HEARTATTACK— OR INDIGESTION?
74 I’m having pains in my chest—could it be a heart attack?
THE key symptom is crushing central chest pain, radiating to the neck and/or arms. Others include shortness of breath, nausea, vomiting, and feeling faint or severely unwell. ‘If you have these with chest pain you must call 999,’ says Dr Amarjit Sethi, a consultant cardiologist at Imperial College Healthcare NHS Trust in London.
The most common cause of chest pain is heartburn as stomach acid rises into the throat. Some patients experience a heavy cramping pain in the middle of their chest, pushing up into their throat. While it feels similar to a heart attack, heartburn won’t have other symptoms such as breathlessness or nausea.
Chest pain is also often caused by angina (pain on exertion). ‘Angina is a sign that not enough oxygen is getting to the heart because your arteries are furred up, so you need to see your GP and start on treatment or more investigations,’ says Dr Sethi. Another common cause is costochondritis, inflammation of the cartilage joining the ribs to the breast bone, causing sharp pains in the chest. But unlike a heart attack it won’t cause other symptoms.
‘This can be triggered by viral infection and over-exertion, such as strenuous exercise, causing inflammation in the area,’ says Dr Sethi. Treatment includes antiinflammatory painkillers. Costochondritis usually resolves on its own, but it can take months.
75 Is it safe to keep taking proton pump inhibitor medication long-term for acid reflux?
PROTON pump inhibitors (PPIs) work by reducing the amount of stomach acid produced by cells called proton pumps. Although research has suggested people taking PPIs are more likely to develop the infection C. difficile, dementia and even cancer, this is not the same as proving the drugs cause these, says Dr Steven Mann, a consultant gastroenterologist at the Royal Free Hospital in London.
‘These are clean, safe drugs which are generally effective.’ But under NICE guidelines doctors should review patients taking PPIs at least annually.
Experts warn against using low-dose PPIs you can buy over the counter for more than two weeks without seeing your doctor.
76 I have tummy pain and bloating after eating. I also get diarrhoea alternating with constipation. What’ s wrong with me?
THESE are the classic symptoms of irritable bowel syndrome ( IBS), especially if mucus is also being passed, says gastroenterologist Steven Mann.
It can occur at any age but most typically affects women under 50. It’s treated by managing diet and lifestyle.
Under NICE guidelines, before diagnosing IBS, your GP should arrange blood tests for conditions such as anaemia and coeliac disease. If these are negative you should have calprotectin testing. This test helps rule out inflammatory bowel diseases, such as Crohn’s disease.
High levels of calprotectin suggest the patient might need further investigation with a colonoscopy (using a tiny camera to examine the bowel). ‘What should concern a GP is if the patient is over 50 and these are new symptoms. This should be further investigated,’ says Dr Mann.
77 Is it worth taking protein supplements to help build up muscle fitness?
THIS partly depends on your age. ‘Over 50 the muscles can start to waste,’ says Dr David Ashton, a consultant epidemiologist and bariatric (obesity) expert at Imperial College London.
‘ If you lose muscle, which is metabolically active and uses up calories, you are likely to gain fat.’ Loss of muscle mass in older people also raises the risk of falls. ‘If you’re over 50 and concerned, there’s no harm and every possible good in taking a protein supplement to boost muscle mass.
‘I’d recommend 20–25g a day; perhaps whey protein as it’s readily absorbed. If you’re under 50 and have a balanced diet there’s no need unless you’re doing a lot of weight training.’
78 Would I qualify for weightloss surgery? Diets don’t work for me.
IN ORDER to qualify for weight-loss (bariatric) surgery on the NHS, your BMI has to be 40 or more, or between 35 and 40 if you also have an obesityrelated condition that might improve if you lost weight (eg. type 2 diabetes).
‘Remember, it’s not a cure for obesity on its own,’ says obesity expert Dr David Ashton. ‘You’ll have to commit long-term to lifestyle changes and attend regular check-ups, as surgery is most successful for people who do this. It’s also important to look at underlying reasons for weight gain.’
Even if you qualify for the surgery, there can be a postcode lottery for intensive weight-loss programmes that are a prerequisite for bariatric surgery.