Health Galaxy

Are you worried about your test reports that reveal a high cholesterol level? Then here are quick fire ways how to get it under control.

Eat more beans:

You cannot rule out carbohydrates completely from your diet because they are important sources of energy for the body. However, some sources of energy are better than others. For example, beans and whole grains have more fiber and less sugar. Hence, they play an important role in bringing down the risk of diabetes while simultaneously controlling the body’s cholesterol level. White bread, potatoes, etc do just the opposite.

Get moving:

Half an hour of physical activity on a regular basis goes a long way in lowering your cholesterol levels. If you indulge in a vigorous exercise, such as jogging, experts suggest that even 20 minutes thrice a week is enough. A tip for starters is not to carry on for 30 minutes at a stretch. You may break down the exercise to three intervals of 10 minutes each. If you hate exercising, or feel that gyming is too boring, go for a walk.

Eat out wisely:

When you are eating out, it becomes all the more imperative to stay cautious. Restaurants have a habit of super sizing everything. Stay clear of fried foods as much as possible. GO for, boiled, baked or steamed menu items. Also ask for the sauces to be served at the side and not mixed with your food. Most of these sauces are high in sodium and calories.

Don’t stress:

Stress directly affects your cholesterol levels, and can also lead to high blood pressure. Try and reduce your stress levels with relaxation and yoga. A simple way out to reduce stress is to exercise levels is to exercise deep breathing.

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ISCHEMIC HEART DISEASE is generic designation as a result of an imbalance between the supply (perfusion) and demand of the heart for oxygenated blood. It comprises not only insufficiency of oxygen, but also reduced availability of nutrient and inadequate removal of metabolites.

> 90 % cases as a result of

Reduction in coronary blood flow due to ATHEROSCLEROSIS in coronary trunk. So designated as CORONARY ARTERIAL DISEASE. ( C.A.D. )

The syndrome of IHD are Late Manifestation of CAD which began during first decades of life.

* CLINICAL MANIFESTATION OF IHD.
* Divide in to 4 syndromes
* 1 ANGINA PECTORIS ;- Ischemia less sever.

THREE SUB GROUP. ;-

A) Stable angina. B) Prezmetal angina C) Unstable angina.

2 ACUTE MYOCARDIAL INFARCTION.

Duration and severity is sufficient cause death of cardiac muscle.

3 CHRONIC IHD WITH HEART FAILURE.

4 SUDDEN CARDIAC DEATH.

* EPIDEMIOLOGY
* I.H.D. in its various forms is the leading cause of
* Death for both M & F .
* Reduced the incidence of IHD as a results of recent
* Technical achievements in diagnosis, prevention, and
* treatments
* Prevention achieved by modification of determination
* Of risk factors such as smoking , hypercholesterolemia, hypertension and sedentary lifestyle.
* Diagnostic and therapeutic advances
* Earlier , more effective , and safer treatments,
* Coronary care units
* Thrombolytic therapy for M. i.
* Per coetaneous transluminal coronary angioplasty, ( PTCA)
* Endovascular stent ,
* Coronary arterial by pass graft .( CABG )
* Control of diabetes mellitus in pt.
* Control of Arrythemias.
* ETIO -PATHOGENESIS.
* Etiology of IHD under five broad headings.
* Coronary Atherosclerosis,
* Role of Acute Plaque Changes,
* Role of coronary thrombosis .
* Role of vasoconstriction.
* Non atherosclerotic causes are

* Embolism ;- Originate any where in body.

* Trauma ;- Due to penetrating injuries.
* Aneurysms ;- Extension of aneurysms of        aorta.
* Compression ;- Primary & secondary tumour.

* CORONARY ATHEROSCLEROSIS.
* It is the major cause of IHD in > 90 % of cases.
* Progressive enchroachment of lumen leading to  stenosis ( FIXED OBSTRUCTION) or to ACUTE Disruption with thrombosis.

* Sudden obstruction cause ACUTE ISCHEMIC ATTACK  Or sudden death. While dynamic slowly developing obstruction may stimulate

COLLETERAL CIRCULATION

* Dynamic interaction among FIXED Atherosclerosis. Narrowing of the epicardial coronary arteries. Platelets clumps & vasospasm.

* DISTRIBUTION AND LOCATION.
* One or more of the major coronary arteries are involved.
* All are involved in descending order.

1 LATERAL ANTERIOR DESCENDING BRANCH OF

LEFT CORONARY ARTERY.

2 LEFT CIRCUMFLEX BRANCH OF CORONARY       ARTERY.

3 ANTERIAL DESCENDING BRANCH OF RIGHT CORONARY ARTERY.

So the single vessel or two or three vessels are involved in IHD. Left heart is more involved due to the atherosclerosis are very common & sever in LEFT rather than RIGHT coronary artery.

* ROLE OF ACUTE PLAQUE CHANGES.
* All most complications are precipited as a result of

Plaque changes followed by THROMBOSIS, Rupture, Fissuring, Erosion/ Ulceration and highly THROMBOGENIC at Sub-Endothelial Level.

* Hemorrhage in Atheroma.
* Plaque disruption lead to Platelets aggragation and

Thromogenesis are common . Repetative and silent complication of Atheroma .

* Platelets release granules and vaso spasmic mediatores which is responsible for  VASO-SPASM.. PRODUCE STABLE ANGINA.

Coronary artery, atherosclerosis

* ROLE OF CORONARY THROMBUS.
* Previous only partialy stenotic plaque gradually
* Become large in size and convert in to total occlusion
* lead to SUDDEN DEATH.
* The mural thrombus in coronary artery
* Lead to micro or macro emboli formation
* Produce micro or macro infarct of    myocardium.
* UNSTABLE ANGINA OR SUDDEN DEATH..
* ROLE OF VASO CONSTRICTIONS .
* VACONSTRICTION COMPROMISES

THE LUMEN SIZE OF VESSELES AND

STIMULATED BY

1 Circulating androgenic agonists

2 Locally released pletelets contents.

3 Impaired secretion of constriction release          factore

4 Mediator release from peri vascular      inflammatory cells.

LEAD TO ANGINAL ATTACK STABLE OR VARIENT.

* ANGINA PECTORIS.
* It is a symptoms complex of IHD charecterized by

*,PAROXYSMAL AND RECURRENT ATTACKS OF SUB-STERNAL OR PRECORDIAL DISCOMFART. ( AS – CONSTRICTING.SQEEZING.HOKING OR KNIFELIKE) As a result of TRANSIENT ( 15 seconds to 15 minutes) MYOCARDIAL ISCHEMIA OR NECROSIS (INFARCT).

THREE OVERLAPPING PATTERNS OF ANGINA PECTORIS.

1) STABLE OR TYPICAL ANGINA.

2) VARIENT OR PRIZMETAL

3) UNSTABLE OR CRESENDO.

* STABLE OR TYPICAL ANGINA PECTORIS.
* Most common form as a result of reduction of coronary perfusion to a critical level by chronic stenosis of cor. Arteries.
* Charecterised by attack of pain following physical exertion or emotional excitement ,relieved by rest
* Local vasospasm may contribute to the imbalance
* between supply and demand.
* There is depression of ST-segment in ECG due to poor perfusion of the sub-endocardial region of LT
* side of heart.
* But no elevation of cardiac enzymes in the blood.a
* PRENZMENTAL OR VARIEN ANGINA.
* Uncommon pattern of episodic angina as a result of sudden vasospasm of coronary trunk.
* Characterized by attack of pain occurs at REST.
* There is elevated ST-segment as a result of THANSMURAL ischemia.
* The angina attacks are unrelated to physical activity , heart rate or blood pressure.
* Generally responds promptly to vasodilators,
* such as Nitroglycerin and calcium channel blockers.
* But no elevation of cardiac enzymes in the blood.
* UNSTABLE OR CRESENDO ANGINA.
* It is referred to as acute insufficiency & most serious patteren of angina.
* The pain is precipitated with progressively less effort often occur at rest with prolonged duration.
* Induced by disruption of an atherosclerotic plaque with superimposed by thrombus & embolus
* The ischemia that occures in unstable angina to inducing clinically detectable INFARCTION.
* Unstable angina lies intermediate between stable angina on the one hand & M.I. on the other.
* ACUTE MYOCARDIAL INFARCTION. M.I.
* DEF.;- Death of cardiac muscle due to ISCHEMIA
* A significant factor that may prevent of diminish the myocardial damage is the development of collateral circulation through anastamotic channels over a period of time.
* Epidemiology ;- Leading cause of death all over the world. About 1.5 mill. Person suffer an acute M.I. annually & 33 % die.
* At least 15 % sufferer die before they reach the hospital. Incidence ratio is 10 % before 40 yrs age & 50 – 60 % under 65 yrs of age.
* Female are less sufferer then male due to ostrogen.
* ETIO – PATHOGENESIS.
* About 90 % of cases due to sever cor. Atheroscle.
* MACHANISM OF M.I. ;-
* 1) Diminished coronary blood flow in one or more
* than one coronary arterial trunk ( C.A.D.)
* 2) Myocardial demand for blood.(Exercise       Emotion)
* 3) Hyperthrophy of heart with out simultaneous
*          of blood supply ( Hypertesion & valular      heart disease.

The wavefront of myocardial necrosis

* SEQUENCE OF EVENTS OF M.I.
* SEQUECE OF EVENTS CONT.
* Loss of blood supply

Induce profound functional, biochemical & morphological changes.

* Cessation of aerobic & anaerobic glycolysis.
* Lead to inadequate production of CKP & ADP.
* Striking loss of contractibility.
* Precipitating acute heart failure long before myocardial cell death.
* This early changes are potentially reversible.
* Ischemia lasting < 20 min. lead to irreversible necrosis.
* Produce electrical instability – arrythemia – Death.
* APPROXIMATE TIME OF ONSET OF KEY  EVENTS IN ISCHEMIC CARDIAC MYOCYTES.
* FEATURE
* A.T.P.Depletion.
* Loss of contractility
* ATP Reduced
* To 50 % of normal.
* To 10 % of normal.
* Irreversible cell injury.
* Micro vascular injury.
* TIME
* Seconds.
* < 2 minute.
* 10 minutes
* 40 minutes
* 20 – 40 minnutes
* > 1 hour.

* TYPES OF INFARCTION.

* Classified by the panel of cardiologist & pathologist
* 1) Accorging to anatomical region of Lt. Ventricle.
* ( Anterior , Posterior(inferior) , Lateral , Septal ,
* Circumferential or combination of any two .)
* 2) According to the demage of thickness of the
* ventricular wall involved.
* 3) According to the age of INFARCTS.
* Acute or Recent or Fresh demages.
* Old or Healed or Organised .

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Rheumatic Fever is a systemic, Post-Streptococcal Non-Suppurative inflammatory disease affecting the heart, Joint, CNS, skin due to autoimmune theory. The chronic stage of R.F. involves all the layers of heart(Pancarditis). William Boyd years ago gave the dictum Rheumatism licks the joints, but bits the whole heart.

Incidence :-

* Commonly in Children, 5-15 age group.
* Both the sex equally affected.
* More in poor socioeconomic strata living in over crowded place where chances of infection is more.
* Incidence is decreased in developed countries due to high living standard and use of antibiotic or prevention measures.
* By survey, in School age Children, by the MCI, an incidence of 1 to 5.5/100 children.

ETIO-PATHOGENESIS :-

* It is universally accepted that Acute R.F. is a hypersensitivity reaction induced by group A-Beta. Haemolytic streptococcus infection.
* Favorable point for this hypothesis are :-
* History of Infection or subsequent infection.
* Rh Cardiditis have been produced in experimental animals by induction of infection with Beta - Haemolytic streptococcus microbes.
* Antibodies directed against the M-Proteins of certain strains of microbes cross-react with glycoprotein antigens in the heart, joints.
* Onset of disease after 2-3 weeks of infection is based on immunology.
* Cell wall polysaccharide of microbes forms antibodies which are reactive against cardiac valves.
* Hyaluronate capsule of microbes is identical to human hyaluronate present in joint tissues and thus these tissues are the target of attack.
* Membrane antigens of microbes react with sarcolemma of smooth and cardiac muscle.

PATHOLOGICAL CHANGES :-

* Auto immune focal inflammatory disorder of the connective tissues throughout the body.
* It is having cardiac and Non-Cardiac lesions.
* The pathogenomic feature of Pancarditis in R.F. is the presence of distinctive.

ASCHOFF NODULES OR ASCHOFF BODIES :-

* It is 1-2 mm size, fusiform or spheroidal tiny structure.
* It is found in all cardiac layer and extra cardiac interstitial connective tissue.

DEVELOPMENT OF ASCHOFF BODIES :-

Three stages of development of these are as follows:-

Ist - EARLY STAGE(Exudative/degenerative)

* About 4th week of illness.
* Oedema of connective tissue.
* Increase in acid mucopolysachharides in ground substance.
* Separation of the collagen fibres.
* Fragmented and disintegrated and fibronoid degeneration.

IInd – Proliferative/Granulomatous:-

* 4th to 13th week of illness.
* Proliferation and infiltration of T-Lymphocytes; Plasma cells; few neutrophil and CARDIAC Histiocytes(ANITSCHKOW) cells at the margin of the lesion.
* This cells are large mononuclear cells having central round nuclei and scanty amphophilic cytoplasm.
* The nuclei are vesicular and prominent chromatin mass like owl’s eye by cross section.

IIIrd Stage Healing or Fibrous :-

* 12-16 weeks after illness.
* The nodules become oval or fusiform about 200cm wide and 600 cm long.
* The Anitschkow cells arrange at Peripheral like palisade manner.
* Afterwards the Aschoff bodies is replaced by a small fibro - collagenous scar.
* Rh. Pancarditis all layers are involved but intensity of lesion is variable.

Rheumatic Endocarditis :-

* Rh.F. may involve the valve and mural endocardium.
* Most commonly the affected valve is mitral and aortic.
* Foci typically results in fibrinoid degeneration within the cups or along the tendenous cords on which sit small(1-2mm) vegetations(verrueae) along the line of closure.
* These irregular, warty projections probably arise from precipitation of fibrin at the site of erosion which disturbed the cardiac functions called Mac - Callam plaques at left atrium.

CHRONIC RHEUMATIC ENDOCARDIAL LESION :-

* It is characterised by organization of the acute inflammation with fibrosis.
* The valvular leaflets become thickened and retracted, causing perminant deformitipes mostly mitral, aortic value involved in which changes are, leaflet thickening, commissural fusion and shortening and thickening and fusion of the tendirous cords.
* Microscopically there is diffuse fibroses which is followed by calcification and formation of fish mouth or button hoce deformity and cause mitral sterosis.

RHEUMATIC MYOCARDITIS:-

Gross:- Left ventricle involve more and it is soft and flabby with small foci of necrosis and at last Pale foci of Aschoff bodies.

Micros:- The Aschoff bodies are best identified in the myocardium which is gradually replaced by small fibrous scar in the vicinity of blood vessels.

Rheumatic Pericarditis :-

Gross:- Loss of normal shiny pericardial surface due to deposition of fibrine and fibrinous exudate in the pericardial sac, look like a “Bread and Butter” appearance.

Micros:- Aschoff’s bodies seen and sub-serosal connective tissue is infiltrated by Plasma cell, lymphocytes, histiocytes and neutrophills.

Extracardiac Lesions :-

Patients of the syndrome of acute rheumatism develop lesions in connective tissue elsewhere in the body, chiefly the joints, subcutaneous tissue, arteries, brain and lungs.

POLYARTHRITIS:-

* As pain and swelling subside in one joint, others tend to get involved, producing the characteristic ‘migratory polyarthritis’ involving two or more joints at a time.
* Histologically, the synovial membrane and the periarticular connective tissue show hyperaemia, oedema, fibrinoid change and neutrophilic infiltration.
* A serous effusion into the joint cavity is commonly present.

SUBCUTANEOUS NODULES:-

* These nodules are small (0.5 to 2 cm in diameter), spherical or ovoid and painless.
* They are attached to deeper structures like tendons, ligaments, fascia or periosteum.
* Characteristic locations are extensor surfaces of the wrists, elbows, ankles and knees.
* Histologically, they consist of 3 distinct zones: a central area with fibrinoid changes, surrounded by a zone of histiocytes and fibroblasts forming a palisade arrangement, and the outermost zone of connective tissue which is infiltrated by non-specific chronic inflammatory cells and proliferating blood vessels.

CHOREA MINOR:-

* Chorea minor or Sydenham’s chorea or Saint Vitus’ dance is a delayed manifestation of RF as a result of involvement of the central nervous system.
* The condition is characterised by disordered and involuntary jerky movements of the trunk and the extremities accompanied by some degree of emotional instability.
* The condition occurs more often in younger age, particularly in girls.

CLINICAL FEATURES:-

* Major criteria are:
* Carditis
* Polyarthritis
* Chorea (Sydenham’s chorea)
* Erythema marginatum
* Subcutaneous nodules

B. Minor criteria are:

* Fever
* Arthralgia
* Previous history of RF
* Laboratory findings of elevated ESR, raised C-reactive protein, and leucocytosis.
* ECG finding of prolonged PR interval.

C. Supportive evidence of preceding group A streptococcal infection: positive throat

culture for group A streptococci, raised titres of streptococcal antibodies

(antistreptolysin O and S, antistreptokinase, antistreptohyaluronidase and

anti DNAase B.)

MAJOR CAUSES OF DEATH IN RHD :-

* Cardiac failure is the most common cause of death from RHD.
* Bacterial endocarditis of both acute and subacute type may supervene due to inadequate use of antibiotics.
* Embolism in RHD originates most commonly from mural thrombi in the left artium.
* Sudden death may occur in RHD as a result of ball thrombus in the left atrium or due to acute coronary insufficiency in association with aortic stenosis.

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Acai berry is the panacea of the hour. We have very recently woken up to its merit. Named as ‘Cuia’ provincially and regarded as the chief reason for the great health that Amazonian tribal have, the fruit Acai has touched the shores of western countries amidst sweeping curiosity.

The fruit contains a very heavy pulp comprising of nutrient bliss. It has vitamins and minerals and quintessential fatty acids; oleic and omega-3. Then there are the monosaturated fats along with the fibers and polyphenols. The polyphenols help in raising the high density cholesterol and lowering the low density one thus giving a much needed boost to the cardiac system. Next we have its antioxidant power which helps it liberates the body of harmful toxic concentration. Such toxic build-up once taken care of liberates the metabolism of its heaviness. The metabolism thus pepped up more than suffices in burning fat. This results in weight loss.

The fruit is so nutritious that it acts as appetite suppressant inhibiting hunger signals from brain. Thus the fruit in its various derivatives like the Extreme Acai and Acai with White Tea has splashed its virtue all over the market. Juice bars carry this latest flavor and dieticians around the globe are vouching for this new-found success story.

What is good for the heart and the nerves in general was deemed to have some kind of benefit for lungs we supposed and yes we have got it dead right. It has been found out that the fruit activates the respiratory passages and improves the overall capacity of alveoli. Acai is being tried as a remedial measure for lung cancer patients. Though it is a trifle early to say but then the fruit in its pharmaceutical derivative might be the answer to deficits of respiratory tract which causes lung cancer in the first place.

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The statement in the title seems a misnomer. Most of us would vouch that the healthy elixir-like fruit of Amazon can only be a danger to toxins and low density cholesterols. Perhaps someone in each family is looking bright due to the supplementation of Acai and thus a great claim in favor of the fruit is building up in the country.

Acai is incorporated with great nutritional blessings. It has minerals, it has vital amines, it has fibers, and it has all kinds of monosaturated fats which help the suffering multitudes. Naturally, there are various herbal companies who are preaching the virtues of this fruit from the Amazon. People in South America and especially those from Brazil and Chile have soaked up the ready nutrition provided by it with kind appreciation. Now comes a time when excessive media attention has brought it to America in such a way that it has got a protected status in the Amazon.

Let us ponder over what might go wrong with the fruit. The first issue is the monosaturated fats present in the form of polyphenols and phytosterols. Though they are considered extremely useful for the heart, they might well turn the nausea taps on. They shift the low density cholesterol to oblivion but at the same time activate certain enzymes which create nausea. This nausea can come as a feeling of disturbed metabolism or a general bout of vomiting.

The omega acids present also manifest certain kind of allergy in few people though the instance is few and far between according the testimonials. We must remember that apart from taking juice at the bar counter what we largely take is a derivative of Acai berry and hence the product might be suitably blended for business interests These blends might contain stimulants which can be a ready cause for nausea, allergy and other disorders.

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Since brain tumours are unique and vary from patient to patient depending on their location and the stage, it is difficult to pinpoint the following symptoms as the true harbinger of the said disease as other diseases are also known to mimic similar symptoms. It is always advisable to seek medical advice to know the actual cause behind these painful symptoms.

Headaches and vomiting happen in the initial stages. An early morning nagging headache which is followed by nausea and vomiting is usually the starting point of a brain tumour headache. It gets worsened with sudden movements and exercises and general medicines are ineffective against the pain.

Seizures occur when the disease starts to progress. A common symptom, it arises due to abnormal flow of energy in the brain. This disruption can cause convulsions, muscle twitching in the arms and legs, numbness, difficulty in speaking and even loss of consciousness. It can also result in a loss of appetite, general ill feeling and lethargy.

Personality changes and mood swings are a common occurrence in brain tumours. Altered behaviour such as sudden mood swings, violent behaviour, inability to concentrate, impatience, confusion and a loss of inhibition can crop up depending on the part of the brain the tumour is located in. The pressure on the brain causes the noticeable behavioural changes.

Sudden loss of hearing or vision impairment should be immediately investigated. Double vision, ringing and buzzing in the ears, drooping eyelids, difference in pupil size and hearing loss are all indications of a brain tumour. Facial or partial paralysis can also happen suddenly.

Having a few of these symptoms are not an indication of a sure fire brain tumour. Since this disease isn’t so common ideally one should seek the advice of a doctor and get the investigations done to root out the reasons for these symptoms.

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Heart is a vital organ of our body .It is an organ that pumps the blood throughout our lifetime. So any disturbance in its work is bound to cause major concern. If the pumping action is ineffective then vital organs like Brain, Kidney will suffer. And if it stops working it results in sudden death in a few minutes.

Heart Disease is a general term used to describe a group of diseases. Coronary Heart Disease also known as Coronary Artery Disease (CAD).CAD is the most common cause of deaths in the United States and also in the developing countries where it is taking an epidemic forms. CAD affects seven million in USA .Each year, approximately 500,000 die due to CAD or related illness in the United States.

Diseases Coronary Arteries (CAD) are almost always caused due to atheroma (plaque) and its complications, particularly thrombosis. However coronary arteries are involved in other disorders such as congenital anomalies (like anomalous origin, fistula or malformations of a major coronary artery), aortitis, polyarteritis and other connective tissue disorders.

SYMPTOMS

Prevention is better than cure. When it comes to the heart, you should know, whether it needs any treatment or not before it starts malfunctioning, worse it stopped working! You must always be aware of the signs and symptoms of a possible heart attack.

1) Chest Pain or Discomfort

Chest pain is the most alarming of all the symptoms. Many people might confuse it with the Heart Pain .However a number of characteristics help to distinguish cardiac Pain from that of other causes Chest pain is incorrect term used to describe feeling of a squeezing, choking, constricting or “heavy”, numbness or any other discomfort in chest, neck, jaw and upper or even lower arms. The duration of pain or discomfort may last from a second to several minutes or days, to develop. The pain may occur frequently or rarely. It may be precipitated by exertion and relieved by resting.

2) Palpitation

Palpitations can be described as unpleasant awareness of irregular and / forceful contractions of heart. These may be signs of an underlying heart disease (arrhythmia) or due to other situations such as caffeine, stress overuse and even due to psychological disorders such as depression, anxiety. Conditions such as hyperthyroidism, low oxygen level in blood, hyperventilation, asthma, blood pressure. Unfortunately, palpitation could be a manifestation of serious conditions like Ventricular tachycardia, atrial fibrillation, supraventricular tachycardia (SVT) , Premature ventricle complexes (PVC ) , Premature Atrial complexes (PAC).

3) Lightheadedness or Dizziness

It can be either room spinning “ vertigo” or general lightheadedness can be caused by general weakness which could results from falling cardiac output , low blood pressure or arrhythmias , anemia ,dehydration , other blood disorder or even deconditioning ( getting up after prolonged bed rest ) , liver disease , kidney disease or even neurological disorders . However vertigo could results from stroke. Since the above symptom occur due to varied conditions it is important to know the exact cause and a thorough examination of all the organ systems related by a physician.

4) Fatigue or Lethargy

Fatigue, lethargy are a very common symptoms of heart disease. This can be attributed to the inability of heart to cope with the demands of organ systems placed during daily routine .However these symptoms can result due to malfunctioning of almost any organ system in the body , therefore it is important to know the exact cause Hence, a thorough examination is important to nail down the culprit.

5) Breathlessness

Breathlessness or Dyspnoea can be defined as an unpleasant subjective awareness of the sensation of breathing. It is a common symptom of cardiac and lung disease, Dyspnoea may be caused due to exertion or when lying on back as in cardiac patients .Sometimes patient wake up in the idle of night gasping for breath, this is known as paroxysmal nocturnal dyspnoea.

Shortness of breath should not be taken lightly as it has invariably an underlying disease therefore should be examined by the doctor.

DIAGNOSIS

With the recent advances in technology various methods are now available to help in diagnosis and treatment of heart diseases. The following are the tests used:

a) The Electrocardiogram (ECG / EKG)

b) Stress Testing

c) Cardiac Catheterization and Angiography

d) Echocardiography

e) Cardiac MRI

F) Transesophageal electrocardiography (TEE)

g) Holter Monitoring

h) Radionucliotide scanning

RISK FACTORS

Important factors considered a high risk in coronary artery disease are:

A) Fixed

It includes factors which cannot be changed or corrected. It includes age, male sex, and family history. CAD often runs in families. This may be due to genetic factors or effect of shared environment (similar diet, smoking habits, etc.)

B) Modifiable

Smoking: tobacco is considered most important avoidable cause of coronary artery disease

High Blood Pressure (Hypertension) incidence of CAD increases Blood Pressure rises

Lipid Disorder. Familial histories have higher chances of early CAD.

Physical Activity: Regular exercise (brisk walking, cycling, swimming for 20 minutes two or three times a week) has shown to have a protective effect

Obesity: it is usually associated with other factors like hypertension, diabetes and physical inactivity.

Alcohol: heavy drinking is associated with hypertension and other cardiac condition.

TREATMENT

Various treatment strategies are present that help increase the blood flow within the arteries.

DRUGS/MEDICINES

Beta Blocking drugs/blockers (atenolon, propranolon, nadolon) they act by decreasing the cardiac output .They have side effect like feeling tired, sexual disturbances, decrease in the fat content in blood and also might interfere with blood-glucose regulation.Calcium channel blocker (nifidipine, diltiazem, verapamil) they exert their action by relaxing the constricted blood vessels, thus lowering the raised blood pressure.Side effects include constipation, swollen legs.

Nitrates: These are quick acting drugs. They also cause dilatation of blood vessels.

Diuretics: They lower the blood pressure by increasing the fluid and sodium output of body through urination. When favorable results are not achieved can be given in combination with hypertension drugs.

(ACE) Inhibitor: Enalapril, captopril lisinopril. They act by increasing diameter and decreasing the blood vessel resistance

Balloon Angioplasty

It is a non-invasive technique used to open clogged arteries. It uses catheter through which a balloon is passed at the site of constriction. The balloon is then inflated thus opening the clogged vessel. Sometimes a hollow wire mesh is placed at the site which can be drug coated. Thus maintaining the lumen for longer time.

Bypass Grafting

It involves creating an alternate route for the blood to reach the heart. Using a vessel cut from leg. It is performed when there is severe compromise in cardiac blood supply. Also known as Coronary Artery Bypass Grafting (CABG).

Primary prevention

The efforts mainly involve:

- Identifying and treatment of high risk individuals To modify the lifestyle at a mass scale involving the whole population - Exercise regularly: a brisk walk for 10 minutes, swimming, all other sports activity. - Maintain ideal body weight. Eat healthy than less eating. Include a variety of nutrient dense food.

- Avoid eating all processed food, including polyunsaturated fats and even foods labeled as “low fat “.

- Avoid stress, take as much work load as you can easily handle. Use relaxation exercise to de-stress oneself.

- Take a healthy diet includes lots of fruits and vegetables as well as meat and dairy products.

Secondary Prevention

It involves minimizing the risk factors that has been established with coronary artery disease particularly smoking and cholesterol level in bl

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We all know its bad for us, we know its killing us drag by drag, and it’s not only affecting our body but also the bodies of those around us.

The lungs are coated with soot and smoke, breath smells foul, skin’s leathery, one’s always exhausted and then one day you awaken and decide STOP no more and stub out the last cigarette you have in your hand.

You do not smoke for an hour, 6 hours, 12 hours , a day a week a month, and feel proud of yourself as to what you have achieved, you can resist the constant allure of cigarette smoke wherever you are, be it in a movie theater coffee shop, DVD parlor, a restaurant, at a meeting in a disco etc.

You are amazed at the control you have on your mind and body.

But then one day everything seems wrong, you cannot concentrate, you are weak, you crave for the golden light just once, the craving is so strong that you cannot think, no matter what you do you are not able to divert your mind and think of anything else, the body desires it so much ..
Nicotine patches, gum, coffee nothing works, and you convince yourself okay just one single cigarette and you fall, suddenly you are back in the loop, you are a smoker once again…
Almost every person who has tried to quit smoking can associate with this story.

Various studies that have been carried out have shown that 2/3rds of smokers who quit quickly revert back in less than a year for nicotine is equally addictive as heroin and cocaine.

Quitting smoking is tough for it’s a vice that forms an integral part of one’s day to day activities. Smokers crave for a puff to get started in the morning, they need it when they are down or when they are happy, when having drinks, before and after work with meals when they have time to kill when they are tensed hell they even need it in the toilet that’s how important a part cigarette plays in a smokers life.

They see a cigarette not differently but rather as an extension of themselves. To succeed smokers need to break this link smoking has with their lifestyle else more often than not they are bound to fail.

Smoking is not an addiction of the body but rather an addiction of both body and mind, so any attempt to help someone kick the butt should work on both physiological and more so on the psychological factors, many times people fail because they just try and control the physiological part but nothing can be farther from reality smoking has a deeper psychological imprint on individuals than a physiological one, for around 2-3 days is the limit normally for the body to adapt within 72 hours of quitting the body carbon monoxide levels start reaching towards normal, but psychologically there is no time frame and it is very difficult to get over.

Many smokers quit when they are spooked from the slowly excruciating painful death because of smoking of someone they knew.

But due to peer pressure or stress they again breakdown and have a puff. Almost all the smokers will admit to the fact that the need is more psychological than physical.

Quitting smoking for good is not easy, but one can stop if he/she decides, the cessation has to be abrupt.

One can never quit slowly by reducing the number of packs smoked daily, because a smoker is a smoker be it 1 cigarette or 2 or a pack of 10, there’s nothing as a reduced smoker, either you are or you are not.

In many clinics where they help quit smoking, people undergo a detailed evaluation assessment and counseling to prepare them to quit smoking, sittings can range anywhere from 7-8 to 15, the team includes a clinical evaluator and most importantly a psychologist, these programs work by teaching how to quit and more importantly how to remain clean forever.

Each individual is unique and so is the tobacco cessation therapy rendered to them, and can or cannot include nicotine replacement aids and therapy.

One of the main things in such tobacco cessation clinics that help an individual quit, is that they help to identify triggers, as to why and what makes you to crave for a puff. It can be anything from a meal, a movie, an ashtray, a box of cigarettes, a person smoking his way to work, a cup of tea or anything else under the sun..

After one has identified what triggers you to smoke, one’s at an advantageous position on how to deal with it, when the desire for a puff strikes one needs to divert the impulse to give in and have a light. Engage yourself in an activity like listen to a song, do some exercise, call a friend, have a coffee break, read a magazine, go walk the dog, have a citrus fruit, be it anything whatever works for you to divert your mind, eat something that ought to quench the desire for a smoke.
Always remember it just takes a moment’s lapse of self control and you are back in the loop back a smoker, a relapse is never planned or expected, one says to himself “what harm will a single drag do” but the again that’s nothing more than fooling oneself for like I said earlier there’s nothing as a partial smoker either you are one or you are not.

Another novel way to help Quit smoking is via hypnotherapy this technique works on the principle of working on the subconscious mind to help it dissociate the positive feelings one has associated with smoking and replace and reprogram them. Every smoker remembers the first time they took a drag be it to impress a gal or to look cool, to defy the rules and be a rebel, all such memories act as a positive reinforcement, under hypnotherapy the therapist dwells deep in the subconscious mind and looks into the past and modifies the positive into neutral to help one quit easily.

It’s like mark twain said “to quit smoking is easy I have done it a thousand times” but to stay clean is tough that’s what I have to say but with a little determination nothing is impossible.

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