England boss Gareth Southgate admits there is a line his players cannot cross following Jack Grealish’s treble celebrations. The manager stopped short of criticising the forward after his partying grabbed the headlines. Grealish joined his Manchester City team-mates for a night in Ibiza – following Saturday’s 1-0 Champions League win over Inter Milan which sealed the treble – before they returned on Monday ahead of their trophy parade. The 27-year-old, Phil Foden, Kalvin Phillips, John Stones and Kyle Walker linked up with the England squad on Tuesday ahead of Friday’s Euro 2024 qualifier in Malta. They will not start and Southgate insisted any celebrations should not go over the top. He said: “There is a line but in our head we weren’t thinking of including the City players for this game. “I have spoken with the players. We have talked about where the focus needs to be, where we need them to be and acknowledged what they have experienced and that’s for me to manage. “A few of our players would be teetotal. What is different is that everyone posts everything. I wouldn’t have liked a few of my nights out to be posted publicly. My generation would have a lot more problems. “We know, talking to Hendo (Jordan Henderson), Harry Kane, Tripps (Kieran Trippier) what that game takes out of you. “It’s a huge occasion and we needed to give those guys the time to take everything in but, point number one, they all wanted to come in to be with the group, which is fantastic. “I don’t think they would have felt anything unusual about how we have dealt with this and how we have embraced the players back in to the group. “We have also got the dynamic that while they are chuffed to bits and we are proud of them, a few others are pretty p****d off that they have won it at their expense. You are always really conscious of that.” England’s last trip to Malta – a World Cup qualifier in 2017 – ended with a 4-0 victory but only after three goals in the final five minutes from Kane, Ryan Bertrand and Danny Welbeck. It saw fans turn on the team, who were drawing 0-0 at half time, and Southgate remembers the atmosphere, with the squad abused on the coach driving to the stadium, during and after the game. “Myself and Steve (Holland) were talking about it as we landed because it wasn’t a pleasant journey to the stadium and it was less pleasant going home,” he said. “I’m not sure everyone knew we had won 4-0, because they were in the bar at 1-0, some at 0-0. “For us it was a good reference to how far the relationship with the fans has come. The performances of the team are going to ebb and flow, the connection with the fans feels completely different now. “It doesn’t matter what we have done in the last few years, last few games, we have to go again tomorrow night and make sure that we give our fans something to be excited about.” Meanwhile, Kieran Trippier believes the squad needs to embrace their final games of the season. England, top of Group C, also host North Macedonia at Old Trafford on Monday aiming to solidify their lead following March’s wins over Ukraine and Italy. It will cap a season which also saw the first winter World Cup in November and December with the Premier League having finished three weeks ago. “It’s difficult. It has been a tough season for myself and obviously the lads in Europe as well,” said Newcastle defender Trippier. We know at the end of the day we are coming away with England and they are two massive games. We want to be going to Germany next year. Kieran Trippier “We know at the end of the day we are coming away with England and they are two massive games. We want to be going to Germany next year. “We know the challenges but for me it is easy to flip the switch and get back into that mode again. “It’s been a good week of training. Everyone is buzzing to be back together and hopefully we can get the result. “You have to be professional in terms of not doing too much and overloading. It’s about ticking over and just getting yourself in the best possible shape to be with England.” Read More Charity boss speaks out over ‘traumatic’ encounter with royal aide Ukraine war’s heaviest fight rages in east - follow live England Under-21s defender Jarrad Branthwaite was close to giving up on football Rickie Fowler and Xander Schauffele set record-breaking pace at US Open Joselu fires Spain to Nations League final with late winner against Italy

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It’s believed around three million Brits have an abnormal heart rhythm or arrythmia – and many may not even realise it. The most common arrhythmia is atrial fibrillation (AF), which causes an irregular and often unusually fast heartbeat, and is associated with a five-times higher risk of having a potentially fatal or life-changing stroke. If diagnosed, AF can be treated – however, it’s estimated there are at least 270,000 people in the UK who are unaware they have the condition, according to the British Heart Foundation (BHF). “What remains troubling is the sheer number of people who are undiagnosed and unaware that they are living with a heightened risk of stroke,” says BHF medical director, Professor Sir Nilesh Samani. “Finding people with this hidden threat must remain a priority.” Trudie Lobban, founder of the Arrhythmia Alliance – a coalition of patients, healthcare professionals and policymakers, adds: “Heart rhythm disorders are a leading cause of sudden cardiac death and devastating strokes, and yet too few people are aware of the rhythm of their heart.” To mark World Heart Rhythm Week (5-11 June), experts are highlighting the importance of being aware of arrhythmia warning signs and getting things checked out. Here’s what you need to know… Arrhythmias can affect all age groupsHowever, AF is most common in older age groups. As Dr Anthony Chow, a consultant cardiologist at The Wellington Hospital, part of HCA Healthcare UK, explains: “Heart rhythm problems are a very common condition that can affect all age groups, but AF is more common in older people. It can be as common as 10% of the population in their 70s, and almost 29% of those in their 80s.” Arrhythmias can have many causes Lobban says many conditions can cause heart rhythm problems, including heart failure, blackouts, electrolyte disturbances, thyroid disorders, infections, heart attacks, strokes, cardiomyopathy, high blood pressure, sleep apnoea and obesity. Triggers can also include stress, caffeine, tobacco, alcohol, diet pills, and cough or cold medicines. “But there is usually an underlying physical reason for it,” Lobban adds. Warning signs to look out for Key warning signs, says Chow, are palpations (a thumping or fluttering sensation in your heart/chest), dizzy spells and feeling faint, breathlessness, chest discomfort, and feeling overly tired. These things don’t automatically mean you have a heart problem, but it’s important to get any symptoms checked out. And Chow adds: “Not everyone experiences these exact symptoms and, in some cases, patients can experience no symptoms at all.” How to measure your heart rhythmThere are many ways heart rhythms can be measured clinically, through ECGs or monitors. You can check your pulse yourself at home, too. “The easiest way to detect an arrhythmia is to feel your pulse and hence your heart rhythm – is it irregular, too fast, or too slow?” says Lobban. “Such a simple thing as a 30-second pulse rhythm check can literally save your life.” The Heart Rhythm Alliance has a ‘know your pulse’ guide on their website. Lobban says you should sit down for five minutes beforehand, and remember that any stimulants you’ve taken, like caffeine or nicotine, will affect the rate. You’ll need a watch that measures seconds (take it off to do the test), or your phone timer could work. Hold your left or right hand out with your palm facing up and elbow slightly bent. With your other hand, place your index and middle fingers on your wrist near the base of your thumb, between the bone and stringy thumb tendon, to find your pulse. Once you’ve found your pulse, maintain a firm pressure and count the beats for 30 seconds, then multiply by two to get your heart rate in beats per minute. If your heart rhythm is irregular, you should count for one minute and don’t multiply. Arrhythmia can cause many serious health problemsHeart arrhythmia can cause a variety of serious heart health complications including strokes, heart failure and heart attacks, explains Chow. “Heart arrhythmias, in particular AF, are often associated with an increased risk of blood clots, so it’s extremely important to be aware of the warning signs,” he says. “If a blood clot breaks loose, it can travel directly from the heart to the brain, which can cause a stroke. You should consult your doctor and get referred to a cardiac rhythm specialist for assessment if you have significant symptoms.” When to see a doctor If you have any previous history of heart problems and/or are becoming increasingly concerned about palpations, you should speak to a medical expert, Chow advises. Those with a family history of arrythmia and/or sudden cardiac death should also make sure they get checked out. “It’s not usual that we’re aware of our heart beating, unless there’s a disturbed rhythm,” he says. “You should speak to your doctor if your heart palpations are lasting a long time, or aren’t improving and seem to be getting worse. Acute instances of symptoms could be a warning sign of something more serious, so it’s important to seek medical advice if you’re concerned. In some cases, arrhythmia could be an indication of a medical emergency such as a heart attack.” Treatment for arrhythmiaArrhythmias can be treated in a variety of ways. “Some require no more than reassurance after diagnosis, but others may need drug therapy, or implantation of an electrical device such as a pacemaker or ICD,” says Lobban. Chow says therapies such as cardioversion can be used to reset the heart rhythm by sending a shock through the chest to the heart, and there are also procedures and surgeries including catheter ablation, where wires are threaded through blood vessels directly to the heart and heat is used to create tiny scars in the heart to block abnormal electrical signs and restore a normal heartbeat. Chow adds: “Most people with abnormal heart rhythms can lead a normal life when the condition has been properly diagnosed and managed.”

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