Cochin Cardiac Club

Health Blog by Dr.Uday Nair

ECTOPIC BEAT


Ectopic heartbeat is an irregularity of the heart rate and heart rhythm involving extra or skipped heartbeats.


Causes;


  •  Drinking too much caffeinated beverages.
  • Drinking alcohol.
  • Smoking cigarettes.
  • Exhaution.
  • Not getting enough sleep.
  • Abnormal electrolytes in the blood.
  • Having a hyperactive thyroid gland.
  • A condition called Mitral Valve Prolapse
  • Insufficient blood supply to heart(ischemia)
  • Rheumatic Heart disease
  • Congenital heart disease mainly Atrial Septal Defect
  • Cardiomyopathy(primary muscle disease of the heart)
  • Right Ventricular Dysplasia
  • Long QT Syndrome
  • Brugada Syndrome

Symptoms;







Symptoms include:
  • Feeling your heart beat (palpitations)
  • Feeling like your heart stopped or skipped a beat
  • Feeling of occasional, forceful beats
Note: There may be no symptoms also.


Diagnostic Tests;








A physical examination may show an occasional, irregular pulse, but if the ectopic beats do not occur frequently, your doctor may not detect them during a physical exam.


  • ECG



  • Echocardiogram



  • Holter monitor or patient-activated recording device



  • Coronary angiography




  • Treatment;



    Most ectopic heartbeats do not require treatment. The condition is treated if your symptoms are severe or if the extra beats occur very frequently.
    An underlying cause, if discovered, may also require treatment



    Prevention;







    Limiting caffeine, alcohol, and tobacco may reduce the risk and frequency of ectopic heartbeats in certain people. Exercise often helps those who are inactive.










    DO IT URSELF STEPS IN S.V.T(SUPRAVENTRICULAR TACHYCARDIA)

    Introduction;
     
     
    Supraventricular tachycardia is one type of heart rhythm disorder.
    • Tachycardias are rhythm disorders in which the heart beats faster than normal.
    • Supraventricular means "above the ventricles," in other words, originating from the atria, the upper chambers of the heart.
    • Supraventricular tachycardia, then, is a rapid heartbeat originating in the atria.
    • These are sometimes referred to as atrial tachycardias. However, the atrioventricular (AV) node may be involved directly or indirectly, so AV nodal tachycardias are also included in this category.

    Nerve impulses and the level of hormones in your blood influence the rate of heart contraction. A problem in any of these areas can cause abnormal heart rhythm (arrhythmia or dysrhythmia).
    In supraventricular tachycardia, the heart rate is sped up by an abnormal electrical impulse starting in the atria.
    • The heart beats so fast that the heart muscle cannot relax between contractions.
    • When the chambers don't relax, they cannot contract strongly or fill with enough blood to satisfy the body's needs.
    • Because of the ineffective contractions of the heart, the brain does not receive enough blood and oxygen. You can become light-headed, dizzy, or feel like fainting (syncope).
    Supraventricular tachycardia can be found in healthy young children, in adolescents, and in people with underlying heart disease. Most people who experience it live a normal life without restrictions.

    Supraventricular tachycardia often occurs in episodes with stretches of normal rhythm in between. This is usually referred to as paroxysmal supraventricular tachycardia (often abbreviated PSVT). Supraventricular tachycardia also may be chronic (ongoing, long term).

    Causes of SVT?

    Causes of SVT include pain, fear, anxiety, exercise, caffeine or alcohol consumption, nicotine, myocardial ischemia or infarction, conduction system disease, hypoxia, shock, electrolyte imbalance, thyrotoxicosis, digitalis toxicity, pulmonary or valvular heart disease, cardiomyopathy, overdose of tricyclic antidepressants, antiarrhythmic medications, and heart failure.

    Symptoms of SVT?

    Symptoms can come on suddenly and may go away without treatment. They are caused for a reason other than stress, exercise, or emotion. They can last a few minutes or as long as 1 or 2 days, sometimes continuing until treated. The rapid beating of the heart during SVT can make the heart a less-effective pump, decreasing cardiac output and blood pressure. The following symptoms are typical with a rapid pulse of 150–251 or more beats per minute:
    • Pounding heart
    • Shortness of breath
    • Chest pain
    • Rapid breathing
    • Dizziness
    • Loss of consciousness (in serious cases)
    • Numbness of various body parts

    Diagnostic Tests;

    • ECG
    • 2D ECHO
    • Stress Test
    • Cardiac Catheterization and Coronary Angiography
    • Electrophysiological Study
    • Blood Tests


    Treatment;

    There are many treatments available for SVT. Your treatment will depend on your symptoms. Your doctor will discuss your treatment options with you.
    The aim of treatment is to control your heart rhythm and rate, and reduce your risk of heart failure. You may not need any treatment at all, especially if your symptoms are mild.

    Medical treatment;

    There are several different types of medicine that can help control your heart rate and rhythm, including beta-blockers, calcium channel blockers and anti-arrhythmic medicines.
    Your doctor may prescribe a combination of any of these medicines. You may have to take them for just a short period until you have other treatments such as electrical (DC) cardioversion to restore your heart rhythm, or you may have to take them for months or years. Alternatively, you may be given medicine to take just when you get symptoms.
    If your symptoms come on suddenly, you may be given anti-arrhythmics, as tablets or through a vein to try and get your heart rhythm back to normal (this is called chemical or medical cardioversion), and is usually given within 48 hours of having symptoms

    Home Self Treatment-

    In most cases, you might attempt the following simple maneuvers, called vagal maneuvers, to assist your body in slowing your heart rate.

    Valsalva Maneuver
    
    • Valsalva:  Lying down, take in a breath and blow hard but don't let breath come out of chest.  Hold nose and close mouth if necessary and strain down hard as if to move bowels for about 5 seconds.
    • Eyeball pressure: Lying down, rub both eyes through closed eyelids firmly enough to hurt a little for about 3 seconds.

    • Cold water:  Immersing your face in cool water for 5-10 seconds.       

    • Hold your breath for a few seconds

    • Carotid sinus massage, carried out by firmly pressing the bulb at the top of one of the carotid arteries in the neck, is effective but is often not recommended due to risks of stroke in those with plaque in the carotid arteries.

    If these maneuvers do not work, lie down and relax. Take some slow, deep breaths. Often, your heart will slow by itself.

    PALPITATIONS






    Introduction;


    Heart is made up of four chambers.Two Atria and Two Venticles.

    The atria (right atrium and left atrium) are the upper chambers of the heart.
    • The right atrium receives venous blood from the body and pumps it into the right ventricle.
    • The left atrium receives oxygenated blood from the lung and pumps it to the left ventricle.
    • The ventricles are lower chambers of the heart.
    • Each heart has two ventricles (right and left ventricles).
    • The right ventricle pumps venous blood to the lung and the left ventricle pumps oxygenated blood to the rest of the body.


    What is Pacemaker of the heart or SA node?



    The SA node is the pacemaker of the heart and is located in the right atrium. The electrical signals initiated in the SA node are transmitted to the atria and the ventricles to stimulate heart muscle contractions (heartbeats). The AV node is specialized heart tissue which acts as an electrical relay station between the atria and the ventricles. Electrical signals from the SA node and the atria must pass through the AV node to reach the ventricles

     What are Palpitations?






    Heart palpitations are sensations that feel like pounding or racing. Sometimes it feels like your heart skipped or stopped beats. Palpitations can be felt in your chest, throat, or neck.







    Some persons with palpitations have no heart disease or abnormal heart rhythms and the reasons for their palpitations are unknown. In others, palpitations result from abnormal heart rhythms (arrhythmias).


  • Arrhythmias refer to heartbeats that are too slow, too rapid, irregular, or too early.



  • Rapid arrhythmias (greater than 100 beats per minute) are called tachycardias.



  • Slow arrhythmias (slower than 60 beats per minute) are called bradycardias.



  • Irregular heart rhythms are called fibrillations (as in atrial fibrillation).



  • When a single heartbeat occurs earlier than normal, it is called a premature contraction, and this can cause the sensation of a forceful heartbeat.



  • Abnormalities in the atria, the ventricles, and the electrical conducting system [the Sino-atrial (SA) node, and the Atrio-ventricular (AV) node] of the heart can lead to arrhythmias that cause palpitations




  • What are the Causes of Palpitations;



    There are many causes of heart palpitations. The most common causes are:
    • Exercise
    • Anxiety
    • Stress
    • Heart Disease
    • Caffeine
    • Nicotine
    • Cocaine
    • Diet pills
    • Hyperventilation
    • Overactive thyroid
    • Anemia
    • Low levels of oxygen in your blood
    • Medications
    • Mitral valve prolapse


    What are the Diagnostic tests for Palpitations?


    • Blood Tests,
    • Xray,
    • ECG
    • 2D Cardiac Echo
    • Stress Test
    • Holter or Event Moniter Test

    What is a Holter or Event Monitor?




    A standard ECG only records the heartbeat for a few seconds. It won't detect heart rhythm problems that don't happen during the test. To diagnose problems that come and go, your doctor may have you wear a Holter or event monitor.
    A Holter monitor records the electrical activity of your heart for a full 24- or 48-hour period. You wear small patches called electrodes on your chest. Wires connect the patches to a small, portable recorder. The recorder can be clipped to a belt, kept in a pocket, or hung around your neck.
    During the 24- or 48-hour period, you do your usual daily activities. You keep a notebook and note any symptoms you have and the time they occur. You then return both the recorder and the notebook to your doctor to read the results. Your doctor can see how your heart was beating at the time you had symptoms.
    An event monitor is similar to a Holter monitor. You wear an event monitor while doing your normal activities. However, an event monitor only records your heart's electrical activity at certain times while you're wearing it.
    For many event monitors, you push a button to start the monitor when you feel symptoms. Other event monitors start automatically when they sense abnormal heart rhythms.
    Event monitors can be worn for 1 to 2 months, or as long as it takes to record your heart's activity during palpitations.

     

    Medical Treatment for Palpitations








    In most people, palpitations do not indicate underlying heart disease, and treatment other than reassurance or lifestyle changes is not needed. In some cases, your doctor may discover that your palpitations are due to an arrhythmia (irregular heartbeat) that warrants medical treatment.

    The basic treatment for the management of most important arrhythmias are medications called "antiarrhythmics." These agents are generally classified according to their mechanism of action. There are four classes of these medications:

    Class I antiarrhythmic drugs, known as "sodium channel blockers."

    These medications have long been used to control arrhythmias. They work by blocking "sodium channels" (the transport of sodium across the cell walls) in order to slow impulse conduction in the heart
    Eg-

    • Lidocaine
    • Flecainide

    Class II antiarrhythmic drugs, known as "beta-blockers."

    These medications slow the heart rate and force of contraction by decreasing the sensitivity of cells to adrenaline and adrenaline-like substances that act at beta receptors. Beta-blockers have long been used to control supraventricular tachycardias (SVTs), and recent evidence suggests they may be helpful in suppressing ventricular tachycardia and ventricular fibrillation

    Eg-
    • Atenolol
    • Metoprolol



    Class III antiarrhythmic drugs, known as "potassium channel blockers.

    They work, in part, by prolonging the recovery time of cardiac cells after they have carried an impulse. This can prevent circuits (electrical pathways) from causing an arrhythmia or only permit slower arrhythmias

    Eg-
    • Amiodarone(It is the most widely used drug to treat atrial fibrillation)
    • Sotalol

    Class IV antiarrhythmic drugs, known as "calcium channel blockers."

    These medications slow the heart rate by blocking heart cells' calcium channels (transport of calcium across the cell walls) and slowing conduction at the AV node.
    • Verapamil

    • Diltiazem 

    In addition to these some other drugs are also used-

    Digoxin - This medication increases the strength of heart muscle contractions and is useful in the treatment of heart failure. Because digoxin also slows conduction through the AV node, it may be useful in controlling atrial fibrillation, atrial flutter, and atrial tachycardia. It often is combined with beta- or calcium-channel blockers

    Adenosine - This drug slows or blocks conduction through the AV node by acting on special adenosine receptors. Since adenosine is only available in intravenous form and only works for a short time, it is only used as acute treatment for supraventricular tachycardias


    Prevention.








    Try to reduce stress and risk factors for heart disease:
    1. Don't smoke.
    2. Eat a well-balanced, low-fat diet.
    3. Exercise regularly.
    4. Try stress management techniques such as yoga, or meditation.
    5. Make sure that your blood pressure and cholesterol are under control.





    BENEFITS OF STATINS

    What are Statins and how do they work?

                  
                                                        
    "Statins" are a class of drugs that lower the level of cholesterol in the blood by reducing the production of cholesterol by the liver. Statins block the enzyme in the liver that is responsible for making cholesterol. This enzyme is called hydroxy-methylglutaryl-coenzyme A reductase (HMG-CoA reductase). Scientifically, statins are referred to as HMG-CoA reductase inhibitors
     

     

    What are the benefits of statins?


    Most people think of statins primarily as cholesterol-lowering drugs. Statins improve blood cholesterol levels primarily by inhibiting a liver enzyme called HMG Co-A reductase, thus reducing the liver's ability to make cholesterol. Statins cause a significant reduction in LDL "bad" cholesterol levels, a moderate reduction in triglyceride levels, and a small increase in levels of HDL cholesterol ("good" cholesterol).
    In addition to lowering cholesterol, however, statins have several other effects that are helpful in patients known or likely to have CAD(Coronary Artery Disease). These beneficial effects include:
           
    • Reducing the size of plaques in the arteries.
    • Stabilizing plaques, so they are less likely to rupture (and therefore less likely to cause acute heart attacks).
    • Reducing inflammation (which is now thought to be an important component of plaque formation and rupture).
    • Reducing CRP levels
    • Decreasing blood clot formation (Blood clot formation at the site of plaque rupture is the cause of most heart attacks).
    • Improving overall vascular function
    In addition, studies have reported other possible benefits from statins, including a reduced incidence of Alzheimer's disease, particular benefits in diabetics, prevention of cataracts, and reducing blood pressure.


                                




    What conditions are statins used?


    Statins are used for preventing and treating atherosclerosis that causes chest pain, heart attacks, strokes, and intermittent claudication in individuals who have or are at risk for atherosclerosis.
    Risk factors for atherosclerosis include:
    • abnormally elevated cholesterol levels,
    • a family history of heart attacks (particularly at a young age),
    • increasing age, and
    • diabetes.
    Most individuals are placed on statins because of high levels of cholesterol. Though reduction of cholesterol is important, heart disease is complex and, as discussed previously, other factors such as inflammation may play a role. Thirty-five percent of individuals who develop heart attacks do not have high blood cholesterol levels, yet most of them have atherosclerosis. This means that high levels of cholesterol are not always necessary for atherosclerotic plaques to form.

    Because it is not clear which effect of statins is responsible for their benefits, the goal of treatment with statins should not be only the reduction of cholesterol to normal levels, but rather the prevention of the complications of atherosclerosis (angina, heart attacks, stroke, intermittent claudication, and death). This concept is important because it allows for individuals who have or are at risk for atherosclerosis, but do not have high levels of cholesterol, to be considered for treatment with statins. Statins, like angiotensin converting enzyme inhbitors (ACE inhibitors), are an important class of drugs because they have been shown to reduce the incidence of heart attacks, strokes, and death.

    What are the different types of Statins-

    Statins that are approved are:
    • atorvastatin ,
    • fluvastatin ,
    • lovastatin,
    • pravastatin,
    • rosuvastatin,
    • simvastatin,  and pitavastatin.     

       
       PLEASE NOTE:


    •  High dose statins eg,40-80mgs/day are recommended in acute coronary syndrome after coronary  interventions and especially when associated with diabetes.
    • Statins should be cautiously used when the liver enzymes are high,with fatty infiltration of liver .                                                                                                                                                                                                                                                                                                                                   

    ALCOHOL AND SMOKING-A DEADLY COMBO.



    Alcohol consumption and tobacco use have been associated with a wide variety of cardiovascular diseases, although these associations include both detrimental and (at least for moderate drinking) some potentially beneficial effects. Alcohol intake of three or more drinks per day and cigarette smoking share similar, and probably additive, adverse effects on some forms of cardiovascular disease. Examples of these adverse effects include increases in blood pressure and levels of triglycerides in the blood and higher risks of stroke and congestive heart failure. On the other hand, there is relatively little evidence that the two act synergistically or that the effects are worse when smoking and drinking occur together than would be expected from their independent effects. In most cases, more moderate drinking does not share these risks and even has effects opposite those of cigarette smoking on HDL-C and blood clotting. Nonetheless, because alcohol and tobacco are used together and in excess so commonly, their joint effects are encountered widely throughout the population. Ongoing public health efforts to minimize tobacco use and harmful drinking should result in clear and important gains to the nation's cardiovascular well-being


    SMOKING-ONLY BAD EFFECTS.



                                                               

    The effects of smoking vary from person to person as it will depend on the person's vulnerability to the chemical in cigarette or tobacco smoke. It will also depend on the number of cigarette sticks a person smokes per day, the age when the person first started to smoke, and the number of years the person has been smoking. Here are some of the different effects of smoking:
    • Heart: The effects of smoking on your heart are devastating. Nicotine raises blood pressure and makes the blood clot more easily. Carbon monoxide robs the blood of oxygen and leads to the development of cholesterol deposits on the artery walls. All of these effects add up to an increased risk of heart attack.
                                                       
                                                                          
    • Lungs: Smoking causes chronic obstructive pulmonary disease (COPD), a group of diseases that includes emphysema, chronic bronchitis and asthmatic bronchitis. COPD is called the "silent killer." Many smokers don't know they are affected until it is too late. There is no cure for these diseases and no way to reverse the damage. Ten percent to 15% of all smokers will develop COPD.

    • Blood Circulation: A major effect of smoking is that veins and arteries get narrower, harder and coated with fatty deposits. This can lead to problems such as:
      • Low fitness, cold skin, hands and feet, and ulcers.
      • Gangrene which leads to amputations.
      • Cramps, pains and blockages in your veins which can cause strokes and heart attacks.

    • Bones: Smoking can cause bones to get weak and brittle. Women need to be especially careful because they are 5 to 10% more likely to suffer from osteoporosis than non-smokers.

    • Stomach: The damage to your stomach area can affect your vital organs. You have increased chances of getting stomach cancer or ulcers. You are also at risk of developing cancers in your kidney, pancreas and bladder.

    • Mouth and Throat: Smoking causes unattractive problems like bad breath and stained teeth. It can also cause gum disease and damage to your sense of taste. The most serious damage smoking causes in this area is an increased risk of cancer in your lips, tongue, throat, voice box and oesophagus (gullet).

    • Eyes: Dangerous smoking effects on eyes include common eye diseases such as Graves' ophthalmopathy, age-related macular degeneration, glaucoma and cataract. The worst smoking effect on eyes can be permanent blindness.

    • Skin: Smoking reduces the amount of oxygen to the skin. This means that the skin ages more quickly and looks grey and dull. The toxins in your body also produce cellulite.

    • Reproduction and Fertility: The effects of smoking on reproduction and fertility are serious. Smoking can increase the risk of impotence. It can also damage sperm, reduce sperm count and cause testicular cancer.Pregnant women who smoke are more likely to suffer miscarriage and stillbirth.
    Passive smoking-

    Smoking not only harms you but also those around you. Adults who breathe in other people's smoke also have an increased risk of lung cancer and heart disease. Children who breathe in other people's smoke are more likely to develop lung diseases like asthma, bronchitis and pneumonia, and their physical growth and intellectual development can also be affected.



    ALCOHOL CONSUMPTION;



    The long term effects of alcohol range from possible health benefits for low levels of alcohol consumption to severe detrimental effects in cases of chronic alcohol abuse. High levels of alcohol consumption are correlated with an increased risk of developing alcoholism, cardiovascular disease, malabsorption, chronic pancreatitis, alcoholic liver disease, and cancer. Damage to the central nervous system and peripheral nervous system can occur from sustained alcohol consumption. Long-term use of alcohol in excessive quantities is capable of damaging nearly every organ and system in the body. The developing adolescent brain is particularly vulnerable to the toxic effects of alcohol.
    Historically doctors have promoted alcohol for its perceived health benefits and most recently for protection against coronary heart disease. There is evidence of cardiovascular benefits from drinking 1 - 2 drinks per day; however, the health benefits from moderate intake of alcohol are controversial. Concerns have been raised that, similarly to the pharmaceutical industry, the alcohol industry has been involved in exaggerating the health benefits of alcohol. Alcohol should be regarded as a recreational drug with potentially serious adverse effects on health and it is not recommended for cardio-protection in the place of safer and proven traditional methods such as a balanced diet, exercise and pharmacotherapy.
    Some experts argue that the benefits of moderate alcohol consumption may be outweighed by other increased risks, including those of injuries, violence, fetal damage, certain forms of cancer, liver disease and hypertension. As the apparent health benefits of moderate alcohol consumption are limited for populations at low risk of heart disease, other experts urge caution because of the possibility that recommending moderate alcohol consumption may lead to an increased risk of alcohol abuse, particularly among the young.The benefits of moderate alcohol consumption may be outweighed by the risks of moderate alcohol consumption.



                                                    

    Alcohol and cardiovascular disease

    Studies have found that there is a reduced risk of mortality from coronary heart disease in persons who drank 1 - 2 drinks per day.Studies in  randomized trials found that alcohol consumption in moderation decreases serum levels of fibrinogen, a protein that promotes clot formation and increases levels of tissue type plasminogen activator, an enzyme that helps dissolve clots.The serum levels of C-reactive protein (CRP), a marker of inflammation and predictor of CHD risk, are lower in people who drink moderately than those who abstain from alcohol suggesting that alcohol consumption in moderation might have anti-inflammatory effects. In addition to its psychotropic properties, alcohol has anticoagulation properties similar to warfarin. Additionally, thrombosis is lower among moderate drinkers than teetotalers.
    Despite epidemiological evidence, some criticize the idea of recommending alcohol for health benefits. But recommending moderate alcohol consumption for health benefits is "ridiculous and dangerous".There have been no randomised controlled trials to demonstrate the cardio benefits of alcohol. Due to the risks of abuse, dependence, adverse effects, alcohol should never be recommended for cardio benefits as a substitute to well-proven measures, such as a good diet, exercise or pharmaceutical drugs. It has been argued that the health benefits from alcohol are at best debatable and may have been exaggerated by the alcohol industry. Alcohol should be regarded as a recreational drug with potentially serious adverse effects on health and should not be promoted for cardio-protection.

    • Peripheral Arterial Disease

    "Moderate alcohol consumption appears to decrease the risk of PAD in apparently healthy men."In this large population-based study, moderate alcohol consumption was inversely associated with peripheral arterial disease in women but not in men. Residual confounding by smoking may have influenced the results. Among nonsmokers an inverse association was found between alcohol consumption and peripheral arterial disease in both men and women."
    •  Heart attack and stroke
    Drinking in moderation has been found to help those who have suffered a heart attack survive it. However, excessive alcohol consumption leads to an increased risk of heart failure.A review of the literature found that half a drink of alcohol offered the best level of protection. However, they noted that at present there have been no randomised trials to confirm the evidence which suggests a protective role of low doses of alcohol against heart attacks.However, moderate alcohol consumption is associated with hypertension. There is an increased risk of hypertriglyceridemiacardiomyopathyhypertension, and stroke if 3 or more standard drinks of alcohol are taken per day



    • Cardiomyopathy

    Large amount of alcohol over the long term can lead to alcoholic cardiomyopathy. Alcoholic cardiomyopathy presents in a manner clinically identical to idiopathic dilated cardiomyopathy, involving hypertrophy of the musculature of the heart that can lead to congestive heart failure.


    QUIT SMOKING AND DRINKING.


























    HIGH BLOOD PRESSURE-GET TO KNOW AND CONTROL YOUR SILENT KILLER


    WHAT IS BLOOD PRESSURE(B.P) AND HIGH BLOOD PRESSURE(HYPERTENSION)?
    'SILENT KILLER'


    High blood pressure  or hypertension means high pressure  in the arteries. Arteries are vessels that carry blood from the pumping heart to all the tissues and organs of the body. High blood pressure does not mean excessive emotional tension, although stress andemotional tension can temporarily increase blood pressure. Normal blood pressure is or below 120/80; blood pressure between 120/80 and 139/89 is called "pre-hypertension", and a blood pressure of 140/90 or above is considered high.
    The top number, the systolic blood pressure, corresponds to the pressure in the arteries as the heart contracts and pumps blood forward into the arteries. The bottom number, the diastolic pressure, represents the pressure in the arteries as the heart relaxes after the contraction. The diastolic pressure reflects the lowest pressure to which the arteries are exposed.
    An elevation of the systolic and/or diastolic blood pressure increases the risk of developing heart (cardiac) disease, kidney disease(renal), hardening of the arteries (atherosclerosis or arteriosclerosis), eye damage, and stroke (brain damage). These complications of hypertension are often referred to as end-organ damage because damage to these organs is the end result of chronic (long duration) high blood pressure. For that reason, the diagnosis of high blood pressure is important so efforts can be made to normalize blood pressure and prevent complications.
    It was previously thought that rises in diastolic blood pressure were a more important risk factor than systolic elevations, but it is now known that in people 50 years or older systolic hypertension represents a greater risk.





    HOW IS BLOOD PRESSURE( B.P ) MEASURED?


    Blood pressure is measured with a blood pressure cuff and recorded as two numbers, for example, 120/80 mm Hg (millimeters of mercury). Blood pressure measurements are usually taken at the upper arm over the brachial artery.
    • The top, larger number is called the systolic pressure. This measures the pressure generated when the heart contracts (pumps). It reflects the pressure of the blood against arterial walls.
    • The bottom, smaller number is called the diastolic pressure. This reflects the pressure in the arteries while the heart is filling and resting between heartbeats

         The recommended guidelines to define normal and high blood pressure.

    • Normal blood pressure less than 120/80
    • Pre-hypertension 120-139/ 80-89
    • High blood pressure (stage 1) 140-159/90-99
    • High blood pressure (stage 2) higher than 160/100


    What are the Symptoms of High Blood Pressure?



    High blood pressure usually causes no symptoms and high blood pressure often is labeled "the silent killer." People who have high blood pressure typically don't know it until their blood pressure is measured.
    Sometimes people with markedly elevated blood pressure may develop:

    • headache,
    • dizziness,
    • blurred vision,
    • nausea and vomiting, and
    • chest pain and shortness of breath.
    People often do not seek medical care until they have symptoms arising from the organ damage caused by chronic (ongoing, long-term) high blood pressure. The following types of organ damage are commonly seen in chronic high blood pressure:
    • Heart attack
    • Heart failure
    • Stroke or transient ischemic attack (TIA)
    • Kidney failure
    • Eye damage with progressive vision loss
    • Peripheral arterial disease causing leg pain with walking (claudication)
    • Outpouchings of the aorta, called aneurysms
    About 1% of people with high blood pressure do not seek medical care until the high blood pressure is very severe, a condition known as malignant hypertension.
    • In malignant hypertension, the diastolic blood pressure (the lower number) often exceeds 140 mm Hg.
    • Malignant hypertension may be associated with headache, lightheadedness, nausea, vomiting, and stroke like symptoms
    • Malignant hypertension requires emergency intervention and lowering of blood pressure to prevent brain hemorrhage or stroke.
    It is of utmost importance to realize that high blood pressure can be unrecognized for years, causing no symptoms but causing progressive damage to the heart, other organs, and blood vessels


    What is White Collar Hypertension?



      White coat hypertension, more commonly known as white coat syndrome, is a phenomenon in which patients exhibit elevated blood pressure in a hospital setting but not in other settings. It is believed that this is due to the anxiety some people experience during a hospital visit.


    How can high blood pressure be controlled?


    Blood pressure control is a lifelong challenge. Hypertension can progress through the years, and treatments that worked earlier in life may need to be adjusted over time. Blood pressure control may involve a stepwise approach beginning with diet, weight loss and lifestyle changes and eventually adding medications as required. In some situations, medications may be recommended immediately. As with many diseases, the doctor and patient work together as a team to find the treatment plan that will work for that specific individual.

     

    Medical Treatment

    • In about half of people with high blood pressure, limiting sodium intake by eliminating table salt, cooking salt, and salty and processed foods can reduce blood pressure by 5 mm Hg.
    • Losing weight and participating in regular physical activity can reduce blood pressure further.
    • If these lifestyle changes and choices don't work, medications should be added. The medications have been proven to reduce the risk of stroke, heart disease, and kidney problems.
    Do not stop taking your medications without talking to doctor.


    How can we prevent having high blood pressure?



    High blood pressure may be prevented by living a healthy lifestyle, including some of the following:
    • eating a nutritious, low-fat diet;
    • exercising regularly;
    • decreasing salt (sodium) intake, read food labels so you know the salt content before you buy a product in the grocery store or eating a meal at a fast food restaurant, and avoid adding salt to foods;
    • maintain a healthy weight and if you are overweight or obese, try to lose weight;
    • drink alcohol in moderation;
    • stop smoking;
    • get routine health assessments and blood pressure screening;
    • taking your blood pressure medications as directed, even if you're feeling fine; and
    • reduce stress and practice relaxation techniques, physical activity will help with this.
    • Keeping an aquarium may be good therapy for you. Studies going back as far as the late 80’s have shown that gazing at aquarium fish reduces stress and subsequently lowers blood pressure





    IN THE END COCHIN CARDIAC CLUB LIKE TO SAY;














    HEART DISEASE AND DIABETES-A DEADLY COMBO.

     

    What is the connection between diabetes, heart disease, and stroke?


    If you have diabetes, you are at least twice as likely as someone who does not have diabetes to have heart disease or a stroke. People with diabetes also tend to develop heart disease or have strokes at an earlier age than other people. If you are middle-aged and have type 2 diabetes, some studies suggest that your chance of having a heart attack is as high as someone without diabetes who has already had one heart attack. Women who have not gone through menopause usually have less risk of heart disease than men of the same age. But women of all ages with diabetes have an increased risk of heart disease because diabetes cancels out the protective effects of being a woman in her child-bearing years.
    People with diabetes who have already had one heart attack run an even greater risk of having a second one. In addition, heart attacks in people with diabetes are more serious and more likely to result in death. High blood glucose levels over time can lead to increased deposits of fatty materials on the insides of the blood vessel walls. These deposits may affect blood flow, increasing the chance of clogging and hardening of blood vessels (atherosclerosis)

    What are the risk factors for heart disease and stroke in people with diabetes?

    Diabetes itself is a risk factor for heart disease and stroke. Also, many people with diabetes have other conditions that increase their chance of developing heart disease and stroke. These conditions are called risk factors. One risk factor for heart disease and stroke is having a family history of heart disease. If one or more members of your family had a heart attack at an early age (before age 55 for men or 65 for women), you may be at increased risk.
    You can’t change whether heart disease runs in your family, but you can take steps to control the other risk factors for heart disease listed here:

    • Having central obesity.

    • Central obesity means carrying extra weight around the waist, as opposed to the hips. A waist measurement of more than 40 inches for men and more than 35 inches for women means you have central obesity. Your risk of heart disease is higher because abdominal fat can increase the production of LDL (bad) cholesterol, the type of blood fat that can be deposited on the inside of blood vessel walls.

    • Having abnormal blood fat (cholesterol) levels.

    – LDL cholesterol can build up inside your blood vessels, leading to narrowing and hardening of your arteries—the blood vessels that carry blood from the heart to the rest of the body. Arteries can then become blocked. Therefore, high levels of LDL cholesterol raise your risk of getting heart disease.

    – Triglycerides are another type of blood fat that can raise your risk of heart disease when the levels are high.

    – HDL (good) cholesterol removes deposits from inside your blood vessels and takes them to the liver for removal. Low levels of HDL cholesterol increase your risk for heart disease.

    • Having high blood pressure.

     If you have high blood pressure, also called hypertension, your heart must work harder to  pump blood    .High blood pressure can strain the heart, damage blood vessels, and increase your risk of heart  attack,stroke, eye problems, and kidney problems.

    • Smoking. Smoking doubles your risk of getting heart disease. Stopping smoking is especially important for people with diabetes because both smoking and diabetes narrow blood vessels. Smoking also increases the risk of other long-term complications, such as eye problems. In addition, smoking can damage the blood vessels in your legs and increase the risk of amputation.

    What types of heart and blood vessel disease occur in people with diabetes?

    Two major types of heart and blood vessel disease, also called cardiovascular disease, are common in people with diabetes: coronary artery disease (CAD) and cerebral vascular disease. People with diabetes are also at risk for heart failure. Narrowing or blockage of the blood vessels in the legs, a condition called peripheral arterial disease, can also occur in people with diabetes.
    • Coronary Artery Disease

    Coronary artery disease, also called ischemic heart disease, is caused by a hardening or thickening of the walls of the blood vessels that go to your heart. Your blood supplies oxygen and other materials your heart needs for normal functioning. If the blood vessels to your heart become narrowed or blocked by fatty deposits, the blood supply is reduced or cut off, resulting in a heart attack.
    • Cerebral Vascular Disease

    Cerebral vascular disease affects blood flow to the brain, leading to strokes and TIAs. It is caused by narrowing, blocking, or hardening of the blood vessels that go to the brain or by high blood pressure.
    • Stroke

    A stroke results when the blood supply to the brain is suddenly cut off, which can occur when a blood vessel in the brain or neck is blocked or bursts. Brain cells are then deprived of oxygen and die. A stroke can result in problems with speech or vision or can cause weakness or paralysis. Most strokes are caused by fatty deposits or blood clots—jelly-like clumps of blood cells—that narrow or block one of the blood vessels in the brain or neck. A blood clot may stay where it formed or can travel within the body. People with diabetes are at increased risk for strokes caused by blood clots.
    A stroke may also be caused by a bleeding blood vessel in the brain. Called an aneurysm, a break in a blood vessel can occur as a result of high blood pressure or a weak spot in a blood vessel wall.
    • TIAs

    TIAs are caused by a temporary blockage of a blood vessel to the brain. This blockage leads to a brief, sudden change in brain function, such as temporary numbness or weakness on one side of the body. Sudden changes in brain function also can lead to loss of balance, confusion, blindness in one or both eyes, double vision, difficulty speaking, or a severe headache. However, most symptoms disappear quickly and permanent damage is unlikely. If symptoms do not resolve in a few minutes, rather than a TIA, the event could be a stroke. The occurrence of a TIA means that a person is at risk for a stroke sometime in the future.
    • Heart Failure

    Heart failure is a chronic condition in which the heart cannot pump blood properly—it does not mean that the heart suddenly stops working. Heart failure develops over a period of years, and symptoms can get worse over time. People with diabetes have at least twice the risk of heart failure as other people. One type of heart failure is congestive heart failure, in which fluid builds up inside body tissues. If the buildup is in the lungs, breathing becomes difficult.
    Blockage of the blood vessels and high blood glucose levels also can damage heart muscle and cause irregular heart beats. People with damage to heart muscle, a condition called cardiomyopathy, may have no symptoms in the early stages, but later they may experience weakness, shortness of breath, a severe cough, fatigue, and swelling of the legs and feet. Diabetes can also interfere with pain signals normally carried by the nerves, explaining why a person with diabetes may not experience the typical warning signs of a heart attack.
    • Peripheral Arterial Disease

    Another condition related to heart disease and common in people with diabetes is peripheral arterial disease (PAD). With this condition, the blood vessels in the legs are narrowed or blocked by fatty deposits, decreasing blood flow to the legs and feet. PAD increases the chances of a heart attack or stroke occurring. Poor circulation in the legs and feet also raises the risk of amputation. Sometimes people with PAD develop pain in the calf or other parts of the leg when walking, which is relieved by resting for a few minutes.


    

    CARDIAC NUCLEAR MEDICINE OR NUCLEAR STRESS TEST

    NUCLEAR STRESS TEST


    Cardiac nuclear medicine studies provide pictures of the structure and function of the heart.
    Nuclear cardiology uses a very small amount of a radioactive dye, or tracer, that is injected into your bloodstream. This tracer makes it possible to take detailed pictures of your heart and the surrounding blood vessels.
    Nuclear cardiology tests are used for several purposes, such as finding out if you are at increased risk of a heart attack or whether you may need heart surgery.
    The amount of radioactive tracer used is very small—much less than the radiation in an X-ray—so risks are minimal. Still, patients who have asthma, glaucoma, a heart rhythm disorder or who have had a recent heart attack may not be appropriate for nuclear cardiology.

    Physicians use cardiac nuclear medicine studies to help diagnose cardiac disease.

    The symptoms include:
    • unexplained chest pain.
    • chest pain brought on by exercise (called angina).



    Cardiac nuclear medicine imaging is also performed:
    • to visualize blood flow patterns to the heart walls, called a myocardial perfusion scan.
    • to evaluate the presence and extent of suspected or known coronary artery disease.
    • to determine the extent of injury to the heart following a heart attack, or myocardial infarction.
    • to evaluate the results of bypass surgery or other revascularization procedures designed to restore blood supply to the heart.
    • in conjunction with an electrocardiogram (ECG), to evaluate heart-wall movement and overall heart function with a technique called cardiac gating.






    PREPARATION FOR THE TEST









    -You may be asked to wear a gown during the exam or you may be allowed to wear your own clothing.
    -You should also inform them if you have any allergies and about recent illnesses or other medical conditions.
    -You should inform your physician if you have asthma or a chronic lung disease or have problems with your knees, hips or keeping your balance, which may limit your ability to perform the exercise needed for this procedure.
    -You should not eat or drink anything after midnight on the day of your procedure, but you may continue taking medications with small amounts of water unless your physician says otherwise. If you take beta-blocker medication (Inderal, Atenolol, etc.) you should specifically ask your physician about temporary discontinuation.
    -Women should always inform their physician or radiologist if there is any possibility that they are pregnant or if they are breastfeeding their baby


    HOW THE TEST IS PERFORMED?


    The most common type of nuclear cardiology test is a myocardial perfusion scan.
    After the tracer is injected, you are asked to exercise on a treadmill  for several minutes. If you are not able to exercise, you may receive a drug that makes your body respond as if it had been exercising.
    A special camera is then used to take pictures of your heart. This camera will detect the tracer as it passes through your heart and the surrounding blood vessels.
    If your heart is healthy, there will be little difference between images of your heart following exercise and when it is at rest. If there are blockages in your coronary arteries, these will show up clearly.






    EXAMPLES OF POSSIBLE NUCLEAR STRESS TEST RESULTS IN A SIMPLE WAY



    -If the scan is normal during both exercise and rest,then blood flow through the coronary arteries is most likely normal as well.No significant coronary artery blockage is suspected.

    -If the scan is normal at rest but abnormal following exercise then the heart isnt receiving enough blood when its under stress.This may be due to blockage in one or multiple coronary arteries.

    -If abnormal blood flow is detected both at rest and with stress,this suggests that part of the heart has suffered injury in the past.This is often the case following a heart attack.



    PATIENTS NOT SUITABLE FOR NUCLEAR STRESS TEST-CONTRAINDICATIONS


    Acute myocardial infarction within 48 hours

     -Unstable angina not yet stabilized with medical therapy

     -Uncontrolled cardiac arrhythmia, which may have significant hemodynamic responses (e.g. ventricular tachycardia)

     -Severe symptomatic aortic stenosis, aortic dissection, pulmonary embolism, and pericarditis.

     -Multivessel coronary artery diseases that have a high risk of producing an acute myocardial infarction.



    CONCLUSION-



    Depending on the results of your nuclear cardiac stress test and your physical and clinical condition, coronary angiography and perhaps coronary artery dilation (ANGIOPLASTY) may be performed. 

    Sometimes coronary artery bypass surgery(CABG) is considered. 
    In other situations, medical management seems more appropriate.

    These alternatives should be discussed with your doctor when you
    get the results of your nuclear cardiac stress test.


                                                                                                                      
    NUCLEAR IMAGE