Chest Pains.Understanding Angina. How is it caused? Part II

Good-day all,

In the last post we spoke about the risk factors of angina.
Were you able to identify any risk factors in yourself, friends or family members?
How many were there?


Today we'll be learning a bit about how angina or chest pain occurs, as a symptom of Coronary Heart Disease or Coronary Artery Disease. In order to do so, we'll be learning about some of the structure of the heart that were not covered in my earliest posts about Understanding Your Heart.... 

These structures are known as the coronary arteries.

What are they?
They are nothing but arterial branches from the biggest artery in our body, the aorta.
That's the big curved tube in the image right in between the labelled right and left coronary arteries.^^

Remember in Understanding Your Heart.... we learnt about how arteries are in charge of bringing oxygen rich blood to organs and cells of the body?
The coronary arteries follow that general rule, they carry oxygen rich blood, to a specific location.
The heart muscle.

        

courtesy dribbble.com

We know that the heart pumps blood to the body but the reality is, that the blood it pumps just isn't enough to provide its own muscle with the oxygen that it needs to continue working.
This is where the coronary arteries come in, they are so named because they surround the heart like a crown, and enable it to receive oxygen just like the other parts of our body.

When you hear the word coronary, doesn't it remind you of other words, like coronation?
Coronary comes from the latin word "corona" which means crown.

How is Angina linked to the Coronary Arteries?

Chest pain or angina develops when the Coronary Arteries become very narrowed by fatty deposits. When this happens, enough oxygen isn't able to flow as much to the heart muscle as it works.

 courtesy www.bidmc.org

The normal amount of blood the heart is accustomed to receiving has become reduced since the size of the arteries the blood flows through has also been reduced by all that plaque build up.
The heart while still maintaining the body, finds it increasingly difficult to maintain itself.

 Here are two examples in everyday life for comparison:

1. Your vehicle uses the fuel it has to get you to your daily destination, however if it doesn't receive gas, eventually it will slowly sputter and break down. Here the reduced blood flow in the narrow coronary arteries are represented by the low amount  of gasoline your car has been running on. 
2. You live in Bethesda and use the public transport system to get to St.John's for work, you haven't been paid in months, after a while you hardly have money to pay a bus or taxi, and have difficulty getting to work. Here the reduced blood flow in the narrow coronary arteries are represented by the low funds that you've been working with.

Can you think of any other everyday examples?
Share them with me by commenting below.

This strained environment under which the heart has to function. is worsened under conditions such as exercise or emotional stress, where the demand for the blood it needs is less than the supply it can receive.
It is precisely this circumstance that causes angina or chest pain.

        

courtesy www.gifsmile.com

Here is a link to an animation that gives a visual explanation of the angina mechanism.
Have you understood the basic mechanism of angina? If you have then please share it with a friend
....or that family member with those horrible "gas pains".


       


Remember in teaching we learn.
Stay #wadadlianstrong my dears.
Next up...types of angina.
Blessings to you and yours.

© August 2015

Chest Pains. What is Angina? Risk Factors. Part I

Chest pains are a common symptom that can cover a range of  illnesses in medicine. It can alert a doctor to not only cardiac disease, but trouble with the lungs, the gastrointestinal system, as well as the muscular structures in the vicinity.

However, truth be told in Wadadlian society, if someone says that their chest hurts, unless its not your asthmatic brother or cousin, most people will think of the heart. 

Most people.

We all have that one family member though, who will diagnose gas pains beyond a shadow of a doubt....

Angina.What do you know about angina? What do you think it is?

Well, first of all, it must be made clear that Angina is not a disease but rather a term that is used to explain chest pain/discomfort that is directly related to low oxygen blood levels dominating in the heart muscle, instead of the oxygen-rich blood it needs to properly function.  

(To understand how the heart works, check out an older blog entry Understanding Your Heart...)

Angina is nothing but a symptom of a bigger problem known as Coronary Heart Disease. 

                                                      courtesy nattokinase.org

WHAT ARE THE RISK FACTORS?

Important risk factors are:

• Smoking/Tobacco Use (This also includes second hand smoking)
• Hypertension
• Diabetes
• High Cholesterol

Other Contributing Risk factors are:

• Family History of Heart disease at an early age
• Obesity
• Anaemia
• A Sedentary lifestyle a.k.a Lack of physical activity
• An Unhealthy Diet
• Ages 55 and above in women and 45 and above in men
• Stress

In the next post we'll learn about different types of Angina, and a general explanation on how this symptom of Coronary Heart Disease occurs. In the meantime, take a look at the risk factors, are there any present in your family?

Stay #wadadlian strong. Blessings to you and yours.

© July 2015

Babies and Heart Defects. A look at Tetralogy of Fallot. Part 2

courtesy chocolatehighh.tumblr.com

In the last post we defined Tetralogy of Fallot, and took a look at the 4 structural defects that play their role in its effect:

                                                            courtesy: cias.rit.edu

1. Pulmonary Stenosis

2. Ventricular Septal Defect

3. Overriding Aorta

4. Right Ventricular Hypertrophy

 For those of you who haven't seen the last post, and are interested to find out more about this condition check out, A look at Tetralogy of Fallot. Part I, and also stop by JJ's Congenital Heart Defect Awareness for Antigua and Barbuda on Facebook piloted by +Jessica Berman.  

Today you will be learning about the signs and symptoms of the condition, that can indicate your child or the child of someone you know could be potentially suffering from this congenital heart defect. 

Signs and Symptoms of Tetralogy of Fallot

1. Bluish nails, and lips. This is known as cyanosis, it is caused by the low levels of oxygen in the child's blood.You may notice that this abnormal colour gets worse when the baby cries, or even when the baby is feeding.

 The infant may not feed for very long either, it will seem almost as if a lot of effort is involved in suckling.

In toddlers and older children, cyanosis will increase after playing,or engaging in some other physical activity.  You may notice that the child becomes easily short of breath. 

2. Squatting. Toddlers and older children may do this intermittently when having a cyanotic episode, or when short of breath. 

                  

 Instinctively the child assumes the squatting position as it increases blood flow to the lungs.

3. Digital Clubbing. In older children, as well as infants, the nails and tips of the fingers may seem to be larger than is normal.

                              

                                           courtesy: http://bestpractice.bmj.com/

4. Poor development and growth. When you take the baby to the clinic, the district nurses might note that the baby is not growing well for his or her age, and hasn't gained an appropriate weight either. You might hear them use a term known as failure to thrive. 

If you've noticed any of these symptoms and signs in your child, it is important to see a health care professional as soon as possible, since the child's condition deteriorates with time if the defects are not surgically corrected. 

Early detection is always helpful. 

Now you know what to look for, spread the word to your family and friends, and visit JJ's Congenital Heart Defect Awareness for Antigua and Barbuda on Facebook. 

Blessings to you and yours,

#wadadlian strong

                                                                   ©  April 2015

Babies and Heart Defects. A look at Tetralogy of Fallot. Part 1

Inspired by +Jessica Berman's dedication to raising awareness about the condition.

Tetralogy of Fallot is a condition that represents a combination of defects in the heart's structure that is present at birth. Thus, it is known as a congenital heart defect.

The term "congenital defect" is just a fancy way of indicating the presence of a structural or functional abnormality in the body that has been there since birth. Since Tetralogy of Fallot deals with the heart it is specified as a congenital heart defect.

Its name comes from the French physician Arthur Fallot (pronounced like fallow in fallow deer) who was one of various doctors who described the condition between the 17th and 19th century.

It is popularly referred to as the "blue baby syndrome", in which the infant or child affected is noted to have a bluish or purplish tinge to the lips or nails. In his famed report "La Maladie bleu" or the blue sickness, Dr. Fallot described four features that characterized the condition:

courtesy: www.sts.org

1. Pulmonary Stenosis

2. Ventricular septal defect.                  

3. Overriding aorta

4. Right ventricular hypertrophy

Now, in order to understand what these defects are and how they function in producing the symptoms that may alert you as a family member,or family friend, it is important to first understand how the heart works normally, so refresh or make a new memory with my second blog entry about Understanding Your Heart...

Let's begin.

Remember " ...the right half our heart is in charge of pumping blood to and from our lungs in a process known as pulmonary circulation, whereas the left half of the heart pumps blood to everywhere else in our body, including itself in what is called the systemic circulation."

However, the normal pumping process is high-jacked due to the four defects I mentioned two small paragraphs above. To give a wider view, I'll explain the pulmonary stenosis and ventricular septal defect together. Firstly, lets get the definition of pulmonary stenosis out of the way.

Pulmonary stenosis, refers to the narrowing in or around the pulmonary artery. Stenosis is a medical term meaning "the abnormal narrowing of a passage in the body" . From a inside perspective, stenosis of the valves of the pulmonary artery looks like this:

courtesy: standfordchildren.org

The blood that enters the right ventricle is blood that is on its way to the lungs in search to be re-filled by oxygen, however due to narrowing in or around the pulmonary artery the blood is unable to flow as it would if the artery was its normal size.

courtesy: www.marvistavet.com

The added problem to the pulmonary stenosis defect is the fact that, right in the vecinity there is a hole in the wall that should separate the lower chambers of the heart from one another...

The muscular wall between the ventricles is known as the interventricular or ventricular septum.

The ventricular septal defect,  is quite literally a hole in between the lower chambers of the heart (ventricles). It can be singular or multiple.

courtesy: 1.bp.blogspot.com

What does this mean as far as the circulation is concerned?

Let me use the analogy of the bus system.

Now, from the blog entry Understanding Your Heart... we learnt that on the right side of the heart we had tired commuters who represented our blood low on oxygen, ready to go home or to the lungs to rest and re-fill on oxygen, but in order to get there there was a particular route they had to take. This was from the Vena Cava, to the Right Atrium, the Right Ventricle and then on to the lungs. 

Here I'll add a new bit of info, the final road to the lungs would be through the pulmonary artery. So we now have Vena Cava, Right Atrium, the Right Ventricle, the Pulmonary Artery and then the lungs.
In the case of  Fallot's Tetralogy, there are two problems with the final route.

First, there is a road block of sorts. This is the Pulmonary Stenosis Defect (PS), and secondly,  in true Antiguan and Barbudan style, there is a massive pothole. This is the Ventricular Septal Defect (VSD). Pardon my doodling :) 

What happens next is logical, the bus driver that is, the blood flow, needs to find a new route, and it does, because the aorta, whose correct position in a normal heart is near to the left ventricle (to ensure that oxygen-fresh filled blood is directed to the body), is out of place. This is known as the Overriding Aorta.

In Fallot's Tetralogy, the aorta is near to the ventricular septal defect. This gives the blood flow an alternative route out, to the wrong destination.

The problem is that this easy route is dangerous to the body, because the tired commuters, or oxygen-poor blood are one their way back to work without getting the oxygen needed to be efficient in the body's work. 

It is because of this children an infants becaome cyanosed, the blood deficient in oxygen has entered into the systemic circulation  without having first gone to the lungs for oxygen renewal.

The heart now has a dilemma, its pumping blood but to the wrong places, and the pathway it needs to function is not as wide as it normally should be, its solution to this?

Pump harder....

This is what causes the last defect in the Tetralogy of Fallot, the Right Ventricular Hypertrophy. This basically means the right lower chamber of the heart, becomes bigger in size as the heart tries to overcome the narrow opening of the pulmonary artery by trying to force more of the oxygen poor blood in at a higher pressure. 

    courtesy: cias.rit.edu

There it is. The four physical defects of the heart in Tetralogy of Fallot, and how each functions. In the next part I'll give signs and symptoms to look out for in babies and children.

Remember to revise Understanding Your Heart... to see how a normal heart works.
Reblog and share.

Thanks to +Jessica Berman for inspiring this blog post. Keep up the awesome work.
Check out JJ's Congenital Heart Defect Awareness for Antigua and Barbuda on Facebook.

Stay #wadadlian strong.
Blessings to you and yours,

© January 2015

A Special Look at Hypertension and Pregnancy Part II

In the first part of this topic you learned about what Pre-eclampsia is, and the risk factors that your mom, sister, tantie, wife, niece or cousin may have, that predisposes her to developing this ailment. You also learnt about signs and symptoms of this sickness, and the importance of encouraging your pregnant loved one to go for her antenatal checkups.

For a review of Part I click here.

In Part II, we'll have a look at the complications of pre-eclampsia, for both mother and baby, as well as treatment, and prevention.

courtesy www.clipartbest.com

First let's have a look at complications for the Moms-to-be...

COMPLICATIONS

Maternal Complications

SEIZURES

For women suffering from preeclampsia, any type of convulsive activity or fit that she suffers after 20 weeks gestation or immediately after giving birth is known by the name of Eclampsia.
When suffering an eclamptic seizure, the mom-to-be may suffer involuntary repetitive, jerky movements of the arms and legs, or may have facial twitching.

STROKE

High blood pressure can cause a brain injury, due to an interruption of blood supply to the brain.

PULMONARY OEDEMA

In this complication fluid builds up inside of the lungs, preventing them from receiving oxygen and functioning properly.

KIDNEY FAILURE

Hypertension can cause more pressure on the kidneys of pregnant women, and the damage it causes allows to kidney to be unable to filter the toxins out of the body, which causes an increase of toxicity in the blood and body.

CLOTTING DISORDERS

This complication can cause an increase in blood clot formation within the mother´s body, or can cause excessive bleeding because the blood clotting system begins to fail.

HELLP SYNDROME

This is a complication that is characterized by:

1) Destruction of the mother's red blood cells, known by the term hemolysis.

2) An increase in the amount of certain liver proteins known as enzymes.

3)  A decrease in one of the blood elements responsible for clotting known as platelets. 

To read about more maternal complications, click here ....

courtesy www.etsy.com

Fetal Complications

Fetal complications stem from a decrease in blood flow to the uterus, the placenta is thus deprived of oxygen and nutrients essential to the baby's growth and development, as a result the baby can suffer:

• Intrauterine Growth Restriction in which the baby does not grow as it should according to its age in weeks. As a result after birth the baby may be smaller than it should be.
• Lack of oxygen while inside the uterus also known as Intrauterine asphyxia.
• Prematurity, or being  born before it is full term, that is, 37 weeks.
• Respiratory Problems after being born (Neonatal Asphyxia).
• Intrauterine Fetal Death.

courtesy www.cen.acs.org

TREATMENT

The optimum treatment of pre-eclampsia is induction of labour. However, the manner in which this is done is very much dependent on the severity of the pre-eclaampsia, the number of weeks the pregnancy currently has progressed to, and how the baby is doing. 

Possible treatment include used of  blood pressure medication such as, methyldopa, nifedipine or labetalol

Methyldopa or Aldomet is the treatment of choice in pregnancy and functions by relaxing blood vessels, reducing the pressure of the blood inside them, ensuring that the blood can circulate more efficiently around the body.

To understand how Nifedipine or Adalat works, read about Calcium Channel Blockers in the last section of the blog post from March:  So You Already Suffer from High Blood Pressure Pt I...

To understand how Labetalol functions, read about Beta-Adrenoceptor Antagonists in the last section of the blog post from April: So You Already Suffer from High Blood Pressure Pt II...

courtesy heart.org

PREVENTION

How can pre-eclampsia be prevented?  Can it be? 

It cannot be totally prevented. However, the risk or suffering from it during pregnancy can be reduced through the following ways:

1) Be aware of the risk factors that are present in your life.

2) Know the symptoms to look out for.

To read about risk factors and symptoms of pre-eclampsia read the first part of the blog post, A Special Look at Hypertension and Pregnancy Part I

3) Make certain that all antenatal appointments are attended. 

Never underestimate the value of the blood pressure checks, the blood and urine investigations done,the weight checks, as well as the constant focus on the growth and development of your baby. 

The more antenatal clinic appointments attended the quicker any risk of developing pre-eclampsia will be detected. In Wadadli antenatal care is free, and thus ought to be taken advantage of. 

It is a privilege that many women on this planet do not have.

4) For women who have high risk of suffering from pre-eclampsia, low dose aspirin or calcium                 supplementation may be prescribed, to lower its appearance as well as its complications.

Pre-eclampsia is one variant of different categories of high-blood pressure related illnesses during pregnancy, to read more about the other variations click here.

You can also read more here.

With this we've ended not only our look at hypertension in pregnancy but our discussion about hypertension in general as a sickness that affects our Wadadlian population.

High blood pressure ought not to be played with whether pregnant or not, whether old or whether young. It is dark portal that leads to a pathway of other diseases and complications that will without doubt affect your daily life. 

Hopefully through these posts you are now able to identify any risk factors present in your life or that of your loved ones, and most importantly be able to share you knowledge with someone who you know may be at risk. 

Rememba wa dem say, "Prevenshan betta dan cyur"

#Wadadlianstrong

Blessings to you and yours, 

© June 2014

A Special look at Hypertension and Pregnancy Part I

Good-day everyone! 

It's been a while but we're back sharing information, and helping you learn more about conditions that affect our Wadadlian Community. 

To continue the series we have embarked upon about the Cardiovascular System and Hypertension on the Wadadlian Health Blog, we'd like to share a bit about Hypertension related to pregnancy. 

courtesy heart.org

Pregnancy is a beautiful period in a woman’s life where she is the nurturing element that propels new life into the world, but too often we see that at this time, where ideally she should be eating wholesome foods, resting adequately and allowing for the healthy development of her baby, she can be plagued with many ills which can further complicate her physiological condition. 

Today our focus will be on Pre-eclampsia also known as Toxemia, one of the most frequently seen complications during pregnancy. This variation of the ‘silent killer” can be asymptomatic in its early stages in pregnancy and only provoke symptoms when it is very advanced. 

In Part I we'll be touching on its definition, risk factors, as well signs and symptoms to look out for.

Pre-eclampsia can be defined as the elevation of blood pressure to at least 140/90 mmHg that is induced during pregnancy usually after 20 weeks of gestation, and often is associated with protein being found in the urine. The condition resolves 6 weeks after the baby is born.

courtesy American Pregnancy Association

The exact cause of pre-eclampsia is not verified but research suggests it may be a problem with the blood vessels in the placenta, and the way it is attached to the womb (the placenta or  afterbirth, is the structure that lies between your baby and your  womb.)

Bear in mind, all pregnant women can develop pre-eclampsia however there are some who may be more likely to have it during pregnancy due to certain risk factors in their life.

                                           

                                                           courtesy blackradionetwork.com

Risk Factors of Pre-eclampsia:

1. History of previous pre-eclampsia.  A personal or family history (mother or sister) of pre- eclampsia increases your risk of developing the condition.

2. First pregnancy. The risk of developing pre-eclampsia is highest during your first pregnancy.             

3. New paternity. Each pregnancy with a new partner increases the risk of pre-eclampsia.

4. Age. The risk of pre-eclampsia is higher for pregnant women younger than 20 and older than 40 years of age. 

5. Obesity. The risk of pre-eclampsia is higher if you're obese.

6. Multiple pregnancy.  Pre-eclampsia is more common in women who are carrying twins, triplets or other multiples.          

7. Prolonged interval between pregnancies. Specifically of 10 years or more seems to increase the risk of suffering from the condition.

8. Diabetes and gestational diabetes.  Women who develop gestational diabetes or already suffered from diabetes prior to becoming pregnant have a higher risk of developing pre-eclampsia as the pregnancy progresses.

9. History of certain pre-existing conditions.  Having certain conditions before you become pregnant- such as chronic high blood pressure, migraine headaches, urinary tract infection, vitamin D deficiency, diabetes, kidney disease, rheumatoid arthritis or lupus, amongst others increases the risk of pre-eclampsia.

10. Ethnicity. Pre-eclampsia is found to be more common amongst the black race. Click here to read more.             

                                                    courtesy womenshealthency.com

Bear in mind it is possible that pre-eclampsia may be asymptomatic, with only high levels of blood pressure and proteins found in urine aiding in its diagnosis, this is why it is SO VERY IMPORTANT  to have regular checks of your blood pressure while pregnant. 

If you are unsure about the values of blood pressure readings and what they mean, no worries, you can read LAWD MA PRESSHA PART II from an earlier post in February.

Please note that in pregnancy values between:

                                               140/90 to 149/99 mmHg = mild hypertension 

                                               150/100 to 159/109 mmHg = moderate hypertension

                                               160/ 110 mmHg and above = severe hypertension

                                                                    

courtesy American Heart Association

Signs and Symptoms of Pre-eclampsia:

Apart from high levels blood pressure (hypertension), and the kidneys leaking proteins into the urine, pregnant women may experience:

Dizziness 

Blurry vision or seeing marks or spots in your vision

Photophobia or the eyes being irritated in the presence of light 

Headaches that are constant, or repetitive

Swelling of the feet, hand, and face (now this happens normally during pregnancy, but if this suddenly becomes worse it must be taken into consideration)

Sudden weight gain

Decrease in urination

Nausea and vomiting, (that is different from morning sickness in the early stages of pregnancy)

Decrease in the baby's movements

Belly pain, most frequently on the right side below the ribs

Shortness of breath

It is important to be aware of these symptoms and signs not only during pregnancy but after giving birth as pre-eclampsia extends for 6 weeks after the baby is born.

In Antigua and Barbuda full antenatal care is provided in our district clinics, this a privilege to be taken advantage of. It cannot be expressed how IMPORTANT it is to receive regular checkups during pregnancy, whether it is the first time being pregnant or the fifth. Pre-eclampsia is a form of hypertension that is harmful to both mother and child when undiagnosed. 

Feeling well, by no means indicates that you actually are, and without proper checkups and antenatal care, it is possible that both the mother and unborn child will suffer in the deadly silence of hypertension.

If you have a loved one who is currently pregnant, encourage them to get their checkups done at the clinic, blood pressure screening will always be done.

In Part II we'll be addressing the complications of Pre-eclampsia as well as the treatment, and most importantly the aim of this blog PREVENTION.

Keep your family, both future and present, #wadadlianstrong.

Blessings to you and yours,

 

© June 2014