DEEP INSIGHT INTO THE HEART.......

By no means are only elderly people at risk from heart diseases. Physically active individuals can also be affected, for example if a seemingly harmless flu bug spreads to the heart muscle. Should this remain undetected and if, for example, a builder continues with his strenuous job or an athlete carries on training, this can lead to chronic inflammation and in the worst case even to sudden death. The latest issue of the Forschung Frankfurt journal describes how modern non-invasive examinations using state-of-the-art imaging technology can reduce such risks.

Professor Eike Nagel and his 12 coworkers at the Institute for Experimental and Translational Cardio Vascular Imaging of Goethe University Frankfurt are developing better ways to predict and diagnose heart diseases. In recent years, the researchers have taken the lead in the development of a procedure that is still very new in heart scans. Nagel explains the advantages: "With the help of magnetic resonance imaging, we can look right inside the heart muscle." Blood flow to the heart muscle is visualized and shows whether there are any constrictions of the arteries supplying the heart. Experts can also spot whether the heart muscle is scarred, inflamed or displays any other anomalies.

The comparatively fast method makes it possible to examine patients at an early stage and may prevent cardiac insufficiency or even a heart attack. "Diseases such as HIV, kidney damage, rheumatic diseases or tumours often affect the heart either directly or as a side effect of therapy," says Nagel, describing groups potentially at risk. The cardiologist is convinced: "Nowadays we can treat or even cure so many diseases, but the heart suffers too and this should be carefully monitored as it mostly remains undetected."

It is concluded  that these rapid advances in imaging over the last decades fascinating: "Nowadays we can spot the slightest changes and literally get a clear picture of the heart's condition."  

Cardiorespiratory fitness is essential to reduce risk of coronary heart disease

Coronary heart disease (CHD) is a leading cause of death for men in the U.S. Both cardiorespiratory fitness (CRF) and the blood triglyceride/high-density lipoprotein ratio (TG:HDL ratio) are strong predictors of death from CHD. In the current issue of Mayo Clinic Proceedings, two new studies highlight the importance of CRF on subsequent CVD and mortality risk. These articles contribute substantive evidence on the importance of achieving moderate to high levels of CRF in both adults and children.

In an investigation led by Stephen W. Farrell, PhD, of The Cooper Institute, Dallas, TX, researchers found strong evidence that moderate-to-high level of fitness counteracted some of the negative effects of a high TG:HDL ratio.

"While it is still extremely important to measure traditional risk factors such as resting blood pressure, blood cholesterol, triglyceride, and glucose levels, having a measure or estimate of the patient's cardiorespiratory fitness level gives us additional information regarding cardiovascular disease risk," explained Dr. Farrell. "The results of this study support this recommendation. Regardless of whether the blood TG:HDL ratio was low or high, having at least a moderate level of fitness provided some protection from CHD death when compared to having a low level of fitness."

A total of 40,269 men received a comprehensive physical examination between January 1, 1978 and December 31, 2010. The exam included a maximal treadmill exercise test to measure cardiorespiratory fitness level, and also included measurement of the blood TG:HDL ratio. This ratio is easily calculated by taking the fasting blood triglyceride level and dividing it by the blood HDL cholesterol level. A lower ratio is an indicator that insulin is working well, while a higher ratio indicates resistance to insulin. Higher ratios also indicate an increased risk of future prediabetes, type 2 diabetes, and cardiovascular disease.

The participants, categorized into low, moderate, and high CRF groups, were followed for an average period of 16.6 years, during which time 556 deaths due to coronary heart disease (CHD) occurred. Moderate to high levels of fitness provided significant protection from CHD death. Lower values for the TG:HDL ratio also provided significant protection. The lowest risk of CHD death was seen among high fit men in the lowest category of TG:HDL ratio, while the highest risk of CHD death was seen among low fit men in the highest category of TG:HDL ratio. Within each of the four categories of TG:HDL ratio, having a moderate to high level of fitness provided significant protection against CHD death when compared to having a low level of fitness. Therefore, knowing the patient's fitness level as well as their TG:HDL ratio provides much more information about CHD risk status than just knowing one or the other. When used in combination with other risk factors, such as the patient's blood pressure, bloodwork, family history, etc., measuring or estimating the patient's level of CRF can result in a much more accurate determination of their cardiovascular disease risk status.

Uninsured heart attack, stroke patients face ‘catastrophic’ costs

"Many patients with large medical bills may have had to declare bankruptcy, sell their home, and be hounded by medical bill collectors as they struggled to juggle rent or mortgage payments while paying for utilities and food," said cardiologist Dr. Rohan Khera, an Internal Medicine fellow at UT Southwestern Medical Center and co-first author of the paper, "Medical expenses are the leading cause of bankruptcy in the United States."

For uninsured patients hospitalized with acute myocardial infarction (heart attack), the median cost for their stay totaled $53,384 in 2012, according to the research. Uninsured stroke patients had a median bill of $31,218.

About 60 percent of the uninsured heart attack patients had bills higher than their annual income, after allowing for the purchase of food, according to the paper.

The research, published in the journal Circulation, looked at thousands of patients hospitalized for acute myocardial infarction (heart attack) or stroke between 2008 and 2012, the year before Americans began signing up for subsidized insurance on exchanges created under the federal Affordable Care Act (ACA).

The patients studied ranged from age 18 to 64 (federal Medicare insurance is available to those 65 and older). More than 39,000 hospitalizations for heart attack and more than 29,000 hospitalizations for stroke were analyzed.

Information for the paper came from the National Inpatient Sample, a large database developed by the federal Agency for Healthcare Research and Quality.

Collaborators included cardiologist Dr. James de Lemos, Professor of Internal Medicine and holder of the Sweetheart Ball‐Kern Wildenthal, M.D., Ph.D. Distinguished Chair in Cardiology and Medical Director for the Dallas Heart Study, and researchers were from Baptist Health South Florida, Johns Hopkins Bloomberg School of Public Health, Florida International University, Michael E. DeBakey VA Medical Center, Brigham and Women's Hospital, and Yale New Haven Hospital.

SURFACE ANATOMY OF HEART

Orientation and Surfaces

The heart has been described by many texts as “a pyramid which has fallen over”. The apexof this pyramid pointing in an anterior-inferior direction.

In its typical anatomical orientation, the heart has 5 surfaces, formed by different internal divisions of the heart:

• Anterior (or sternocostal) – Right ventricle.

• Posterior (or base) – Left atrium.

• Inferior (or diaphragmatic) – Left and right ventricles.

• Right pulmonary – Right atrium.

• Left pulmonary – Left ventricle.

Borders

Separating the surfaces of the heart are its borders. There are four main borders of the heart:

• Right border – Right atrium
• Inferior border – Left ventricle and right ventricle
• Left border – Left ventricle (and some of the left atrium)
• Superior border – Right and left atrium and the great vessels

By TeachMeSeries Ltd (2017)

Fig 1.0 – Borders of the heart.

Sulci of the Heart

The heart is a hollow structure. On the interior, it is divided into four chambers. These divisions create grooves on the surface of the heart – these are known as sulci.

The coronary sulcus (or atrioventricular groove) runs transversely around the heart – it represents the wall dividing the atria from the ventricles. The sinus contains important vasculature, such as the right coronary artery.

The anterior and posterior interventricular sulci can be found running vertically on their respective sides of the heart. They represent the wall separating the ventricles.

Pericardial Sinuses

The pericardial sinuses are not the same as ‘anatomical sinuses’ (such as the paranasal sinuses). They are passageways formed the unique way in which the pericardium folds around the great vessels.

• The oblique pericardial sinus is a blind ending passageway (‘cul de sac’) located on the posterior surface of the heart.

• The transverse pericardial sinus is found superiorly on the heart. It can be used in coronary artery bypass grafting – see below.

Heart Conduction..........

The sequence of electrical events during one full contraction of the heart muscle:

• An excitation signal (an action potential) is created by the sinoatrial (SA) node.
• The wave of excitation spreads across the atria,causing them to contract.
• Upon reaching the atrioventricular (AV) node, the signal is delayed.
• It is then conducted into the bundle of His, down the interventricular septum.
• The bundle of His and the Purkinje fibres spread the wave impulses along the ventricles, causing them to contract.

BLOOD PURIFIERS......

1. Water

The standard recommendation for drinking water is 8 glasses of water But drink as much as you need.

This should come as no surprise to you. Since urine is the means through which kidneys flush out toxins from the blood, having sufficient water is your best bet to keep the blood clean. As with a deep cleanse of your home, a proper purification regimen for your blood will require you to incorporate plenty of water. Staying hydrated can help your kidneys flush out the impurities in the body, aided by the fiber and minerals from all the other blood purifying foods.

Ayurveda outlines an ideal way to have water for detox benefits. Keep some warmed water in a copper vessel overnight and drink it next day morning when you wake up. The copper cools your liver and the water helps with waste elimination and purification of the blood.

2. Garlic

Garlic is antibacterial and can cleanse your system of viruses and parasites that could harm it. This pungent food removes excess fat from the blood. In the bargain, it lowers the levels of bad LDL cholesterol and total serum cholesterol in your body.

Lead is a common toxin lurking in paint and other household objects that pollutes the blood. Garlic can bring down lead levels by 19%.

Exposure to toxic metals can pollute your blood and body, causing all manner of problems – from cramps and appetite loss to brain damage. The antioxidants in garlic not only detoxify your body as a whole but can also fight mild-to-moderate lead poisoning. You are often exposed to this metal through lead paints, contaminated dust, etc. Garlic can reduce metal levels by as much as 19% and ease toxicity symptoms like headaches. Research has shown that the sulfur compounds in garlic have a therapeutic effect not unlike that of d-penicillamine (used for treating lead poisoning). Garlic could, in fact, be a safer option to cleanse your body of the heavy metal.

3. Jaggery

Though sweet, jaggery helps detox the blood.

A popular ingredient from India, this golden-brown unrefined sugar is also known to be a good blood purifier. Its fiber content helps it cleanse the digestive system, prevent constipation, and expel waste from the body. Because of the high iron content, it can help sort out an iron deficiency and restore hemoglobin levels. If you’ve just had a baby, jaggery can help expel clotted blood from the body, acting as a natural cleanse/flush for your blood.

4. Turmeric

Turmeric on its own is a wonderful natural healer that can fight inflammation. It can help treat liver trouble and even keep it functioning optimally. And this is important because the liver and kidneys are the two primary centers for cleansing the blood of impurities and purging them from the body.

Infuse black pepper, cardamom, cinnamon, cloves, and ginger in a glass of turmeric milk for blood-purifying benefits.

When this golden spice is combined with milk, its purification powers go up a notch. Turmeric milk figures prominently in liver cleanse diets in Ayurveda. One such diet recommends turmeric milk that has been infused with spices like black pepper, cardamom, cinnamon, clove, and ginger for 72 hours. This drink is supposed to help your body generate fresh red blood cells besides plying your system with nutrients and acting as a good health tonic.

5. Fresh Fruit Like Apples, Pears, And Guavas

Don’t peel fruits like apples and guava. The peel is a richer source of antioxidants.

The pectin fiber in fruit like apples, guavas, plums, and pears is useful for detoxifying the blood. Besides binding with the excess fats in your blood as well as liver, pectin also combines with heavy metals and other harmful chemicals or waste in your blood stream. The fiber helps with the fat removal, while the lycopene and glutathione in the fruits are useful for eliminating waste and chemicals. Lycopene is found in red fruits like watermelon and pink guava while apples are a good source of glutathione.

6. Lemon

Warm water with lemon juice is recommended in both Ayurveda and naturopathy as a good start-of-day drink to cleanse the blood. As per Ayurveda, this helps release the “ama” or toxins in your digestive tract, cleansing your system.

A warm glass of lemon water in the morning can increase glutathione in your body, which helps the liver detox the blood better.

Research also backs this up. The warm water aids in the breakdown of fat and also eases the load on your kidneys and the vitamins and minerals in the lemon help the body detox. The vitamin C, in particular, is needed by your body to create glutathione. Your liver then uses this compound to purge your blood of harmful chemicals.

7. Dark Green Leafy Vegetables

Not only do leafy greens like spinach supply your blood with iron to help maintain the hemoglobin levels, they also check free radical damage to the blood cells.

Not everyone’s a fan of dark green leafy vegetables. But they can be very useful thanks to their abundant nutrient content (vitamins A and C, as well as B vitamins, folic acid, and iron). The antioxidants in these vegetables help remove harmful free radicals, responsible for cell damage to red blood cells. By limiting free radical damage to blood cells, these vegetables help keep your blood replenished with new cells.  Choose from kale, spinach, Romaine lettuce, or even mustard greens and Swiss Chard.

8. Cabbage

Cook the cabbage well if you suffer from hypothyroidism. Cooking removes the goiter-causing substances.

Cabbage is considered in Ayurveda as a blood purifier. This leafy cruciferous vegetable has antioxidants like vitamins A and C that are good for your liver. The fiber in cabbage helps cleanse the digestive tract. It can neutralize chemical compounds like those in cigarette smoke and cleanse your liver, too. The glucosinolates in cabbage (which give cruciferous vegetables their distinctive taste) break down to form isothiocyanates. These help expel carcinogens in the body.

9. Oats, Wheat Bran, And Nuts

These fiber-rich whole grains and nuts are a must-have for their ability to rid your system of excess fat, chemicals, and waste. The high fiber content in foods like oats, whole grains, wheat bran, flaxseeds, and nuts lowers blood cholesterol and glucose levels, cleanses your intestinal tract, eases constipation, and helps your body eliminate waste better.

10. Watercress

This may not be your usual mealtime staple, but watercress is a delicious alternative to regular greens. It helps increase levels of detoxification enzymes in the body. It also eliminates carcinogens in the body in much the same way as cabbage does – through the action of the glucosinolates in it. In one study on the effects of watercress intake on smokers, researchers found that just 170 g a day resulted in higher levels of carcinogens being expelled in the urine, leaving the blood and body more purified.

Besides incorporating these blood-purifying foods in your diet, remember to avoid foods that increase cholesterol and triglycerides and foods that increase glucose in the blood.