“acquiring” other conditions
This is the second of two articles Written by Dr Leisa Freeman, Consultant GUCH Cardiologist, and Toni Hardiman, Specialist GUCH Nurse GUCH Clinic Norfolk & Norwich University NHS Hospital. These articles originally appeared in issue 68 (spring 2012) and issue 69 (summer 2012) issues of GUCH News
In this concluding chapter on getting older as a GUCH, Dr Leisa Freeman and Specialist GUCH Nurse Toni Hardiman, both from the GUCH Clinic at Norfolk & Norwich University NHS Hospital, explore further conditions that GUCH patients – along with the general ageing population – could acquire, and helpful hints on keeping healthy
Peripheral Vascular Disease
Narrowings of the arteries in the legs may produce pain in the leg muscles when you walk, which is provoked by exercise and relieved by rest. Smoking and diabetes are particular causes.
Sometimes these narrowings can be relieved by stents to the leg arteries. A GUCH may have similar pain in the legs with walking due to damage to the leg artery (the femoral artery) following a cardiac catheterisation.
Not being able to get or maintain an erection is sometimes related to atheroma (swelling) in the arteries to the penis. People with diabetes may be more prone to this condition. Beta blockers can also be associated with erectile dysfunction. If you think this might be affecting you, speak to your GP or GUCH team as there may be other medications you can try. There are effective treatments available for erectile dysfunction so ask for a referral to a specialist. If you find it difficult talking about this sensitive subject, write it on a piece of paper and show it to your GP or GUCH specialist instead.
Stroke or Cerebrovascular Disease (CVA)
A stroke occurs if there is interruption of the blood supply to the brain. This may be due to a narrowing of the carotid arteries or other main branches or a clot from atrial fibrillation, for example. Other times it can be due to a bleed. The main symptoms of a stroke can be recognised with the word FAST:
Face – The face, mouth or eye may droop to one side and/ or they may not be able to smile.
Arms – They may not be able to raise both arms and keep them there due to arm numbness or weakness.
Speech – There may be slurred speech.
Time – Act quickly. Dial 999 immediately if you or someone you are with develops ANY of these symptoms.
Increasingly clot busters may be given for major strokes – after a CT scan of the head to exclude bleeding as a cause.
A mini stroke orTIA (Transient Ischaemic Attack) occurs due to a temporary interruption in the blood supply to part of the brain. The symptoms may be similar to a stroke but they usually last a few minutes. Having a TIA is a warning sign, and you should still report the symptom and get seen by your GP or specialist.
The main symptom of gout is an incredibly painful and red joint due to tiny needle like uric acid crystals. It usually affects the big toe but other joints as well. Furosemide and Thiazide diuretics make you more prone to gout and people with Eisenmenger Syndrome, who produce more red blood cells to carry oxygen to the body, are more likely to develop it. Sometimes clinical gout can occur as a result of this over production of cells although many GUCH patients have a small rise in uric acid level without clinical gout. Strawberries, alcohol, home-grown tomatoes and asparagus can also make gout worse.
Heart failure means that the pumping function of the ventricle(s) is no longer as dynamic and effective so fluid is retained in the body. There are many causes of heart failure and having certain types of congenital heart disease may mean that the ventricle(s) have always been less effective and that diuretics are needed. Heart attacks can also cause the ventricle(s) to be damaged. Based on the studies of acquired heart failure in the rest of the population, the same medications, such ACE inhibitors or angiotension blockers, e.g. A2RB, beta blockers, are used in GUCH heart failure. Certain types of pacemaker improve the function and synchronicity of the ventricle(s) and may be helpful, for example cardiac resynchronisation therapy or CRT, which is sometimes called biventricular pacing.
The kidney is vulnerable to the effects of high blood pressure and diabetes, as well as perhaps having been made to work harder by diuretics. Kidney dysfunction is shown when the levels of urea and creatinine rise in the blood. You may have heard the term ‘U & Es’, which is the term used to refer to checking the kidney function. Dependent on these results you may need to reduce the dose of your usual medication(s) as you get older, though GUCHs may have kidney abnormalities as part of their congenital condition.
The prostate is a gland in men which guards the exit from the bladder. Ageing increases its size, making passing water more of a problem, e.g. trouble starting and stopping and/or poor stream. If you are over 50 years of age, your GP may want to do a test for prostate cancer e.g. prostate specific antigen or PSA.
Problems or cancers in other organs of the body can develop as the body ages. Ensuring that you have the regular check ups offered (e.g. well man and well woman checks at the GP) and trying to keep your diet and lifestyle as good as you can is all any of us can do. If non-cardiac surgery is required, make sure that the surgeon and anesthetist discuss the operation with your GUCH specialist. In some instances it may be best for the surgery to take place at the GUCH specialist centre due to your particular heart condition.
As you get older it is frighteningly easy to put on weight. One of the most important things you can do for yourself in middle and older age is to keep the weight off – exercise if you can, use a smaller plate, only have treats once a week. Being too ‘heavy for your joints’ puts strain on your heart and lungs and increases your risk of developing Diabetes.
A Scottish farmer said to me on his 80th birthday: “Life is like a lavatory roll, you never realise how much you have wasted till you get to the last piece.”