Privention strategy of ischaemic heart disease

Primary prevention-two coTmplementary strategies can be usued to prevent ischaemic heart disease is apparently healthy but at risk individuals.

The poulation strategy aims to modify the risk factors of the whole population through diet and life style advice like;

•     Do not smoke, or consume smokeles tobacco

•     take regular exercise(minimum of 30 minutes, 5-7 days a week)

•     maintain ideal body weight

•     Eat a mixed diet rich in fresh fruits and vegetables

•     Aim to get no more than 10% of energy intake from saturated.

The targeted strategy aims to identify and treat high risk individuals, who usually have combination risk factors.There is strong obeservational evidence that miderate to high levels of physical activity reduce the risk of coronary heart disease and stroke.

Secondary preventiopn- patients who already have evidence od atheromatous vascular disease are at high risk of another vascular event offered a variety of measures that have shown to improve their outlook.The energetic correction of risk factors, particularly smoking,hypertension,hyperlipidaemia, is particularly important in this patient group because the absolute risk of further vasculaar events is very high.<<learn more

Major clinical features of ischemic heart disease

Major clinical features of ischemic heart disease is the very important thing of every human body.so all person should know the Major clinical features of ischemic heart disease..

The typical patient with angina is a man older than 50 years or a woman older than 60 years of age who complains of chest discomfort, usually described as heaviness, pressure, squeezing, smothering, or choking, and only rarely as frank pain.<<learn more.

When the patient is asked to localize the sensation, he or she will typically place their hands over the sternum, sometimes, with a clenched first, to indicate a squeezing, central, substernal discomfort. Angina is usually crescendo-decrescendo in nature, typically lasts 2-5 minutes, and can radiate to either shoulder and to both arms. It can also arise in or radiate to the back, intercapular region, the root of the neck, jaw, teeth, and epigastrium.

Although episodes of angina are typically caused by exertion (eg. exercise, hurrying, or sexual activity) or emotion (eg. Stress, anger, fright, or frustration) and are relieved by rest, they may also occur at rest and while the patient is recumbent. Nocturnal angina may be due to episodic tachycardia, diminished oxygenation as the respiratory pattern changes during sleep, or expansion of the intrathoracic blood volume that occurs with recumbancy. The threshold for the development of angina pictures may vary by time of day and emotional state. Many patients report a fixed threshold for angina, which occurs predictably at a certain level of activity, such as climbing two flights of stairs at a normal pace. In other patients, the threshold for angina may vary considerably within any given day or day two day.<<learn more

Risking factors of ischaemic heart disease

There are many risk factors of ischaemic heart disease-


Age and sex : Age is the most powerful independent risk factor for atherosclerosis process. Pre-menopausal women have much lower rates of disease than age -and risk-matched males; the gender difference disappears rapidly after the menopause.>> learn more


Family history : It also runs in the family. This may be due to a combination of shared genetic, environmental and lifestyle (e.g.. Smoking, exercise and diet) factors. A 'positive' family history is present when clinical problems in first -degree relatives occur at a relatively young age, such as<50 years for men and <55years for women.So family factors is the important thing of ischaemic heart disease.

Smoking : Most important avoidable cause of atherosclerotic vascular disease; there is a strong, consistent and dose-linked relationship between cigarette smoking and ischemic heart disease.

Hypertension : The incidence of atherosclerosis increases as blood pressure rises and this excess risk is related to both systolic and diastolic blood pressure as well as pulse pressure.

Diabetes mellitus : Is a potent risk factor for all forms of atherosclerosis and is often associated with diffuse disease that is difficult to treat. Insulin resistance is associated with obesity and physical inactivity.

Hemostatic factors : Platelet activation and high level of fibrinogen are associated an increased risk of coronary thrombosis.

Physical activity : Physical inactivity roughly doubles the risk of coronary heart disease.

Other dietary factors : Diet deficient in fresh fruit vegetables and polyunsaturated fatty acid are associated with an increased risk of vascular disease.So we should careful by risking factors of ischaemic heart disease.>>learn more

Treatment of lunch cancer

Treatment for lung cancer can involve

     Surgical removal of the cancer

                                                                                    

• ·         Chemotherapy

• ·         Radiation therapy

• ·         Combinations of these treatments.

The decision about which treatments will be appropriate for a given individual must take into account the location and extent of the tumor as well  as the overall health status of the patient.

Intend to treatment may be 

1.    Curative (removal or eradication of a cancer) or

1. Palliative (measure that is unable to cure a cancer but can reduce pain and suffering).

More than one type of therapy may be prescribed. In such cases, the therapy that is added to enhance the effects of the primary therapy is  referred to as adjuvant therapy. An example of adjuvant therapy is chemotherapy or radiotherapy administered after surgical removal of a tumor in an attempt to kill any tumor cells.

Risking factors of lung cancers

 There are two major risk factors of lung cancer are,

 

•  Smoking                                                            

•   Airpolution 
  
   Smoking

The incidence of lung cancer is strongly correlated with cigarette smoking, with about 90% of lung cancers arising as a result of tobacco use. The risk of lung cancer increases with the number of cigarettes over 4,000 chemical compounds, many of which have been shown to be cancer-causing or carcinogenic. The two primary carcinogens in tobacco smoke are chemicals known as nitrosamines and polycyclic  aromatic hydrocarbons. Passive smoking or the inhalation of tobacco smoke by nonsmokers, also is an established risk factor for the development of lung cancer.

          Airpolution

Airpolution from vehicles, industry, and power plants can raise the likelihood of developing lung cancer in exposed individuals. Up to 1% of lung cancer deaths are attributable to breathing polluted air, and experts  believe that prolonged exposure to highly polluted air can carry a risk for the development of lung cancer similar to that of passive smoking.

General concept on lung cancer

  Like all cancers, cancer of the lung, results from an abnormality in the growth of the body’s basic unit of life, the cell. Normally, cells divide to produce new cells only when new cells are needed. Disruption of this system of checks and balances on cell growth results in an uncontrolled division and proliferation of cells that eventually forms a mass known as a tumor.

Tumors can be benign or malignant. “Cancer,” usually refers to those tumors that are malignant. Benign tumors usually can be removed and do not spread to other parts of the body. Malignant tumors, on the other hand, grow aggressively and invade other tissues of the body, allowing entry of tumor cells into the bloodstream or lymphatic system and then to other sites in the body. 



This process of spread is termed metastasis; the areas of tumor growth at these distant sites are called metastasize very early after it forms, it is a very- threatening cancer and one of the most difficult cancers to treat. While lung cancer can spread to any organ in the body, certain organs- particularly the adrenal glands, liver, brain, and bone- are the most common sites for lung cancer metastasess.

Major clinical features of a stroke patient

Rapid evaluation is essential for a stroke patient. However, patients with acute stroke often do not seek medical assistance on their own, both because they are rarely in pain, as well as because they may lose the appreciation that something are wrong; it is often a family member or a bystander who calls for help. therefore, patients and their family members should be counseled to call emergency medical services if they experiences or witness the sudden onset of the any of the following;

1.  Contralateral hemiplegia or haemiparesis. Weak limbs are at first flaccid and areflexic, after a variable period of time, the reflexes return, becoming exaggerated, an extensor planter response. Weakness is maximal at first; recovery gradually over days, weak or many months can occur.
2.   Aphasia (if dominant hemisphere is affected) 
3.  The clinical feature of major of TIAs-Amaurodis fugax, aphasia,     haemiparesis, hemisensory loss, 
4. Diplopia, vertigo, vomiting, choking and dysarthria, ataxia, hemisensory loss, hemianopic visual loss, Transient global amnesia, tetraparesis, loss of consciousness-if there is vertebrobasilar system involve ment.More details

Pathogenesis of stroke

Different pathological processes may cause similar clinical events in cerebrovascular disease.

•        Completed stroke-One of four mechanisms is the usual cause.

1.     Arterial embolism from a distant site and subsequent brain infarction.

2.    Atheromatous carotid or vertebral artery occlusion and subsequent brain infarction.

3.    Atheromatous arterial throm

     bosis within a cerebral vessel and subsequent brain infarction.

4.    Hemorrhage in the brain.

•       Transient ischemic attack (TIA) -TIA are usually result of the passage of microemboki, small areas of brain infarction following thrombosis or hemorrhage may occasionally cause a clinical TIA. The principle sources of emboli to the brain are thrombi and atheromatous  plaques within the great vessels, the carotid and vertebral systems, or in the heart. Thromboembolism from sources outside the brain generates 70% of all strokes and 80% of TIAs. Of patients presenting with a stroke, 85 with have sustained a cerebral infarction infarction due to inadequate blood flow to pare of the brain. 

The remainder will have had an intracerebral hemorrhage. rupture of microaneurysms and decoration of the walls of small deep penetrating arteries is the principle pathology. In this setting hemorrhage is usually massive, often fatal and occurs in chronic hypertension and at well defined sites –basal ganglia, Pons, cerebellum and subcortical white matter. The causes of SAH are rupture of saccular aneurysms, Arterionvenous malformation Idiopathic.More details