World of Health

The angle of the tilt table used in cardiology is inclined to find the cause of a certain type of severe dizziness or fainting.  The use of the tilt table test tilt to cause syncope with Finnish research is old, but as a method of syncope vasovagal diagnosis in clinical practice began in 1986.

The proof of the inclined table is used mainly to know whether the vasovagal syncope is the cause of fainting and investigate other possible causes. Basically, the proof of the inclined table is based on inducing a vasovagal reaction rate in the patient.

The vasovagal syncope is usually found in patients who at first had what would be considered normal response but show an inability to maintain blood pressure as well as cerebral perfusion abnormalities caused by autonomic regulation. The percentage of positive results of tilt testing in patients with syncope ranged on average between 26% and 75% of cases.

The vasovagal syncope should not be mistaken for orthostatic hypotension which is recorded during the test by an almost instant drop in blood pressure immediately as the patient is placed upright. If blood pressure drops too low, there is no blood flow to the brain and the person faints. When a person faints they are placed immediately in a horizontal position so it is easier for the blood to reach the brain and the person wakes.

Ask the patient to lie on a special table with the ability to tilt and restrain them by safety belts both in the chest by the legs, just as it is used for a person who has damaged his spinal cord. This table allows the patient to a full horizontal position to a vertical position overall, with no exfuerzo for him.

You insert an intravenous catheter in one arm and a cuff for measuring blood pressure in the other, and then put a series of electrodes on the chest to monitor heart rate with a device for obtaining electrocardiograms electrocadiógrafo at any time of the test and heart and the answer in real time. Initially, the patient is lying face up on the table in a horizontal position. Then the doctor will tilt the table until the patient’s head is upright, between 60 and 80 degrees and remains so for 20 or 30 minutes with monitoring of heart rate and blood pressure before returning to the horizontal position.

In this initial period (Phase I) no drugs are used at any point. At this stage the patient should inform the doctor if they have the same symptoms before fainting. If at the end of this stage there were no clinical symptoms or abnormal blood pressure or heart rate, the patient returns to the supine and starts a second phase in which it is used a pharmacological provocation (Phase II) usually Isuprel (isoproterenol chloride is a bronchodilator that acts as a sympathomimetic amine) is applied to the patient via venous or sub-lingual nitrates partners back to the same degree of inclination of the first phase.

According to the patient responds and the results obtained with the diagnostic equipment used, can get sigientes results.

* Case cardiac disorders in heart rhythm (arrhythmia), acute coronary syndrome (myocardial infarction or angina), problems with heart valves or pulmonary embolism.

* Case no heart: Elevation or sudden decrease in blood pressure vasovagal syncope, seizures, transient cerebral ischemia, hypotension or migraine.

* Unknown Cause: approximately 14% of cases is not possible to detect the origin of the fainting with this test.

* Negative result, the patient does not suffer from any vascular dysfunction that causes your symptoms.

The test is considered positive if the person completed faints or goes to the brink of collapse. When this test is positive, treatment should be a cardiologist for pre-medication to help control the problem

The results of research carried out at the Wolfson institute indicates that those over the age of 55 who are receiving treatment for heart disease in the form of statins and pills are getting no more benefits than those who are screened. The institute, part of Barts, has conducted the research with the LSMD, London School of Medicine and Dentistry.

Well known GP Dr. Hilary Jones has spoken about the findings, saying that although the age for predicting heart disease has been set by the survey at 55,other factors must be taken into consideration. These include Diabetes, smoking, obesity and blood pressure. There is also a real concern about the common but under estimated side effects such as muscle pain, indigestion and flatulence.

It is estimated that to save 2 lives you would have to treat 100 patients with statins. Undoubtedly there will be some that see significant benefits but many will see no palpable difference as well as suffering unpleasant and adverse reactions. High risk patients under the age of 55 should also still be screened and not abandoned.

“My recommendation is to consider lifestyle changes including lowering stress, getting enough sleep, exercising regularly, and adopting a healthy eating regime. Simple steps, such as including garlic in your daily routine has to be a better option than having half the population taking unnecessary pharmaceuticals,” comments Dr Hilary Jones. Other experts also acknowledge the circulatory benefits of garlic supplements.

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Research into the biggest killer in Britain has uncovered a landmark answers to heart disease and its link to a few rogue genes and choices in lifestyle. These 18 genes have been detected, in three studies that have included hundreds of scientists worldwide, to increase the risk of cardiac problems from hardening of arteries to heart attacks.

Preventing heart disease, blamed for over 12% of death worldwide, now can be better treated and even possibly prevented, possibly lowering the over 90,000 deaths annually in the UK, costing the economy over 9 billion pounds and killing a Briton every six minutes.

Researchers are saying that heart disease could be eliminated within 50 years with the discovery of these genes that increasing the number of known genes that can cause heart disease by 50%. What many of the genes do to effect the heart is still unknown but ones that are include; blood pressure, cholesterol and other processes of the heart.

Scientists are pleased knowing that causes of the disease are yet to be found and drugs to fight against the genes can one day be found and the result will be much improvement to health. With the identification of many genes, this has become a landmark result since most of the genes operate using mechanisms unknown to us now and the job now is to understand how they work and develop new drugs to fight them and also identify the people most benefit by their use.

In three studies the 18 genes were discovered by some 300 scientists from all over the world including Britons analyzing over 200,000 people. Narrowing of the arteries that supply oxygen-rich blood to genetic links was focused on by the scientists. The narrowing is caused by fatty deposits that build up raised the percentages of many illnesses ranging from heart attacks, to heart failure angina and irregular heartbeats and drugs that were made to stop vessels from clogging would reduce profoundly the risk of having a heart attack.

It is thought that in under a decade the first new drugs could be available in the market said Oxford University Professor Hugh Watkins, that co-led the studies.

According to a study from the BMC Public Health journal, research indicates that the longer one stays in education the lower their blood pressure this seems to be more common in women but those stressed on the night before important exams will not agree.

The study was based on information from the American Framingham Offspring Study that was researched by scientists from the UK, US, and Canada and covered nearly 4,000 people for 30 years following how long they were in education and their medical past.

Professor Eric Loucks of Brown University in the US, says the study should explain about the widely documented relationship between education and heart disease risk in developed countries around the world.

Wanting to answer the question as to whether education influences heart disease they had to find out if education was related to blood pressure, one of the major influences of heart disease.

Comparisons were made between people that had more than 17 years or less than 12 years of education and found that women that studied for more than 17 years had a lower blood pressure of on the average of 3.26 millimeters than those that only studies for 12 years.

There was less of a difference in men with only a difference of 2.24mm but still that difference was in favor of those with longer education.

The benefit of education was still present even after taking into affect smoking, obesity, drinking and blood pressure medications even though the differences decreased to just under 3mm for women and 2.25mm for men. The study is from mostly white suburban areas and is one drawback to the  quality of the study.

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The noise at your workplace can increase your risk of heart attack, especially if you are a young male smoker.  This was determined by a recent study that researched the effects of a noisy workplace on labourers.  If the noise is continual and well above normal volume it leads to much increased stress.

Individuals who are stressed are likely to smoke more, eat more, and exercise less.  All of these factors are strong indicators of heart disease and, therefore, loud noise in the workplace can lead to a higher risk of heat disease.

Participants were separated into those workers who had to endure persistent loud noise three months running and those who didn’t.  Loud noise was determined to be sound that caused the participant to have to speak above normal talking levels in order to be heard.

Those who suffered the loud noise were more than twice as likely to suffer cardiac problems and heart disease.  Those who didn’t suffer the noise did not see any rise in the chances for heart disease and cardiac problems.

Certainly other factors, like smoking and obesity, can play into cardiac problems as well.  Those with such conditions need to be doubly aware and adjust their lifestyle for a better chance to avoid heart attack.

Millions of people have been able to watch their cholesterol fall with help from statin drugs, but some researchers are advising doctors to be aware of potential side effects, even though the drugs are great for preventing strokes and heart attacks.

Every year doctors write about 40m NHS prescriptions for statins, but although they are seen as relatively safe drugs, for some people they can cause aching or weak muscles and in some cases muscle tissue will begin to break down.

Due to the fact that statins are a drug that needs to be taken for the long term researchers indicated that it is very important that doctors use them in a way that allows for maximum benefits but minimal side effects.  In order to define what this manner is, researchers studied two million people out of which 200,000 were on statins.

The study showed without a doubt that the drugs are effective at preventing cardiovascular disease, but also that there are side effects with about one out of 10,000 people prescribed the drug exhibiting symptoms of the side effects.

Additionally, the numbers could increase to 110 out of 10,000 men and 39 out of 10,000 women may experience muscle weakness after being on statins for five or more years.

In addition, statins were linked to a higher risk of cataracts as well as kidney and liver problems the latter of which was linked to higher doses of a statin.

Unintentionally, the study also showed that those who used statins had a lowered risk of developing cancer of the throat although this may be because those on a statin tend to reduce the amount of alcohol they intake.

Statins are found in large amounts in some mushrooms.

A report published in The Lancet medical journal this month indicates that triglycerides may be a contributing factor in the incidence of heart disease.  While this is not a new concept, the study confirmed that an increased risk factor is related to the apolipoprotein A5 gene, which determines the level of triglycerides in the blood.

People with extra copies of this gene had as much as a 40% higher risk of developing heart disease, according to researchers’ calculations.  The findings were based on data from more than 300,000 participants in 101 different tests.

Cholesterol and triglycerides are two separate forms of fat.  The body uses cholesterol to build cells and it uses triglycerides to provide energy.  In recent years the medical profession has concentrated on reducing levels of ‘bad’ (LDL) cholesterol and increasing those of ‘good’ (HDL) cholesterol, but it seems that we need to be concerned about levels of triglycerides also.

Triglycerides are produced by the liver and also derived from certain foods.  The same foods that contribute to LDL cholesterol also raise the level of triglycerides.

Nadeem Sarwar, lead researcher in this study, emphasized the need for more extensive and specific research.  Other medical professionals agree that further testing is required before any definitive correlation can be made.

However, there is general agreement that the information presented by Sarwar and his team, though far from definitive, will certainly lead to more research to determine whether lowering triglycerides can help prevent heart disease, and to what degree.  In the meantime, exercise and a healthy diet are still the best means of preventing or at least mitigating the problem.