SC- Athletes are prone to CVD

High-performance sport is a focal point for the media, and sadly, cases of sudden death in elite athletes appear in the news with relative frequency. This news added to findings such as those of Pellicia et al. (2016), who reported an unexpected and not negligible prevalence of cardiovascular (CV) abnormalities and pathological conditions among Olympic athletes (Pelliccia et al., 2016), have put exercise on the spotlight, with growing concern about the possible negative effects that regular strenuous exercise can provoke.

In light of the existing debate about the increased health risks of elite athletes, we consider that this information could lead people to misconceive the high volumes of exercise that these athletes perform during their sportive life as the cause of the aforementioned CV abnormalities. However, considering that nowadays sedentarism and its associated diseases are one of the greatest public health issues, we must avoid people from thinking of strenuous exercise per se as a source of increased morbidity or mortality.

Performing moderate physical activity has well-documented beneficial effects on CV morbidity, but there is controversy surrounding the effects of larger doses of physical activity (Eijsvogels, Fernandez, & Thompson, 2016). Concerning the CV maladaptation to strenuous exercise, Sanchis-Gomar et al. (2016) found in former elite and amateur athletes aged 40-70 years old that, although they presented an overall pattern of cardiac remodeling in comparison with control non-athletes participants (e.g. larger left and right ventricles and left auricle cavities), these changes were benign, with no differences in cardiac biomarkers (Sanchis-Gomar et al., 2016). Similarly, Bohm et al also reported these non-pathological morphological adaptations in elite master endurance athletes with a training history of 29±8 years, with no differences between these athletes and the control group neither for left or right ventricle volumes nor for cardiac biomarkers (Bohm et al., 2016). These results confirm that although the possibility of exercise-induced cardiac remodeling in elite athletes is high, these adaptations are very likely to be benign.

In fact, there is a large body of research supporting that the population that performs the highest levels of physical activity (i.e. elite athletes) seem to present a lower risk of CV diseases and mortality. Specifically, a meta-analysis including 42087 elite athletes reported a 27% lower risk of mortality associated to CV diseases in comparison with the general population (Garatachea et al., 2014). Furthermore, an epidemiological study that analyzed 15174 Olympic medalists found that these subjects lived a mean of 2.8 years more than the average population, independently of the country or the type of sport performed (Clarke et al., 2012).

On the other hand, it has been described a higher prevalence of sudden death in young athletes than in their non-athletes counterparts (Corrado, Basso, Rizzoli, Schiavon, & Thiene, 2003). However, it is important to highlight that physical exercise was not per se the cause of this enhanced mortality, but it triggered the event in those subjects who were already affected by an undiagnosed CV disease.

Therefore, very large doses of physical exercise such as those performed by elite athletes seem not to increase the prevalence of CV diseases during youth or even in later years, as the CV and mortality risk of elite athletes is the same or even lower than that of the average citizen. The dramatic occurrence of cardiac events in young athletes as well as the interesting results reported by Pelliccia et al. (2016) must raise consciousness about the necessity of an appropriate medical screening in the sportive context; strenuous physical exercise can trigger cardiac arrest in those subjects with a previous undiagnosed CV disease. However, they should not sharpen the discussion on the suitability of performing high-performance physical exercise from early ages.

SC- Cardiac Rehabilitation

There is a saying that “what goes around comes around”, and exercise training as a treatment for patients severing from coronary heart disease is no exception to the rule. The eighteenth century English physician, William Heberden, recorded the case of a patient severing from angina “who set himself the task of sawing wood every day and was nearly cured”.1 Almost a century later in 1854, the Irish doctor, William Stokes wrote “the symptoms of debility of the heart are often removable by a regulated course of gymnastics, or by pedestrian exercise”.2 His “pedestrian cure” consisted of comfortable walking initially on level ground, the distance and gradient being increased as tolerance improved—always, however, cautioned against excessive fatigue, breathlessness, or chest pain. Have we progressed that far since then? Over the ensuing years, Stokes’ exercise training regime was largely forgotten, obscured by the teaching of the London surgeon John Hilton, who stressed the value of strict bed rest.3 Unfortunately, Hilton’s precept was carried to extremes. Prolonged immobilization in bed became the cornerstone of medical care for close to a century; seldom was it practiced more assiduously than after a myocardial infarction. However, by the 1950s, doctors had begun to question the wisdom of strict bed rest, and when Levine and Lown introduced their innovative and highly successful “armchair treatment”, in which they progressed their heart attack patients to sit up in a chair by the bed a few days after admission, the era of early mobilisation had arrived.

Thus, the past five decades of the twentieth century have seen noteworthy advances in the application of exercise training as part of a comprehensive approach for the secondary prevention and rehabilitation of coronary heart disease. As a result, national and international health bodies have stressed the importance of exercise rehabilitation and have advocated that it be made available to all cardiac patients. Unfortunately, in most countries, this goal has not been achieved. Cardiac rehabilitation is grossly undervalued and underused, and it has been estimated that only about 20–30% of potential candidates receive the service. Greater efforts are required on the part of the government, health professionals, and the public alike if we are to meet the challenge of providing improved cardiac rehabilitative care for patients into the next century.

SC- Cardiovascular screening principles and practices

In a recent BMJ report, Van Brabandt and colleagues present their assessment of cardiovascular (CV) screening in athletes to prevent sudden cardiac death (SCD) from the perspective of a health economist.

The authors make several points of which we agree:

1) the diagnostic yield of CV screening by history and physical examination alone is extremely low and with little supporting evidence;

2) national, universal screening should not be mandated, especially without appropriate physician infrastructure;

3) CV screening will detect disorders associated with SCD but with an unclear absolute risk of CV events; and

4) the potential benefits and harms of different CV screening programs are not fully understood.

However, we disagree with their conclusion, “As long as those at high risk of sudden death cannot reliably be identified and appropriately managed, young athletes should not be submitted to pre-participation screening.” We wish to share a different perspective on why early detection of CV disorders in athletes is both justified and can save lives.

Purpose and Assumptions

The premise of CV screening in athletes is that early detection of cardiac disorders associated with SCD has the potential to reduce morbidity and mortality through individualized and evidence-driven disease-specific management. Without this belief, then screening by any strategy is called into question. If one believes in early detection, screening by history and physical examination alone is inadequate. The addition of ECG, while still imperfect, will increase detection of disorders at elevated risk of SCD and can be achieved with a low false-positive rate and high quality when proper infrastructure and skilled cardiology resources are available.

SC - Principles and practices of Cardiovascular evaluation of athletes

Sudden death in young athletes is largely due to a variety of clinically unsuspected congenital cardiac abnormalities. In the United States, genetic cardiovascular diseases including hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy, Marfan syndrome, and ion channelopathies (eg, long QT syndrome) account for approximately 40% of sudden deaths in young athletes, with HCM being the single most common cause and accounting for one third of the cases. Other less common causes include coronary artery anomalies, myocarditis, aortic valve stenosis, mitral valve prolapse, dilated cardiomyopathy, and premature atherosclerotic coronary artery disease. Available prevalence data for sudden death in young athletes are limited and may underestimate the magnitude of this public health problem.

Preparticipation Athletic Screening

Preparticipation screening is the systematic medical evaluation of large, general populations of athletes prior to training for the purpose of identifying (or raising suspicion) of cardiovascular abnormalities that could provoke disease progression or sudden death. Identification of these diseases may well prevent or delay some cases of sudden death because of physician-recommended temporary or permanent withdrawal from sports or treatment interventions. An impediment to implementing preparticipation screening is a large number of young athletes (an estimated 10 million-12 million per year) and the infrequency of sudden death. Furthermore, customary screening practice for US high school and college athletes consists only of performing a personal and family history and a physical examination. The efficacy of this practice has come under scrutiny. The 1996 American Heart Association consensus panel6 stipulated that such preparticipation cardiovascular screening is a justifiable clinical practice, but routine non-invasive testing is not recommended due to the low-anticipated yield and associated cost-efficacy considerations. Specific screening recommendations were formulated to target those cardiovascular lesions known to cause youthful sudden death.

Thoughts impact on Health

In many cases, our thoughts have a great impact on our health. There is also a famous saying which says, "health is wealth". Our health is well when we maintain it at the right way. More the positive thoughts around us more energetic and fresh we feel. More the negative thoughts around us the lower we feel which increases depression and stress. These two factors, in turn, increase our BloodPressure which causes Hypertension. 

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SC - Cardiovascular Anatomy and Physiology

The cardiovascular anatomy and physiology:
Function of the heart:

• Managing blood supply - The blood supplied according to the metabolic need by knowing the heart rate variations. 
• Producing blood pressure - For the blood to flow through the blood vessels the heart muscle contracts which releases the pressure required. 
• Securing one-way blood flow - The valves help in one-way blood flow through the blood vessels. 
• Transmitting blood - Heart separates the pulmonary and systemic circulations that ensure oxygenated blood flow through the tissues. 

Anatomy of the heart: 

The different parts that make up the heart and also the functioning of it in the right way are

• Heart Structure and Functions
• Layers of the heart - Epicardium, myocardium, endocardium
• Chambers of the heart - receiving chambers (atria), discharging chambers (ventricles), septum
• Associated great vessels - superior and inferior vena cava, pulmonary arteries, pulmonary veins, aorta. 
• Heart Valves - atrioventricular valves, tricuspid valve, bicuspid valve, semi-lunar valve
• Cardiac circulation vessels - coronary arteries, cardiac veins
• Blood vessels - arteries, arterioles, veins
• Tunics - tunica intima, tunica media, tunica externa
• Major arteries of the system circulation - arterial branches of the ascending aorta, arterial branches of the aortic arch, arterial branches of the thoracic aorta, arterial branches of the abdominal aorta
• Major veins of the system circulation - veins draining into the superior vena cava, veins draining into the inferior vena cava

Physiology of the heart: 

• Intrinsic conduction system of the heart
• The pathway of the conduction system
• Cardiac cycles and Heart sounds
• Cardiac output
• Physiology of circulation
• Cardiovascular vital signs
• Blood circulation through the heart
• Capillary exchange of gases and nutrients

Music and CHD

The effect of Music therapy is said to have an impact on adults and Infants who have heart diseases but, there are no explores in this field. Thus, recently a study was carried on to check the effect of Music therapy on infants who were affected with CHD and were in the Cardiac Intensive Care Unit (CICU). 

Five infants in the CICU received music therapy entrainment 3–5 times per week for up to 3 weeks. Sessions took place both prior to and after the infant’s surgical cardiac repair. Heart rate, respiratory rate, blood pressure, and oxygen saturations were recorded every 15 seconds for 20 minutes prior to the intervention (baseline), during the 20-minute music therapy entrainment (intervention), and for 20 minutes after the intervention (return to baseline). Comparisons of baseline to intervention measures were based on means, standard deviations, and derivatives of the signal.

Results

Four of 5 infants experienced a decrease in average heart and respiratory rates as well as improvement in the derivative of the heart rate signal. Greater improvements were found when infants were located in the open bay and were receiving sedatives or narcotics.

Conclusions

The study was carried out to show an initial evidence on the effectiveness of Music therapy against CHD in infants. This was, just started as a baseline of the Music therapy. 

Source: https://goo.gl/rU5Ncu

Must eat foods for Hypertensive people

Hypertensive people when they include lots of fresh juices and fruits it improves health. They become stress-free and healthy. Fruits reduce the blood pressure.  Taking the fruit diet with the consultation of the doctor will improve the person's health. 

Head and Heart - Create Wisdom?

The key purpose of the research is to show that "Wise reasoning is not exclusively the function of the mind and cognitive ability. The study extends to show how the heart's function impacts the mind.

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Sports Cardiology

In recent years the growth of athletes and sports person’s has been increased more than double the rate. In general, we all know that the physical exercise reduces the risk of heart diseases and blood pressure. The desire of sports is raised in children and adult with heart disease. But, at the same situation vigorous physical exercise increases the risk of CV outcomes in competitive athletes and high outcome people (CAHOP). These CAHOP people are always at an intense risk of adverse CV outcomes and also inherited CV Diseases. A multidisciplinary team of trained coaches, trainers, physical therapists, primary care sports medicine physician and orthopedic surgeon functions with CAHOP people. In recent days the situation arose for a demand of CV specialist in the team. These members must have the essential skills necessary to practice sports cardiology. By seeing the demand a separate council has been started at American College of Cardiology – Sports and Exercise Council. In just a short span of 2 years, this council has reached up to 4000 members which show the increased interest of people in the emerging risks and innovations. This CV attack is also termed as sports-related sudden cardiac death. Commonly, sudden cardiac death is triggered by a malignant tachyarrhythmia such as ventricular fibrillation (VF) or ventricular tachycardia degenerating into VF. There is typically an underlying substrate for arrhythmia trigger, such as hypertrophic cardiomyopathy, channelopathies, arrhythmogenic cardiomyopathy, or coronary congenital abnormalities, among others.

Diabetes and Hypertension Awareness

Diabetes mellitus and hypertension are common diseases that coexist at a greater frequency than chance alone would predict. Hypertension in the diabetic individual markedly increases the risk and accelerates the course of cardiac disease, peripheral vascular disease, stroke, retinopathy, and nephropathy. Our understanding of the factors that markedly increase the frequency of hypertension in the diabetic individual remains incomplete. Diabetic nephropathy is an important factor involved in the development of hypertension in diabetics, particularly type I, patients. However, the etiology of hypertension in the majority of diabetic patients cannot be explained by underlying renal disease and remains "essential" in nature. The hallmark of hypertension in type I and type II diabetics appears to be increased peripheral vascular resistance. Increased exchangeable sodium may also play a role in the pathogenesis of blood pressure in diabetics. There is increasing evidence that insulin resistance/hyperinsulinemia may play a key role in the pathogenesis of hypertension in both subtle and overt abnormalities of carbohydrate metabolism. Population studies suggest that elevated insulin levels, which often occurs in type II diabetes mellitus, is an independent risk factor for cardiovascular disease. Other cardiovascular risk factors in diabetic individuals include abnormalities of lipid metabolism, platelet function, and clotting factors. The goal of antihypertensive therapy in the patient with coexistent diabetes is to reduce the inordinate cardiovascular risk as well as lowering blood pressure.

Hypertension and Kidney Diseases

Chronic kidney diseases – arising from inborn or acquired renal disorders – are one of the most common causes of secondary hypertension. Renal parenchymatous hypertension accompanying bilateral or unilateral kidney diseases is more prevalent than renovascular hypertension. The prevalence and severity of hypertension are influenced by age, weight, type of renal affliction, and depth of renal dysfunction. In multifactorial pathogenesis, sodium retention plays the crucial role together with dysbalance concerning effects of different vasoactive substances; however, unequivocal distinction between volume- and renin-type hypertension is difficult. The treatment of renal hypertension includes appropriate lifestyle changes, pharmacotherapy, hemoelimination methods and radiological or urological invasive procedures. In chronic kidney diseases with increased albuminuria or proteinuria, ACE inhibitors and AT1-blockers are preferred. Combination of several antihypertensives is often required to achieve the target blood pressure. Increased blood pressure represents not only the manifestation of chronic kidney diseases but also an important factor concerning the renal and cardiovascular risk.

Hypertension in patients with Comorbidities

Hypertensive patients tend to develop many other diseases in their body. Comorbidities included the combination of two or more diseases other than hypertension. These diseases include heart diseases, kidney diseases, diabetes mellitus and blood vessel diseases. Inclusive of all the major effects of hypertension is cardiovascular diseases and cerebrovascular diseases. The patients with diabetes and hypertension are insulin resistant. The complication of hypertension is mainly categorized under two as macrovascular and microvascular. There are various organizations working on the medications to be followed for hypertensive patients to reduce the effects of other diseases. These organizations work on statistics in order to identify the patient's adherence to the medications. There are certain guidelines provided by National Institute for Healthcare and Excellence to be followed for the comorbidities patients. 

• Track 1-1 Combination of Diseases
• Track 2-2 Patient Adherence and Comorbidity
• Track 3-3 Study of Hypertensive Prescribing Practices
• Track 4-4 Guidelines by National Institute for Health Care and Excellence
• Track 5-5 Cardiovascular Medicine