Present day life style of moving in air conditioned cars and remaining confined to AC rooms has been associated with increased incidence of cardiac diseases. It has also been seen that there is increase in cardiovascular events during the winter, particularly so, in the regions located in the high latitudes. Now researchers have found out that, these people have low vitamin D level in their blood; and correlated it to the increased incidence of heart diseases, asthma and many more diseases.
Vitamin D is synthesized in the skin by the activity of ultraviolet rays received from sun. Recent day life style leaves a little room for sun exposure. So there is low level of this vitamin in blood. Over protected children, not engaged in outdoor activity also get less exposure to sun and consequently a low vitamin D level in blood. Low vitamin D level decreases endothelial function. This decrease causes insulin resistance in type II diabetics and worsens diabetes status. It helps in formation of atheroma; a plaque composed of bad fat, calcium and some blood components; which may get deposited in the inner cell layer, the endothelium of coronary arteries. There is increase in blood pressure due to increase vascular resistance. All these factors combined together may be responsible for heart attack; whose incidence rises, particularly in the winter days in the region of high latitude.
Some years back, one of my friends asked me that a person known to him is having pain in the left arm while walking, compelling him to take a break; and gets back the pain sometimes after resuming his walk. I suggested an electrocardiogram (ECG), and as expected by me a coronary artery disease was diagnosed. This symptom is somewhat a tale tell story of angina pain of heart. In my childhood, I have seen dancing of some superficial arteries of old aged persons and surprised over it; now, I am clear about its cause i.e. it is due to thickening of wall of peripheral arteries from atherosclerosis. In atherosclerosis; there occurs deposit of cholesterol, calcium, some blood cells and some other components in the inner layer of blood vessels called intima. This is equally seen larger as well as smaller blood vessels in the body. Smoking is an important cause of atherosclerosis.
Recently, researchers have found out the role of immune cells in the formation of atheroma after triggering an inflammation in the intima of blood vessels. Drugs targeting these cells also cause harm to useful effects of these cells. So, now they are targeting research, how to destroy the bad effect of cells leaving ahead the good effects. They also found out one molecule that switches on the harmful effect of these immune cells. The new research will be focusing more on blocking the action of the molecule.
Pot bellied persons due excess abdominal fat; the apples are prone to develop atherosclerosis than the pears; persons having fat deposit around hip, researchers say. Smoking, alcohol, sedentary life style and more saturated fat consumption are some of the contributing factors for atherosclerosis. Measurements of waist circumference (WC), waist to hip ratio (WHR) and Body mass index (BMI) are some of predictors of risk of heart attack. Waist circumference >32 inches in female and >37 inches in male have the risk of heart attack. Persons having WHR > 0.7 and BMI >30 are at the risk of developing atherosclerosis.
Aspirin appeared and used fro treatment of headache alone or in combination with paracetamol and caffeine long time back .It was very much an effective remedy.But is notorious to cause stomach problem in form of gastritis, ulcers and bleeding.Then it was not used for many years till its beneficial effect in myocardial ischaemia and infarction was rediscovered.In low doses, as low as 75 mgs per day is prescribed to myocardial infarction patients to keep their blood more fluid i.e. to prevent thrombosis.It is also prescribed in combination with other thrombolytic agents.The advantage it has is low cost and easy availability. It is said that if heart attack is suspected and nothing is found a tablet of aspirin will prevent much damage to heart muscle.The potential side effect ,gastrointestinal bleeding can be prevented by other anti-ulcerogenic drugs. Researchers also say that aspirin helps in early diagnosis of colon cancer.The hall mark of colon cancer is painless bleeding per anus besides other symptoms.the bleeding tendency is probably facilitated by aspirin. It is still the drug of choice for a very important disease called Rheumatic arthritis having much dreaded sequelae of rheumatic heart disease. So in right doses and judicious combination it is a panacea for health.
The thicker slice is the left side and and the separator is the mitral valve.
“It leaves joints and bites the heart” is well said.Rheumatic arthritis has this notorious reputation.Most commonly affects a female of younger age group,usually having a history of long standing throat infection in the past.Bigger joints such as knees,elbows,ankles and hips are affected. Both sides are affected and shifts from one to other.Affected joints are greatly swollen,extremely painful and crippling associated with fever.This arthritis may occur several times to subside even without treatment.This is classified under the group of collagen diseases.The arthritis is diagnosed and confirmed basing on the Jone’s criteria.
After some time, over years it may affect the one way valve of left side of heart which regulates blood flow collected from the lungs after addition of oxygen and removal of carbon dioxide.The valve becomes rigid and narrowed in the course of disease to hamper the easy flow of blood. So swelling of face followed by extremities even abdomen occur with breathlessness and weakness.The patient may not be able to follow his/her day to day pursuits.This is called Mitral Stenosis.
Some eleven years back one known to me asked about his relative who was getting pain in his left shoulder and becoming breathless while walking.The presumptive diagnosis was somewhat straight forward.And an ECG revealed that he is suffering from Myocardial Ischaemia.The typical description of angina pectoris pain is a feeling of severe compression of chest ,a squeezing or a sharp pain in the left lower chest lasting for minutes and radiating to neck,shoulder tip,axilla,Lt. arm,back,right side of chest and upper abdomen.Unfortunately this typical description is lacking in many.
Other symptoms of Myocardial Ichaemia include sweating,breathlessness,stupor,fainting , vomiting and many other atypical ones. But in a physically active person with regular brisk walk having some burning symptom of upper abdomen and normal ECG in two different occassions ,it is hard to digest that he is suffering from myocardial ischaemia.But later his description of this burning sensation and discomfort of upper abdomen while walking, compelling him to take breaks two to three times in about two kilometers distance should have given rise to suspicion of ischaemia. Eventually an ECG on that day revealed a change in ECG prompting an urgent treatment.Further an angiography revealed narrowing in one of the branches of a main coronary artery and he was treated according.Also it was noticed that the artery in question was little less in caliber than usual.During review of literature in the Wiley Interscience database it was seen that narrow coronay may go for spasm.And I think this must be happening during an exercise while there is demand for more oxygen in the myocardium i.e. heart muscle.
But the lesson is that highest degree of suspicion till ischaemic heart disease is excluded confidently.
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Headache ???
