J urnalIssue 163December 2008 / January 2009 BCPA

THE PATIENT

AND CARERS INDEPENDENT

VOICE

The official magazine of the BRITISH CARDIAC PATIENTS ASSOCIATION

Blue light to PapworthHow well do you know yourself?

Aspirin at bedtime – how sure can one be?Study confirms importance of checking the pulse

Acupuncture treatment for heart disease Fast angioplasty after a heart attack

Clot-dissolving drugs for strokes

www.BCPA.co.uk

admin@BCPA.co.uk

We, the Editorial Team wish you all a lovely Christmas and New Year. I, Dr Richard Maddison, married to Pat, have

been on the Executive Committee and a Trustee since 1998, am currently Vice-Chairman, and was appointed Editor in 2005. Jean Sanderson, a friend for many years with extensive experience of editing and proof reading, proof reads the text before I hand it over to John. John Hunt, who was for many years employed producing

Contents

Do you have concerns or worries that you would like to talk to someone about? Our telephone helpline, as part of our national support services, normally operates 9.00am to 7.00pm Monday to Saturday. If you get no reply please leave your name and number and we shall attend to your call as soon as possible.

If you have a question or issue that is best in writing, please write to our Head Office who will try to find an appropriate person to answer it. All the people who answer our helplines have been patients or carers so are likely to understand your concerns because they have been there.

NATIONAL HELPLINE – 01223 846845

The Journal is the bimonthly magazine of theBRITISH CARDIAC PATIENTS ASSOCIATION

also known as BCPA. Registered Charity 289190

President Sir Terence English KBE, FRCSVice-Presidents: Ben Milstein MA FRCS, Alan Bowcher DMS FFA

Executive OfficersChairman Keith Jackson Tel: 01954 260731

Vice-Chairman & Journal Editor Dr Richard Maddison Tel: 01234 212293 Email: richard.maddison@virgin.netTreasurer Derek Holley OBE FCA

BCPA Head Office 2 Station Road, Swavesey, Cambridge CB24 4QJ Tel: 01954 202022Email: admin@BCPA.co.uk Website: www.BCPA.co.uk

Opinions expressed in the Journal are not necessarily those of the Editor or the BCPA. No item may be reproduced without consent. Advertisements must conform to the British Code of Advertising Practice. Publication does not indicate endorsement by the BCPA.

© Copyright 2008 BCPA and/or the authors

Design and production – john@cartog.co.uk Printed by – Core Publications Ltd, Kettering

3 From Me to You – Keith Jackson 4-6 News from around the Areas – Bedford to Wirral6 Dates for your diary7 Study confirms importance of checking the pulse

– Sue Lyon8-9 Blue light to Papworth – Sarah Clarke9 Aladdin – Holy Cross Players10 Acupuncture treatment for heart disease – Diana Olafsdottir10 Fewer Clostridium difficile cases – RM11 How well do you know yourself? – Corey Beecher11 Recipes: Easy risotto with bacon and peas;

Smashing Barabrith cake – Janet Jackson12 Aspirin at bedtime – how sure can one be? – Letter

to the Editor13 Fast angioplasty after a heart attack – RM

Clot-dissolving drugs for strokes – RM9, 14 Puzzles: Wordsearch, Crossword14 Co-ordinators, Contacts and Affiliated Groups15 Membership and aims16 Index to Journals 2004 to 2008

The items on pages 12 and 13 are instead of Ricky’s Quickies.The Cardio & Vascular Coalition consultation document (Green Paper) has been delayed. We hope to give further information in the February issue.

Donations

Journal contributions and dates

We gratefully thank all those who have sent donations, including the following.

In memory of Mr Edward Simpson of Bar Hill £289.78£2500 from the Trust of Mr Jack SmithIn memory of Mr Alan Nicholls of Histon £162.50In memory of Mr Richard Foers £670.56Biggleswade Rotary Club gave £50 to Mr Philip Dean for his

services to Rotary, and he has given it to the BCPA.We acknowledge here donations over £50 unless the donor

wishes otherwise. The BCPA really needs the donations.

Please send donations as cheques payable to BCPA to BCPA Head Office, 2 Station Road, Swavesey, Cambridge, CB24 4QJ

We invite members to send in items for publication – not only heart-related information and articles, but also lighthearted items and stories.

Please phone me, Dr Richard Maddison, 01234 212293, to agree the easiest way to send it in – don’t send it to Swavesey. Normal closing dates are 20th of an even month – February, April ... Please phone me before that date if you may be late.

maps and other printed items in The Open University, and whom I have known equally long, produces the

final layout and design of each issue in the correct form for the printers.

Daddy’s given us some very large parcels this Christmas.’

‘Yes, he’s had a transplant and the donor had a very big

heart!’

Anne Curtis, our daughter, helps with puzzles

and crosswords. The cover is Anne’s painting of

A Winter Scene.

From Me to YouKeith Jackson, National Chairman

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May I take this opportunity to give Season’s greetings to all members, friends and supporters of the

Association. Also a big thank you to all our Journal contributors – members of the medical professions, some who contribute month on month, letter writers, and advertisers. Without you, and of course our hard working Editor and his Team, we would not have a flagship publication.

As we approach Christmas, hustle and bustle, a round of preparations and then it is all over in next to no time, let us take a moment to reflect. Let us take the opportunity, as part of the season of giving, to give thanks. To many BCPA members that means reflecting on the care we have received from those working in the medical profession at all levels – GPs, consultants, or someone in a less glamorous position – they all have had a part to play. In this I also include carers – often a husband, wife, partner, relative, friend; or someone special who has a very important part to play. And of course, for many, it is not only during the past year but may relate to a situation many years ago.

Growing the AssociationAs a valued member of the Association it is likely that you are aware of someone who may benefit from also becoming a member. The initial reaction to my suggestion may seem a strange one but might it be that when you are considering purchasing Christmas presents you may consider membership as that present? If so, then please contact the Head Office so that we can get the new member details back to you in time for you to gift wrap with a personal note.

BCPA Annual General MeetingSaturday 16th May 2009 at The Westminster Hotel, Nottingham

Please note the changed date and place.The 2009 Annual General Meeting will

be held at the Westminster Hotel, Mansfield Road, Nottingham on Saturday 10th May 2009.

The Westminster Hotel, part of the Best Western Group, is situated one mile away from the city centre. Access to the hotel is good, it being only 10 minutes from Junction 26 on the M1 motorway. Members wishing to visit the city may travel in by car, bus, or the fast and efficient tram service that is located close by the hotel.

We are making a departure from the pattern of recent AGM weekends by concentrating all the activities into one day. The Co-ordinators meeting and AGM will both take place on Saturday afternoon followed by an Open Session. For the third year running

we are able to offer hotel accommodation at a very reasonable £60.00 per double room per night and £50.00 per single per night including breakfast.

While we are concentrating activities into the Saturday, members are welcome to attend the hotel for both Friday and Saturday nights. Friday evening provides an opportunity to meet up with friends from previous years or to make new ones. Saturday evening is the time of the Gala Dinner.

Fuller details will appear in the February/March Journal. For further information and a booking form please telephone the Chairman (Keith) on 01952 260731 or Head Office on 01954 202022.

Please note that these arrangements replace those published in the August Journal.

In August our East Suffolk Group were very much looking forward to hosting the weekend. However, with the changing economic climate, in the best interest of members they considered it more appropriate that a more central venue should be used. Our thanks go to them for the preparations they had already undertaken.

Election of Executive CommitteeNominations are invited for the Association Vice-Chairman (three years) and four Executive Committee members – three for three years and one for two years.

The Executive Committee is appointed to oversee the running of the Association. There are usually two meetings per annum. The Executive has full responsibility for the charity and must ensure that the objectives of the charity are being met, including managing the finances.

Any member can be nominated. All positions are honorary. By Charity Commission rules the Executive Committee

members must be over the age of eighteen years.

If you feel you could serve the Association in this capacity we would be please to hear from you. Please contact me by phone 01954 260731 or letter for a nomination form. Should you have any questions over seeking election, I or another Executive member will be happy to answer your questions.

Nominations need a proposer and the written consent of the nominee and must be submitted in writing to the Head Office by no later than mid-day on Monday 9th February 2009. Nomination forms can be obtained on request from Head Office. Nominations are required to be accompanied by a statement or personal profile not exceeding 250 words and a passport size photograph.

Should a ballot be required member statements/profiles and ballot papers will be issued to members along with the April/May journal.

There will be vacancies for the Vice-Chairman and four Executive Committee Members – three for three years, and one for two years. The following members are due to retire and are eligible for re-election: Dr Richard Maddison (Vice-Chairman), Alan Lea, and Keith Atherton (Members).

Membership applications Are you reading this Journal as someone who is not a member of the Association? If so we are pleased to count you as a valuable part of our readership.

However, might you take a few moments to consider making use of the application form to join the Association. It may be that you are a heart patient, a relative or carer of someone with a heart condition, or indeed someone taking a general interest in the Association and the support we are able to offer.

Whatever your interest it may be that becoming a member is something you have never considered. May we invite you to consider it now? We would be delighted to hear from you.

What do you do with your past copies of the Journal?Some readers retain Journals – enabling them to refer back to any items of particular interest.

Many copies are destined for the bin once they are finished with after the initial reading.

To those of you who do not retain copies please consider whether your copy could be of use to others. Perhaps it could be useful reading in a doctor’s waiting room rather than some of the old and perhaps tatty copies of the regular reading matter usually available.

1983 just after the Group was formed. They very quickly became regular attendees at the meetings, and soon became involved in the fund-raising side of the Group. Over the years they have organised and run many events including car boot sales, and raised nearly £3,500 to help buy much needed equipment for both Ipswich and Papworth Hospitals.

Their kindness and generosity doesn’t stop there. In 1998 when they celebrated their Golden Wedding Anniversary they asked their friends and family for donations to the East Suffolk Group in lieu of gifts. Their popularity shone and they handed over a massive £1,000, with which the Group was able to purchase two portable heart rhythm machines for Ipswich Hospital in recognition of this wonderful event.

The couple met over 60 years ago when Iris was working in her parents’ pub and Maurice came in whilst on leave from the army. They immediately struck up a relationship and were married within a year.

In August this year Maurice and Iris celebrated their Diamond Wedding Anniversary, and again wanted to do something special for the Group. They raised a whopping £600, which will go towards buying a piece of life-saving equipment for the local hospital.

Anita, Chairman of the local Group, says ‘Maurice and Iris are a lovely couple and are real stalwarts of the Group and always support me in all our events wherever possible. They truly are a couple of Suffolk’s real gems.’

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News from around the AreasLocal news from some of our groups

Dates for your diary are on page 6. A full list of co-ordinators and contacts are on page 14.

Bedford Eileen Marriott 01234 303834

Cambridge Bert Truelove 01223 844800

East SuffolkAnita Postle & helpline 01473 829777

In October we had an excellent concert by Five in Harmony and everyone thoroughly enjoyed their beautiful singing.

We will be pleased to see as many members as possible for our last meeting on 18th December when Bedford Town Band, our entertainers, will give us a rousing concert and we can go out with a happy evening helping us remember all the good times we have had over the years. Don’t forget to bring friends and relations to join us and as usual a wine glass and a plate of something good to share. We will also be having a raffle.

Best wishes to you all for Christmas, New Year and the future.

Our last report covered a very enjoyable summer’s day out at Southwold, with lunch and the theatre. This was followed a few days later with Andrew Jackson’s illustrated talk on unusual pub signs. Everyone enjoyed this most interesting and enlightening talk – in view of recent comments in the national press referring to the fact that multiples running public houses today are making traditional pub signs obsolete.

Our speaker in October will have been Ian Burton, who some years ago gave us a very interesting talk on Papworth before Heart Surgery. His talk this month will have been a complete contrast, but looks to be equally enjoyable. He describes it as a rambling on about some unusual musical instruments, and his attempts to play these – we look forward to an amusing and fun evening.

Looking to the future and the Christmas Festive season, the committee have been busy finding things that members should find enjoyable, and that provide quality at reasonable prices. So we have arranged firstly our Christmas Social on Wednesday 26th November – this has to be this early as a problem with bookings at our normal hall. Secondly, on 18th of December we are holding a Christmas tea at the Meridian Golf Club.

In the New Year on Wednesday 14th January we have a lunch at the same venue. All these dates seem to make the year slip away all too quickly.

We are making good progress with the purchase of a special bed for the Mallard Ward at Papworth Hospital. This should be installed long before Christmas, and will give extra comfort to those patients who are

not too well following surgery.May I remind all the members of the

Cambridge Group that the Annual General Meeting will be held on Wednesday 25th February 2009, please give your support as I am sure we do not wish to see Cambridge Group going the same way as Bedford. May I wish the Bedford committee and members well in the future, with thanks from so many who have received help and support from them over many years.

It seems strange in the middle of October to wish you all a Very Happy Christmas and good health in 2009, but of course there will not be another opportunity.

By the time you get this we will be days away from our massive Suffolk Christmas Party – it’s not too late to come along but please give me a quick ring first so I can book you some food. It is a super event and always very popular and you can bring anyone with you (as long as they are house-trained).

I am delighted to say that the 15 of us who went to Felixstowe Spa for the End of the Pier Show had a wonderful time, it was hilarious and good old-fashioned family fun – it was a shame there was so few of us.

Another BCPA year is quickly drawing to a close. The Committee will be meeting in January 2009 to formulate a programme for the coming year. It is always very hard to find new ideas, so please if you have seen a speaker or been to an evening and thought that would be good for us, please give me a call – all suggestions extremely welcome.

We do not meet in January but will be back in February with the AGM – more details in our local newsletter.

Due to circumstances completely out of our control, eg certain people’s health and the current economic position, it is with deep regret that the East Suffolk Area Group has had to withdraw their offer to host the 2009 AGM. This is not a decision that was taken lightly and I would like to thank all of you who have helped to try to get this event off the ground.

All that is left for me to say is take care of yourselves and each other and have a wonderful Christmas and very Happy and Healthy New Year.Suffolk’s Diamond CoupleTwenty-seven years after coming through his open-heart surgery, Maurice Lambert and his wife Iris are still thinking of ways to repay the local hospital for what they did for Maurice.

Maurice and Iris joined the BCPA in

HaltonStella Bate 01928 566484

From Margaret RimmerHalton Group has had a busy couple of months. In September Mr Phil Black gave a very informative and interesting demonstration of first aid and resuscitation techniques. We thank him. In October Charlie Ford gave a slide show of pictures of Halton in days gone by. We thank him for a very enjoyable evening.

In September we had a lovely day out in the lakes, and in October members enjoyed a trip out to Bury Market.

We were pleased to welcome the Mayor of Halton and her Consort to our session at The Grangeway Centre on 18th September. We enjoyed meeting them and showing them some of our activities. They both joined in

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LincolnBrian Bigger,01522 880843

Peterborough Gordon Wakefield 01733 577629

Margaret and Stella with the Mayor

Earlier this year Pat Williams and Trevor Bowyer brought their guide dog puppy, Lake, to our meeting and Pat talked about her experiences of being a guide dog puppy walker. I thought members might be interested to hear that Lake passed successfully as a guide dog and has been handed over to her new owner. This is the second of Pat and Trevor’s puppies to pass as guide dogs (Gypsy passed last year) so well done to Pat and Trevor (and Lake and Gypsy of course!).

We are going to see Cinderella at the Liverpool Empire on 12th December; and our Christmas dinner dance is at The Forest Hills on 19th December.

We wish everyone a Merry Christmas and a happy, healthy New Year.

Our Christmas party in place of the monthly meeting will be held on 12th December at the Hykeham Social Club HG, starting at 7pm until 11pm approximately. Final arrangements concerning the food and entertainment for the evening are being completed.

River Avon Transport in the City of Bath

At our September meeting our speaker Mr Harry Tibbit talked about his War memories – a very informal meeting covering interesting memories of Harry’s boyhood experiences in London during the Second World War.

In October we had our first of, hopefully, regular lunch time meetings. It is now our plan to hold these on the alternate months to our evening meetings – the Cherry Tree puts on an excellent two-course lunch, with a large menu choice to suit every taste. We gladly welcomed back two of our older long serving members who are not now able to

Firstly, I must apologise for not writing an article for the October/November Journal – all I can say is I forgot.

Our thanks to the Committee and Members who prepared the food for our Strawberries and Cream meeting on 18th July. In my absence, this was one of the best-attended meetings. At this meeting, our Chairman, Michael Corrigan, retired from this position. Michael was presented with a nice bottle of wine and a Marks and Spencer gift card. Michael thanks all involved for your help in arranging speakers and looks forward to seeing you at future meetings.

Julie Westall was contacted by the Rehabilitation Department at the Princess Royal University Hospital to give a talk about the BCPA on 3rd September.

On 12 September, we held our second Quiz Night. Thanks again to Michael Deves, our Quiz Master. The winners were the Goggles with 42 points, closely followed by Kaypal with 41 and Hopeless with 40. The Goggles were presented with the new Quiz Shield donated by Ray and me.

The dates for 2009 meetings are 16th January, 13th March, 15th May, 17th July, 18th September and 13th November, with Christmas Lunch in December.

with the line dancing and the Mayor drew the first ticket of the raffle. South East London & Kent

Chris Howell 01689 821413

Staffordshire and District , Alan Lea 01782 838730

On behalf of the Staffs Area Group Committee I wish all of our members, their families, and all our friends a very Merry Christmas and a Healthy, Happy New Year.

This year’s Christmas lunch will be held at the Borough Arms Hotel on Tuesday 9th December at 12 for 12.30pm, with a festive three-course meal, and a special raffle on the day. The cost per person is £14.95 for the festive three-course meal – a non refundable deposit of £10 is required.

Then, to keep us in the Christmas mood, on Tuesday 16th December we are holding our Annual Carol Service at the City General Chapel at 7pm. After the service we hope you will come along and join us at Holy Trinity Social Club, Newcastle, Staffs, for some Christmas fayre in pleasant surroundings

with all our friends. We look forward to seeing you all at this special event.

To start the New Year, at our meeting on January 27th 2009, after a long history of holding the Potter’s Picnic, we are going to have a fun karaoke night, with the option of a pie and pea supper being available. If you do not require the supper, please just come along and enjoy the entertainment. Why not bring your family or friends with you?

Best wishes.

Our speaker in January will be a member of Share The Care. All monthly meetings take place at The Ruston Marconi Sports Club on the Newark Road, Lincoln, on the first Tuesday in the month starting at 7.30pm.

At the Tunstall Carnival

Alan and George at the presentation

of three chairs to

the Cardiac Department

at the University Hospital of North

Staffordshire

1 Mary Lyth demonstrating decorating pottery2 Ellen Lea demonstrating how to make sugar paste flowers3 Pat Archer making cards4 Ian Garner demonstrating his model engines5 John & Jean Booth with their post card collection6 George Austin showing his card collection

Photos from our Hobby & Craft Night

1 3

45

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2

attend our evening meetings. Anyone in the BCPA is welcome to come along to these lunches, we will be glad to see you; all we ask is a bit of advance notice to give our landlady some idea of numbers.

The Goggles winning team

Dates for your diaryBedford Th 18 Dec 7.30 Bedford Town Band, at Putnoe Heights ChurchCambridge Th 18 Dec 3.00

W 14 Jan 2009 12.30W 25 Feb 7.30

Christmas Tea, Meridian Golf Club, CombertonNew Year lunch. Also at MeridianAGM. Memorial Hall, Great Shelford Meetings are usually there 7.30 4th Wed of even months

Chelmsford and District Cardiac Support Group

F 12 Dec 8 Christmas Social. All 8.00 at Broomfield Parish Hall

East Suffolk Th 4 Dec 7.30 Christmas party. David Padwick. Singing & dancing. Kesgrove Social ClubHalton W 10 Dec 7-9

Fr 12 DecFr 19 Dec

Meeting TBA, The Grangeway CentreCinderella, The Liverpool Empire. Every Th 1-3 at The Grangeway Centre Christmas Dinner Dance, The Forest Hills. Every M 10.30 at The Brindley Café

Havering Hearties 2nd Th 7.30 At Conference Centre, Oldchurch HospitalKing of Hearts, Redbridge, Essex

3rd Wed 7.30 Ford Sports and Social Club For details contact Tony Roth 020 8252 0877

Lincoln F 12 Dec 7.30Tu 7.30

Christmas Party at North Hykeham Social ClubEach first Tu 7.30, Ruston Marconi Sports Club, Newark Road

Martlets, Sussex 2.30 Lancing Parish HallMerseyside First W First W at OPD at the Cardiothoracic Centre, BroadgreenPeterborough Tues 7.15

Th 12 for 12.30In 2009 all Tu 7.15: 20 Jan, 17 Mar, 19 May, 21 July, 15 Sept, 17 Nov. Lunches Th 12 for 12.30: 19 Feb, 23 Apr, 18 June, 15 Oct, Dec TBAAt the Cherry Tree Public House, Oundle Road.

SE London & Kent All Victory Social Club, Kechill Gardens, Hayes. In 2009: 16 Jan, 13 Mar, 15 May, 17 July, 18 Sept and 13 Nov, & Dec Christmas Lunch

Staffs & District Tu 16 Dec 7.00Tu 27 Jan 7.30 for 8

Carol Service, City General Hospital Chapel Fun karaoke night, pie and pea supper

Take Heart, Southend Second Th 8.00 At Eastwood Community Centre, Western Approaches, Leigh-On-SeaWest Suffolk & SW Norfolk

Tu 9 Dec 12.30 for 1 Christmas Dinner, Bushell Restaurant, Bury St Edmunds

Warrington Third Th 7.00 All third Th 7pm, Post-Graduate Centre, Warrington Hospital Wirral M 8 Dec 7.30 Christmas Social

M 12 Jan Beetle Drive, Tu 13 Jan Meal, M 9 Feb AGM. See report aboveWrexham Third Tu 7.00 At Association of Voluntary Organisations, AVOW, Egerton Street, Wrexham

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WirralMartin Legge 0151 625 6529

In September we had a lovely lunch at our new venue, the Tollgate Restaurant, Bury St

May I start with an apology to everyone who came to the Quiz Night in September as there was no bar. We booked the bar but Heswall Hall did not open it and have apologised. As you all know I was not there due to having to go into hospital just before the meeting, so a special thank you to all who helped out on the night to make it an enjoyable evening for all.

On Monday 13th October we welcomed Dr P Currie to our meeting. The room was full on the very cold night. We thank Dr Currie and we look forward to the next time.

Christmas is coming round again and it is time to make our preparations.

West Suffolk & South West NorfolkBrian Hartington 01284 762783

Members voted not to have a Christmas meal but to have our meal in January 2009. This is booked for Tuesday 13th January 2009 at The Grange Club at a cost of £14.95 per person. We have only 36 seats so it is first come first served. To book please ring me on 625 6529.

We start our year on January 12th 2009 with a Beetle Drive. All are welcome to come along and we look forward to seeing you. This is followed on the 13th with the New Year meal.

February 9th is our AGM – looking back over 2008 and ahead to 2009. If anyone would like to put themselves forward for any job on the Committee please send your details in writing two weeks before the AGM to me as Co-ordinator. We need all of your help so please give us your support by attending the AGM if you possibly can.

Edmunds. The meal was excellent and all our ‘old faithful’ members attended.

As I reported before, the Christmas Lunch will be at our favourite ‘watering hole’, the Bushell Hotel, Bury St Edmunds, on the 9th December at 12.30 for 1.00pm. The price is the same as last year £19.50 (it could be reduced if you don’t have the full fare). If you

ring me I will advise you of the menu, which look delicious. Please let me know your choice of menu by the 30th November.

We understand that Bernard Carrington, our favourite photographer, is in poor health and we wish him and Eileen a speedy recovery.

Many thanks. Cheers.

Our thanks go to Mr Steve Rhodes who sadly lost his wife Esther in 2008. Steve presented a cheque for £205 at our October meeting to Mr Bird in memory of Esther. Our thanks to Esther’s family and friends.

Also our thanks to Mr & Mrs Yates who sadly lost a father in 2008. Mr Alan Galt left a donation of £100 in his will for the Wirral Area Group. Again we are most appreciative.

It is with the support of friends like these that we are able to carry out our support of people with heart problems across the Wirral and it is most appreciated by all of us all in the Wirral BCPA.

As always, if I have forgotten anyone or anything I say sorry now. Take care and have a Merry Christmas & a Happy New Year to you all. We look forward to seeing you at our meetings in 2009.

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Study confirms importance of checking the pulse

Sue Lyon, Freelance Medical Writer, London

Simply checking the pulse could help doctors to identify people with heart disease who need special care, according to BEAUTIFUL, a large study recently reported in the medical journal The Lancet.

In BEAUTIFUL, people who had a resting pulse or heart rate of over 70 beats per minute (bpm) were found to be more likely than people with a lower resting pulse rate to: • experience problems such as heart attack, or• need surgery to clear blockages in the blood vessels of the heart (called coronary revascularisation).

The results of BEAUTIFUL were first announced at the end of August 2008 at the Annual Congress of the European Society of Cardiology, a large meeting of doctors and scientists specialising in the treatment of heart disease. Speaking at the meeting, Professor Kim Fox said: ‘We were aware that raised heart rate predicted some adverse outcomes, but BEAUTIFUL shows for the first time that higher heart rate predicts heart attack, and [the need for] coronary revascularisation.’ Professor Fox is a heart specialist at the Royal Brompton Hospital in London, and led the team of investigators responsible for designing and conducting BEAUTIFUL.

What is resting heart rate?Your resting heart or pulse rate is the number of times your heart beats each minute when you are at rest. Each time your heart pumps blood to the rest of your body, the walls of your arteries briefly stretch and bulge – called a beat. You can feel this beat or pulse yourself at your wrist or at other places where an artery is close to the surface of your skin. So your pulse is the rate at which your heart beats, and you or your doctor can measure your heart rate by feeling your pulse.

A heart or pulse rate of between 60 and 100 bpm is regarded as normal for healthy adults. Your heart rate changes throughout the day, increasing for example during physical activity or when you are stressed. But in general the fitter you are, the lower your resting heart rate will be. So it is better to have a lower rather than a higher heart rate, and some athletes may have heart rates of 40-50 bpm or lower.

People with angina experience episodes of chest pain, mainly during exercise. Since doctors know that there is a close relationship between angina pain and increased heart rate, some treatments for angina such as

beta-blockers are designed to lower the heart rate. However, accurate diagnosis is essential because a fast heart rate may also be caused by other health problems (such as anaemia, fever or an overactive thyroid gland), medicines used to treat asthma, and stimulants such as caffeine, tobacco or diet pills.

How to measure your resting pulse or heart rate A good time to measure your resting pulse or heart rate is first thing in the morning just after you wake up but before you get out of bed. The pulse or heart rate is usually measured at the wrist (called the radial pulse, as it is taken over the radial artery), though doctors may sometimes check your pulse at other sites such as the side of your neck or on your ankle. To take your pulse, NHS Direct advises:• If you are right-handed, hold out your left

hand with your palm facing up and your elbow straight. Put the index and middle fingers of your right hand together. Press the pads of your fingers lightly on the underside of your left wrist, just at the base of your thumb.

• If you are left-handed, use the index and middle fingers of your left hand to find the pulse on the underside of your right wrist.

• If you are having trouble finding the throb of your pulse, move your finger around slightly. Keep a firm pressure on your wrist with your index finger, while feeling the blood move under your skin with your middle finger. But don’t press too hard as you will temporarily stop the flow of blood and be unable to take the pulse.

• When you find your pulse, look at a clock with a second hand and count the number of beats in a full minute. For an adult, a normal resting heart rate is between 60-100 beats a minute. You can check someone else’s pulse in

the same way. Never use your thumb to measure the pulse. The thumb has a pulse of its own, and you may be counting your own heartbeats rather than the other person’s.

Source: www.nhsdirect.nhs.uk/articles/article.aspx?articleId=2024

Your pulse rate indicates how well your heart is working and your general level of health and fitness. But taking your pulse also helps your doctor to find out the cause of symptoms such as dizziness, chest pain, or shortness of breath, or to see if your angina treatments are working to reduce your heart rate. It’s very simple to check your own

resting pulse or heart rate (see panel). If you are worried by your pulse rate, you should of course talk to your doctor.

About BEAUTIFULBEAUTIFUL included over 10,000 people with coronary artery disease (i.e. angina, a previous heart attack or coronary revascularisation) and left-ventricular systolic dysfunction (when the heart cannot pump blood efficiently to the rest of the body). The aim of the study was to see if there were any benefits of lowering the heart rate by adding a medicine called ivabradine (brand name: Procoralan®) to people’s usual medication. Ivabradine became available in 2005, and lowers heart rate without other effects, such as reducing blood pressure. It is currently used to treat the symptoms of angina in people with a normal heart rhythm who cannot take a beta-blocker.

People included in BEAUTIFUL received either ivabradine or a dummy pill (placebo) as well as their usual medicines such as aspirin, a beta-blocker, an angiotensin converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB), and/or a statin.

The study was double blind, which means that neither the people in the study nor their doctors knew whether they had been assigned to receive ivabradine or the placebo tablet.

BEAUTIFUL began in 2004 and lasted for three years. At the end of the study there was no difference between ivabradine and the placebo on the main result. But ivabradine did reduce the likelihood of hospital treatment for heart attack and coronary revascularisation in people whose resting heart rate was over 70 bpm at the start of the study.

Professor Fox felt that this latter result was important because it was achieved by lowering heart rate in people who were already very well treated with their usual medication. He agreed that other large studies are needed to confirm the benefits of adding ivabradine to the usual treatment, but noted that, when added to a beta-blocker, ivabradine is the first angina treatment to lower heart rate and the likelihood of heart attack or revascularisation.

‘We now have an anti-anginal agent that is not an alternative to, but can be safely used in conjunction with, beta-blockers in people with coronary artery disease and left-ventricular systolic dysfunction. I believe that ivabradine has an important role in these patients,’ concluded Professor Fox.

For more information about heart rate and BEAUTIFUL, visit the study website: www.beautiful-study.com.

Blue light to PapworthDr Sarah Clarke, Consultant Cardiologist &

Clinical Director Cardiac Services, Papworth Hospital

New Heart Attack CentrePapworth opened a new facility, the Papworth Hospital Heart Attack Centre, on 22nd September 2008 – the first Heart Attack Centre in the East of England.

Available 24/7, it covers 999 calls for patients who have a heart attack either at home or in hospital – covering the ambulance catchment areas around Peterborough, Hinchingbrooke, and Addenbrookes Hospitals.

Such patients can be admitted directly to Papworth Hospital Catheter Laboratory at any time of day or night for Primary Percutaneous Coronary Intervention, PPCI. PPCI is also known as Primary Angioplasty.

The early warning signs of a heart attack are: • pressure in the centre of chest• pain in shoulders, neck, or arms; and/or • chest discomfort with dizziness, sweating, breathlessness or nausea.

An unexplainable chest pain is your body saying ‘Call 999’. The paramedics will assess and decide if treatment is required at Papworth.

This drawing2 of a heart shows the main heart arteries and how blood flows to them from the aorta.

Unfortunately, as shown here3, any or all of these arteries may become partially or completely blocked by plaque. This reduces or stops the flow of blood to parts of the heart muscles – so the heart then cannot pump correctly.

An electrocardiograph, or ECG, will show abnormal patterns that indicate such

partial or complete blockages and whether the patient is having a heart attack.

ThrombolysisUntil recently a clot-busting injection known as thrombolysis has been the gold standard treatment for a heart attack. This is given either pre-hospital or in-hospital. The aim is to dissolve the blood clot and restore blood flow.

For best outcome the thrombolysis must be ASAP – preferably in the first hour of the onset of chest pain – the golden hour.

However:• 30% of patients are not eligible to receive it• it does not always work – 20 to 30% of patients given thrombolysis re-block their artery shortly after and have a further heart attack• it only dissolves the clot and does not remove the plaque; and • there is risk of bleeding – eg stroke.

Nowadays, 25% of heart attack patients in the UK get primary angioplasty, PPCI. This procedure removes the clot and treats the narrowing to keep the artery open. With lower risk of renarrowing and/or bleeding, PPCI gives superior outcomes provided it is delivered quickly.

Why should we change to PPCI?In 2006 Dr Roger Boyle made the clinical case for re-configuration of heart disease and stroke services, stating that local accident and emergency

units may not always be the best place to treat heart attack and stroke victims.1

National coverage of primary angioplasty services would prevent around 500 deaths, around 1,000 further heart attacks and around 250 strokes each year (Mending Heart and Brains, DoH 2006).

Lord Darzi stated in his interim report: ‘we are beginning to lag behind other countries in treating heart attack patients with primary angioplasty’.

Steps to reach Papworth for PPCIThe main steps in getting a patient quickly to PPCI are that either: • after a 999 call, the paramedics on the ambulance diagnose the condition and take the patient directly to Papworth Hospital catheter laboratory; or • a local hospital diagnoses a heart attack and sends the patients immediately to Papworth.

Example of a PPCI procedureThis patient has a blocked artery. A clot can be seen as a haziness in the middle of the artery.

A specially-made tube or catheter is passed up to the coronary artery from the groin or wrist. The clot can be removed by a special device – this is called thrombectomy.

Stent to keep artery openThe artery may need to be stretched by a balloon and then a stent, which is a wire mesh tube, can be placed where the narrowing is seen, to keep the artery open.

The other right artery is clear of any blockage

Clot blocking left coronary artery

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Wordsearch – Wines and Cheeses

Flowchart of main steps

Ambulancediagnosisand transport

A&E/warddiagnosis

999 forambulancetransport

Rapidassessment

Aorta

Left MainCoronaryArtery

LeftCircumflex

Left AnteriorDescendingRight

CoronaryArtery

Blood clot formsaround the ruptureblocking the artery

Capruptures

Plaque withfibrous cap

PATIENT/GP CALLS999 FOR

ANBULANCE

PATIENT PRESENTSTO A&E / WARD ATLOCAL HOSPITAL

CARDIACCATHETER LAB

PAPWORTH

PRIMARYANGIOPLASTY

What next?After 6 months, Papworth plan to expand the service to include a wider catchment area. There are likely to be 2 other Heart Attack Centres in the East of England to ensure all patients can benefit from this PPCI.

1 See BCPA Journal 155 Aug/Sept 2007 page 8.2 © Copyright 1997 HeartPoint3 © Copyright 2008 Healthwise Inc.

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These stents may have a special coating to reduce renarrowing in the future, called drug-eluting stents.

After the procedure the patient will be taken to a High Dependency Unit for observation, and will be discharged in 48 hours if all is well. He or she will then join the cardiac rehabilitation programme, and have follow-up in the cardiology clinic of their local hospital.

Stent being delivered on an inflated balloon

Stent as left in the artery

Holy Cross Players

Wordsearch – Wines and Cheeses

Crossword answersAcross 1 Cinches 5 Replace Anagram REEL CAP 9 Two Twins Were Only 10 Rower REWORKING not KING, return = backwards 12 Undergo Anagram GROUND + E 13 Boxing 14 Bipod 17 Holiday Anagram OH DAILY 18 Len hoLE Now 19 Gene 20 Players 21 Redness Loch Ness monster 24 Present 28 Decimal Anagram CLAIMED 31 Year 32 Day 33 Catch up CUP + CHAT

AmontilladoBlueBristolBrutChampagneCheddarCheshireCottage CreamDanish

Holy Cross Players, based in Greenford, Middlesex, have chosen the BCPA as the charity to benefit from their forthcoming production of Aladdin.

Formed in 1982, for more than 25 years The Players have provided the opportunity

for people of all ages to join in amateur dramatics, whether on or off stage, in a relaxed and rewarding atmosphere. In the main that means their annual Panto, which is always an original piece of work written by one of the players.Aladdin, written and directed by BCPA

member Tony Jordan, is being staged from 8th to 10th January 2009 at Glaxo Smith Kline Leisure Club, just off the A40 roundabout in Greenford. Show dates are January 8th, 9th and 10th, 2009, evenings at

34 Parse SPARE 36 Inrush Fools rush in 37 Fabrics 38 Aorta AbOaRd ThAt 40 Tie 41 Cheeses 42 Someone SEE + MOON

Down 1 Carob OR CAB 2 New aNnE aWaY rEpAiRs 3 Herod otHER ODd 4 Stripes PRESS IT 5 Rougher ROUGH ER 6 Paddled 7 Abridge I’D BARGE 8 Eponyms PS MONEY 11 Ebony 15 Iller Initial letters

16 Pea Sweet pea 19 Grin RING 22 Ever bEVERley 23 Stays 24 Pacific 25 Eatable ABLATE + E 26 Ethnics IN CHEST 27 Typists 28 Dairies AIR in SIDE 29 Idaho Known as Gem state, capital Boise 30 Mar Aries = RAM 34 Psalm LAMPS 35 Erase these ARe 39 Rho Greek letter that denotes density

7.30pm, with a Saturday matinee at 2.30pm. As a totally non-profit making organisation, every penny raised is donated to a charitable cause, and this year that will be the BCPA. For further information, please visit www.holycrossplayers.org.uk

Tickets for the show are priced at between £5.50 and £7.50. For bookings please contact Tony Jordan on 07724 079840. Tony had a coronary artery bypass graft several years ago.

The photos are examples of some of Tony appearances.

As Pletrac the Ogre confronting Puss in Puss In Boots

As the Compte in Puss In Boots Playing Dame on Ready Steady Cook and hamming it up with Ainsley Harriott

EdamFatGloucesterGoatsGoudaLancashireLeicesterMediumMerlotMilk

MozzarellaPaleParmesanPortRedRiesling RoquefortRoseSauvignonSmoked

Soft SoyaSparklingVegetarianVintageWensleydaleWindsor

R B A E G E E V L N A S E M R A P S G TO A B L L N N R E E W R M G M E R L O TS G D R L A I O I G I E O O A E I S A HD E N D I E D L N H E C N Q K T D E T EN H G I E S R Y S G S T E G U E T I S DI S S A L H T A E I I E A S A E D O U AW T O I T K C O Z L E V H R T P F S C MT R E Y N N R B L Z S R U C I E M O O FG O U D A A I A R Y O N O A O A R A R AU P L L R E D V P U F M E S S A N L H TL Z B G L O U C E S T E R W E M A E R C

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Acupuncture treatment for heart diseaseDiana Olafsdottir, BSc (Hons), Lic. Ac., MBAcC.

Diana is a fully qualified registered acupuncturist and member of the British Acupuncture Council.

Recently, cases of the hospital bug clostridium difficile have fallen significantly. From April to June 2008 in England 8,683 cases in patients aged 65 and over were recorded – an 18% drop on the previous quarter and 38% less than in the same period last year.

C. diff is a bacterium found in the gut.

Fewer clostridium difficile cases In healthy adults and children it rarely causes problems. Symptoms range from mild diarrhoea to severe inflammation of the bowel, which can occasionally be fatal. People over 65 are more susceptible to contracting infection, particularly if they are on antibiotics that disrupt the ‘normal’

bacteria in the gut. From April 2007 to March 2008, nearly 60,000 patients caught some infection while in hospital. RM

What is acupuncture?Acupuncture is one of the most popular complementary therapies in the UK.

Modern acupuncture practice derives from a 3,000-year-old tradition, which originated in the Far East but has been adapted to meet the needs of Western patients. It is based on the principle that by inserting very fine needles into carefully selected points on the body, the body’s energy or Qi can be manipulated to stimulate the body’s healing response and restore balance. It may be used to treat illnesses as well as to maintain health and wellbeing1.

Acupuncture and heart diseaseHeart disease can be a complicated illness and has many contributing factors. Among those are hereditary reasons, lifestyle, medication, and emotions, all of which need to be taken into account to formulate an accurate traditional Chinese medical diagnosis and point prescription to suit each individual patient.

Acupuncture can play a significant role in heart disease treatment and prevention, as an adjunct to drug therapy and medical interventions. One of acupuncture’s greatest attributes is that side effects from treatment are almost non-existent. Most people feel relaxed or perhaps slightly drowsy after treatment2.

A medical diagnosis should always be sought before commencing acupuncture treatment, and therefore an appointment with your GP prior to your first acupuncture consultation is vital. Acupuncture, although effective, does not replace Western medical treatment and is not proposed as a cure.

Acupuncture has however traditionally been used to treat a wide variety of cardio-vascular disorders and has been shown to be effective3. It can reduce disease symptoms, extent of and areas of pain, number and duration of attacks, and if started early enough prevent or lower the risk of further progression. Furthermore, it plays an important role in reducing common side effects such as nausea, headaches, oedema, palpitations, dizziness, and shortness of breath4.

What else can acupuncture help with?Although in the West acupuncture is most renowned for its pain-relieving capacities, it has been shown to be effective in the treatment of various ailments, both physical and mental-emotional, including:

● Digestive problems (irritable bowel syndrome, constipation, diarrhoea)

● Menstrual problems (painful periods, PMT, menopausal symptoms)

● Musculo-skeletal pain (backache, sciatica, tennis elbow, sports injuries)

● General aches and pains (arthritis, rheumatism)

● Headaches and migraines● Insomnia and lack of energy● Infertility and IVF support● Stress, anxiety and depression.

What to expect from a treatment?Your health is at the forefront of our consultation. Please be advised that an acupuncturist is not qualified to consult you on your medication and you should always consult your physician before seeking treatment, particularly if you have a heart condition.

The initial consultation usually takes up to an hour (although this will vary between practitioners) and includes an assessment of your general health as well as your presenting ailment to establish a Chinese medical diagnosis and to give you the most effective treatment. You will be asked detailed questions about current symptoms, medication, medical history, diet, digestion, and sleeping pattern among others.

The acupuncturist will also examine your tongue and feel your pulses on both wrists, as these are vital indicators to the state of the body’s energy and health.

The needles used in acupuncture are hair thin (0.2-0.25mm), solid, sterilised and for single-use, after which they are safely disposed of. Despite commonly being compared to syringes, they bear little resemblance to them in real life. The insertion and manipulation of the needles causes a sensation commonly described as a tingling, or dull ache, and should not be painful.

To ensure optimum patient safety, it is recommended that you see a practitioner who is a Member of the British Acupuncture Council (BAcC), the main regulatory body for acupuncture in the UK. The profession is currently moving towards statutory regulation, which will benefit both acupuncturists and further secure public safety. Until then, either ask to see the practitioner’s membership card on your visit; or find out if a practitioner is a member by calling the BAcC or looking on their website www.acupuncture.org.uk. (Not all practitioners are listed on the website.)

For any further queries, please do not hesitate to contact me via email at info@diana-acupuncture.co.uk I operate from clinics in the London boroughs of Hackney and Tower Hamlets and am a registered Member of the BAcC.

Please note that the contents of this article do not reflect the opinion of the BCPA and the BCPA cannot be held accountable for any of its content.

1 British Acupuncture Council. (n.d.). Introducing Acupuncture. Retrieved 21.10.08 from the BAcC website: www.acupuncture.org.uk 2 MacPherson H, Thomas K (2005). Short-term reactions to acupuncture. Acupuncture in Medicine 12(3):112-1203 Stux G, Berman B, Pomeranz B (2003) Basics of Acupuncture, 5th edn p278- 280. Springer4 Zhang X (2002) Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials. Geneva: World Health Organisation

An impression smear photomicrograph of Clostridium difficile bacteria

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How well do you know yourself?Corey Beecher

That may seem like a weird question, but one that I hope will get you thinking.

It is not a question that we really think too much about. But maybe we should take more notice of what happens around us. On a few occasions recently, I have had cause to think about myself and how much information one’s brain is capable of taking in and holding onto. There have been at least two thoughts that I felt were original thoughts of mine – only to be proved wrong when I skimmed through a book later and found the ideas there sitting on the page in front of me.

That was the prompt for this article, and the inspiration leading me to think about how much we really know about ourselves. The brain has an amazing capacity –and many scientists spend their life’s work trying to work out the exact capacity of an average brain.

Many too, spend a career looking into how we avoid or enjoy exercise.

Ignore one’s body talk?What really do you know about your body? Do you listen to it when it talks to you? Do you answer it back? Or even try to find some answers to the questions it may pose?

I didn’t realise that I tend to ignore my body when it asks me something, unless I want to do that thing. For example I may feel tired and my body lets me know that it needs a rest, but if I am enjoying what I am doing I’ll carry on until my eyes are closing themselves!

On the other hand, if the washing needs hanging out on the line and I hear my

Recipes – from Janet JacksonEasy risotto with bacon and peasServes 41 onion chopped6 rashers streaky bacon, chopped300g/10oz risotto rice1 litre/ 1¾ pints hot vegetable stock100g/4oz frozen peas2 tbsp olive oilKnob of butterSalt and pepperHeat the olive oil and a knob of butter in a pan, add the onions and fry for about 7 minutes until lightly browned.Add the bacon and fry for a further 5 minutes until crisp.Add the rice and stock and bring to the boil. Stir well, then reduce the heat and cook covered for 15-20 minutes until the rice is almost tender.Stir in the peas, add a little salt and pepper, and cook for a further 3 minutes until the peas are cooked.

body call for a rest I am up those stairs so fast my feet hardly touch the carpet. What is it then that makes us choose what is correct for us at that one moment?

Attitude to exerciseWe all appreciate the benefits of regular exercise and we have all experienced feeling better following an exercise session – but why then do we do anything to avoid exercising?

It also affects me, as some days I have all the good intentions of exercising. I even go through remembering the last exercise session I completed and bring back memories of how much better I felt after it. But then I get home, sit down, and find myself there until it’s time for bed.

How then could we change our attitude? Well, I am working on the first part, which is just realising when your body talks to you. Over 24 hours we make so many decisions it can feel as though all we are doing is answering questions.

However, when you are asked a question you could ask one back. How about: ‘Does this hinder or help me?’ For example if your body feels a little sluggish and it has been nudging you to go for a walk, ask if it will help or hinder.

Now there is not a definitive answer. It is subjective, but in the main it would be beneficial to go for a walk. Not only to answer your body’s call for it, but also to clear the mind – and maybe then you will be able to solve an issue that is clouding what you are thinking about.

Try remembering that you choose what you feel about something and no one else

can really make your mind up for you. Of course, there can be influences that others could bring to the front of your mind, but in reality only you can make those decisions. This can be great for exercising, as you will only have to be choosing to exercise rather than avoiding it. When you feel you should be doing some exercise, say to yourself that there is not even a choice to be made, as exercise is the best and only possible result. This will clear the mind of all the other things that you have to do and spare the time for a walk or some exercise. As soon as you get moving, your body will be invigorated and you will gain the rewards. Test this theory today when your body asks for some exercise, recognise it, then act as though the answer is just to exercise, note down your feelings and the benefits that you feel.

The next stage is to just do some light exercise before the question comes from your body – and see how it reacts to being second-guessed. The results are quite amazing.

Finally, pick up a new way of exercising that tricks your body in a different way, such as cycling if you normally walk. Having a swim if you normally run, or take up a new sport, maybe one that you watched during the Olympics. Something – anything that gets you off the chair and moving – is a beneficial activity. But most of all, learn to listen to your body and answer the questions it is posing with the only win-win positive answer that gives it what it is asking for – Exercise. Make exercise a necessary part of your daily routine.

I’m off for a walk now, so catch up with me for the next issue.

Smashing Barabrith cake6oz currants6oz sultanas8oz soft brown sugar½ pint hot tea10oz S.R. flour1 egg beatenPut fruit and sugar into a bowl and pour over the hot tea. Stir well, cover with a clean teatowel, and leave to stand overnight.Preheat oven Gas 2 150C. Grease and line a 2lb loaf tin or two 1 lb loaf tins.Stir in the flour and egg into the mixture and mix well. Pour into the tin(s). Bake the 2lb loaf tin for 1hr 45 minutes, or 1hr 15 minutes for the two 1 lb loaf tins.This cake keeps very well. It also freezes.

Your 1 It can be wise to act on the results of a single research study.

The significance of a research finding may be given as:

● Probability P less than 1 in 20, P<0.05; or ● P less than 1 in 100, P<0.01; or ● P less than 1 in 1000, P<0.001.

‘Probability’ here is the probability that the observed results would occur by chance if there were no association – the null hypothesis.

Unfortunately, some people have used the term highly significant for less than 1 in 100, and others for less than 1 in 1000; so nowadays the probability should be given.

It is arbitrary as to what a user of the information chooses to regard as sufficient to justify acting on. Many people normally choose P<0.01, and most would act on P<0.001.

Your 2 In more detail, Ramon Hermida’s research on aspirin at night, which I reported in the Aug/Sept Journal, was as follows.

The 244 patients with pre-hypertension (97 men and 138 women), aged 43.0 + or – 13.0, were randomly divided into 3 groups: ● Hygienic-dietary recommendations (HDR), and no aspirin; ● The same HDR with 100 mg/day aspirin on awakening; or ● The same HDR but the aspirin at bedtime.

The researchers measured blood pressure at 20-min intervals from 07:00 to 23:00 and at 30-min intervals at night for 48 consecutive hours before the start and again after 3

months of treatment. They also monitored physical activity, including whether walking about, asleep, or awake. For each patient they calculated the awake, the asleep, and the 24-hour average changes in blood pressure – ie of the mean systolic and the mean diastolic BP.

They found the following. (a) Both the patients on HDR only and those on aspirin on awakening had no significant change of blood pressure when walking about. (b) The aspirin-at-bedtime patients had lower average BP

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Letter to the Editor

Aspirin at bedtime – how sure can one be?

Dear RichardAs a retired lecturer in physiology and a BCPA member following my quadruple coronary artery bypass graft, CABG, in 2002, I am interested in the debate about low dose aspirin and the time of dosing.

1 Is it wise to act on the basis of a single study?2 Was the lowering of blood pressure sufficient to be clinically significant? 3 Might it be sufficient to allow one to reduce the dose of other antihypertensive drugs and thus their possible side effects?4 Might there be a greater risk of gastric bleeding when taken at bedtime, with the stomach empty, rather than before breakfast when the pH buffering effect of food could be protective?

Just a few thoughts to assist the debate perhaps!

Yours sincerely,Tim Nicholson

My reply

Dear TimThank you for your letter. I hope what follows makes sense to you, with your knowledge of physiology. [The following has been edited.]

Here is a second copy of the crossword so two people can do it. Fold back the pages from here to page 14 down the middle to see the clues.

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over 24 hours – decreases of 5.4 and 3.4 mmHg in the systolic and diastolic means – with P<0.001. (c) These bedtime aspirin patients had decreased systolic and diastolic BPs both during daytime active hours (5.6 and 3.7 mmHg reduction); and at nighttime (5.2 and 3.1 mmHg), with P<0.001. (d) These bedtime aspirin people had no significant change in heart rate or in pattern of physical activity compared to the values before the start.

This trial corroborates the highly significant effect of the time of taking the low-dose aspirin on blood pressure. It is here extended to patients on the pre-hypertensive range. The timed administration of low-dose aspirin could thus provide a cost-effective valuable approach for added blood pressure control of patients with pre-hypertension.

The (b) and (c) results clearly imply the findings with probability P<0.001. But (a) clearly implies that aspirin on waking doesn’t reduce BP enough to be significant! It may however reduce the risks of various heart conditions.

Your 3You asked whether the findings are sufficient to allow one to reduce the dose of other antihypertensive drugs and thus their possible side effects. Surely this would depend on the patient’s other medical details including the reasons for the various other drugs, and should be discussed with the patient’s doctor.

Your 3They did not investigate whether any increased risk of gastric bleeding. Doctors already know that if a patient on aspirin has such, they should for example change the patient to clopidogrel. Relatively few patients on low dose aspirin have such anyway.

With best wishes, Richard

Tim’s response

Tim phoned me, said he understood all my reply, discussed his personal situation, and agreed to this being put in this Journal. He also wrote to me.

Dear RichardAs background information in case it is of interest, since my quad CABG six years ago, I have been all fine – no angina.

I take clopidogrel as well as aspirin. I also take a beta-blocker, a calcium channel blocker, an angiotensin antagonist, and a statin – so I have a tendency to rattle!

I am a keen mountain walker, though my clogged-up femoral arteries do cause me to struggle a bit!

Best wishes,Tim

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Fast angioplasty after a heart attackThe government announced on 20th

October that they would like, within three years, to have a service where at least 97% of all eligible heart attack patients would have fast angioplasty, instead of thrombolysis (clot-busting drugs). The angioplasty treatment, where a balloon is inserted to open a coronary artery and a stent inserted to keep it open, has to be done quickly – within two hours of the heart attack onset.

About 25,000 patients per year would be eligible for such primary angioplasty. The planners estimate that this would reduce the death rate by about 5 to 7%, saving about 240 lives a year. Of patients in 2007-8 treated with fast angioplasty, less than 3% died within the next 30 days. By contrast, of patients first taken to a district general hospital before being referred to a specialist centre, about 10% died within 30 days.

The plan envisages that regional cardiac networks would have a rota of cardiologists working in each specialist centre around the clock. Paramedics and ambulance staff would diagnose and rush the patient to the right hospital – not take him or her to the nearest one. As soon as the blockage is opened most patients show a considerable improvement. The length of stay in hospital is less. Indeed at present where patients are given the clot-busting drugs, often many need angioplasty a few days later.

The NHS already has enough cardiologists to provide this service with appropriate local

Clot-dissolving drugs for strokesAmong adults, stroke is the commonest cause of disability in the world. A stroke is damage or blockage of a blood vessel in the brain, usually resulting in unconsciousness and/or paralysis.

Stroke is the only neurologic disorder that physicians can completely reverse the disabling effects with thrombolysis. Thrombolysis means injecting a drug such as alteplase that dissolves blood clots that have already formed.

Physicians already know that giving alteplase by injection into a vein within 3 hours after the onset of symptoms improves the outcome after acute ischemic stroke – where blood flow to part of the patient’s brain is acutely obstructed. International guidelines recommend alteplase as treatment for eligible patients when administered within 3 hours after the onset of stroke. Thrombolysis with alteplase is the only approved treatment for acute ischemic stroke.

But its efficacy and safety when administered more than 3 hours after the onset

of symptoms have not been established. W. Hacke, at Heidelberg University, and others tested the efficacy and safety of alteplase

reorganisations. The angioplasty costs £800 more per patient than the clot-busting drugs. In 2007-8 4,472 such patients received primary angioplasty – a 42% increase on the previous year. The intention is not to replace the existing thrombolysis service, which saves many lives, but to add the fast angioplasty services. It needs units that are properly equipped and staffed.

In some parts of the UK, including 10 pilot hospitals that started fast angioplasty in 2004 or 2005, this angioplasty is already being done as routine. Already almost all patients in North East London and some patients in parts of Beds and Herts would get this, as reported in the BCPA Journal for August 2007 page 8. On the other hand few patients in parts of north-west England would currently get this – in 2007-8 only 6% of Cheshire and Merseyside patients got fast angioplasty. In some areas, eg parts of Cumbria and East Anglia, arranging the availability of fast angioplasty within two hours will require considerable reorganisation of the existing services. Similar schemes are being set up in Wales and Scotland. The service in NHS Lothian started in May 2008.

At present within England about 60% of all such patients receive either angioplasty or thrombolysis within three hours of the onset of their symptoms.

See also the article on pages 8-9 herein –

Papworth have set up a primary angioplasty service.

Unfortunately, from some of the remoter parts of the UK it will be difficult or impossible to get every such heart attack patient to a suitable specialist hospital within say an hour of the onset.

American research results1 have shown the following.

● For heart attack patients angioplasty definitely saves lives – many studies have proven this. ● Also for patients with advanced disease who are at risk of a heart attack (Acute Coronary Syndrome) angioplasty and stenting have been proven to be a significant therapy. ● Patients with chronic stable angina are at low risk of death or heart attack – for them stents are not intended to prevent death but to relieve pain and improve quality of life. ● Angioplasty and stents were proved to be as safe as clot-busting drugs. ● Coronary artery disease is a chronic condition – lifestyle changes, medications, and stents are ways of managing the disease and relieving symptoms, but they do not ‘cure’ the disease. 1 COURAGE trial results and interpretation at the American College of Cardiology annual meeting, New Orleans, 28 March 2007. RM

injected between 3 and 4½ hours after the onset of a stroke.

Despite the guideline recommendation, alteplase is underused. In most countries, fewer than 2% of patients receive this treatment – mainly because of delayed admission to a stroke centre. Only one-third of all patients with stroke get to an emergency department within the 3-hours time window and satisfy the criteria for acute thrombolytic therapy.

Hacke and others did a randomised trial giving the drug or a placebo to 831 patients aged 18 to 80 who arrived between 3 and 4½ hours after their stroke. Clinical outcomes, ie no disability after 90 days, were significantly better in patients treated with alteplase than in patients given the placebo – favourable outcome in 52% vs. 45% of patients.

Obviously, though treatment with alteplase may be effective in patients arriving 3 to 4.5 hours after the onset of their stroke symptoms, patients should be treated with alteplase as early as possible to maximize the benefit.

The door-to-needle time is the time from the patient’s arrival at an emergency department until he or she receives thrombolysis.

The current recommendation is that thrombolysis for acute ischemic stroke must be given within 3 hours after the onset of symptoms, which often means within one hour or less after arriving at the emergency room. Hacke and colleagues say the door-to-needle time of one hour or less remains paramount and must be kept as short as possible to increase the chance of a positive outcome.

Unfortunately however, internal bleeding within the patient’s head occurred more often among the alteplase patients. But there was no significant difference between the groups in the patterns of deaths or of any other serious adverse effect.

Sources. Hacke W and others: Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic Stroke. NEJM 25/9/2008. 359:1317-1329. Lyden P: Editorial.RM

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Co-ordinatorsBedford: Eileen Marriott 01234 303834 Cambridge: Bert Truelove 01223 844800East Suffolk: Anita Postle & helpline 01473 829777Halton: Stella Bate 01928 566484Lincoln: Brian Bigger 01522 880843Martlets, Sussex: George Beer 01903 763902Merseyside: Douglas Broadbent 07751 254444Peterborough: Gordon Wakefield 01733 577629South East London & Kent: Chris Howell 01689 821413Staffordshire: Alan Lea 01782 838730 Warrington: Dennis Atkinson 01925 824856West Suffolk & South West Norfolk: Brian Hartington 01284 762783Wirral: Martin Legge 0151 625 6529Wrexham: Alan Ellis 01978 352 862

ContactsBelfast: John Hamill 028 9081 3649Bourne: Win Felstead 01778 423869Cannock Area: Brian Nicholls 01922 412753Chester: via Head Office 01954 202022Hampshire: Derek Rudland 01329 282809Hull & East Riding: Stephen Hackett 01482 561710Llandudno: Joan Owen 01492 876926Lowestoft: John Genower 01502 511894North Lancashire: Alan Egar 01200 424801Norfolk: Anne Caswell 01953 604457North Staffordshire Implantable Cardioverter Defibrillator ICD Group:

James Lyons 01782 852509New Zealand: Neil Kerr enkay@wxc.net.co.nzOxfordshire: Chris Gould 01491 872454Swindon: Jim Harris 01793 534130

Affiliated GroupsChelmsford & District Cardiac Support: Malcolm Gibson 01621 893064Chester Heart Support: Peter Diamond 01244 851441Croydon Heart Support: Ken Morcombe 020 8657 2511Freeman Cardiac Rehabilitation Fund, Washington, Tyne & Wear: Ian Murray 0191 419 1048Havering Hearties: Jackie Richmond 01708 472697King of Hearts, Redbridge, Essex: Tony Roth 020 8252 0877Southend Take Heart: George Turner 01702 421522Wolverhampton Coronary Aftercare Support: Ken Timmis 01902 755695

Crossword – second copy page 12, answers page 9There is also a Wordsearch on page 9.

Across1 Things easily done, certainties (7)5 Put back reel cap (7)9 Twins were only the start (3)10 Oarsman reworking his return uncrowned (5)12 Endure as Edward’s in the ground (7)13 32 across, Feast of Stephen (6,3)14 Two legged support (5)17 Oh! Daily time of no work (7)18 In hole now I find a man (3)19 DNA part (4)20 Team members have video machines (7)21 Monster follows Santa’s colour for blush (7)24 Someone got one now (7)28 Claimed to be post-1971 currency (7)31 See 2 down (4)32 See 13 across (3)33 Hurry to be near cup and chat (5,2)34 Analyse sentence structure to spare jumble (5)36 Angels fear but fools acting backward provide a flood (6)37 Materials sound like fantastic haystacks (7)38 Oddly aboard that arterial route (5)40 Fasten string (3)41 Our wordsearch also has wines (7)42 A person could see stretched blurred moon (7)

Down1 Edible powder tasting like chocolate or cab crashed (5)2 31 across, Anne away repairs this evenly for 2009 (3,4)3 King of Judea 37-4BC among other odd things (5)4 Press it around banded pattern (7)5 Coarser texture long grass on golf course over Queen (7)6 Canoed or put feet in the water (7)7 I’d barge around to shorten text (7)8 PS: Money changed for those with same names (7)11 Dark hardwood like Snow White’s hair (5)15 Increasingly laid low – extremely rundown (5)16 Vegetable or sweet (3)19 Broad smile from ring (4)22 Beverley Hills Cop contains eternity (4)23 Supports remains (5)24 Peaceful ocean? (7)25 Ablate Eastern mixture edible (7)26 Social groups mixed in chest (7)27 Keyboarders work in a pool (7)28 Milking areas with air inside (7)29 Gem state of Boise (5)30 Spoil Aries’s animal climbing (3)34 Sacred song of lamps (5)35 Delete as these are up (5)39 Density Greek letter written (3)

Private payment for top-up drugsOn 4th November Alan Johnson, Health Secretary, announced proposals on paying privately for non-NHS drugs. Currently, people are usually excluded from the NHS if they pay for any non-NHS treatment. Prof Mike Richards’s review made 14 proposals that the government have put out for consultation till the end of January.

Under the proposals, most patients may top-up without losing other NHS care but: top-up patients must be separated from other NHS patients; and the patient will have to pay for associated staff time, tests, and scans.

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Whatever your interest it may be that becoming a member is something you have never considered.

Are you reading this Journal as someone who is not a member of the Association? If so we are pleased to count you as a valuable part of our readership.

However, might you take a few moments to consider making use of the application form to join the Association. It may be that you are a heart patient, a relative or carer of someone with a heart condition, or indeed someone taking a general interest in the Association and the support we are able to offer. Whatever your interest it may be that becoming a member is something you have never considered. May we invite you to consider it now. We would be delighted to hear from you.

We partly rely on donations to help us support cardiac patients and their families or carers. We aim to provide advice, information and support to help anyone who has had a heart condition, and aim

Membership and aims

If you wish to make a donation, please add the amount to your membership, or send it with your name and address and a signed copy of the Gift Aid wording if appropriate to the Head Office address. Donations will be acknowledged.

Amount of donation £ ...........

If over £50 may we also put it in the BCPA Journal Yes / NoIf you would like your donation to go to your local group, give

Name of Group ................................................

Please make cheques payable to: BCPA (The British Cardiac Patients Association).

to help reduce or prevent heart-related troubles. Your generosity could help us to help others to live a fuller and healthier life.

If you do not have a group near you and would be willing to help start a group in your area, please contact our Head Office for an informal discussion.

If you have any questions that we can help you with please write them on a separate sheet of paper and we will do our best to help you.

Address BCPA, 2 Station Road, Swavesey, Cambridge, CB24 4QJ

Telephone 01954 202022 Email admin@bcpa.co.uk Website www.BCPA.co.ukRegistered Charity 289190

Membership application & renewal

Please send this application to: BCPA, 2 Station Road, Swavesey, Cambridge CB24 4QJ

Subscription enquiries telephone: 01954 202022

Membership £10 per annum Life £100 Joint membership £15 per annum Life £150 Overseas subscriptions £10 per annum

Life members may pay in two installments, the second being 6 months after the first.

New member Renewal

If you are paying income or capital gains tax at the standard rate or above, you should make the following declaration:

I want the BCPA to treat all donations I make in this tax year and all donations I make from the date of this declaration until I notify you otherwise as Gift Aid donations.

I understand that I must pay an amount of UK income tax and/or capital gains tax at least equal to the tax the BCPA reclaims on my donations in each tax year (currently 25p for each £ given).

1 You can cancel this declaration at any time by notifying the BCPA2 If your circumstances change and you no longer pay income or capital gains tax equal to the tax that the BCPA reclaims, you should cancel your declaration3 If you pay tax at the higher rate you can claim further tax relief in your self-assessment tax return4 If you are unsure if your donations qualify for Gift Aid tax relief, ask the BCPA or refer to help sheet IR65 on the HMRC website www.hmrc.gov.uk/charities

Signed………………………………………. Date…………………………………

Mr/Mrs/Ms ................... Date of Birth .............................................

Forename(s) .....................................................................................

Surname ...........................................................................................

Address ............................................................................................

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.................................................Postcode ..........................................

Telephone .........................................................................................

Email ................................................................................................

Joint member’s name .......................................................................

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Type(s) of treatment(s) & hospital(s) ..............................................

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Is there anything you would like help with or information about?

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Index to BCPA Journals 2004-2008CB = Corey BeecherDC = Derrick CuttingDH = Derek HolleyF, G = BCPA Factsheet, Glossary on website

RM = Richard Maddison, or report bySL = Stephen LargeTE = Sir Terence English

Ablation for atrial fibrillation TE, Steven Hunter J157p10-11; Warfarin L J158p12Ablation Nick Beattie L J156p10Acupuncture Diana Olafsdottir J163p10Acute coronary syndrome J138p10-11Acute coronary syndrome J140p6Ageing population RM J154p5; J152p10-11Aims of BCPA RM J146p22Analgesics RM J149p16 GAngina frequent attacks Eve Knight J152p13Angina not diagnosed Barry Mappley L J156p10Angina, refractory, squeezy pants J142p7Angiography early save lives RM DH J144p17Angioplasty NC J140p14-15; J163p13Angioplasty story Alec Keeble J139p25Antibiotics at dentists end Susan Wallin J162p6Anti-platelet therapy, clopidogrel J135p26-27Antivirals, flu RM J150p5; RM J151p20-22Apple a day, flavonoids J159p3, p10Arrhythmia Alliance J147p19Aspirin at bedtime RM J161p3; J162p10-11; Tim Nicholson L RM J163p12Aspirin clopidogrel don’t stop NC J150p18- 19; aspirin, ACE inhibitor J134p15Aspirin for women RM J147p25Atkins diet DC J134p10-11 GBCPA 25 years J153BCPA Aims RM J146p22Beds & Herts conference RM J155p8-12Beds & Herts conference RM J161p10-13Beliefs, feelings, CHD J149p12-13Bilirubin L RM J146p19Blood pulse wave speed RM J147p11&21Blue Light Papworth Sarah Clarke J163p8Buncefield fire J147p16-17C diff, MRSA numbers RM J158p5; J163p10C diff Paul Giannasca J159p11CABG RM et al J134p9 FCalcium in diet J142p18-19Cardiac arrhythmias J137p17Cardiac rehabilitation Geoff Dorrie J156p14Cardio & vascular Coalition TE J162p7-9Cardiomyopathy Association J157p9Cell therapy SL J143p16Cereal killers DC J135p7CHD hypertension, VALUE J137p17CHD mortality patterns RM J160p13CHD omega-3, B vitamins J147p14CHD silent, risk findings NC J147p20-21Cholesterol UK Cathy Ratcliffe J152p12Cholesterol UK survey J135p28Chronic obstructive pulmonary D J135p30Co-enzyme Q10 J151p12-13Communication RM J144p5Computerised tomography J153p18Consent J143p11; RM J158p13 F GConsultant contracts NC J141p12Consultant hours NC J137p18-19

J134-9 in 2004; J140-5 in 2005; J146-151 in 2006; J152-157 in 2007; J158-163 in 2008L = letter & replyNC = Nick Curzen

Cox-2 inhibitors RM J149p17Crossword explained RM J158p14Drugs, aspirin, ACE inhibitor J134p15Drug-eluting stents, NICE NC J156p8-9; RM NC J159p4-5Drugs at bedtime RM J161p3; John Barlow, Mike Wilson L J162p10-11; see AspirinDrugs, risks, anti-inflammatory RM J149p16Dump your toxic waist! book DC J162p12EECP, squeezy pants J144p20Emergency angioplasty NC J134p18-19Emergency life support training J151p18-19European health card J142p26-27Exercise benefits CB J160p9 changes over the years CB J153p21 diabetes CB J162p13 DVT CB J142p10 equipment CB J149p14-15 FITTE CB J143p14 goals CB J158p10 gym CB J140p10-11 in your armchair CB J148p16-17 keep ball rolling CB J152p9 know yourself J163p11 lifestyle change CB J141p16-17 motivation CB J147p22-23 myths CB J150p12-13 physical activity CB J137p15 plan CB J146p16-17 positive mental attitude CB J157p12 regular aerobic CB J138p14-15 skipping CB J155p13 technology CB J159p13 the buzz CB J160p13 think of as fun CB J144p14 true costs CB J151p20 walking CB J139p14-15 Wii or me CB J161p7 winter warning CB J145p13Experience of a lifetime DH J156p13Fat, good .. to fight CHD J143p12-13Fats explanation RM J150p17Flavonoids, chocolate DC J139p12Flavonoids, red wine, onions, tea, apple, cocoa, polyphenols J159p3, 10Fosamax & atrial fibrillation RM J160p7Fred Roach J149p4, J153p8Game for a change DC J146p13Glycaemic index RM J148p5; J147p21,26 GHealth of older people, RCN J135p9Heart imaging, Cardioscan J150p21Heart operation survival rates RM J148p15Heart pressure/volume SL J141p14-15Heparin trial J149p13Herbs for hearts Afifah Hamilton J144p12-13Homeopathy RM J144p13; story J145p18Homocysteine, NORVIT trial DC J145p17Hospital, risks Eve Knight J160p10-11Informed consent NC J135p10-11 GInsurance, Travel .. J160p11Journal contents, invitation RM J149p5

Knowledge RM J146p5LDL & HDL DC J144p19LDL pill RM J158p4LDL diet to lower DC J138p12Life expectancy A Robin & RM J152p10-11Marathon SL J141p14-15Marathon, Didier Biron J152p6; J154p4Metabolism DC J140p12Nerves trapped Don Brookman L J156p10NICE, anticlotting drugs DC J143p18NICE, CHD targets J143p19Octogenarians, BP drugs J160p8Octogenarians, cardiac surgery J144p21Oily fish DC J137p12 GOily fish protect brain decline RM J160p14Oily fish, omega-3 benefits RM J148p20 GOpioids, non-opioids, NSAIDs RM J149p16 GPapworth pause heart transplants RM J157p13Pathology Nick Kirk J151p14-15Patient choice NC J142p16-17; J145p14-15PCI, PPCI Lynne Holt J161p9; Papworth Blue Light Sarah Clarke J163p8Pharmocogenics J134p11Prevent deterioration RM J143p5Primary care J141p24-25Primary care nursing, CHD J137p19Pulmonary endarterectomy J147p24-25Pulmonary Hypertension Assoc J148 p18-19Pulse checking Sue Lyon J163p7Recipes Janet Jackson J151-J163Refractory Angina, squeezy pants J142p7Research studies NC J146p14-15Reviving elderly outcry RM J147p17Salt J139p16-17; Bill Darling L J150p20Simvastatin L RM J146p19Smoking ban J146p18Statins J136p6-7; J140p16-17; L J158p12 G

dose RM J144p21; NC J148p14-15; J149p5 cholesterol RM J154p5; J148p14; J149p20; J152p12

less smoking, fewer deaths RM J153p18more people on RM J149p18reversing plaque DC RM J149p21

Stem cells hype J152p13; trial J157p9Strokes drug for J150p13; RM J163p13Temperature of home J144p18Tower bellringers J151p1,3Trans fats in foods RM J150p16Transplant games Ray Pearson J152p12Transplant story Diana Sanders J150p14-15Transplant donor heart beating RM J149p10Unmemberables RM J147p5Vaccines, antiviral drugs RM J151p20-22Visitor, Hospital .. J149p15Waist measurement, obesity J137p18 GWaiting times coming down RM J160p8Waiting times 18-weeks target J155p8-12Warfarin satisfactory many years L J158p12Women, angina, poorer care RM J154p5; RM J160p8

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