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Thursday, 23 November 2017

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."

Image result for heart attackFor 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.

Thursday, 16 November 2017

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
Fig 1.1 - Borders of the heart.

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:
    Fig 1.0 - Animation of the spread of conduction through the heart
  • 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.

World Heart Day

This year on World Heart Day, as part of our mission to ensure heart health equity for all, we want to create a global community of He...