A Question of Health

Can a heart attack go unnoticed? And is it possible to be addicted to lip balm?
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Heart of the matter

Heart of the matter

Q. My husband recently saw a doctor after many years and was sent for a routine ECG and blood tests, as his blood pressure was high. The doctor said the results showed he had had a heart attack, of which he was completely unaware. Since then he has seen another doctor, on an unrelated matter, who says it is not possible to detect previous heart attacks. Who is right?

A. A heart attack occurs when the blood supply to the heart muscle is cut off. Without blood, and the oxygen that it carries, the heart muscle cells cannot survive. A heart attack is said to have taken place if a portion of the heart muscle dies. An electrocardiogram (ECG) is a relatively simple test that detects the electrical activity of the heart. If the heart muscle is performing normally, the ECG looks fine. But if some of the heart muscle is either dead or dying, this is reflected in the ECG tracing. So your husband's doctor is right - it is possible to detect previous heart attacks by looking at an ECG, even many years after the event. "Silent" heart attacks, without any chest pain, are more common than most people believe. One study in America found evidence of small silent heart attacks in 13 per cent of people who had cardiac risk factors but no history of a heart attack. Most of these "heart attacks" were not detectable by looking at an ECG, and required sophisticated MRI scans to see the damage.

Am I going balmy?

Q. Is it possible to become addicted to lip balms, such as Lipsyl and Chapstick? I am using them all the time, and when I try to stop I find it impossible. Is there something in these tubes that is genuinely addictive, or is it just a habit?

A. Lip balms are big business, and that must mean they are popular. They are used more by women than men, and some people say they can't live without them. Often the underlying problem is lip-licking. If you lick your lips to wet them, the saliva quickly evaporates and makes them feel dry. This leads to a vicious cycle of licking and drying. Lip balms break this cycle, by making the lips feel moist longer. But the cycle continues. Once you start using lip balms, the licking is replaced by applying the lip balm. Sufferers from lip balm addiction now have their own organisation, known as Lip Balm Anonymous. Log onto www.kevdo.com/lipbalm; it makes fascinating reading.

Stinging reaction

Q. I woke up this morning with my right eye completely swollen and closed. Through the night it felt like I was covered with ants, and the itching was terrible. Now my ears are sticking out perpendicular to my head as they are very swollen, and I have lumps at the back of my neck and shoulders. I know this is all caused by urticaria. Previous attacks have left me with both eyes shut, and with swelling on my face, shoulders, torso and outer thighs. It also leaves me very tired. The swellings can sometimes last for three or four days. I have been to a dermatologist who diagnosed urticaria and he said that apparently I was one of the 50 per cent of sufferers who will never find out what triggers it. The urticaria began when I was in my mid-40s. Sometimes the attacks will occur one after the other, and sometimes, like now, with big intervals that lead me to believe that the disease has disappeared as mysteriously as it started. As it is very debilitating, and stops me from working, I am desperate to know what is causing this.

A. Urticaria is the name for a skin reaction that consists of red itchy swellings. If you've ever been stung by nettles, you will know what urticaria is. If the swelling goes deep into the tissues around the eyes, throat and elsewhere, it is known as angioedema. Some people who get urticaria know what causes it - eating strawberries or being stung by a wasp are two common examples. This type of urticaria is caused by an acute allergic reaction and can usually be either avoided or treated with antihistamines. Another sort of urticaria, known as physical urticaria, is provoked by a variety of physical stimulants. Some people develop urticaria from simple pressure on the skin, even from a tight-fitting belt or a shoulder bag. Other physical stimulants include sunlight, cold and immersion in water.

The most difficult urticarias are the ones like yours where there is no easily identifiable cause. Sometimes by keeping a diary of everything you eat you can identify what causes the urticaria. It can be a food, or an additive, such as tartrazine (E102) and the benzoates (E210 - E213). Other things to think about are perfumes and cosmetics. Very occasionally, urticaria is the first manifestation of an underlying immune disorder, such as SLE (systemic lupus erythematosus).

Have your say: readers write

Simon from Liverpool and JC from Norwich contribute to last week's discussion about acne.

Simon writes:

I have suffered for years with acne and the best relief I've found is Weleda Aknedoron, a lotion available from health shops. I've also had some success by using Manuka honey at night on the afflicted areas.

JC says:

From 15 I suffered from severe acne vulgaris on my face, back, chest and arms. I took three 16-week courses of Roaccutane over four years and after every treatment the acne returned within six months. What did help was a change of diet - cutting out wheat and dairy and increasing my intake of green vegetables.

Send your questions and suggestions to A Question of Health, 'The Independent', 191 Marsh Wall, London E14 9RS; fax 020-7005 2182; or e-mail health@independent.co.uk