- Studies show you don’t have to work up a sweat to keep your cholesterol in check. Walking is no strain, all gain, exercise for your heart.
- Regular activities that burn 2,500 calories a week may cut your heart attack risk in half
- Patients who regularly exercise may greatly improve their chances of avoiding a heart attack
- Exercise is a new lease on life, even for those with a family history of heart disease
Friday, February 29, 2008
Preventing Heart Disease, Heart Attack through Physical Exercise
Thursday, February 28, 2008
What is the need for cardiac CT
Coronary Artery disease (CAD) is the leading cause of death in the industrialized world.
- “Screening” is a widely accepted strategy to combat CAD for early detection of stenosis of the coronary artery lumen.
- Exclusion of stenosis in non- symptomatic high risk patients.
- Prior to major (non-cardiac) Surgery.
- Atypical (unstable) chest pain.
- Refractory chest pain with doubtful coronary origin.
- Non-conclusive stress tests.
- As a substitute to conventional coronary angiography prior to percatareous coronary intervention and in high risk patient like aortic disease.
- Adjuvant to coronary Angio for Plaque characterization ,Complicated coronary intubation., Total coronary occlusion.
- Follow-up in -Percutaneous coronary intervention-Bypass Surgery.
- Evaluation of coronary anomalies.
- Evaluation of chest pain at emergency department.
- Evaluation of lifestyle, dietary or pharmacological interventions on progression /regression of coronary atherosclerosis.
Tuesday, February 26, 2008
Heart-Lung Machines
Gale Encyclopedia of Surgery, (2004)
by Allison J.
Definition
The heart-lung machine is medical equipment that provides cardiopulmonary bypass, or mechanical circulatory support of the heart and lungs. The machine may consist of venous and arterial cannula (tubes), polyvinyl chloride (PVC) or silicone tubing, reservoir (to hold blood), bubbler or membrane oxygenator, cardiotomy (filtered reservoir), heat exchanger(s), arterial line filter, pump(s), flow meter, inline blood gas and electrolyte analyzer, and pressure-monitoring devices. Treatment provides removal of carbon dioxide from the blood, oxygen delivery to the blood, blood flow to the body, and/or temperature maintenance. Pediatric and adult patients both benefit from this technology.
Purpose
In the operating room , the heart-lung machine is used primarily to provide blood flow and respiration for the patient while the heart is stopped. Surgeons are able to perform coronary artery bypass grafting (CABG), open-heart surgery for valve repair or repair of cardiac anomalies, and aortic aneurysm repairs, along with treatment of other cardiac-related diseases.
The heart-lung machine provides the benefit of a motionless heart in an almost bloodless surgical field. Cardioplegia solution is delivered to the heart, resulting in cardiac arrest (heart stoppage).
The heart-lung machine is invaluable
In critical care units and cardiac catheterization laboratories, the heart-lung machine is used to support A heart-lung machine. ( Photograph by Albert Paglialunga. Phototake NYC. Reproduced by permission. ) and maintain blood flow and respiration. The diseased heart or lung(s) is replaced by this technology, providing time for the organ(s) to heal. The heart-lung machine can be used with venoarterial extracorporeal membrane oxygenation (ECMO), which is used primarily in the treatment of lung disease. Cardiopulmonary support is useful during percutaneous transluminal coronary angioplasty (PTCA) and stent procedures performed with cardiac catheterization. Both treatments can be instituted in the critical care unit when severe heart or lung disease is no longer treatable by less-invasive conventional treatments such as pharmaceuticals, intra-aortic balloon pump (IABP), and mechanical ventilation with a respirator.
Use of this treatment in the emergency room is not limited to patients suffering heart or lung failure. In severe cases of hypothermia, a patient's body temperature can be corrected by extracorporeal circulation with the heart-lung machine. Blood is warmed as it passes over the heat exchanger. The warmed blood returns to the body, gradually increasing the patient's body temperature to normal.
Tertiary care facilities are able to support the staffing required to operate and maintain this technology. Level I trauma centers have access to this specialized treatment and equipment. Being that this technology serves both adult and pediatric patients, specialized children's hospitals may provide treatment with the heart-lung machine for venoarterial ECMO.
Description
The pump oxygenator had its first success on May 6, 1953. Continued research and design have allowed the heart-lung machine to become a standard of care in the treatment of heart and lung disease, while supporting other non-conventional treatments.
Foreign surfaces of the heart-lung machine activate blood coagulation, proteins, and platelets, which lead to clot formation. In the heart-lung machine, clot formation would block the flow of blood. As venous and arterial cannulas are inserted, medications are administered to provide anticoagulation of the blood which prevents clot formation and allows blood flow through the heart-lung machine.
Large vessels (veins and arteries) are required for cannulation, to insert the tubes (cannulas) that will carry the blood away from the patient to the heart-lung machine and to return the blood from the heart-lung machine to the patient. Cannulation sites for venous access can include the inferior and superior vena cava, the right atrium (the upper chamber of the heart), the femoral vein (in the groin), or internal jugular vein. Oxygen-rich blood will be returned to the aorta, femoral artery, or carotid artery (in the neck). By removing oxygen-poor blood from the right side of the heart and returning oxygen-rich blood to the left side, heart-lung bypass is achieved.
The standard heart-lung machine typically includes up to five pump assemblies. A centrifugal or roller head pump can be used in the arterial position for extracorporeal circulation of the blood. The four remaining pumps are roller pump in design to provide fluid, gas, and liquid for delivery or removal to the heart chambers and surgical field. Left ventricular blood return is accomplished by roller pump, drawing blood away from the heart. Surgical suction created by the roller pump removes accumulated fluid from the general surgical field. The cardioplegia delivery pump is used to deliver a high potassium solution to the coronary vessels. The potassium arrests the heart so that the surgical field is motionless during surgical procedures. An additional pump is available for emergency backup of the arterial pump in case of mechanical failure.
by Allison J.
Definition
The heart-lung machine is medical equipment that provides cardiopulmonary bypass, or mechanical circulatory support of the heart and lungs. The machine may consist of venous and arterial cannula (tubes), polyvinyl chloride (PVC) or silicone tubing, reservoir (to hold blood), bubbler or membrane oxygenator, cardiotomy (filtered reservoir), heat exchanger(s), arterial line filter, pump(s), flow meter, inline blood gas and electrolyte analyzer, and pressure-monitoring devices. Treatment provides removal of carbon dioxide from the blood, oxygen delivery to the blood, blood flow to the body, and/or temperature maintenance. Pediatric and adult patients both benefit from this technology.
Purpose
In the operating room , the heart-lung machine is used primarily to provide blood flow and respiration for the patient while the heart is stopped. Surgeons are able to perform coronary artery bypass grafting (CABG), open-heart surgery for valve repair or repair of cardiac anomalies, and aortic aneurysm repairs, along with treatment of other cardiac-related diseases.
The heart-lung machine provides the benefit of a motionless heart in an almost bloodless surgical field. Cardioplegia solution is delivered to the heart, resulting in cardiac arrest (heart stoppage).
The heart-lung machine is invaluable
In critical care units and cardiac catheterization laboratories, the heart-lung machine is used to support A heart-lung machine. ( Photograph by Albert Paglialunga. Phototake NYC. Reproduced by permission. ) and maintain blood flow and respiration. The diseased heart or lung(s) is replaced by this technology, providing time for the organ(s) to heal. The heart-lung machine can be used with venoarterial extracorporeal membrane oxygenation (ECMO), which is used primarily in the treatment of lung disease. Cardiopulmonary support is useful during percutaneous transluminal coronary angioplasty (PTCA) and stent procedures performed with cardiac catheterization. Both treatments can be instituted in the critical care unit when severe heart or lung disease is no longer treatable by less-invasive conventional treatments such as pharmaceuticals, intra-aortic balloon pump (IABP), and mechanical ventilation with a respirator.
Use of this treatment in the emergency room is not limited to patients suffering heart or lung failure. In severe cases of hypothermia, a patient's body temperature can be corrected by extracorporeal circulation with the heart-lung machine. Blood is warmed as it passes over the heat exchanger. The warmed blood returns to the body, gradually increasing the patient's body temperature to normal.
Tertiary care facilities are able to support the staffing required to operate and maintain this technology. Level I trauma centers have access to this specialized treatment and equipment. Being that this technology serves both adult and pediatric patients, specialized children's hospitals may provide treatment with the heart-lung machine for venoarterial ECMO.
Description
The pump oxygenator had its first success on May 6, 1953. Continued research and design have allowed the heart-lung machine to become a standard of care in the treatment of heart and lung disease, while supporting other non-conventional treatments.
Foreign surfaces of the heart-lung machine activate blood coagulation, proteins, and platelets, which lead to clot formation. In the heart-lung machine, clot formation would block the flow of blood. As venous and arterial cannulas are inserted, medications are administered to provide anticoagulation of the blood which prevents clot formation and allows blood flow through the heart-lung machine.
Large vessels (veins and arteries) are required for cannulation, to insert the tubes (cannulas) that will carry the blood away from the patient to the heart-lung machine and to return the blood from the heart-lung machine to the patient. Cannulation sites for venous access can include the inferior and superior vena cava, the right atrium (the upper chamber of the heart), the femoral vein (in the groin), or internal jugular vein. Oxygen-rich blood will be returned to the aorta, femoral artery, or carotid artery (in the neck). By removing oxygen-poor blood from the right side of the heart and returning oxygen-rich blood to the left side, heart-lung bypass is achieved.
The standard heart-lung machine typically includes up to five pump assemblies. A centrifugal or roller head pump can be used in the arterial position for extracorporeal circulation of the blood. The four remaining pumps are roller pump in design to provide fluid, gas, and liquid for delivery or removal to the heart chambers and surgical field. Left ventricular blood return is accomplished by roller pump, drawing blood away from the heart. Surgical suction created by the roller pump removes accumulated fluid from the general surgical field. The cardioplegia delivery pump is used to deliver a high potassium solution to the coronary vessels. The potassium arrests the heart so that the surgical field is motionless during surgical procedures. An additional pump is available for emergency backup of the arterial pump in case of mechanical failure.
Monday, February 25, 2008
Nutrition: Diet and Heart Disease
Robert M. Russell, M.D., and Alice H. Lichtenstein, D. Sc.Alice H. Lichtenstein, D. Sc., is an Associate Professor of Nutrition in the School of Nutrition Science and an Associate Professor of Family Medicine, Community Health at Tufts University School of Medicine. Her research investigates the behavior of lipoprotein molecules. particles, predictive factors for changes in blood lipids induced by diet in individuals. Dr. Lichtenstein is on the Editorial Board of the Journal of Nutrition and Atherosclerosis.
Being Thin Is Not Necessarily the Solution
RMR
How important a factor is dietary fat intake in the development of coronary artery disease? Put another way, if a person has a high fat diet but stays relatively thin will their arteries be okay?AHLYou can't tell by looking at someone whether they are of a desirable body weight or overweight, or their risk of developing heart disease. Each person is different.First, you have to know how much fat (lipid) is in your blood (see Table 1 below for more detail). Most physicians do this blood test every time you have a check-up or annual medical exam. The most important factor affecting blood cholesterol levels is how much saturated fat and cholesterol you eat.
Risk Factors Vary with the Individual, but They Do Add Up
RMR
What risk factors affect your blood lipid levels? Alice, you mentioned the various risk factors for coronary artery disease and I wonder if you would list them in order of importance as a review and, secondly, could you review the main sources of saturated fats in our diet and the mechanism whereby saturated fats give rise to elevated cholesterol levels?
AHL
The significant risk factors are hypertension, family history of cardiovascular disease, current cigarette smoker, hypertension, low HDL cholesterol (the good cholesterol) and diabetes. Although not considered independent risk factors, obesity and physical inactivity should also be taken into consideration. No one risk factor is more important than another (see Table 2 below).
Major Sources of Saturated Fat in the Diet
AHL
The American Heart Association (AHA) and the National Cholesterol Education Program (NCEP) have issued recommended guidelines, Step 1 and Step 2 they're called, for the dietary treatment of too much cholesterol Table 3. The patient should be first counseled to follow a Step 1 diet. If a patient is already on a Step 1 diet, or an acceptable response is not achieved, the patient should be advised to follow a Step 2 diet by further decreasing their saturated fat intake to 7% of calories and their cholesterol intake to 200 mg/day. For this strategy to be effective, you'll probably require the help of a registered dietitian. Usually, decreasing the total fat content of the diet is easier to do than decreasing the saturated fat content. In order to decrease effectively the saturated fat content, it is important to know its major sources. These include animal fats such as meat and full fat dairy products and, depending on one's tastes, a few selected plant oils (Table 7). The plant oils, frequently termed tropical oils, include coconut oil, palm oil, palm kernel oil and cocoa butter and contain a fair amount of saturated fat. However, they do not tend to be used in high levels in the United States.For Americans with high blood lipid levels, the focus should be on decreasing full fat dairy products and meat. Many non-fat, reduced-fat and low-fat dairy products are now available. To reduce the intake of saturated fat from meat, buy cuts of meat with the least amount of visible fat; trim meat of excess fat; with poultry, remove the skin before eating; and, of course, cut down on the size portion of meat actually consumed.
The other potential source of animal fat can come from cooking, as discretionary fat is added during food preparation. We recommend that individuals switch from animal fats such as lard or butter to vegetable oils.The other dietary factor which elevates blood cholesterol levels is dietary cholesterol.
Major sources of dietary cholesterol are eggs and animal fats (both dairy and meat). By decreasing the consumption of animal fat, in addition to saturated fat, dietary cholesterol intake should also decrease.
Being Thin Is Not Necessarily the Solution
RMR
How important a factor is dietary fat intake in the development of coronary artery disease? Put another way, if a person has a high fat diet but stays relatively thin will their arteries be okay?AHLYou can't tell by looking at someone whether they are of a desirable body weight or overweight, or their risk of developing heart disease. Each person is different.First, you have to know how much fat (lipid) is in your blood (see Table 1 below for more detail). Most physicians do this blood test every time you have a check-up or annual medical exam. The most important factor affecting blood cholesterol levels is how much saturated fat and cholesterol you eat.
Risk Factors Vary with the Individual, but They Do Add Up
RMR
What risk factors affect your blood lipid levels? Alice, you mentioned the various risk factors for coronary artery disease and I wonder if you would list them in order of importance as a review and, secondly, could you review the main sources of saturated fats in our diet and the mechanism whereby saturated fats give rise to elevated cholesterol levels?
AHL
The significant risk factors are hypertension, family history of cardiovascular disease, current cigarette smoker, hypertension, low HDL cholesterol (the good cholesterol) and diabetes. Although not considered independent risk factors, obesity and physical inactivity should also be taken into consideration. No one risk factor is more important than another (see Table 2 below).
Major Sources of Saturated Fat in the Diet
AHL
The American Heart Association (AHA) and the National Cholesterol Education Program (NCEP) have issued recommended guidelines, Step 1 and Step 2 they're called, for the dietary treatment of too much cholesterol Table 3. The patient should be first counseled to follow a Step 1 diet. If a patient is already on a Step 1 diet, or an acceptable response is not achieved, the patient should be advised to follow a Step 2 diet by further decreasing their saturated fat intake to 7% of calories and their cholesterol intake to 200 mg/day. For this strategy to be effective, you'll probably require the help of a registered dietitian. Usually, decreasing the total fat content of the diet is easier to do than decreasing the saturated fat content. In order to decrease effectively the saturated fat content, it is important to know its major sources. These include animal fats such as meat and full fat dairy products and, depending on one's tastes, a few selected plant oils (Table 7). The plant oils, frequently termed tropical oils, include coconut oil, palm oil, palm kernel oil and cocoa butter and contain a fair amount of saturated fat. However, they do not tend to be used in high levels in the United States.For Americans with high blood lipid levels, the focus should be on decreasing full fat dairy products and meat. Many non-fat, reduced-fat and low-fat dairy products are now available. To reduce the intake of saturated fat from meat, buy cuts of meat with the least amount of visible fat; trim meat of excess fat; with poultry, remove the skin before eating; and, of course, cut down on the size portion of meat actually consumed.
The other potential source of animal fat can come from cooking, as discretionary fat is added during food preparation. We recommend that individuals switch from animal fats such as lard or butter to vegetable oils.The other dietary factor which elevates blood cholesterol levels is dietary cholesterol.
Major sources of dietary cholesterol are eggs and animal fats (both dairy and meat). By decreasing the consumption of animal fat, in addition to saturated fat, dietary cholesterol intake should also decrease.
Heart attack : BBC News Friday, 23 June, 2000
A heart attack occurs when blood flow to part of the heart is blocked, often by a blood clot, causing damage to the affected muscle.
This is usually caused by atherosclerosis - hardening of the artery walls. The clot, often caused by rupturing or tearing of plaque in an artery is sometimes called a coronary thrombosis or a coronary occlusion.
If blood supply is cut off for a long time, muscle cells are irreversibly damaged and die, leading to disability or death depending on the extent of the damage to the muscle.
A heart attack, also known as myocardial infarction, can also occur when a coronary artery temporarily contracts or goes into spasm, decreasing or cutting the flow of blood to the heart.
An unexpected and abrupt heart attack occuring soon after the onset of symptoms can result in sudden death.
It accounts for about half of all coronary heart disease deaths and can be caused by nearly all types of heart disease.
Three main symptoms of a heart attack:
1. Pressure or pain in the centre of the chest, lasting more than a few minutes or going away and coming back
2. Pain spreading to the shoulders, neck or arms
3. Chest discomfort combined with light-headedness, fainting, sweating, nausea or shortness of breath
Other common warning signs of heart attack include unusual chest, stomach or abdominal pain, nausea or dizziness, shortness of breath or difficulty breathing, unexplained anxiety, weakness or fatigue, palpitations, cold sweat or paleness.
Anybody experiencing these symptoms should call an ambulance immediately, but should not try to drive themselves to hospital, as complications can begin to occur before they get there.
Most people do have time to get to hospital and be treated before collapsing, but they do need to act quickly.
Some people wait for hours or even days before seeking help - they are the ones that get into trouble.
After a heart attack
Diagnosis of a heart attack usually involves a clinical examination, an electrocardiogram, heart rhythm monitoring and blood tests.
Echocardiograms or angiograms will detect the extent of damage to the heart.
Immediately after a heart attack, clot-busting drugs will be used to restore blood flow. Aspirin, to aid blood flow, and beta-blockers, to ease the heart's work rate, may also be used.
In the days or weeks after a heart attack, surgery - either angioplasty or coronary artery bypass surgery - may be performed.
http://news.bbc.co.uk/2/hi/health/medical_notes/g-i/764015.stm
A heart attack, also known as myocardial infarction, can also occur when a coronary artery temporarily contracts or goes into spasm, decreasing or cutting the flow of blood to the heart.
An unexpected and abrupt heart attack occuring soon after the onset of symptoms can result in sudden death.
It accounts for about half of all coronary heart disease deaths and can be caused by nearly all types of heart disease.
Three main symptoms of a heart attack:
1. Pressure or pain in the centre of the chest, lasting more than a few minutes or going away and coming back
2. Pain spreading to the shoulders, neck or arms
3. Chest discomfort combined with light-headedness, fainting, sweating, nausea or shortness of breath
Other common warning signs of heart attack include unusual chest, stomach or abdominal pain, nausea or dizziness, shortness of breath or difficulty breathing, unexplained anxiety, weakness or fatigue, palpitations, cold sweat or paleness.
Anybody experiencing these symptoms should call an ambulance immediately, but should not try to drive themselves to hospital, as complications can begin to occur before they get there.
Most people do have time to get to hospital and be treated before collapsing, but they do need to act quickly.
Some people wait for hours or even days before seeking help - they are the ones that get into trouble.
After a heart attack
Diagnosis of a heart attack usually involves a clinical examination, an electrocardiogram, heart rhythm monitoring and blood tests.
Echocardiograms or angiograms will detect the extent of damage to the heart.
Immediately after a heart attack, clot-busting drugs will be used to restore blood flow. Aspirin, to aid blood flow, and beta-blockers, to ease the heart's work rate, may also be used.
In the days or weeks after a heart attack, surgery - either angioplasty or coronary artery bypass surgery - may be performed.
http://news.bbc.co.uk/2/hi/health/medical_notes/g-i/764015.stm
Sunday, February 24, 2008
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