medication. “They did an ECGD and they were really calm,” says Mark. “But when we got to the hospital there were people waiting and they said to me straight away: ‘You’ve had a heart attackD.’”

Road to recoveryMark was taken for an angioplastyD and had a stentD fitted. After three nights in hospital he returned home, but his journey back to health would last a further six months. He was offered a place on the University Hospital of North Staffordshire’s award-winning cardiac rehabilitationD programme, where he met rehab practitioner Paul Stern.

“He was absolutely amazing,” says Mark. “PE wasn’t my thing at school; I’d done cross country and stuff, but nothing had ever stuck. Paul took me through different things like the rowing machine, the bike and the treadmill. I did little bits of each and my confidence

UP ANDEven if it’s just running for two minutes, give it a try”

Following cardiac rehab,Mark started taking short

runs around the block

grew. I found running was something I could do and Paul was really supportive. He just said: ‘If you’re comfortable, then do as much as you feel you can.’”

This advice stuck with Mark. When cardiac rehab finished, he decided to keep on running and began challenging himself to cover greater distances. (Remember: if you’ve had a heart event, check with your GP before taking up a new form of exercise.)

“When I came out of hospital, it was just a short walk for a few minutes. After a while, I’d run for five minutes around the block. As time’s gone on, I’ve built up the distance and the length of time. [In 2013] I ran about 700 miles, and I’ve done five half marathons and eight 10k races.”

Last year, Mark set himself a goal of running 1,000 miles and decided to use the challenge as an opportunity to raise money for the BHF. “I know the

Mark advises anyonewith a pair of trainersto give running a try



ACTIVITY

You could get running and raise funds for the BHF at the same time. We’ve got some major runs coming up in the next few months:≠ 12 April, Bournemouth Bay Run≠ 6 May, Tower of London Run (10k)≠ 31 May, Edinburgh Marathon≠ 4 October, Blenheim Palace Half Marathon.Register at bhf.org.uk/runs and find our training plans, tailored to all fitness and experience levels, at bhf.org.uk/training.

Running with the BHF

Phot

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Paul Peacock uses gardening to stay active, despite living with heart

failure. He shares tips to keep you and your garden in shape

Paul’s tips for spring

into actionSpring

valuable work that you’re doing for people who have been through what I’ve been through,” he says. “If it wasn’t for their work and the people at the NHS and people like Paul Stern, I wouldn’t be doing what I’m doing and I wouldn’t be here. All the help that I got over the last three years, I just want to give a little bit back.”

Positive stepsMark found that, together with support from Heart Matters and the NHS, running has helped his physical

Personalised shoes can enhance your running technique and prevent injury by providing support, cushioning and grip, while protecting you from debris.

Everyone has a running style, depending on the foot’s arch and the way it rolls on each stride. Specialist shops offer gait analysis, where cameras capture you doing a short treadmill run at your own pace. Experts can then tell whether you over-pronate (roll your feet inwards), supinate (roll your feet outwards) or are a ‘neutral’ runner.

“The analysis itself is about five minutes,” says Mark Linnane, Assistant Manager at Runners Need. “With trying on shoes, it takes 15–30 minutes, depending on the level of support needed. If you’re not getting the right support for your run, it throws everything off. From knee

problems to back problems, it all starts with the feet. Correct arch support in a shoe can level you up by stopping the inward roll of the foot and giving you balance.”

Customised insoles, which can be moulded to the shape of your foot, may help people with certain foot problems, as Mark explains: “They could have arch problems, like collapsed arches. In those instances, it may be a good idea to get insoles as well.”

It’s also useful to match footwear with terrain. “For off-road running, shoes don’t need as much support because your foot moves in different ways on uneven surfaces,” says Mark. “Most trail shoes won’t have any pronation support. The sole of a trail shoe is different to a road shoe, so you don’t get good traction on road. Likewise, the other way round.”

The right shoes

1 Grass rootsIt’s a little too early to be mowing the lawn, but give it an edging with a lawn edger or a light spade to neaten it up. Aerate the grass by stabbing it with a garden fork or a sharpened stick, making holes about 2cm in diameter, 15cm deep. This will keep the grass healthy and green.

2 Transplanting onionsLast issue I talked about sowing onion seeds. If you followed my advice, by now your seedlings will be 10–15cm tall. The bed for onions should be well-prepared, but my condition means I can’t always do this. If, like me, you can’t hoe your bed to a fine, crumbly soil, get someone to bring you some compost, plonk yourself on a chair, and use a trowel to get about 15cm of compost roughly onto your bed. Use a

dibber (I use a stick about 2cm in diameter) to make a hole a hand’s depth and pop an onion plant into the hole. Let the rain water the onion in position and the soil

will do the rest. I plant them about 25cm apart to make it easier for me to hoe between the onions.

3 Early lettuce, beet and turnip‘All Year Round’ is such a great lettuce, but like all lettuces, it doesn’t enjoy being transplanted, which means sowing outdoors. It’s a bit cold right now, but I have

a raised bed with a polytunnel top, so it gets warm enough for the

next couple of plants. Lettuce, turnips and

beets are all sown in a drill (a straight line). For

some reason, scraping a drill in the ground makes me breathless. Instead, I put my rake on the soil and give it a tap or two with the spade. This makes an indentation, and I sow in this.

4 Bedding inI use module trays for my bedding, and keep the seeds at around 12°C, more or less. You can sow asters, dahlias, stocks, ageratums, coreopsis and salvias right now. Fill the module trays with compost, firm it in with

the bottom of another module tray, and then sprinkle about three seeds in each cell. Sprinkle with compost, firm in again and water. Later in March, thin them out to one plant per cell, which means they’ll be easier to transplant in May.

5 Pruning Roses can be trimmed to give them shape. You want a wineglass shape to maximise the amount of air flowing to counter fungal infections. Cut the stems so the buds face outwards, not inwards. Cut just above a bud, and think: if the rain falls on this cut, where will it flow? You want it to flow away to prevent the plant rotting, so make a slanting cut away from the bud.

In late winter and early spring, it can be hard to resist sowing too much, too soon. The sky’s blue and it’s no longer

dark at four o’clock, so you just can’t help yourself. Trays of compost and neatly sown vegetables invade the kitchen table, only to be marooned there by a prolonged April cold snap that stops you putting them outside.

In reality, there’s no rush. My advice is to take it easy and don’t do or plant too much. Even if you put it off until May, nature has a way of catching up. That said, there are some profitable tasks you can start now.

Roses can be trimmed to counter fungal infections”

and mental recovery. “It’s just brilliant; it’s time away from everything. Sometimes I think things through, and sometimes I think of nothing at all,” he says.

He even discovered that running could be a useful study aid. Last year, as he was completing a BA in early childhood studies, evening runs brought academic inspiration. “I found that when I was running, I’d think of phrases to use for my dissertation, so I’d grab my phone and record a few sentences. I just feel brilliant when I come back from a run.”

Mark’s most memorable running experience happened in 2012. After months of slow-but-steady training, he signed up to the Newcastle-under-Lyme Seven (now the Newcastle 10k). “I’m a volunteer for the Samaritans and I have a colleague who runs. He said: ‘Do this race with me, have a go, I think you’ll be

ready for it.’ That was the first race I did, and I had a really close friend and my brother running with me. That was really good.”

Mark believes anyone who’s ever considered running should just go for it. “Give it a try,” he says. “It’s really cheap to do – all you need is a half-decent pair of trainers, and everybody’s got a pair of shorts or tracksuit bottoms and a T-shirt.

“Even if it’s just running for two minutes, give it a try for a couple of weeks. If you don’t like it, fine, but I’d guess if you do it for a few weeks or a couple of months, you will become hooked. You’ll become addicted and you’ll have to run. I have to do it now. I have to run.”

Gait analysis can helpyou find the perfect

running shoe

I just feel brilliant when I come back from a run”

0300 330 3300*

When it comes to anything heart related, we’re here to help. Call or email our Helpline for support and information on:

Heart conditions

Healthy eating

Heart medications

Heart Support Groups

Keeping your heart healthy

Lowering your risk factors, such as high blood pressure

HEART MATTERS HELPLINE

Call the Heart Matters Helpline or email [email protected]

*Call rates are similar to 01 and 02 numbers. Lines are open 9am–5pm, Monday to Friday

FIGHTFOR EVERY HEARTBEAT

49bhf.org.uk

A Ablation A procedure to correct types of arrhythmias.

It involves using radio-frequency waves to destroy the abnormal electrical pathways.Angina An uncomfortable feeling, tightness or pain in your chest. May also be felt in arms, neck, jaw or stomach. Symptoms 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. Atheroma Fatty material that can build up within the walls of the arteries. Sometimes called ‘plaques’. 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.



this education and exercise programme helps you recover from a cardiac event and get back to as full a life as possible.Cardiomyopathies Diseases of the heart muscle that cause it to work less effectively. It may become thickened, enlarged and/or stiff. It affects people of all ages and is usually inherited.

Cardiovascular disease (CVD) All diseases of the heart and circulation – for example, coronary heart disease or stroke.Congenital See below.Congenital heart disease A heart abnormality that a person is born with, such as, a hole between heart chambers (‘hole in the heart’). There are many types; some are due to faulty genes or chromosomes.Coronary artery bypass surgery An operation to treat coronary heart disease. Arteries from your chest wall or arms, or veins from your leg, are used to bypass 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.Cardiopulmonary resuscitation (CPR) Actions performed to keep blood circulating around the body when a person is in cardiac arrest. CPR consists of chest compressions (pumping the heart) and rescue breaths (inflating the person’s lungs).CT angiogram A type of scan to show the blood flow through the coronary arteries.

D Diabetes A condition in which glucose (sugar) levels

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








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 within artery walls. If the atheroma becomes 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 This is when your blood pressure 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.Hypertension The medical term for high blood pressure.

I Implantable cardioverter defibrillator (ICD) A small





steel mesh, inserted into an artery to hold it open after an angioplasty, improving the flow of blood through the artery.Stroke Interruption of blood flow to part of the brain, damaging or killing cells. This happens if an artery carrying blood to your brain becomes blocked or bleeds into your brain. It is a medical emergency.

V Ventricular tachycardia A very fast abnormal heart rhythm

that starts at the ventricles. If it doesn’t resolve quickly, it’s a medical emergency. It can lead to collapse and cardiac arrest.

DICTIONARY

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

Healthy eating and lifestyleBe active for life (physical activity information for over-65s) G364Coping with stress G187Cut down on salt G160Cut the saturated fat M4Eating well G186Everyday triumphs G972Get active, stay active G12Healthy living, healthy heart (information for African Caribbean communities) G532A taste of South Asia (South Asian recipes) G606Keep your heart healthy HIS25Looking after your heart (information for South Asian communities) G223Put your heart into walking G26Risking it – short films designed to help you tackle risk factors bhf.org.uk/riskingit or DVD21Facts not fads – your simple guide to healthy weight loss M2Stop smoking G118This label could change your life G54Taste of the Caribbean (African Caribbean recipes) G503Your heart, our help G598Women and heart disease M37 Living with a heart conditionAn everyday guide to living with heart failure G275UAngina HIS6Atrial fibrillation HIS24Blood pressure HIS4Cardiac rehabilitation HIS23Caring for someone with a heart condition HIS20Coronary angioplasty HIS10Diabetes and your heart HIS22Having heart surgery HIS12Heart attack HIS7Heart rhythms HIS14Heart to heart: heart disease and your emotional wellbeing G954Heart transplantation HIS13

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 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) DVD5Pacemakers HIS15Peripheral arterial disease HIS16Physical activity and your heart HIS1Primary angioplasty for a heart attack HIS26Reducing your blood cholesterol HIS3Returning to work with a heart condition HIS21Test for heart conditions HIS9The road ahead – your guide to heart tests and treatments DVD30

BHF SUPPORT

Facts not fads is our new and improved guide to healthy weight loss. It provides advice for adults about losing weight steadily and gradually, by making long-term changes. The booklet includes a useful eating plan and strategies for success. Please note, this booklet replaces So you want to lose weight for good.A5 bookletOrder code: M2

Facts not fads – your simple guide to healthy weight loss

Salad40g (11/2 oz) baby spinach leaves25g (1oz) watercress85g (3oz) cherry tomatoes (about 7 cherry tomatoes), halved1 small ripe mango (about 300g/10 1/2 oz total/unprepared weight), peeled, stoned and diced25g (1oz) walnuts, chopped2 tbsp roughly chopped fresh coriander

1 tsp olive oil175g (6oz) skinless, boneless chicken breast, cut into thin strips4 spring onions, cut into short (1cm/ 1/2 in) lengths

Dressing4 tsp walnut oil2 tsp red wine vinegarFreshly ground black pepper, to taste

Chicken mango salad with walnut dressing

Preparation time: 20–25 minutesCooking time: 10 minutesServes: 2

1 For salad, put spinach leaves, watercress, cherry tomatoes, mango, walnuts and coriander into a bowl; toss to mix. Set aside.

2 For dressing, put all ingredients into a small bowl or cup; whisk together until well mixed. Set aside.

3 Finish salad. Heat olive oil in a small non-stick frying pan (or wok). Add chicken; stir-fry over a medium heat for 5 minutes. Add spring onions; stir-fry for

a further 3–4 minutes or until chicken is cooked and lightly browned (increasing heat slightly towards end of cooking time, if necessary). Remove from heat.

4 Give dressing a quick whisk; drizzle over salad and toss to mix. Divide salad between 2 serving plates; top with hot chicken mixture (see Anne’s tips). Serve on its own or with oatcakes or fresh wholemeal bread.

Ingredients

Method

“For a packed lunch, cool the cooked chicken mixture before adding it to the salad, then pack in an airtight container and store in the fridge. Add the dressing just before serving. To save time, add raw spring onions and pre-cooked cold chicken breast to the salad.”

Anne SheasbyOur resident food writer Anne has had over 26 cookery books published covering bread, soup, vegetarian meals and more.

Anne’s tips

23%

Each portion contains:

Sugars22.1gMed

Energy1701kJ407kcal

Fat18.8gMed

Saturates2.3gLow

Salt0.2gLow3%27% 12%25%20%

% = an adult’s reference intake

CHICKEN SALAD

Ingredients

Recipes: Anne Sheasby; food styling: Sara Lewis; prop styling: Tony H

utchinson; photography: William

Shaw

4 tsp rapeseed oil1 tsp ground cumin1 tsp ground coriander1/2 tsp ground cinnamon6 small shallots, halved1 red pepper, deseeded and cut into chunks225g (8oz) sweet potato, peeled and cut into small chunks or wedges2 carrots (about 225g/8oz total/unprepared weight), sliced

227g (8oz) can chopped tomatoes in rich natural juice200–225ml (7–8fl oz) hot home-made or reduced-salt vegetable stock115g (4oz) canned chickpeas in water (drained weight), drained and rinsed4–6 ready-to-eat dried apricots (about 25g/1oz), halvedChopped fresh coriander, to garnish (optional)

1 Preheat oven to 200ºC/180ºC fan/gas mark 6. Combine rapeseed oil and ground spices in a small dish.

2 Place shallots, red pepper, sweet potato and carrots in a medium non-stick roasting tin. Add oil mixture to vegetables; toss together to mix well. Shake tin to level vegetables into a single layer.

3 Roast in oven for about 25 minutes or until vegetables are tinged brown and almost

Methodtender, stirring once or twice. Add tomatoes, stock (the amount you add depends on juiciness of tomatoes), chickpeas and apricots to roasting tin; stir to mix. Cover with foil; roast in oven for a further 15–20 minutes or until hot and bubbling, stirring once.

4 Sprinkle over chopped coriander (if using); serve on its own or with couscous, wholemeal bread or some baked potatoes.

These recipes are from Heart Matters magazine, March/April 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.

“For a packed lunch, cook the tagine as above, then cool, transfer to an airtight container and refrigerate. Reheat gently in microwave, on hob or in moderate oven until piping hot, before serving. You may need to add a little extra stock too.”

Anne’s tip

23%


Sugars25.5gLow

Energy1493kJ356kcal

Fat9g

Low

Saturates0.8gLow

Salt0.5gLow8%13% 4%28%18%


HEARTY STEW

Roast vegetable and chickpea tagine

Preparation time: 20 minutesCooking time: 35–45 minutesServes: 2

FREE

March/April 2015





of goldHeart




RECIPECARDS

1 Combine mango chutney, apricots, spring onions and chilli in a small bowl, mixing well; season with black pepper. Place each tortilla wrap flat on work surface or large chopping board; divide chutney mixture between wraps and roughly spread mixture over one side of each wrap. Sprinkle with coriander (if using).

Ingredients3 tbsp mango chutney55g (2oz) ready-to-eat dried apricots, finely chopped2 spring onions, finely chopped1 small fresh red chilli, deseeded and finely choppedFreshly ground black pepper, to taste1 tbsp chopped fresh coriander (optional)

2 plain wheat flour tortilla (deli) wraps (each about 25cm/10in in diameter)4 slices cooked cold turkey breast (about 115g/4oz total weight)85g (3oz) cucumber, thinly sliced25g (1oz) watercress or rocket leaves

Method

“For a packed lunch, wrap the filled wraps (before cutting into portions) in foil and refrigerate until ready to serve. Make them in the morning to eat at lunchtime the same day.”

2 Arrange 2 turkey slices across middle of each wrap. Top with cucumber slices and watercress.

3 Wrap/fold or loosely roll up tortilla wraps to enclose filling; cut each into 3 or 4 portions to serve (see Anne’s tip).

Anne’s tip

23%


Sugars29g

High

Energy1662kJ392kcal

Fat2.4gLow

Saturates0.6gLow

Salt1.3gMed22%3% 3%32%20%


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/recipefinder.

QUICK WRAP

Tangy turkey wraps

Preparation time: 15 minutesCooking time: N/AServes: 2

Love fruit? Try our orange salad (Jan/Feb 2014). Visit bhf.org.uk/recipefinder or call 0870 600 6566.

1 Combine dried fruit and sugar in a mixing bowl. Add hot tea; mix well. Cover and leave to soak at room temperature for at least 8 hours or overnight, until fruit is plumped up.

2 Preheat oven to 180ºC/160ºC fan/gas mark 4. Grease and line a 900g (2lb) loaf tin; set aside.

3 Stir eggs and orange zest into soaked fruit mixture; add flour and mixed spice, mixing

Recipes: Anne Sheasby; food styling: Sara Lewis; prop styling: Tony H

utchinson; photography: William

Shaw

175g (6oz) ready-to-eat dried apricots, chopped175g (6oz) ready-to-eat dried figs, chopped115g (4oz) sultanas115g (4oz) light brown soft sugar225ml (8fl oz) strong hot brewed (strained) tea (such as Darjeeling or breakfast tea)

2 large eggs, beaten1 tsp finely grated orange zest225g (8oz) self-raising wholemeal flour2 tsp ground mixed spice

Ingredients

Methodwell. Turn mixture into prepared loaf tin; level surface. Bake in oven for 45–60 minutes or until browned on top and a skewer inserted into centre comes out clean.

4 Cool slightly in tin; turn out on to a wire rack and cool. Serve warm or cold on its own, or spread with a little sunflower spread or honey.

“For a packed lunch, wrap individual slices of teabread in foil. This teabread will keep for a few days, if you wrap it in foil once cooked. You can also freeze it for up to 1 month.”

Anne’s tips

≠ 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%


Sugars27.3gHigh

Energy886kJ

210Kcal

Fat2g

Low

Saturates0.4gLow

Salt0.3gLow5%3% 2%30%11%


10 MINUTES TO CHANGE YOUR LIFE Time to eat well

TEATIME TREAT

Deliciously fruity teabread

Preparation time: 25 minutes, plus overnight soakingCooking time: 45–60 minutesMakes 1 loaf (10–12 slices)

Inspired? Bake an apple crumble (Sep/Oct 2014). Call 0870 600 6566 or go to bhf.org.uk/recipefinder.

Documents

If you answer any of the questions on this form, please ... › - › media › images › heart... · to home. As we celebrate Mother’s Day, Leanne Clarke, born with a congenitalD