Jonathan C. Pitts Crick

In general, it is your average salt (sodium chloride) intake over a week or so that counts so an occasional cheat day" will not make much difference. You can check your fluid balance by weighing yourself daily and comparing this with your symptoms if your weight goes above a certain level you will start to notice swelling in your ankles and increased breathlessness, so you just need to keep your weight below this level by adjustment of your salt intake and diuretic treatment. As you are already taking two diuretics, furosemide and spironolactone you may not need to be too strict with your salt intake. Too little salt in your blood can cause muscle cramps and a feeling faint when you stand up, especially if you are drinking too much water. So if you have fluid overload AND muscle cramps it may be more important to restrict your water intake than your salt.=20 With congestive heart failure, managing your fluid balance is very important and the details depend on the cause of your heart failure, your kidney function, your medication, your level of activity, and the weather (you lose a lot of salt and water by perspiration in hot weather). So daily weighing and updating a graph to monitor it allows you to take effective control, and ideally also measure and note your blood pressure. In addition to controlling your salt and water intake, you should also discuss how to adjust your diuretic dose with your cardiologist or specialist heart failure nurse. It is also important for your family doctor or heart failure clinic to check your kidney function and potassium level (a blood test) regularly. Best wishes, Jonathan

The appearance of an enlarged heart on a chest X-ray can be just due to its position, so the first thing to check is if it really enlarged, and which part of it is this can be done with an ultrasound scan, called an echocardiogram. If this does show an abnormality, then a more detailed look with a cardiac MRI scan will show exactly what the problem is, and then you can discuss with a cardiologist what treatment or precautions if any, are needed.

Hypertension can be a temporary reaction to stress, medication, or possibly some other illness, but mostly it develops because of a genetic factor. These genes are not going to change so once hypertension has developed, treatment needs to be long-term. Sometimes, if the treatment is very effective the BP can go down to normal and stay there even without continuing it for a while, but after a month or two it gradually starts to creep up again. Occasionally, successful lifestyle changes can be sufficient to overcome the genetic tendency, but this may only work for a few months or years, so you have to keep monitoring it.

This kind of pain is almost always caused by a trapped nerve, which usually comes on because of sitting still with a stooped posture (such as using a computer). The more serious pain from your heart (angina) is felt in the center of your chest and comes on when doing sustained exercise like walking uphill, recovering rapidly when you rest. If you can still do fairly vigorous exercise, then your heart is okay, but if you find your physical stamina is reducing, you should have a check-up with your doctor.

I hope this helps,

Jonathan

The first thing to check is whether it is angina. This is quite simple: if it is reliably brought on by walking uphill and settles in a few minutes when you rest, then it probably is angina and you should see a cardiologist urgently.

If not, the most likely causes are
1) acid reflux — you can check this simply as well: if it settles rapidly when you take an antacid, 2-3 tablets of “Settlers” or similar, then it probably is and you can treat it with regular esomeprazole from your chemist for two weeks; if that works but it comes back when you stop, you should speak to your doctor about it.
2) nerve root pain, caused by nerves being pinched at your mid-thoracic spine (like sciatica but higher up). It is caused by sitting with a stooped posture, especially while using a computer or relaxing in a comfy sofa. The solution is to sit up very straight and keep moving every few minutes. Regular mobility back exercises (eg disco dancing) also helps.

All other causes are rare but should be looked into if neither of these fits.

The dose of propranolol you are taking, 10 mg twice a day, is very low compared to the doses that were used for blood pressure or angina (160 mg or more per day), so the weaning off period would only be 1-2 months. I'm not completely convinced that your irregular heart rhythm is entirely related to clonazepam withdrawal so it could turn out to be a longer term issue and you may need to stay on a beta blocker or other rhythm-stabilizing medication long-term. There is a beta blocker that hardly crosses the blood-brain barrier called NADOLOL and you could find this, at a low dose, better than the propranolol which can cause fatigue and depression (though quite unlikely at that small dose).

The usual cause for this kind of pain is "thoracic nerve root compression," which is where the nerves coming out of your spine in the area between your shoulder blades are being pinched by the spinal bones (vertebrae) getting slightly out of position. It is mostly caused by spending long periods sitting in a stooped position (typically using a computer). It can be relieved by sitting up very straight (with your computer screen at eye-level) and taking frequent breaks to get up and do something energetic. Even better, but not always practical, is to sit on a large ball (e.g., one used in yoga exercises) while working, which keeps your back muscles toned up and the vertebrae nicely in line. The feeling of swelling under your armpit may be just a sensation from the same nerves, but if you think it is really swollen, you should get a check-up with your doctor.
I hope this helps.

Mostly, having high blood pressure is a hereditary trait – these genes are common because they can give a survival advantage in situations where salt is scarce and it is hot (e.g. inland Africa, where much of our evolution took place). The problem is that where salt is easy to get and you are not perspiring a lot it puts the BP up and this causes an increased risk of strokes and heart attacks in the over 50s (and evolution isn't that bothered about what happens after you have successfully passed on your genes). So, although limiting your salt intake, losing weight if you are overweight and undertaking regular exercise can help a bit, you basically have to defeat your hypertension genes which requires regular medication longterm. Modern BP-lowering medications are very effective with few side-effects so just get started and take enough to get your BP down to near-normal – and look forward to living to a ripe old age...

Coronary artery spasm is a bit like migraine – there are several possible causes. The most reliable trigger is hyperventilation, which may itself be caused by anxiety but can be controlled consciously by leaving 5 seconds between breaths, with an "in - out - pause" pattern.

CKD does increase your risk of both hypertension and coronary artery disease but your nephrologist (kidney specialist) should be able to advise you on how to minimise this. You should see a cardiologist promptly if you develop heart symptoms, especially deteriorating exercise capacity.

What you had was an episode of tachycardia (which means the heart goes out of normal rhythm and about twice as fast as normal). There are different types but the main three are 1) atrial flutter, 2) ectopic atrial tachycardia, 3) re-entry SVT (supraventricular tachycardia). (1) and (2) may be a one-off event in response to the stress of the situation you were in, especially if combined with a viral infection (any sort) or recent alcohol intake. (3) would be likely to recur at random times. None of them is dangerous. Less likely (much more common in older people) is atrial fibrillation which is very irregular and can go on for days or weeks, sometimes needing an electric shock to revert to normal rhythm (cardioversion).

No, it may be completely normal or it may be that you have recently had a viral infection that caused some temporary inflammation of your heart.

It could be just Raynaud's syndrome which is relatively harmless, but it could be a heart problem so if it is getting worse you should have a heart check-up.

It could be due to mild asthma but it could possibly be something more serious related to his coronary arteries. I think he should be assessed by a paediatric cardiologist, who may suggest a heart scan.

Most likely it is thoracic nerve root compression pain. It is common, including in young people, and harmless. It is mainly caused by bad posture, especially when using a computer for long periods. It is helped by sitting up straight and doing mobilising back exercise – especially manic dancing (maybe best in private!).

Yes, depending on which type of cholesterol is high. But it can be controlled by regular medication with few side-effects.

It depends on the type of infection, but generally 6 weeks.

It doesn't sound like a heart attack or anything serious – most likely a trapped nerve in your back due to bad posture (especially when using a computer for long periods). It is helped by sitting up straight and doing some back-mobilizing exercise, especially manic dancing!

Yes, the margin of error allows that there may have been no change. Even if there was twice the change it is not yet at a dangerous level so they will probably arrange another CT in a year or two, to get a clearer idea of whether it is progressing. In the mean time it is vital to keep your blood pressure on the low side of normal, by regular medication (in addition to the metoprolol) if required.

If properly treated you can stay healthy for decades.