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Category : All ; Cycle : February 2011
Medical Articles
Feb13
FORMS OF ACUTE CORONARY SYNDROME (ACS)
Acute coronary syndrome or ACS is an umbrella term used for any condition characterized by symptoms of acute myocardial ischemia caused by an abrupt reduction in blood flow to the heart. Three related but distinct clinical entities fall under the category of ACS; Unstable Angina (UA), Non ST segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI)
Unsable Angina; This occurs when a thrombus partially or intermittently blocks blood flow through a coronary artery. It is characterized by the development of chest pain that may or may not radiate. The chest pain may be associated with additional symptoms such as dyspnea, diaphoresis, nausea, lightheadedness, elevated heart rate, hypo or hypertension, and arrhythmias. Chest pain occurs with rest or exertion: the pain and associated symptoms are severe enough to limit the patients activity. A 12 lead ECG will show transient / temporary ST- segment depression or T-wave inversion. Cardiac biomarkers are not elevated. Chest pain that occurs with minimal exertion or requires an increasing dose of sublngual nitroglycerine to obtain relief is defined as UA. It also includes prolonged episodes of chest pain at rest, any chest pain that increases in severity, or any chest pain that is very severe upon first presentation.
NSTEMI; Also occurs when a thrombus partially or intermittently blocks blood flow through a coronary artery. On initial presentation, it may be difficult to differentiate between UA and NSTEMI. Like unstable angina, it is characterized by chest pain that may or may not radiate to the arm, neck, back or epigastric region. The chest pain may be accompanied by additional symptoms such as dyspnea, diaphoresis, nausea, lightheadedness, tachycardia, hypo or hypertension, arrhythmia and a drop in oxygen saturation. Pain may occur at rest or with activity. Compared with UA chest pain in NSTEMI lasts longer and is more severe. A 12 lead ECG may show signs indicative of myocardial ischemia.; ST segment depression or T wave inversion. Diagnosis of NSTEMI is made on the basis of elevated cardiac biomarkers.
STEMI; Occurs when a thrombus fully occludes a coronary artery resulting in necrosis of part of the myocardium. Development of an acute MI is characterized by a central necrotic area surrounded by zone of injury. Tissue in the zone of injury can recover if blood flow is restored quickly enough; if it is not, the area of injury will become necrotic. The zone of injury in turn, is surrounded by outer zone of reversible ischemia. Like other forms of ACS, STEMI is characterized by chest pain that may or may not radiate to the arm, neck, back, or epigastric region. Accompanying symptoms may include dyspnea, diaphoresis, nausea, lightheadedness, tachycardia, tachypnea, hypo or hypertension, a drop in oxygen saturation and arrhythmias. Also like UA and NSTEMI, this pain may occur at rest or with exertion and is severe enough to limit the person's activity. Quantitatively, pain is longer in duration and more severe than chest pain in UA. Definitive diagnosis of STEMI is made on the basis of 12 lead ECG changes indicative of MI. Serum biomarkers are elevated.
Adherence to evidence based guidelines for the management of ACS has been associated with better patient outcomes and decreased risk for subsequent cardiac events such as recurrent ischemia/ infarct.


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Feb01
KEYHOLE HEART SURGERY-guidelines
INTRODUCTION
Coronary bypass surgery without cutting sternal bone sound like description of a cardiac surgery of future but at Ahmedabad this ground breaking advances in surgical treatment of heart disease
is now reality. Fracture created on the sternum hurts patient and worries them the most most of the patient can be discharged from the hospital within 48 to 72 hrs, and return to full activity within a week or two.

Recommendations for Keyhole(MIDCAB) bypass
surgery should be perform if any of the below
criteria are met.

· Patient with very old age particularly female because of
osteoporotic bone.
Patient who is engaged in manual labors.
· Patient with failed angioplasty with CTO lesions.
· Patient with double vessel disease.
· Patient with triple vessel disease.
· Patient with LMCA with triple vessel disease.
· Patient with compromise LV with triple vessel disease.
· Patient with very bad LV function with Tripple vessel disease in
whom CABG+stem cell therapy is indicated.
· Patient with very bad LV function with triple vessel disease in
whomCABG+TMR is indicated.
· Patients with CABG+AVR.
· Patient with CABG+MVR.
· Following are NOT contraindication to Keyhole surgery.
· Very obese patient.
· Very old patient.
SYNONYMS:
Keyhole surgery, Minimally invasive cardiac surgery, sternal sparing
heart surgery, Video assisted cardiac surgery, port access heart
surgery.


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Feb01
How You Can Have Better Sexual Life...
Erectile dysfunction, which affects an estimated 30 percent Indian and is more prevalent in men over 40, is defined as the inability to achieve or maintain an erection adequate for sexual function. Erectile dysfunction (ED) is common in older men. But it's not a normal part of aging. I recommends getting evaluated for cardiovascular risk if there is a persistent erectile issue that lasts for three months or longer.

Recent research has also shown that ED may be linked to diabetes, high cholesterol, hypertension, as well as the early stages of heart disease, so encouraging your man to set up a check up with his doctor is a good starting point.

The problem is, there are men who don’t come in because of embarrassment and denial. If a man develops erectile dysfunction, he has a window of opportunity to make some lifestyle changes that may reduce his risk of having a heart attack.

How can you avoid ED? Here's what you can do.

1. Avoid high blood pressure and high cholesterol.

More than 50% of adults with diabetes have high blood pressure or take blood pressure medication. The combination of high blood pressure and diabetes also increases the risk for blood vessel damage, further reducing blood flow. Eventually, this can lead to ED.

Do regular cheack up with your doctor for your cholesterol levels and blood pressure.

2. Maintain a healthy weight.

Being overweight can bring many health problems, including type 2 diabetes, which can cause nerve damage throughout the body. If that affects the nerves affecting the penis, ED can result. Complicating matters further, the more body fat you have, the higher your level of SHBG (sex hormone binding globulin). The more testosterone that is bound to SHBG, the less there is available to stimulate desire. So lose a little weight, even 5 kg, can often free up testosterone and almost immediately give a boost to your love life.

3. Watch what you eat.

A diet that's bad for a man's heart is also bad for his ability to have erections.

If you eat a heart-healthy diet, the benefits to your heart will improve the blood flow to other organs in the body. And increasing the blood flow to sexual organs will increase desire and function. The same eating pattern that can cause heart attacks by impeding blood flow in the coronary arteries. Lots of fatty, fried, and processed foods can impede blood flow to and within the penis. That blood flow is needed for the penis to become erect.

Eating the right kinds of foods are just the prescription for a healthier sex life. Anything that is bad for a man's heart is also bad for his penis. Even simple diet modification such as following a low-fat diet and eating lots of fruit and vegetables that help get blood sugar and cholesterol under control can also help turn your sex drive around even if you don't lose weight.

4. Drink alcohol in moderation or not at all.

There is no evidence that mild or even moderate alcohol consumption is bad for erectile function. But chronic heavy drinking can cause liver damage, nerve damage, and other conditions that can lead to ED.
5. Do not take stress.

Psychological stress boosts levels of the hormone adrenaline, which makes blood vessels contract. That can be bad news for an erection. Anything a man can do to ease tension and feel better emotionally is likely to give his sex life a big boost.
6. Keep tabs on testosterone.

Even in healthy men, testosterone levels often begin falling sharply around age 50. Every year after age 50, a man's testosterone level typically falls about 2.0%.

Symptoms like a low sex drive, moodiness, lack of stamina, or trouble making decisions suggest a testosterone deficiency, as do spongy erections.
7. Avoid anabolic steroids.

These drugs, which are often abused by athletes and bodybuilders, can shrink the testicles and sap their ability to make testosterone.
8. If you smoke, stop.

Smoking cigarettes can harm blood vessels and curb blood flow to the penis. And nicotine makes blood vessels contract, which can hamper blood flow to the penis.
9. Steer clear of risky sex.

Some cases of erectile dysfunction stem from penile injuries that occur during sex. To keep your penis from bending painfully, start thrusting only after making sure her vagina is well lubricated. And make sure your penis doesn't slip out of the vagina while thrusting (so you won't accidentally jam your penis against a hard part of her body). If she moves in such a way that hurts your penis -- for instance, by bending it the wrong way -- have her stop at once.

If the woman is on top and comes down hard, and the penis does not enter the vagina, that is the equivalent of a big weight crashing down on the penis. No penis on earth can withstand that.
10. Exercise regularly.
Getting regular physical activity is an easy way to boost your sexual prowess. Adults who exercise regularly not only have increased levels of desire, but also enhanced ability to perform sexually and greater sexual satisfaction, Strong evidence links a sedentary lifestyle to erectile dysfunction. Running, swimming, and other forms of aerobic exercise have been shown to help prevent ED. One exercise for women is the Kegel -- the same exercise gynaecologists recommend to keep the pelvic floor strong during pregnancy. These muscles can increase pleasure sensations during sex. They're the same muscles you use to stop the flow of urine when you're using the bathroom. Just practice tightening them whenever you think about it during the day.

A healthy diet, regular exercise, and a positive attitude are only the beginning. It also helps to get plenty of sleep, quit smoking, and control the stress in your life. Not only will you look better, you'll feel good about yourself -- a real boost in the between-the-sheets department. A dash of positive attitude ties it all together: You have to believe you're hot if you want to make things sizzle in the bedroom. Being sexy and self-confident is just a state of mind.

Remember, a lifestyle that's healthy for you overall will be healthy for your sex life period. Boost your sexual potency naturally with a healthy diet, lots of physical activity, and an attitude that screams, "I'm worth it!"


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