Why do I keep on getting a pain in my chest at bedtime?

A FEW years ago I was diagnosed with atrial fibrillation. I take medication for it but have recently begun to feel a pain in my chest when I go to bed and when I wake up. It’s not agony – but uncomfortable. What could it be?

CHEST pain is always a reason to speak to a doctor promptly. In the first instance, I would advise a telephone conversation with a GP or cardiologist.

Atrial fibrillation is an abnormal heart rhythm – problems with the nerves cause the heart to beat irregularly. Symptoms include noticeable palpitations, shortness of breath and even dizziness. But atrial fibrillation does not typically cause chest pain.

We know that people with atrial fibrillation are more likely to suffer from high blood pressure and coronary artery disease – blocked arteries that raise the risk of a heart attack.

It’s possible that this kind of pain is angina, which is chest pain caused by coronary artery disease, but angina attacks are usually linked to physical activity and it’s not normal to get this type of chest pain at rest or in bed.

There are other causes of chest pain, for example heartburn or indigestion, or there could be a musculoskeletal cause.

People with atrial fibrillation are more prone to blood clots due to the abnormal flow of the blood within t he heart. This increases the risk of a stroke, and medications are needed to reduce that risk.

But some of the medications may be responsible for the pain. Keep a diary of your symptoms and speak to your doctor as soon as possible.

I HAVE read that eating oily fish and taking fish oils can help to prevent heart attacks and even dementia. Is it true?

THE simple answer is that eating oily fish or taking fish-oil supplements is very unlikely to do any harm, but we cannot say if any specific food or factor can prevent heart disease and dementia as the risk factors for these are multiple and complex.

Omega-3 fats which are found in oily fish are considered to be good for the heart. The British Heart Foundation recommends eating fish twice a week, with at least one portion being oily fish.

Omega-3 fats can also be found in flaxseed, walnuts and some fortified foods. But it is the fish itself that appears to offer the best heart benefits, according to the studies.

A detailed statement from the Scientific Advisory Committee on Nutrition in 2018, reviewing the evidence of diet and dementia, showed that people who have a Mediterranean diet, which is rich in oily fish, are less likely to suffer dementia – but of course this diet comprises a range of ingredients, so it may not be simply the fish.

It could be the combination of oils and vitamins in fish that is protective, or the fact that fish is being eaten instead of less healthy options. Or it may not even be the diet at all.

It i s becoming i ncreasingly clear t hat heart disease and dementia, as well as type 2 diabetes, are linked. So staying on top of your weight, blood press ure and other factors such as cholesterol l evels i s al so key to staying free from all of these illnesses.

MY GRANDSON was born in May. After a month, having suffered from a urine infection, he was found to have a ‘horseshoe kidney’. Is this curable and how will it affect him?

A HORSESHOE kidney i s an abnormality that babies can be born with. It is incurable, but for many people it causes no longterm problems.

The kidneys are a pair of normally bean- shaped organs on either side of your spine, below your ribs, towards the back of the body. Each is about 5in long – the size of a large fist.

While developing in the womb, in some babies the kidneys don’t develop separately and instead remain joined at their lower end, forming a horseshoe shape. We don’t really know why this happens, but it’s more common in boys than in girls and occurs in about one baby in 500. Genetics, undoubtedly, play a role.

Horseshoe kidney is sometimes detected during a pregnancy scan, or later on when investigations are done for other reasons, such as trying to find the cause of a urinary infection.

In about a third of children with horseshoe kidney, there are no symptoms or problems and the abnormality is discovered only by accident, often in later life.

Because of the abnormal kidney shape, children with horseshoe kidney can be more likely to suffer from kidney stones and reflux, which is when urine travels the wrong way back from the bladder up towards the kidneys, leading to infections.

Once the abnormality is spotted, specialists may want to arrange for further investigations of the kidneys and bladder to check that everything is working well.

It’s important that parents watch out for fevers, as these can be a sign of a urinary infection.

But on a day- to- day basis, a horseshoe kidney is unlikely to cause much trouble.