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Keep breathing

February 4th, 2015


Keep breathing

There will always come a day when you have to take a deep breath before doing something. For example, one of my patients who had suffered from high blood pressure came to see me when she was (much) overweight. Yet, she had that confident smile. I opened her file and saw that her weight was 86.5kg (and her height was 162cm). I was about to give her a cordial advice, but I took a deep breath and looked at her record. A month ago, her weight was 91kg.

So apparently she had lost quite a lot of weight (so in a way it was lucky I had not said anything about her current weight). Her blood pressure also improved.

“It was so difficult! I was afraid that you would be harsh on me, so I tried my best to lose weight. I had to note down everything I ate so I realised that I actually ate way too much. Now I am more careful about what I eat and I exercise. It feels great! I even get cranky on days that I don’t exercise,” the patient said.

See? Sometimes it’s good to just take a deep breath and do it, even if you feel it’s hard.

Another patient of mine aged 64 had diabetes, high blood pressure and weight problem. She had never had pain in her chest or felt tired. The result of her treadmill test indicated that she had mild ischaemia heart disease, so I suggested taking an X-ray and Doppler ultrasound test. She said she would think about it first, because she felt strong and had no problem playing golf. A few days later, though, she helped her family move furniture and felt a sharp pain in her chest and became dizzy. Her family rushed her to the hospital.

Things like this can happen to a lot of people. The symptoms of heart disease only show when lifting heavy weights (in this case, lifting/moving heavy furniture) or doing something strenuous. In colder countries it could happen when shovelling snow in brutally cold weather. Cardiologists have to warn those with heart disease or at risk of heart disease to be careful when using a lot of strength, such as when lifting suitcase off the carousel at the airport.

Why does it happen? This is when you hold your breath, which is not good for your heart. When you lift heavy things, cough or strain your bowel movement, your breath is obstructed. Notice when you cough, you are not breathing normally, but breath is released through your cough.

What happens when you hold your breath is increased pressure in your chest and stomach, which results in higher blood pressure, and your veins have to shoulder more pressure as well. Consequently, less blood goes back to the heart, so there is insufficient blood flow. When you resume breathing, the pressure drops suddenly, which explains dizziness.

Holding your breath could be dangerous for your heart especially if you already have heart problems. Lifting heavy weights or exercising must be done cautiously in order to avoid risks. Cardiologists always ask their patients other stuff that seems irrelevant to the heart, such as how they sleep and their bowel movements. If they are constipated, laxatives are prescribed in order to avoid breath-holding while straining.

Apart from that, exercise must be done correctly, with stretching before exercise, light weight lifting and rhythmic breathing. Those with narrowed artery always hold their breath for wrong reasons. Some could feel out of breath when walking up the stairs and they hold their breath and keep walking to the top without resting. Such breath-holding could be permanent, resulting in the patients losing their lives and no longer breathing.

I have one unfortunate (or some might say fortunate) patient felt tight in his chest after dinner, so he left the table and rested. He still didn’t feel better so he just went to bed and thought he would go to the doctor the next day when he woke up. Unfortunately, he didn’t. For symptoms like this, it’s best to just take a deep breath and see your doctor!

Prof Nithi Mahanonda is consultant cardiologist and interventionist, Perfect Heart Institute.



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