I often tell patients with palpitations and even blackouts that coffee and tea may be the cause. Stopping it may avoid more investigations and invasive treatments.
This site takes you through the origins of coffee. It appears that dancing goats in Ethiopia lead the goat gerder to look for the cause- coffee beans that they had eaten. Now it is one of the largest commodities traded in the world. And it tastes good!
Although originating in the Muslim world, initially declared “Haraam” or sinful, and then declared “Hala” or permissible by the Ottomans, Pope Clement VIII sampled coffee for himself and decreed that it was indeed a Christian as well as a Muslim drink.
Inside the red fruit of coffea lie two green coffee “beans”. The rich brown hue to appear only after roasting. In fact, they are fruit, and the seed is the coffee bean you need!
Here is a tale from a very worthy journal suggesting that high coffee intake may be linked to reduced mortality. It was a randomised trial. This is the gold standard of evidence. BUT still it is by no means certain that these high coffee drinkers were not different from the non coffee drinkers in some other way, although the study did try to control for smoking habits, social class, body mass index etc.
It will make you pass water. It can give you palpitations. It can make you anxious and irritable. It might increase your heartburn. And the Buzz can wear off. Evidence suggests there can be a reliance on the drink, and tolerance builds over time.
Finally, it can be addictive. So beware. Going cold turkey now and again will keep the addictive tendancies at bay. Withdrawal symptoms include a headache, fatigue, irritability, difficulty concentrating, and depressed mood.
If you like coffee and are not getting side effects, then keep on going. There seems no need to cut back on this ubiquitous and legal “high”.
Professor Sir Bruce Keogh, previously Medical Director of the NHS, and a cardiac surgeon by trade, said all surgeons should have their operation statistics published. He felt that doing so would make the surgeon more careful. The risk taken would not be just for the patient, but would now also hang over the surgeon.
This seems obviously a great idea.
Like all issue, it is more complicated than it seems.
So. Do you want a surgeon with very low mortality for their procedures- YES
But. Do you want a surgeon used to dealing with high risk cases-YES because they will find the easier cases very simple and get great results. BUT this surgeon will a mortality rate that will of course be higher than for the average surgeon.
It is hard to know who is “the best”. A personal recommendation by someone in the know is probably better than searching for statistics that are harder to interpret. On average surgeons, including interventionalists like me, get appointed as Consultants (in USA speak, “Attending Physicians”) at about 35-40, and reach their peak of experience 45-55- when they have been around long enough to know all of the issues, experienced all of the complications, and thus know how to deal with them. Their data is also more stable- as they have done so many cases that their average mortality is a true representation of what they do.
UK surgeons are now moving AWAY from individual surgeon data, but presenting data for their unit. If the whole unit data is looking bad, then individual surgeons data should be examined. This makes more sense to me.
I was watching the game and Christian Eriksen, the Denmark captain collapsed. It reminded me of Fabrice Muamba and his collapse at a premiere league game. He survived. https://www.youtube.com/watch?v=IChMmD5dx7I
This can be due to the brain- eg epilepsy- a blackout.
This can be due to the heart- the heart can go too fast (tachycardia) or too slow (bradycardia)- a syncope.
In addition the heart can STOP. In younger perople this is uusually due to ventricular fibrillation (VF)– the electricity of the heart goes haywire, and there is no coordinated heart beat. In older patiients, you may see asystole– absolutely NO electrical activity, or PEA– then there is activity that looks normal, but the heart muscle can no longer respond. This is a cardiac arrest.
Most commonly, of course, it can be a simple faint- the heart does not stop, and recovery is quick.
Obviously as yet, just after it has happened, no one will know. He is a professional athlete, and will have had regular medicals to ensure he is fit to play. Just as in other athletes that suddenly collapse, VF is the likely mechanism of his collpase, but WHY it occured will take time to sort out. The early news is that he has made it to hospital alive.
It is likely that he will have:
I wish his well in his recovery- the cardiology input will be key in sorting out what actually happened. As the resusitation was immediate and successful, one would hope for a full recovery.
Dr Malik is Medical Director of OneWelbeck Heart Health and London Cardiovascular Clinic, and is Clinical Director of Structural Heart Disease at Hammersmith Hospital, Imperial College Healthcare NHS Trust, London.
It was great to see that Christian Eriksen left Rigshospitalet Hospital in Copenhagen following a successful operation to fit a defibrillator implant. This device will protect him in case the heart rhythm misbehaves again. I wish him well for the future.
This is a “shock box”. If the heart is too slow, it will “pace” to ensure it cant go slower. If the heart is in “VF”, then it will “Shock” to reset the heart electrically. See
Dr Malik, Professor Peters and Professor Mayet now consult at One Welbeck Heart Health, minutes away from Harly Street, and 60 seconds walk from Bond Street Station.
We consult there. In additon we can do:
I hope you will agree when you visit that it is a special place to visit. We hope to give you a seamless experience with Consultation, Bloods, and Investigations all under one roof.
Dr Malik explains what this new drug does and when it might be used.
Nilemdo lowers levels of ‘bad’ cholesterol (also called “LDL-cholesterol”), a type of fat, in the blood.
Nilemdo contains Bempedoic Acid, which is inactive until it enters the liver where it is changed to its active form. Bempedoic Acid decreases the production of cholesterol in the liver and increases the removal of LDL-cholesterol from the blood by blocking an enzyme (ATP citrate lyase) needed for the production of cholesterol.
The dose is 180mg once a day
Nilemdo is given to adults with primary hypercholesterolaemia or mixed dyslipidaemia, which are conditions that cause a high cholesterol level in the blood. It is given in addition to a cholesterol-lowering diet.
Nilemdo is given:
• if a statin (such as simvastatin, a commonly used medicine that treats high cholesterol) and this does not lower your LDL-cholesterol sufficiently;
• alone or together with other cholesterol-lowering medicines when statins are not tolerated or cannot be used.
Do not take Nilemdo:
• if you are allergic to bempedoic acid or any of the other ingredients of this medicine (listed in section 6);
• if you are pregnant;
• if you are breast-feeding;
• if you take more than 40 mg of simvastatin daily (another medicine used to lower cholesterol).
Warnings and precautions:
Talk to your doctor before taking Nilemdo:
• if you ever had gout;
• if you have severe kidney problems;
• if you have severe liver problems.
Your doctor may do a blood test before you start taking Nilemdo. This is to check how well your liver is functioning.
Tell your doctor if you are taking medicine(s) with any of the following active substances:
• atorvastatin, fluvastatin, pitavastatin, pravastatin, rosuvastatin, simvastatin (used to lower cholesterol and known as statins).The risk of muscle disease may increase when taking both a statin and Nilemdo. Tell your doctor immediately about any unexplained muscle pain, tenderness or weakness.
• bosentan (used to manage a condition called pulmonary artery hypertension).
• fimasartan (used to treat high blood pressure and heart failure).
• asunaprevir, glecaprevir, grazoprevir, voxilaprevir (used to treat hepatitis C)
Do not take this medicine if you are pregnant, trying to get pregnant, or think you may be pregnant, as there is a possibility that it could harm an unborn baby. If you get pregnant while taking this medicine, call your doctor immediately and stop taking Nilemdo. Do not take Nilemdo if you are breast-feeding because it is not known if Nilemdo passes into milk.
If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine.
This medicine contains less than 1 mmol sodium (23 mg) per tablet, that is to say essentially ‘sodium-free’.
The recommended dose is one tablet once daily. Swallow the tablet whole with food or between meals. If you take more Nilemdo than you should contact your doctor or pharmacist immediately. It is unlikely one exta dose will harm you.
If you notice that you forgot:
• a dose late in a day, take the missed dose and take the next dose at your regular time the next day.
• the previous day’s dose, take your tablet at the regular time and do not make up for the forgotten dose.
Like all medicines, this medicine can cause side effects, although not everybody gets them. Side effects can occur with the following frequencies:
Common (may affect up to 1 in 10 people)
• lower number of red blood cells (anaemia)
• increased levels of uric acid in blood, gout
• pain in shoulders, legs, or arms
• blood test results indicating liver abnormalities
Uncommon (may affect up to 1 in 100 people)
• decreased haemoglobin (a protein in red blood cells that carries oxygen)
• raised creatinine and blood urea nitrogen (laboratory tests of kidney function)
• decreased glomerular filtration rate (a measure of how well your kidneys are working
This is a brand new treatment for lipids. Lipid lowering is known to reduce the risk of heart attack and stroke. Statins are the 1st line agents. This new tablet will not be 1st line. It is also , like any new tablet, expensive- costing about £300-400 per year. The fact that it is onec a day and a tablet, of course makes it easier to take.