What is Heart Attack

INTRODUCTION

A heart attack (also called “myocardial infarction”) occurs when a blood vessel supplying blood to a part of the heart becomes blocked, resulting in permanent damage to the heart muscle due to the lack of blood flow. The blood vessel can become blocked from advancing atherosclerotic plaque lesions, a sudden formation of a blood clot, or from the spasming of a coronary artery – an artery that supplies blood to the heart.

Most people believe that a heart attack is caused by a slow, progressive build-up of plaque, comforting themselves that it takes a lifetime to become completely clogged – but this just isn’t true for a majority of heart attacks. Heart specialists now believe that most heart attacks occur when an unstable, atherosclerotic plaque lesion, filled with cholesterol and fat, suddenly breaks apart, thus forming an open wound within the artery wall. Blood platelets and clotting proteins rush to the wound and form a clot — called a thrombus. The clot can enlarge in a matter of moments, causing obstruction of blood flow to the heart with resultant angina (chest pain). If the blood flow becomes completely obstructed, a heart attack ensues.

Surprisingly, it is the small plaques that can be the most lethal. A person with a 50% blockage who suddenly becomes obstructed is at much greater risk of having a large amount of heart damage than a person with a slowly progressive blockage. A person with a 90% blockage that was slow to progress has probably had a chance to develop “collaterals”–– smaller blood vessels that grow to take over the job of the big vessel that has been gradually closing down.

Is it an Emergency ?????

Every Second Counts
A heart attack is a life–threatening event. With immediate medical intervention — preferably within the first hour of onset of symptoms – heart damage may be averted or reduced. A new blood test measuring “troponin” – a chemical released into the blood during a heart attack – allows doctors to diagnose a heart attack more quickly and accurately than ever before. Time equals muscle is the theme that resounds in emergency rooms and treatment is aimed at quickly restoring blood flow to the heart muscle to prevent permanent damage.

Risk Factors ????

1) Increased LDL/HDL ratios (i.e.,, elevated LDL and low HDL levels)Cholesterol

2) Smoking

3) Diabetes

4) Hypertension

5) Obesity

6)  Stress (i.e., stress or depression)

7) Failure to eat fruits and vegetables daily

Failure to Exercise

9) Failure to drink Moderate Alcohol (complex relationship between alcohol and the heart.)

10) Metabolic syndrome.

11) Increased CRP ( C reactive Protein)

12) Taking Birth Control Pills

13) Complicated Pregnancy

Non modifiable Risk factors?????????

• A family history of premature CAD (generally, CAD that has occurred in male relatives before the age of 50, or in female relatives before the age of 60.)
• Age 55 or older (men), or 65 or older (women)
• For women, being post-menopausal, or having your ovaries removed.
• Chronic kidney disease.

Is there a recent rise Of Heart Attack patients in INDIA???

Yes Bcoz of the Follwing Reasons :

1. Economic Progress

2. Better standard living

3. Westernisation

4. Change of food habits

5. More prone genetics

6. Small vessel Coronary Artery Disease

7. High incidence of Diabetes

8. More Smokers

Symptoms ?????

A unique fact about heart disease is that, in general, the more serious the condition the more remote from the heart are the symptoms.   Amongst danger signals that may, but not necessarily do, betoken heart disease and invite prompt medical attention are:

1 Shortness of breath after slight exertion.

2  Pain or tightness in the chest, often running down the left arm.

3  Swelling in the ankles and abdomen.

4  Dizziness, light-headedness, or vertigo.

5  Seeing double (a particularly dangerous sign).

6  Indigestion that is vague and hangs on.

7  Persistent head-ache.

8  Fatigue without otherwise explained origin.

SIGNS?????

• Bradycardia to Tachycardia
• Angina
• Arrythmia
• Low cardiac Output
• Rales in case of Pulmonary edema
• Cyanosis
• Cold extremities

DIAGNOSIS ???

Essentials of Diagnosis

• Sudden but not instantaneous development of prolonged (> 30 minutes) anterior chest discomfort (sometimes felt as “gas” or pressure) that may produce arrhythmias, hypotension, shock, or cardiac failure.
• Sometimes painless, masquerading as acute CHF, syncope, stroke, or shock.
• ECG: ST-segment elevation or depression, evolving Q waves, symmetric inversion of T waves.
• Elevation of cardiac markers (CK-MB, troponin T, or troponin I).
• Appearance of segmental wall motion abnormality by imaging techniques.

Treatment ????

1)Aspirin and Clopidogrel All patients with definite or suspected myocardial infarction should receive aspirin at a dose of 162 mg or 325 mg at once regardless of whether thrombolytic therapy is being considered or the patient has been taking aspirin. Chewable aspirin provides more rapid blood levels. Patients with a definite aspirin allergy should be treated with clopidogrel; a 300 mg (or 600 mg) loading dose will result in faster onset of action than the standard 75 mg dose.

2) Thrombolytic Therapy: Streptokinase is not commonly used for treatment of acute myocardial infarction since it is less effective at opening occluded arteries and less effective at reducing mortality. It is non-fibrin-specific, causes depletion of circulating fibrinogen, and has a tendency to induce hypotension, particularly if infused rapidly. This can be managed by slowing or interrupting the infusion and administering fluids. There is controversy as to whether adjunctive heparin is beneficial in patients given streptokinase, unlike its administration with the more clot-specific agents. Allergic reactions, including anaphylaxis, occur in 1–2% of patients, and this agent should generally not be administered to patients with prior exposure.

3) Nitrates: Nitroglycerin is the agent of choice for continued or recurrent ischemic pain and is useful in lowering BP or relieving pulmonary congestion. However, routine nitrate administration is not recommended, since no improvement in outcome has been observed in the ISIS-4 or GISSI-3 trials, in which a total of over 70,000 patients were randomized to nitrate treatment or placebo. Nitrates should be avoided in patients who received phosphodiesterase inhibitors (sildenafil, vardenafil, and tadalafil) in the prior 24 hours.

4) Beta Blockers  : Although trials have shown modest short-term benefit from intravenous -blockers given immediately after acute myocardial infarction, it has not been clear that this provides a major advantage over simply beginning an oral -blocker. The Chinese COMMIT/CCS-2 trial involving 45,000 patients found no overall benefit to intravenous followed by oral metoprolol; the aggressive dosing (three 5 mg intravenous boluses followed by 200 mg/d orally) appeared to prevent reinfarction at the cost of increasing shock in patients presenting with heart failure. Thus, -blockade should be avoided in patients with decompensated heart failure, decompensated asthma, or high degrees of AV block. The CAPRICORN trial showed the benefits of carvedilol following the acute phase of large myocardial infarction with contemporary care.

5)ACE Inhibitors: A series of trials (SAVE, AIRE, SMILE, TRACE, GISSI-III, and ISIS-4) have shown both short- and long-term improvement in survival with ACE inhibitor therapy. The benefits are greatest in patients with low EFs, large infarctions, or clinical evidence of heart failure. Because substantial amounts of the survival benefit occur on the first day, ACE inhibitor treatment should be commenced early in patients without hypotension, especially patients with large or anterior myocardial infarction.

6) Calcium Channel Blockers : There are no studies to support the use of calcium channel blockers in most acute myocardial infarction patients—and indeed, they have the potential to exacerbate ischemia and cause death from reflex tachycardia or myocardial depression. One exception is that diltiazem and verapamil appear to prevent reinfarction and ischemia in the subset of patients with non-Q wave infarction. Diltiazem is preferable because it causes less myocardial depression. The dosage is 240–360 mg daily. Otherwise, long-acting calcium channel blockers should be reserved for management of hypertension or ischemia as second- or third-line drugs after -blockers and nitrates

7) Surgery:

Prevention>>>

How Can a Heart Attack Be Prevented?

Lowering your risk factors for coronary artery disease (CAD) can help you prevent a heart attack. (See “Who Is At Risk for a Heart Attack?“) Even if you already have CAD, you can still take steps to lower your risk of heart attack.

Reducing the risk of heart attack usually means making healthy lifestyle choices. You also may need treatment for medical conditions that raise your risk.

Healthy Lifestyle Choices

Healthy lifestyle choices to help prevent heart attack include:

• Following a low-fat diet rich in fruits and vegetables. Pay careful attention to the amounts and types of fat in your diet. Lower your salt intake. These changes can help lower high blood pressure and high blood cholesterol.
• Losing weight if you’re overweight or obese.
• Quitting smoking.
• Doing physical activity to improve heart fitness. Ask your doctor how much and what kinds of physical activity are safe for you.

Treat Related Conditions

In addition to making lifestyle changes, you can help prevent heart attacks by treating conditions you have that make a heart attack more likely:

• High blood cholesterol. You may need medicine to lower your cholesterol if diet and exercise aren’t enough.
• High blood pressure. You may need medicine to keep your blood pressure under control.
• Diabetes (high blood sugar). If you have diabetes, control your blood sugar levels through diet and physical activity (as your doctor recommends). If needed, take medicine as prescribed.

Have an Emergency Action Plan

Make sure that you have an emergency action plan in case you or someone else in your family has a heart attack. This is especially important if you’re at high risk or have already had a heart attack.

Talk with your doctor about the signs and symptoms of heart attack, when you should call 9–1–1, and steps you can take while waiting for medical help to arrive.

INTRODUCTION

In each menstrual cycle, follicles grow on the ovaries. Eggs develop within those follicles, one of which will reach maturity faster than the others and be released into the fallopian tubes. This is “ovulation”. The remaining follicles will degenerate.

In the case of polycystic ovaries, however, the ovaries are larger than normal, and there are a series of undeveloped follicles that appear in clumps, somewhat like a bunch of grapes. Polycystic ovaries are not especially troublesome and may not even affect your fertility.

However, when the cysts cause a hormonal imbalance, a pattern of symptoms may develop. This pattern of symptoms is called a syndrome. These symptoms are the difference between suffering from polycystic ovary syndrome and from polycystic ovaries.

How common in PCOS???

Polycystic ovary syndrome is the most common hormonal disorder occurring in women during their reproductive years. It’s thought that 4% to 10% of all women have the disorder. However, since many women don’t know they have polycystic ovarian syndrome or some aspect of it, the actual number probably exceeds 10%. Polycystic ovarian syndrome is one of the leading causes of infertility. Symptoms frequently start to show up soon after puberty.

Causes????

There is disagreement and uncertainty as to what causes polycystic ovarian disease. Polycystic ovaries and polycystic ovary syndrome have been associated with one or more of these factors:

• Genetic predisposition.
• Insulin resistance or hyperinsulinism (high blood levels of insulin).
• Obesity.
• Hyperandrogenism (excessive production of male hormones).
• Abnormality of the hypothalamic-pituitary-gonadal axis (organ/hormonal disorder).
• Environmental chemical pollution (hormonal disruptors)
• Food adulterantion (excitatory amino acids, for example)
• Chronic inflammation.

Some of these causal factors may also be consequences of polycystic ovary disease. In other words, we have an amazingly complex network of interacting variables, each of which influences the other. Polycystic ovarian syndrome is not a simple disease with a single cause.

The Natural Diet Solution for PCOS and Infertility describes the possible causes of polycystic ovary syndrome in great detail.

Symptoms???

Polycystic ovarian syndrome presents a complex and baffling array of symptoms, consisting of some combination of the following symptoms that vary with each individual:

• Multiple ovarian cysts
• Irregular or absent menses
• Infertility
• Acne
• Obesity or inability to lose weight
• Excessive body or facial hair (hirsutism)
• Insulin resistance and possibly diabetes
• Thinning of scalp hair
• Velvety, hyperpigmented skin folds (acanthosis nigricans)
• High blood pressure
• Polycystic ovaries that are 2-5 times larger than healthy ovaries.
• Multiple hormone imbalances, commonly including:
  • Androgens (testosterone)
  • Cortisol
  • Estrogens
  • FSH (follicle stimulating hormone)
  • Insulin.
  • LH (luteinizing hormone)
  • progesterone
  • Prolactin.
  • Thyroid hormones.
• Impaired lung function.
• Sleep apnea.
• Fatty liver degeneration (NAFLD).
• Depression

Treatment ????

The first PCOS treatment for Infertility is usually the administration of medications to stimulate ovulation.

Clomiphene citrate (Clomid or Serophene)

An oral fertility drug used to stimulate ovulation, correct ovulation process, to improve egg production and to fix luteal phase deficiency. The drug is taken for five days early in the menstrual cycle. Clomid may become futile with a long use, for more than six cycles.

With some evidence, it has been stated that continual use of the drug, for twelve or more cycles, may increase the risk of ovarian cancer.

Metformin (Glucophage)

It is an insulin-sensitizing agent used to induce ovulation. Common Metformin medications include, Generic Metformin Hcl, Glucophage, and Glucophage XR. If Clomid fails to ovulate, a combination of “Metformin” and “Clomid” is taken as a PCOS treatment drugs for infertility.

The medication ‘Metformin’ increases the fertility by improving the effectiveness of the insulin while decreasing the insulin levels and in turn androgen levels. Normalizing the androgen levels enhances the natural ovulation.

hCG (human chorionic gonadotrophin) (Profasi)

An intramuscular injection used in conjunction with Clomid. The effect of hCG on follicle is same as LH (luteinizing hormone). HCG stimulates the follicle to release its egg (ovulate) approximately 36 hours later.Ovulation may be blocked, when hCG is taken too early. Ovarian hyper stimulation and cyst formation can result with too much hCG usage.The other commonly used PCOS treatment drugs for infertility include hMG (human menopausal gonadotrophin), FSH (follicle stimulating hormone), GnRH (gonadotrophin releasing hormone), GnRHa (GnRH analogs) and Prolactin inhibition drugs.

PCOS Treatment For Infertility – Medical Procedures

IUI (intrauterine insemination)

A basic PCOS treatment for women with infertility problem is intrauterine insemination, also known as Artificial Insemination. It is a fast and painless medical procedure where the male partner’s sperm is introduced directly into the female’s uterus (intrauterine) for the purpose of conception.

The procedure is usually done in conjunction with the ovarian stimulation drugs because regular menstrual cycle and healthy ovulation makes conception very successful.

IVF (in-vitro fertilization)

A simpler, safer and more successful PCOS treatment option to induce ovulation in infertile women is in vitro fertilization. The procedure involves the removal of eggs from female partner’s body and fertilizing them with the sperm of male partner.

The embryo (fertilized egg) is then introduced into the uterus (womb). Ovarian stimulation drugs (hCG, hMG, FSH or progesterone) are used to stimulate the ovaries to produce fertilizable oocytes (eggs).GIFT (Gamete Intra Fallopian Transfer), ICSI (Intracytoplasmic Sperm Injection) are the medical procedures of PCOS treatment for infertile women.The success rate of PCOS treatment options to induce ovulation depends on the age of the woman, the type of ovarian stimulation medication, and other factors that contribute to infertility in the woman.

Yoga asans that help PCOS???

Down the years, it has been found that Yoga is the only recourse left to PCOD / PCOS sufferers. Yoga is a holistic science and art of living. This is because routines Yoga consisting of asanas (poses), pranayamas (breathing techniques) and kriyas (cleansing exercises) prescribed in Yoga help tone up the whole system. There are certain fixed Yoga asanas (poses) like the sitting, standing and supine poses that haven proven to greatly help PCOD / PCOS patients. In general, the Yoga program for PCOD / PCOS is as follows:

• A series of Yoga asanas (poses). While there is no exact pose or exercise that is known to help heal PCOD / PCOS, experience tells us that some of the poses – if done regularly – sitting, standing and lying on the back, over time yield the desired results. But, you should make sure to avoid all the inverted poses.
• Practice lots of Pranayamas (Breathing Exercises) in a slow, unhurried, relaxed rhythm. You may breathe at your own slow pace, or inhale and exhale to the count of 3 or 4. But do this very slowly and avoid straining or putting pressure on your lungs. The recommended pranayamas (breathing exercises) for PCOD / PCOS women are Mild Kapalabhatti (Skull Cleansing), Anuloma-Viloma (Alternate Nostril Breathing) and Ujjayi (Ocean Breath).
• You should also practise Nispanda Bhava (Unmoving Observation) and Shavasana (Corpse pose) 2 – 3 times every day. These will definitely help since PCOD / PCOS victims are, by and large, tense and stressed out. Subsequently, they need plenty of relaxation.
• Finally, let your diet be Yogic and Sattvic. This essentially means pure and predominantly vegetarian, with lots of seasonal fruits, sprouts, fresh salads and dried fruits. Steer clear of milk and milk products, particularly cheeses and butter, all confectionery products, fatty, fried and spicy foods, cigarettes and alcohol
• Likewise, avoid stress and tension, so try and avoid all stressful situations. Even if difficult, you will find that taking the trouble and making a few short term sacrifices will benefit you enormously in the long run.

What is it ???

Impotence is a medical condition that affects a male’s ability to get or sustain an erection. It is often called erectile dysfunction, as it usually only affects erectile ability, which distinguishes it from other male sexual problems of both physical and psychological natures. Causes of impotence are typically physical, but in some cases it may also be caused or aggravated by psychological issues.

CAUSES???

Impotence is a medical condition that affects a male’s ability to get or sustain an erection. It is often called erectile dysfunction, as it usually only affects erectile ability, which distinguishes it from other male sexual problems of both physical and psychological natures. Causes of impotence are typically physical, but in some cases it may also be caused or aggravated by psychological issues. Medical treatment for this problem is now widely available, and widely used.

Psychological  causes???

- Stress and anxiety
- Fear of failure
- Problems with your relationship

Some people may wonder why they need to take medicines for a condition that doesn’t have symptoms and doesn’t appear to affect their quality of life. Your doctor is aware of this and will try to avoid treatments that make you feel bad or interfere with your lifestyle. Although taking medication may seem like a chore, it is being prescribed to prevent serious illness or even death. Always take medicines according to instructions, and do not stop taking them abruptly as this can cause problems. If you have any questions about your medicine, always ask your doctor.

Impotence can nearly always be treated – 95 percent of men find a suitable treatment. The simplest are talking therapies, such as cognitive behavioural therapy, and medicines.If the cause is mainly because you are anxious or are having relationship difficulties, then talking to a counsellor or psychosexual therapist will probably be most helpful for you.

Risk factors ??

1. Chronic health conditions

People suffering from chronic diseases have a high risk of erectile dysfunction. Chronic diseases such as:
a) Heart diseases are caused by cholesterol building up in the arteries and blood vessel resulting in inadequate blood flow into the penis.
b) Diabetes with unhealthy diet causes high levels of glucose build-up in the bloodstream resulting in narrowed arteries and blood vessels that prevent adequate blood from entering the penis.
c) Prostate enlargement and chronic prostate: Inflammation of the prostate also reduces the blood flow entering the penis resulting in erectile dysfunction.
Other chronic diseases affecting organs like the lung, liver, and kidney also can lead to erectile dysfunction because of inflammation, inadequate blood flow or hormonal imbalance.

2. Aging

Aging results in more testosterone to be converted to dihydro-testosterone causing erections to take longer to develop and to need more direct touch to the penis.

3. Nerve damage

It is obvious that any damage to the nerve that directly controls erections can cause temporarily erectile dysfunction.

4. Medication

The side effects of some medications used to treat high blood pressure, depression, and prostate enlarged may interfere with nerve impulses and reducing the blood flow to the penis.

5. Prolong cycling

Prolong cycling over an extended period and pressure from a bicycle seat compresses nerves and blood flow to the penis, leading to temporary erectile dysfunction.

6. Psychological conditions

Other psychological conditions such as depression, anxiety and stress also contributes to some cases of erectile dysfunction.

7. Substance abuse

Substance abuse such as smoking, alcohol, marijuana or other drugs often causes erectile dysfunction.
There are many other risk factors such as obesity, diabetes, high levels of cholesterol and triglycerides that can cause erectile dysfunction.

Treatment ???

1)Sexual counselling

2)Oral Medication :

The introduction of Viagra by Pfizer in March, 1998,, marked the beginning of a revolution in the oral medical management of erectile dysfunction (ED, E.D., impotence). The launch of Viagra was soon followed by that of Levitra and Cialis. Other (even better) drugs are in the pipeline.Effective oral medication has re-written the management of ED and is effective in nearly 70 – 75 % of cases. Several internet resources are available for more detailed information about these drugs and these will not be discussed in detail here.

3)Hormone Replacement therapy:

Testosterone is the major male hormone that gives men their sexual characteristics (deep voice, beard, chest hair). As men age, their level of testosterone decreases (andropause) and this may have an adverse effect on sexual performance. In proven cases of andropause, testosterone preparations may enhance potency and improve sex drive. However, this therapy must be only offered under expert medical supervision because many side effects can occur.

4)External Vaccum Devices

vacuum device, and one or more tension rings. This therapy is purported to be effective for over 90% of the men who use it. In fact, most can technically master its use in one day, and can use it to maintain erections for up to 30 minutes, even after ejaculation and/or orgasm.

Prevention  of Impotence????

There is no specific treatment to prevent impotence. Perhaps the most important measure is to maintain general good health and avoid atherosclerosis by exercising regularly, controlling weight, controlling hypertension and high cholesterol levels, and avoiding smoking. Avoiding excessive alcohol intake may also help.