The death of Sir Roger Moore aged 89 has saddened many men of a certain generation who believed that he was the definitive James Bond and who lived out their Walter Mitty moments via his screen escapades.
Although the nature of the cancer that killed him is not public knowledge, most people are unaware that he could have died decades ago due to medical problems. Even as a small boy he did remarkably well to survive pneumonia in the pre-antibiotic age (his parents were told he would not survive the night). In 1993 he was diagnosed with prostate cancer, but had surgery to remove it and appeared to make a full recovery.
His main challenge, however, came while performing on stage on Broadway in 2003. He collapsed mid-performance and was subsequently diagnosed with an abnormally low pulse rate — a condition known as bradycardia. The following day he was fitted with a pacemaker just under his left collarbone which subsequently helped to regulate his heart and prevent further attacks from occurring.
It is virtually impossible to give accurate figures on how common bradycardia is in Britain, as for most young people bradycardia is not a sign anything is wrong. Its incidence rises with age, though, as underlying possible causes become more frequent.
For most people, symptoms do not arise unless the heart rate drops below 50 beats per minute, and absolute bradycardia is defined as being less than 40 beats per minute. Some types of bradycardia produce no symptoms, and others may cause dizziness, weakness or fainting.
If not due to fitness or youth (known as physiological bradycardia), there are a number of pathological causes as to why a bradycardia may occur, with the most common ones being:
• Sick sinus syndrome. This occurs when the heart’s natural pacemaker (called the sino-atrial node), does not work properly, causing an irregular heartbeat. Patients with sick sinus syndrome may experience bradycardia or a fast heartbeat (tachycardia), or heartbeats that swap between fast and slow. Most common in elderly people, this can also occur in children, sometimes after heart surgery.
• Heart block (atrioventricular block or AV block). This occurs when electrical impulses are slowed or blocked as they travel from the atria chambers of the heart into the ventricles of the heart. There are different types of heart block:
I. First–degree heart block occurs when the electrical impulses slow as they pass through the heart but this rarely causes any symptoms, and is often found in athletes. No treatments are generally necessary.
II. Type I second–degree heart block occurs when the electrical impulses are delayed to a greater extent with each heartbeat until a beat is skipped entirely and the cycle then repeats itself.
III. Type II second–degree heart block occurs when some of the electrical impulses from one node of the heart are unable to reach the ventricles, usually because of underlying disease.
IV. Third–degree heart block (complete heart block) occurs when no electrical impulses reach the ventricles at all. This is usually as a result of underlying disease or medications.
Unlike Moore’s collapse on stage, some people don’t have symptoms, or their symptoms are so mild that they think they are just part of getting older. If symptoms do occur due to a very slow heart rate, these include dizzy spells and feeling faint (because a slow heart rate causes a drop in blood pressure), feeling tired, short of breath and finding it harder to exercise, having chest pain or a feeling that your heart is pounding or fluttering (palpitations), and feeling confused, or having trouble concentrating. However, the symptoms of someone in heart block depend on its severity and the type of heart block present.
Moore had a long chequered history of close shaves with his health. Somehow I can’t get the image out of my head of St Peter looking at his watch by the pearly gates and saying: ‘Ah, Mr Bond. I’ve been expecting you.’