Monthly Archives: December 2016

What Are The Characteristics Of Heart Disease

Heart disease impacts the lives of millions of Americans each year so understanding what are the characteristics of heart disease is a subject of great interest to many. This is especially true for those who have one or more of the risk factors associated with this condition.

The risk factors of heart disease fall into two categories; those that can be controlled and those that can cannot. The latter group includes age, being a man, and heredity. While growing older in itself doesnt cause heart disease, statistically it is known that most deaths from a heart attack occur after the age of 60. Additionally, as people age the ratio of heart disese between men and women tends to narrow and become virtually equal by the age of 62.

When asking what are the characteristics of heart disease certainly genetics should always be something carefully weighed. Individuals with a parent who suffered a heart attack because of arterial blockage at a relatively young age are at greater risk for the disease.

But while age, gender, and heredity are unavoidable there are a number of factors which can be reduced or even eliminated. At the top of this list is not smoking and avoiding second hand smoke. It has been known for years that tobacco smoke increase the risk of plaque deposits in the arteries which in turn greatly increases the chances of heart attack, and sudden death. Smoking also reduces the amount of high density lipoproteins (good cholesterol) in your bloodstream thus raising the concentration of bad cholesterol and triglycerides. It is pretty much a given that giving up smoking is essential to cardiovascular health, and ultimately reducing ones chances of becoming another heart attack statistic. It should also be pointed out that the combination of smoking and high blood pressure more than doubles a persons chances of having a heart attack.

Diabetes is another serious concern. Men with diabetes are 2.5 times more likely to have coronary artery disease, while women are 5 times more likely. It is also not uncommon for a diabetic to have a total cholesterol reading of 500 mg/dl which is well over the 240 mg/dl considered to be high risk.

But some would argue that the two factors that a person has the most control over linked to heart disease are diet and weight management. Surprisingly, being as little as 20 percent over your ideal weight increases dangerous blood cholesterol levels. By implementing a weight loss plan that is both low in saturated fat, cholesterol, and in calories you will be taking an important first step in avoiding that unexpected trip to the emergency room.

Note: Early warning signs of heart disease are chest pain, shortness of breath, swelling of the ankles, irregular or rapid heat beat, lethargy, and unexplained spells of light-headedness.

What else? As a preventative approach many are finding lifestyle modification along with a natural cholesterol supplement to be a very effective one two punch in the fight against heart disease. If you are interested in learning more about what are the characteristics of heart disease or natural cholesterol reduction supplements Click Here

The Japanese Chin Is A Healthy Breed With A Few Health Problems To Look Out For

The Japanese Chin is a very old Oriental breed who was considered by many to be of royalty. They originally lived with the Chinese Aristocracy and eventually lived at the Imperial Palace. It is believed that the Chinese so admired these dogs that the Chinese Emperor gave a pair to the Emperor of Japan. In Japan the Japanese Chin was kept by the Noble who used them as gifts to very special people.

In 1853 Commodore Perry visited Japan. While he was there he was given several Japanese Chins. He gave a pair to Queen Victoria, Admiral Perrys daughter and to the President. This was the introduction of the Japanese Chin to England and North America. The Japanese Chin had been known as the Japanese Spaniel until 1977. In 1977, the name of the breed was officially changed to the Japanese Chin.

The Japanese Chin is a dainty little toy breed with a distinctive oriental expression. I am so amazed at how the Oriental people created these dogs with this type of expression. I feel it was a work of art and genius. The Chin is a regal little dog who displays himself in a very proud aristocratic manner. He stands about 8 to 11 inches at the shoulder and weighs between 4 and 11 pounds.

Interesting to note about the Japanese Chin is that he uses his paws to wash his face like a cat.

The Japanese Chin like other Oriental breeds is a fairly healthy dog with a life expectancy of 12 to 14 years. However, as with all dog breeds, small or large, there are a few diseases to watch out for especially in the Japanese Chin. They are:

Heart disease;
Dyspnea;
Dislocated knees.

Dilated cardiomyopathy (DCM) is characterized by dilation or enlargement of the heart chambers and markedly reduced contraction. Symptoms to watch out for this disease in the Japanese Chin are:

Shortness of breath;
Coughing;
Exercise intolerance;
Collapse;
Sudden onset of pain and paralysis, usually in the back legs.

The start of these symptoms should alert you that your Japanese Chin is in need of emergency medical treatment.

Treatment of DCM is usually drug therapy. Administer all advised veterinary medications. Watch for difficulty in breathing, increase in coughing, lethargy or sudden inability to use one or more limbs. Notice the breathing rate when your pet is relaxing. Regular veterinary visits to monitor the condition are required.

DCM is very common in dogs. The canine disease is acquired in life, but is influenced by genetic factors still not explained.

Dyspnea is actually respiratory distress. It is labored, difficult breathing or shortness of breath. The causes of dyspnea could be any of the following:

Heart disease or heart failure;
Lung disease;
Tumors or cancer in the lung;
Infection such as pneumonia;
Trauma;
Bleeding into the lungs or chest;
Abnormal fluid accumulation in/or around the lungs.

Brachycephalic breeds such as the Japanese Chin (short faced breeds) are predisposed to upper airway problems.

Symptoms to watch for:

Coughing;
Shortness of breath;
Difficulty breathing;
weight loss;
Fatigue.

The treatment for dyspnea depends upon the underlying cause. Treatment may include:

Hospitalization with administration of oxygen;
Minimizing stress;
Draining the fluid that has accumulated around the lungs;
Diuretics;
Combination drug therapy.

True Dyspnea is usually an emergency. When you first note your pet having trouble breathing, note his general activity, exercise capacity and interest in the family activities. Note the presence of any coughing or severe fatigue and report these symptoms to your vet for further a diagnostic evaluation.

Dislocated knees are a condition in which the patella (knee-cap) no longer glides within its natural groove in the femur. Dislocated knees can occur as a result of trauma or develop during the first year of an animals life. Congenital or developmental dislocated knees are more common. It is more commonly found in small dogs such as poodles, Yorkshire terriers, Maltese and the Japanese Chin. Traumatic dislocated knees usually occurs secondary to being hit by a car at any age.

Treatment in low grade cases can be managed with restricted exercise and non-steroidal anti-inflammatory medication. More severe cases can be addressed surgically.

When selecting your Japanese Chin it is wise to ask the breeder about the history of patella problems in the bloodline.

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Preventing Heart Attack

DID YOU KNOW?

In 2008, heart related diseases accounted for 24% of all deaths caused by non-communicable diseases. In other words 12,57,936 people died of heart diseases or cardiovascular diseases (CVDs).

In 2004, total number of deaths due to ischaemic heart disease (IHD) was 5,54,194. Out of that 2,55,782 people died in urban areas while 2,98,412 died in rural areas.

The total number of DALYs for IHD in 2004 was estimated at 1,60,00,808. (1 DALY equals one lost year of healthy life.) The total number of YLL (Years of Life Lost due to premature death) for IHD stood at 49,52,150.

Cardiovascular disease (CVD) related deaths are expected to rise from 27 lakh in 2004 to 40 lakh by 2030.

The prevalence of coronary heart disease (CHD) ranges from 6.6% to 12.7% in urban and 2.1% to 4.3% in rural India, among those aged 20 years or older.

It is estimated that there are currently 3 crore CHD patients, with 1.4 crore residing in rural and 1.6 crore in urban areas. But these are likely underestimates given that surveys do not include those CHD patients without the symptoms.

As compared to other countries CVD in India is characterized by early onset and premature death and higher cases of deaths related to complications from CVD. Also the diseases manifest more easily in Indians than their Western counterparts, particularly from risk-factors like overweight and obesity.

CVD disproportionately affects the young in India with 52% of deaths occurring under the age of 70 years compared to just 23% in Western countries.

Consequently, the country suffers a very high loss in potential productive years of life because of premature CVD deaths among those aged 35 to 64 years: 92 lakh years lost in 2000 and 1.79 crore years expected to be lost in 2030.

HOW DO I KNOW IF I’M HAVING A HEART ATTACK?

A heart attack takes place when blood supply to a part of the heart is interrupted, causing heart cells to die. The interruption is caused by accumulation of fatty particles called plaque inside the walls of the pipes (arteries) carrying blood to the heart. A lack of blood supply results in the shortage of oxygen, which if left untreated for a sufficient period of time leads to death.

A heart attack is a medical emergency and should be attended to with highest priority. The most common symptom for a heart attack is chest pain. The sensation is often described as tightness, pressure or squeezing. The pain may be felt in only one part of the body or it may also move from the chest to the left arm (most often), lower jaw, neck, right arm, back, and upper central region of the abdomen. Other symptoms of a heart attack include anxiety, cough, fainting, light headedness/dizziness, nausea or vomiting, palpitations, shortness of breath and sweating which may be heavy.

HOW CAN I PREVENT IT?
Cardiovascular diseases such as coronary heart disease (CHD) or ischaemic heart disease (IHD) lead to a heart attack. Such diseases are non-communicable, i.e., they do not spread through infection or contamination. Also known as lifestyle diseases, their onset depends on health habits in most cases. Keeping the blood pressure in strict control by eating food that is less in fat and oil content, cessation of smoking, limitation of alcohol intake and regular physical exercise can reduce the incidence of heart diseases and heart attacks by a great margin. In addition, regular screening of the heart with a preventive health check-up helps in early detection of blockage. Some of the tests commonly recommended are lipid profile, 2D echocardiogram, CT scan, etc.

Obesity and Heart Disease

We only have to look at a Titian painting to recognize that at one point in the history of Western culture, fat was considered beautiful. Before the 20th Century, corpulence was touted as a sign of wealth and luxury, largely because most people were barely surviving on a meager existence.

Ironically, now in our era of affluence and plenty, we have to contend with the health and economic problems of obesity. We have a population in North America that is more than 55% overweight. More than 20% of those overweight are considered obese, a situation which proves to be an economic burden on our Health Care system because of the coronary risk factors associated with obesity. In 2004, total national health expenditure in the USA was $1.9 Trillion or $6,280 per person.

Why is obesity a risk factor for heart disease?

Among obese individuals, triglyceride levels are unusually high, while HDL levels tend to be low; both of these situations are risk factors for heart disease .A recent study involving tissues collected from autopsies of 3000 men (15-34 years old) who had died of external causes (not heart related) identified an association between obesity and coronary atherosclerosis.

Abdominal fat which characterizes obese individuals is also an area of concern. A study of 1300 Finnish men (42-60 years old) suggests that abdominal fat is an independent and major risk factor for coronary events. Several reasons have been suggested for this: a) stomach fat is continually released into the bloodstream in the form of artery-clogging fatty acids; b) abdominal fat also releases compounds that facilitate risk factors such as atherosclerosis, metabolic syndrome and inflammation; c) abdominal fat initiates biochemical events that lead to insulin resistance, a precursor of Type 2 diabetes and heart disease.

Obesity is often a precursor to metabolic syndrome, a dangerous health situation that is manifested through a cluster of symptomsexcess body fat, insulin resistance, low HDL cholesterol, high triglyceride levels and high blood pressureall risk factors for coronary events. People with metabolic syndrome release immune system messengers called cytokines into their bloodstream. Cytokines lead to a communication breakdown between body cells and insulin which leads to excessive insulin production by the pancreas, creating a situation that is a literal time bomb for heart disease . In addition, this excessive insulin production can raise fibrinogen concentrations in the bloodstream, thus allowing blood to clot more easily, a situation that is a direct risk factor for heart attacks and strokes.

Because of their size, obese individuals are more often than not sedentary in lifestyle. Inactivity in and of itself is also a coronary risk factor. Data from more than 88,000 women in the Nurses Health Study shows that a lean sedentary woman had 1.48 greater risks for coronary heart disease than a slightly heavier but physically active woman.

Heart Disease In Women Treatment And Prevention

Heart disease in women is the same in men. But symptoms trigger often in women than men. Why is this so? What is chelation? Can Detoxamin help relieve symptoms of your heart disease?

Heart disease is the leading killer in women in the United States. As a women grows older, the higher the risk that she’ll have a heart disease. But it doesn’t mean other age groups can’t be affected. Though the main cause is lifestyle, some cases are due to genetic problems, family history and underlying medical illnesses.

The most common heart diseases are arterial plaques or arthrosclerosis. It is the narrowing or complete blockage of the arteries which carries oxygen to the heart. It is the main reason why people get a heart attack. A couple of seconds the heart can’t get oxygen, an attack could occur. Symptoms like angina attacks, fatigue, and increased blood pressure could result in this situation. Warning signs include severe angina attack and pain radiating to the left shoulder as well as the neck.

Risk factors of heart disease in women include high blood pressure, stress and depression, lowered levels of estrogen (a hormone only found in females) and cigarette smoking. Depression is the most common factor in triggering an attack in women. It is because, as we all know, women are more emotional and worriers than men. Depression is difficult to prevent, especially in women. It is their nature to worry about things and having anxiety. This situation can be complex to maintain a good and healthy lifestyle.

Treatments of heart diseases include drug regimens, natural or herbal remedies, supplements, home treatment, surgery and alternative medicine. Drugs include nitroglycerin patches for angina attacks, and analgesics. Some people rather choose to use alternative ways than taking medicines. They are known to have lesser side effects than drugs.

Chelation therapy is an example of an alternative. It works by removing plaques in the arteries by a chelating agent. Detoxamin is type of chelating agent used by many. It said that it is capable to remove arterial blockage and maintains regular blood pressure, not only for women but also for males.

This product is a suppository type of chelation treatment. It is because IV chelation can be very expensive and inconvenient, so they made a brand which can save you money and resources. This brand is said to be scientifically proven and safe to use.

Prevention of heart disease is through lifestyle change. Modifying your diet, having a regular exercise and decreasing anxiety levels are good things to do. Coping with stress and depression can be managed by seeking help from support groups or even by your friends or relatives.

Heart disease especially in women can be very risky due to the triggering factors. An alternative like Detoxamin can be a help, but consulting your doctor for an advice is necessary. Heart disease in women can be life threatening, so having enough knowledge on its treatment and prevention is a must.

Chronic Obstructive Pulmonary Disease. Copd

Plan of Attack
Definitions
Epidemiology
Goals of Management
Diagnosis
Managing Stable COPD
Managing Acute Exacerbations of COPD

A disease state characterized by airflow limitation that is not fully reversible. Airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. Symptoms, functional abnormalities, and complications of COPD can all be explained on the basis of this underlying inflammation and the resulting pathology.
Definitions
Chronic Bronchitis (clinical)
Sputum production more days than not for at least 3 months a year for at least 2 years
Emphysema (pathologic)
Parenchymal destruction airspace walls distal to terminal bronchioles, without fibrosis
Important: You can have either, but to have COPD you MUST demonstrate obstruction (thus the O in COPD)

Epidemiology
Fourth leading cause of death in U.S.
100,000 American deaths each year
15-20% of chronic smokers develop COPD
2.5% mortality for COPD hospital admissions
COPD with acute respiratory failure:
24% in hospital mortality
59% one year mortality
If you have COPD and PaCO2 > 50mmHg:
67% chance of being alive in 6 months
57% chance of being alive in 12 months

Diagnosis
Symptoms
Dyspnea
Sputum production (especially in the morning)
Recurrent acute chest illnesses
Headache in the morning possible hypercapnia
Cor pulmonale (Right heart failure)

Goals Of Management
Identifying and ameliorating (if possible) the cause of the acute exacerbation
Optimizing lung function by administering bronchodilators and other pharmacotherapy
Assuring adequate oxygenation and secretion clearance
Averting the need for intubation, if possible
Preventing complications of immobility, such as thromboemboli and deconditioning
Addressing nutritional needs at the time of the acute illness, most patients are in negative nitrogen balance, which is exacerbated by steroid therapy

Diagnosis:
Signs
Prolonged expiratory time
Expiratory wheezes
Increased AP diameter of chest
Decreased breath sounds (especially upper lung fields)
Distant heart sounds
End stage: accessory muscles, pursed lip breathing, cyanosis, enlarged liver and pedal edema (in case of cor pulmonale).

Diagnosis
Radiology
Chest X-ray
Hyperinflated lung fields more radiolucent
Bullae, often bilateral upper lobes in smokers
Flat diaphragms (best seen on lateral) and retrosternal airspace can indicate air trapping
High Resolution CT of Chest
Most sensitive to detect above changes
No role in routine care of COPD patients
Can be useful for giant bullous disease surgeries or lung volume reduction surgery planning

Diagnosis
Pulmonary Function Testing
Spirometry: Decreased FEV1/FVC
FEV1 percent predicted defines severity
Lung volumes: Increased TLC, RV, RV/TLC
DLCO: Decreased

Gold Staging Criteria
Stage O: Normal spirometry; chronic sx
Stage 1 (Mild):
FEV1/FVC 80% predicted
Stage 2 (Moderate):
FEV1/FVC
2A: FEV1 50-80% predicted
2B: FEV1 30-50% predicted

Diagnosis
Stage 3 (severe):
FEV1/FVC
FEV1
FEV1

Diagnosis
American Thoracic Society Spirometry
Low FEV1/FVC defines obstruction
FEV1%predicted Category

35-50% Severe
50-60% Moderately Severe
60-70% Moderate
70-80% Mild
80-100% Mild vs. Normal variant
> 100% Normal

Managing Stable COPD
Smoking Cessation Is KEY!
YOUR intervention will make a difference must address at each visit
Medication
Two therapies ONLY have been shown to improve mortality in stable COPD:
1) Smoking Cessation
2) Oxygen Therapy

Bronchodilator Technique
MDIs get better drug deposition than nebs
Use a spacer device with MDIs
Technique is key important for patient and doctor
Inadequate dosing can hamper treatment

Sympathomimetics
Beta-2 selectivity is good
Some additive vs. slightly synergistic effects of combining beta-2 agonist and ipratropium (Combivent)
Some data to support decreased H.influenzae pneumonia incidence with Serevent
Anticholinergic Agents (Atrovent, glycopyrrolate)
Similar ability to bronchodilate (in appropriate doses) as beta-agonists
Also reduces sputum volume; no change in viscosity
Usually under dosed
Recommend 2 (36 mcg) puffs qid
glycopyrrolate which is manufactured for IV/IM use for other indications, is available only “off label” for nebulized use in COPD (1 to 2 mg every two to four hours).
Aminophylline and theophylline are not recommended for the management of acute exacerbations of COPD. Randomized controlled trials of intravenous aminophylline in this setting have failed to show efficacy in excess of that afforded by therapy with inhaled bronchodilators and corticosteroids

Mucokinetic agents
There is little evidence supporting the use of mucokinetic (mucolytic) agents, such as N-acetylcysteine or iodide preparations, in acute exacerbations of COPD. In fact, some drugs of this class may worsen bronchospasm.

Oxygen. Yes.
Demonstrated to improve exercise performance, symptom indices and mortality
Goal in hypercapnic patients for SpO2 need not be greater than 88-90%
Always test COPD patients for oxygenation with ambulation if baseline at rest room air SpO2 ok

Systemic Corticosteroids
Never demonstrated to significantly impact mortality or exercise capacity
Slight improvements in symptom indices
Significant side effects
Rarely of benefit, generally of harm to your patient
Occasionally useful in a small subset failing other therapies AND with demonstrated bronchodilator response on PFTs

Inhaled Corticosteroids
Jury still out
Lots of recent research with some favorable data supporting its use
May be part of standard regimens in the future

Vaccines
Pneumovax, annual flu shots
Chronic antibiotic therapy BAD IDEA
Nutritional status Important
Pulmonary Rehabilitation
Improved exercise capacity, symptom scores
Lung Volume Reduction Surgery
Transplant

Managing Acute Exacerbations of COPD
Common precipitants:
Infection esp viral or bacterial
Acute bronchospasm
Sedation

Who To Admit
Countless studies, few definite answers
Worsening hypoxemia and/or hypercapnia
Otherwise, mostly a clinical decision
Key points to consider:
Oxygen
Bronchodilators
Steroids
Antibiotics

Albuterol:
Neb or MDI neb MAY be better in acute setting, but MDIs have better drug deposition overall
Continuous nebulizer treatments confer no benefit over treatments every 1-2 hours
Generally should avoid subcutaneous beta-agonists
BEWARE: Hypokalemia, tachycardia (occasional)
Levalbuterol still with weak clinical data few situations where it is clinically indicated

ATROVENT (anticholinergic bronchodilator)
Bronchodilation
May decrease secretions
Few significant side effects
Usually significantly under dosed emerging data supports much higher doses than usually used currently

Corticosteroids Parenteral corticosteroids are frequently used in treating acute exacerbations of COPD. Methylprednisolone (60 to 125 mg intravenously, two to four times daily) or the equivalent glucocorticoid dose of other steroid preparations commonly is given.
Corticosteroids Utilization in this setting was initially based upon small randomized trials in which only a minority of patients benefit and the degree of improvement is modest
A randomized, placebo-controlled trial of 271 patients has confirmed the benefits of systemic corticosteroids given for up to 2 weeks to hospitalized patients with COPD exacerbation

Antibiotics
Winnipeg Criteria (give for 2-3 of the following):
Increased cough
Increased purulence
Increased sputum production
Antibiotics accelerate improvement in peak expiratory flow rates and lessen the rate of recrudescence in this setting
Amoxicillin, Doxycycline, TMP/SMX, Azithromycin, Clarithromycin, Levaquin for 10 days

Mucokinetic Agents JUST SAY NO.
N-acetylcysteine is actually contraindicated in patients with airway obstruction
No significant clinical benefit ever demonstrated
Chest PT, intermittent positive pressure breathing and postural drainage may actually be harmful in the setting of acute obstruction

Methylxanthines (Theophylline, Aminophylline)
Not recommended for acute exacerbations
No significant benefit ever demonstrated in large, prospective trials

Oxygen: YES!
Generally a good thing cells like that stuff
If requiring a significant increase in FiO2 over baseline requirement, start hunting for something other than just COPD exacerbation
BEWARE of CO2 RETAINERS! (goal SpO2 90%, PaO2 of 60 to 65 mmHg )
1) Altered V/Q relationships
2) Haldane effect (Hgb*O2 holds less CO2 goes out into plasma)
3) Decreased ventilatory drive (least impt mechanism)

Non-Invasive Positive Pressure Ventilation
BiPAP
Set FiO2, inspiratory (IPAP) and expiratory (EPAP)
Difference between IPAP and EPAP augments tidal volume, therefore improving minute ventilation. CO2 then gets blown off
MORTALITY BENEFIT in patients who will tolerate

Mechanical Ventilation
Respiratory distress
Acidemia that does not correct quickly with therapy
Inability to oxygenate adequately
Often a clinical decision relative to patients work of breathing