Jonathan C. Pitts Crick

Very unlikely – almost certainly it was always there but newer echo machines are better at detecting them. You should see a cardiologist who may arrange a trans-esophgeal echo or other investigation to get a more detailed picture.

You should phone the ward you were in and ask them to arrange an urgent check.

Yes, it is a major risk factor for heart attacks and heart failure, even without the added associated risk of diabetes. A low-carbohydrate diet and regular exercise can help with reducing the risk and reducing anxiety. If you have tried every kind of diet and none of them worked, you should discuss gastric banding or some other kind of bariatric surgery with your doctor – it is often the only thing that DOES work. If you don't do something soon, you are heading for a fairly miserable middle age and not much beyond that. But if you take some definite action NOW, you can look forward to getting your life back, like any other young woman.

It sounds like a transient heart arrhythmia (not a heart attack or stroke). It could be ventricular tachycardia which is quite serious, so you should get your heart checked.

Any exercise or stress puts up your blood pressure while it is going on and for a short time afterwards. But, over time, regular exercise such as undewater swimming puts blood pressure down.

The story about blood pressure and being underwater relates to very frequent and prolonged breath-holding resulting in a drop in blood oxygen level. Over a period of years this can lead to pulmonary hypertension, especially in young women, which can be irreversible. In the past, his was a cause for early deaths in the pearl divers in the far east.

Too mch salt increases blood pressure but too little makes it unstable, so on your lisinopril treatment I would not advise cutting out salt – just go with your taste buds: if they tell you that you need salt, you probably do.

BP down to 90 systolic when lying is not too low so your treatmet seems to be about right.

Yes it is an emergency – he should go to hospital. It could be a pulmonary embolus, pneumonia or heart failure.

There are 3 main problems with congestive heart failure:

1) Fluid overload. This is a natural reaction to the reduced pumping of the heart which causes salt and water retention by your kidneys. The holistic/naturopathic solution is to limit your salt and water intake so as to keep a stable fluid balance. This can be checked by monitoring your weight daily. If you are already fluid overloaded (leg swelling, breathless at night) you will need to be in "negative fluid balance", i.e. losing weight, until these symptoms have settled – and then keep the weight steady. If this cannot be achieved by salt and water restriction you will need some help from diuretic medication.

2) Limited pumping power of your heart. This is mainly apparent when trying to exercise when a normal heart can increase its power by x 5 but a "failing" heart can only manage x 1½-3 depending on how severe it is. It causes breathlessness and fatigue when you try. The holistic work-around is to increase your body's efficiency by regular gentle fitness training and to reduce the sensation of breathlessness by controlled breathing. Many people with a diagnosis of heart failure can actually achieve a normal exercise level in this way – or at least enough for normal daily activities. If your heart's power is barely sufficient for your body to "tick over" you are in "stage-4" heart failure and you will just have to rest and maybe get an electric buggy to move around. Medical treatment with beta blockers can be very helpful especially if the heart is going too fast.

3) Risk of sudden death. This is only significant in severe heart failure. A holistic response is to avoid extreme stress or sudden exertion, and to accept the idea that you have to die sometime and sudden cardiac death is one of the better ways to do it. A very efective medical intervention is implantation of an automatic internal cardiac defibrillator (ICD) which can resuscitate you if the heart suddenly stops pumping. Even if you have one, you still have the option of turning it off if you feel like your quality of life is not worth it continuing.

In summary, there are important holistic remedies but careful use of conventional medical treatment is also highly beneficial.

It depends on the type of infection; there are several different bacteria which respond to different antibiotics. So, the first step is to do a blood culture to identify the bug and its sensitivity to a range of antibiotics; then choose the best one or two based on what is likely to work with a minimum of side effects. Generally, intravenous antibiotics are used initially, but the course of treatment may be for 6 weeks or so (depending on the bug) and it may be possible to switch to an oral antibiotic for the later part of the treatment.

Regular exercise does lower blood pressure but usually not enough. Especially if you have hypertension in your family, it is likely you should be on regular medication to avoid the increased risk of developing vascular disease over the next decades.

Yes, the tendency to both run in families and often go together. The diabetic tendency can usually be kept at bay by avoiding getting overweight using a low-carb, limited calorie diet.

They are also linked because they both increase the risk of vascular disease (heart attacks and strokes) later in life but most of this risk can be avoided by treating them effectively even at the stage when they are mild.

A heart murmur is a sound coming from the heart that can be heard using a stethoscope. An echocardiogram (ultrasonic scan of the heart) usually shows exactly what is causing the murmur and how serious (if at all) it is.

Usually but not always. The pain is typically in the centre of the chest or across the front of it but can also be felt in the left arm, up to the jaw. Heart attacks affecting the underside of the heart may be felt as severe indigestion with nausea. Around 20% of heart attacks are "silent", i.e. not painful, and may cause just severe fatigue for a few days,

Yes, either with open heart surgery or a catheter device (minmally invasive). If it is just a small ASD and you are not planning to be a professional diver it may be OK to leave it alone.

The same as for men as close as possible. Obviously it can ba difficult to attach the sticky electrodes on the left side of the chest in exactly the "correct" positions relative to the ribs because the breast can "get in the way" so the cardiographer has to get them as close as possible, either above or below. It cannot be done properly without removing the bra.

In general, yes. But it does depend on whether there are any other problems with her heart. You should discuss this with your paediatric cerdiologist or surgeon – it is a very reasonable question to ask.

Myocarditis is inflammation of the heart muscle, usually caused by a virus. It usually settles down allowing a good recovery but may require a period of rest for a few weeks. Occasionally the heart can be left with a weakened muscle (cardiomyopathy).

It's a heart attack affecting the front of the heart. It's caused by a blocked coronary artery resulting in an area of damage to the heart muscle. ECGs often show the pattern of a suspected anterior infarct when the heart is just slightly rotated, but you can check whether there really has been a heart attack by having an echocardiogram, which is an ultrasonic scan of the heart (like an antenatal scan but higher up). It will also tell you if you have any abnormal heart valves, etc., which could cause the ECG pattern.

Best wishes,

Jonathan

It was likely to be just fatigue, but it may have been a temporary arrhythmia of the heart such as atrial fibrillation. If she is now feeling fine there is probably no need to worry, but if it happens again, she should have a check-up, especially if the feeling doesn't pass after 10 minutes of rest. It would be a good plan to build up her fitness gradually by walking regularly, provided it doesn't make her feel unwell.

Best wishes,

Jonathan

Clogged arteries in your heart limits the amount of work you heart can do. This shows up initially as increasing fatigue on walking uphill or other strenuous exercise. If you push yourself harder you can get a feeling of pressure or tightness in the middle of your chest which settles quite quickly when you rest. It is made worse by cold air, exercising soon after a meal or being stressed.

Best wishes,

Jonathan