Cochin Cardiac Club

Health Blog by Dr.Uday Nair

CHRONIC OBSTRUCTIVE PULMONARY DISEASE-COPD



Chronic Obstructive Pulmonary Disease, or COPD, refers to a group of diseases that cause airflow blockage and breathing-related problems. It includes emphysema, chronic bronchitis, and in some cases asthma.COPD is a leading cause of death and illness worldwide.


What causes COPD?




COPD can be caused by many factors, although the most common cause is cigarette smoke. Genetics and environmental factors may cause COPD. For example, heavy exposure to certain dust at work, chemicals, and indoor or outdoor air pollution can contribute to COPD. Most COPD is caused by long-term smoking and can be prevented by not smoking or quitting soon after you start. This damage to your lungs can't be reversed, so treatment focuses on controlling symptoms and minimizing further damage.

What Are the Signs and Symptoms of COPD?



The signs and symptoms of COPD include:
  • An ongoing cough or a cough that produces large amounts of mucus (often called "smoker's cough")
  • Shortness of breath, especially with physical activity
  • Wheezing (a whistling or squeaky sound when you breathe)
  • Chest tightness
These symptoms often occur years before the flow of air into and out of the lungs declines. However, not everyone who has these symptoms has COPD. Likewise, not everyone who has COPD has these symptoms.
Some of the symptoms of COPD are similar to the symptoms of other diseases and conditions. Your doctor can find out whether you have COPD.
If you have COPD, you may have colds or the flu (influenza) frequently. If your COPD is severe, you may have swelling in your ankles, feet, or legs; a bluish color on your lips due to a low blood oxygen level; and shortness of breath.
COPD symptoms usually slowly worsen over time. At first, if symptoms are mild, you may not notice them, or you may adjust your lifestyle to make breathing easier. For example, you may take the elevator instead of the stairs.
Over time, symptoms may become severe enough to see a doctor. For example, you may get short of breath during physical exertion.
How severe your symptoms are depends on how much lung damage you have. If you keep smoking, the damage will occur faster than if you stop smoking. In severe COPD, you may have other symptoms, such as weight loss and lower muscle endurance.
Some severe symptoms may require treatment in a hospital. You—with the help of family members or friends, if you're unable—should seek emergency care if:
  • You're having a hard time catching your breath or talking.
  • Your lips or fingernails turn blue or gray. (This is a sign of a low oxygen level in your blood.)
  • You're not mentally alert.
  • Your heartbeat is very fast.
  • The recommended treatment for symptoms that are getting worse isn't working.
Diagnosis of COPD


To make an accurate diagnosis of COPD, your doctor should spend time with you discussing your medical history and perform a physical examination. Chest X-rays, spirometry, CT scans or blood work may also help in diagnosing your condition.
Treatment and Management of COPD


There's no cure for COPD. But proper medications and lifestyle changes can control symptoms and reduce the progression of damage to the lungs.
If you smoke, stop. It is the only way to prevent COPD from getting worse. Quitting isn’t easy, so talk to your doctor about medications that might help.
Medications are used to treat symptoms of COPD. These include:
•    Bronchodilators that relax the muscles around the airways
•    Inhaled corticosteroids can be helpful for people with moderate to severe COPD
•    Antibiotics are prescribed during symptom flare-ups because infections can make COPD worse
People with COPD are susceptible to getting lung infections, so get flu and pneumonia shots every year.
Avoid things that can irritate your lungs, such as smoke, pollution, and air that is cold and dry.

There are many things you can do at home to stay as healthy as you can.
  • Avoid things that can irritate your lungs, such as smoke, pollution, and air that is cold and dry.
  • Use an air conditioner or air filter in your home.
  • Take rest breaks during the day.
  • Get regular exercise to stay as strong as you can.
  • Eat well so you can keep up your strength. If you are losing weight, ask your doctor or dietitian about ways to make it easier to get the calories you need.

Complications of COPD



  • Irregular heartbeat (arrhythmia)
  • Need for breathing machine and oxygen therapy
  • Right-sided heart failure or cor pulmonale (heart swelling and heart failure due to chronic lung disease)
  • Pneumonia
  • Pneumothorax
  • Severe weight loss and malnutrition
  • Thinning of the bones (osteoporosis)

Prevention



Not smoking prevents most COPD. Ask your doctor or health care provider about quit-smoking programs. Medicines are also available to help kick the smoking habit. The medicines are most effective if you are motivated to quit.

 

CHOCOLATES AND ITS HEALTH BENEFITS.



Since centuries, chocolate has been extremely appreciated by individuals of all ages because of its unique taste. Several experts have observed that chocolates are harmful and excessive consumption frequently leads to tooth decay. A number of medical professionals have affirmed that chocolates have sugar substances and therefore enhance the level of calories in the body and augment the sugar concentration in the blood. But, it has been in recent times established that chocolates are beneficial for the health since they have numerous advantages.

Let's start off with some of the health-giving attributes of chocolate:


  • It's rich in certain essential minerals, and it's packed with bioflavonoids, especially flavonols.
  • Chocolate is thought to improve blood flow and elasticity in blood vessels; lower blood pressure; improve overall heart health; and reduce the risk of death from cardiovascular disease.
  • It can decrease LDL (bad) cholesterol as well as the body's inflammatory immune responses.
  • Chocolate is thought to improve insulin resistance and sensitivity.
  • It can increase alertness, lessen pain and promote a general feeling of well-being.
  • Chocolate may reduce the risk of cancer.


Chocolate is also a good source of magnesium, copper, and iron; with lesser amounts of calcium, zinc, Vitamin A, niacin, and phosphorus.
  • Magnesium is critical to a large number of body functions, including the formation and maintenance of strong bones, muscle and nerve function, and regular bowel function.Magnesium helps ease menstrual cramps. So that gives you a good reason to have chocolate before and during your periods.
  • Iron is an important part of hemoglobin and thus is essential to oxygen transport in the body. Iron also assists short-term storage of oxygen in muscle tissue, including the muscle tissues in the heart.
  • Copper is an important antioxidant and is critical to the body's detoxification mechanism. It's also important to the formation of red blood cells.


Chocolate also has a more direct stress-reducing effect. It contains a compound called anandamide—also known as the "bliss chemical"—that binds to certain receptors in the brain to promote relaxation.
Another mood-altering compound found in chocolate is phenylethylamine, a chemical supposedly released by the brain.Phenylethylamine in chocolate is too rapidly metabolized by the body to have the purported effect.


If that weren’t enough, chocolate also boosts brain levels of serotonin. Women typically have lower serotonin levels during PMS and menstruation, which may be one reason women typically experience stronger cravings for chocolate at these times in their cycles. People suffering from depression so characteristically have lower serotonin levels that an entire class of anti-depressive medications called serotonin uptake inhibitors (including Prozac, Paxil, and Zooloft) have been developed that raise brain levels of serotonin.


In the end the health benefits of chocolate are many...I'm talking about chocolate in its purest form - as close to the bean as you can get.The key is to find a bar with high cocoa content. The higher the cocoa content, the less room there is for cocoa butter, sugar, lecithin, vanilla, milk, and other stuff that makes chocolate less of a vegetable and more of a candy.It would be wiser to choose dark chocolate over milk or white as “sweetened, concentrated milk could cause health problems like diabetes and obesity if consumed daily,


Most notably, chocolate is a champion antioxidant. Antioxidants help rid the body of free radicals, nasty little molecules running amok in your body which cause aging and disease. Antioxidants bond to free radicals and whisk them from your body via digestion and other means.


Below is the nutritional information for leading 4 chocolates in India:

Kitkat
: 486 calories, 6.5 gm protein, 60 gm carbohydrates, 24.5 gm fat, 23.5 gm saturated fat, 0.5 unsaturated fatty acids, 0.5 gm trans fatty acids, 192 mg calcium
Ingredients: sugar, partially hydrogenated vegetable oils, milk solids, wheat flour, cocoa solids
Mars: 455 calories, 4.3 gm protein, 68.5 gm carbohydrates (sugar 62 gm), 18 gm fat (saturated fat 8 gm), 1 gm fiber
Ingredients: sugar, glucose syrup, whole milk powder, cocoa butter, vegetable fat (palm oil), cocoa mass, skim milk powder, whey powder
Snickers: 506 calories, 9.5 gm protein, 55.4 gm carbohydrates, 27.4 gm fat
Ingredients: Sugar, peanuts, glucose syrup, skim milk powder, vegetable fat, cocoa butter, cocoa mass, whey powder
Cadbury Dairy Milk: 529.7 calories, 10.2 gm protein, 59.7 gm carbohydrates (sugar 56.5 gm), 29 gm fat
Ingredients: sugar, cocoa butter, milk solids, cocoa solids
Cadbury 5 Star:  440.6 calories: 3.9 gm protein, 72.3 gm carbohydrates (sugar 52.3 gm), 16 gm fat
Ingredients: Liquid glucose, sugar, hydrogenated vegetable fats, milk solids, cocoa solids,
Munch: 480 calories: 5.9 gm protein, 64.6 gm carbs (sugar 27.5 gms), 21.5 gm, trans fatty acids: 0.1 gm, calcium 106 mg
Ingredients: sugar, wheat flour, partially hydrogenated vegetable oils, milk solids, cocoa solids
Twix: 492 calories: 4.8 gm protein, 64.0 carbs, 24.1 gms fat
Ingredients: sugar, glucose syrup, wheat flour, vegetable fat, skim milk powder, cocoa butter
Gems: 390 calories: 4.8 gm protein, 64.4 gm carbs (60.1 gm sugar), 13.4 gm fat
Ingedients: Sugar, milk solids, hydrogenated vegetable fat, cocoa solids
Note: All weights and nutritional analysis is per 100 gms of each product.


Eat Chocolate in Moderation


Of course, as with all things, eating too much isn’t good. Just because something has health benefits, doesn’t mean you should eat it all day long. Eat your chocolate in moderation. Savor your chocolate and eat .


IMPORTANT BLOOD TESTS FOR HEART


Tests to Detect Heart Attacks

Patients presenting to the emergency department with chest discomfort will have an initial assessment for a possible heart attack (myocardial infarction). Electrocardiograms (ECGs or EKGs) are used in the evaluation of patients with chest discomfort but can be normal or not diagnostic in patients with a myocardial infarction. Thus, blood will be obtained to check for any heart damage that can be indicated by abnormal protein levels in the blood. The specific proteins that are the subjects of these blood tests include:
  • Creatine kinase (CK)
  • Creatine kinase-MB (CKMB)
  • Myoglobin
  • Cardiac troponin I or cardiac troponin T

What is CK and CKMB?
Creatine kinase (CK) is an enzyme—a protein that helps cells perform their normal functions—found in the heart, brain, muscle and blood of healthy people. Blood levels of CK rise when your muscle or heart cells are injured. CKMB is a form of the enzyme that is found mainly in heart muscle. While a high level of total CK can indicate damage to muscle, a high CKMB level suggests that there is disease or damage to the heart muscle specifically.
CKMB levels begin to rise within the first 4 to 6 hours after heart attack symptoms begin and reach their highest level after about 18 to 24 hours. Levels return to normal in about 2 or 3 days.
What is myoglobin?
Myoglobin is a protein found in heart muscle and other muscles in the body. When the muscle is injured, myoglobin is released into the blood. Myoglobin levels rise about one to four hours after heart attack symptoms begin and reach their highest level eight to 12 hours later. Because myoglobin is released into the blood more rapidly than CKMB or troponin, it is useful for diagnosing a heart attack in the very early stages. Myoglobin levels fall off after about 24 hours.
What are troponins?
Troponins are proteins found in skeletal and heart muscle fibers that help muscles to contract. Cardiac troponin tests measure levels of troponin T and troponin I because these are found only in heart muscle. When a person has a heart attack, troponin is released into the blood three to six hours later. The cardiac troponin test is better for diagnosing a heart attack than the CK, CKMB, or myoglobin tests because troponins are not found in the blood of healthy people. Damage to other muscles does not affect levels of the cardiac troponins. Troponin levels rise three to six hours after heart attack symptoms begin and stay high for up to one to two weeks after a heart attack.
Tests for Heart Failure




Heart failure is an inability of the heart to pump a sufficient amount of blood to the body. The most common cause is a weakened heart muscle (usually caused by repeated heart attacks). The diagnosis of heart failure is made on the basis of the patient’s presentation and confirmatory tests.
New blood tests also assist physicians in the diagnosis of heart failure. These tests measure substances called natriuretic peptides, which are produced in increased amounts by the heart in response to congestive heart failure. These natriuretic peptides assist in the body’s response to heart failure by lowering the pressure in the lungs and increasing the flow of urine. Tests for 2 kinds of natriuretic peptides are currently available for the diagnosis of heart failure: BNP (B-type natriuretic peptide) and pro-BNP (N-terminal pro–B-type natriuretic peptide).

What is BNP?
B-type natriuretic peptides (BNP) or N-terminal proBNP (NT-BNP) are proteins that are released into the bloodstream when the heart does not work properly. They are relatively new markers that are used for diagnosing or ruling out heart failure.Your BNP level can help in the diagnosis and evaluation of heart failure and other heart conditions. Normal levels vary according to age and gender. One of the most important uses of BNP is to try to sort out whether shortness of breath is due to heart failure. For people who have heart failure, establishing a baseline BNP can be helpful and future tests can be used to help gauge how well your treatment works.
Detection of Future Cardiac Risk



Approximately one-third of patients who present with heart attacks have normal cholesterol levels. Clearly, in such patients, other factors are responsible.
Attention has been focused on a blood test that measures the level of C-reactive protein (CRP). CRP is a marker for inflammation, and atherosclerosis has an inflammatory component. Patients with elevated levels of CRP have an increased risk for heart attack, stroke, sudden death, and vascular disease. Physicians are beginning to add the measurement of blood CRP levels to other measures of risk to recommend potential options to reduce risk.
What is CRP?
C-reactive protein (CRP) is a substance that is released into the blood in response to inflammation, the process by which the body responds to injury. Elevated levels of CRP in the blood mean that there is inflammation somewhere in the body, but other tests are needed to determine the cause and location of the inflammation.
Physicians now believe that atherosclerosis, or hardening of the arteries, is an inflammatory process. Atherosclerosis causes only a small amount of CRP to be released into the blood. Therefore, a very sensitive test called a high-sensitivity CRP test (hs-CRP) is used to measure CRP levels.
The level of CRP has been shown to correlate with future risk as follows:
  • CRP level less than 1: lowest risk
  • CRP levels of 1 to 3: intermediate risk
  • CRP greater than 3: highest risk

What is homocysteine?


Homocysteine is a chemical found in the blood that is produced when the amino acid methionine (a building block for proteins) is broken down. High levels are linked to an increased risk of heart disease.Your doctor may check your homocysteine level if you've had cardiovascular problems but don't have any of the traditional risk factors, such as smoking. Your doctor may also suggest screening if any family members developed heart problems at a young age or have high homocysteine levels. A normal homocysteine level is between 4.4 and 10.8 micromoles per liter (┬Ámol/L).


SILENT HEART ATTACK

Silent heart attack is described as the death of heart muscle due to complete blockage of blood supply to the heart muscle which does not produce any symptoms.Since there is damage to the nerve supply to the coronary arteries which supplies blood to the heart the patient may not be get chest pain with even in severe heart attacks.

It may sound unbelievable, but most people who have silent heart attacks are not able to recognize it and carry on with their lives as normal. This is a main reason, why silent heart attacks are more dangerous than conventionally painful ones. Studies have revealed that, those who have had a history of silent heart attacks are at 10 times higher risk of death. The reason being, that heart attack remains in the undetected state and can cause irreparable damage to the heart and the overall health.

Symptoms of Silent Heart Attacks



The best way to identify this disease is through careful study of medical history, ECG (electrocardiogram; measures heart activity) and testing blood for cardiac enzymes. The most important treatment in silent heart attack is restoring the blood flow to the heart.
Restoring blood flow can be accomplished by dissolving clots found in the artery (thrombolysis) or by pushing the artery open using a balloon (angioplasty). Both thrombolysis and angioplasty may be used at the same time.
It is reported that as much as 25 percent of those having a heart attack and being diabetic never felt any of the common warning signs such as crushing chest pressure, weakness, arm pain or others.
Silent heart attacks and heart attacks in general can damage to nerves that affect the heart (autonomic neuropathy, or AN) could be the culprit.

Symptoms of a silent heart attack can include discomfort in your chest, arms or jaw that seem to go away after resting, shortness of breath and tiring easily. The most common complaint of visitors to the emergency room is Chest Pain which is by far the most symptom you're having a heart attack. Although Chest Pain takes 1st place as an indicator, second place would be given to extreme shortness of breath! Oddly enough, many heart attack victims reported a feeling of overwhelming doom just before an attack.

The best way to identify a silent heart attack is through careful study of medical history, ECG (electrocardiogram; measures heart activity) and testing blood for cardiac enzymes. The most important treatment in silent heart attack is restoring the blood flow to the heart.
Restoring blood flow can be accomplished by dissolving clots found in the artery (thrombolysis) or by pushing the artery open using a balloon (angioplasty). Both thrombolysis and angioplasty may be used at the same time.


Recognize the Danger




Either silent or otherwise, the most common factors that can bring on heart attacks are:

  • Diabetes
  • Smoking
  • No exercise
  • High blood pressure
  • High cholesterol
  • Family history of heart attacks
  • Obesity
Silent heart attacks come without any warning, so it is best to be alert and be medically examined in such high risk cases.


Reduce the Possibility



Though the symptoms may be mild, they can be easily detected, by a family history check of the patient. You need to access the risk factors and speak to your doctor about the possibilities of you having a heart attack. The doctor may suggest certain tests such as blood pressure, cholesterol test, echo stress test, blood sugar level test. There are various self-help measures, you need to take to reduce the risk of heart attack, silent or otherwise.
  • If you are above 35 years, it's advisable to go for heart check-up regularly
  • If you are obese, losing weight would help improvise your cardiovascular health
  • Walk briskly for 15-20 minutes everyday
  • Cut down on your intake of saturated fat like meat, cheese and butter
  • Lower your salt intake
By making a few changes in your lifestyle, you can actually minimize the possibility of a heart attack.Please also read articles Heart Attack,Unstable Angina and Emergency Chest Pain.


Please Note-




To prevent oneself from silent heart attack, one should avoid consumption of fat foods, stop smoking and should do regular exercise or yoga. It is necessary for those above 35 to go for an ECG, stress test, lipid profile, sugar tests at least once in two years