2014 September

Exercise stress laboratories in the future

Exercise Stress Laboratories in the Future What Should their Capabilities Be?

Тhe current issue of this journal contains information from Guiney et al demonstrating the ability of thallium (Tl) myocardial scintigraphy to differentiate false-positive from true-positive ECC responses that are indicative of myocardial ischemia during exercise. That report emphasizes the usefulness of 201T1 in identifying the presence of anatomically (and presumably physiologically) important coronary artery luminal diameter narrowing. It is important to differentiate true- from false-positive ECG responses indicative of myocardial ischemia, since there is a relatively high frequency of false-positive tests in women, in persons taking digoxin, in those with ventricular hypertrophy, in persons with electrolyte or cardiac conduction abnormalities, and in those with abnormal ECGs preceding exercise.

During the past several years, the sensitivity of rest and maximal exercise 201Tl scintigrams in the recognition of anatomically important coronary artery disease has been 70 to 80 percent, with a specificity of approximately 90 percent 2,8 More recently, quantitative measurements of regional ventricular mTl uptake, “reperfusion” ^Tl imaging,4 the insistence on obtaining images within five minutes after the injection of mTl9 and assuring maximal exercise effort have improved the sensitivity to 85 to 90 percent in several centers. 5»6

The correct recognition of physiologically important coronary disease is critical in the evaluation, management, and predicting prognosis in patients with chest pain and ischemic heart disease Canadian Pharmacy viagra. Relatively noninvasive methodology, such as T1 myocardial scintigraphy, that allow the identification of functionally important coronary disease represent an important development in the diagnostic capabilities of the cardiologist.

In addition to the study by Guiney et al, others have also shown that the combination of 201P myocardial scintigraphy and ECG monitoring during stress testing is better than either alone in detecting the presence of anatomically important coronary artery stenoses.8»9 Therefore, if used properly and with experience and contemporary methodology, 201T1 myocardial scintigraphy can be a valuable and relatively noninvasive diagnostic tool in evaluating chest pain.

However, myocardial imaging techniques can also make other important contributions to assessing the presence or absence of physiologically important coronary artery disease. Borer and associates have demonstrated that measurements of left ventricular ejection fraction at rest and during exercise help identify those persons with important ischemic heart disease. We have suggested that measurements of left ventricular end-systolic volume and of systemic arterial systolic blood pressure/left ventricular end-systolic volume ratio (TP/V index”) are also useful means of identifying physiologically important ischemic heart disease.Our approach was suggested by the earlier efforts of Suga and Sagawa demonstrating that alterations in the P/V index provide a means to assess changes in contractility.

Estimates of alterations in regional ventricular wall motion from rest to exercise should also provide important clues to the presence of functionally important coronary artery disease and help to differentiate cardiomyopathy with global ventricular dysfunction from the segmental ventricular alterations typical of ischemic heart disease.We believe that future developments will also emphasize alterations in segmental diastolic function and systolic wall thickening in the differentiation of functionally important ischemic heart disease from cardiomyopathies. In patients with ischemic heart disease, functional studies that evaluate regional ventricular alterations potentially allow one not only to determine that ischemic heart disease exists, but also to assess the functional impact of coronary artery disease on global and regional ventricular function. This should also have prognostic significance.

By admin on September 23, 2014 | Diseases

A Good Heart

The human heart is an organ that is about the size of a closed fist and it is located in the chest behind the breast bone, in the middle and to the left. The heart is an amazing organ. It is basically a muscular pump designed to pump blood, firstly to the lungs where it gets oxygen, and then all around the body to the organs and muscles that need the oxygenated blood.

Vital Statistics

The heart beats and pumps on average seventy times per minute or over one hundred thousand times per day. This equates to over two and a half billion cycles over seventy years, and all this without maintenance. It is a truly remarkable pump and without comparison in engineering terms.

However, this heart muscle can become damaged. This damage mainly occurs if the small blood vessels supplying blood and oxygen to the heart itself become narrowed or blocked. Your heart is a muscle and like any other muscle in the body it needs oxygen, good nutrition and plenty of exercise to stay at its best. The plumbing of the heart muscle is provided by small arteries called the coronary arteries, which are wrapped around the heart muscle itself. There are three of these: the LCA (left coronary artery), the RCA (right coronary artery) and the circumflex artery. Narrowing of these arteries results in heart disease and sudden blockage can cause heart attack. The LCA is known as the ‘widow makers’ artery’ as blockage of this artery can result in sudden death.

Heart Disease – The Silent Killer

Perhaps the biggest problem with heart disease is that you may not know you have it. Narrowing of the coronary arteries can occur over many years without necessarily causing any symptoms. Indeed, men who get heart-related chest pain (called angina) may be the lucky ones in that they get an early warning that something is not right. The first symptom or sign of heart disease may be a heart attack or even sudden death. There is no doubt that early detection, and preferably prevention, of heart disease is much better than cure.

Risk Factors for Heart Disease

As an Irish male you are already at an increased risk of heart disease. Indeed, Irish men have some of the highest rates of heart disease in the world HQ Canadian Pharmacy online store Viagra. This is largely because of the following risk factors:

  • Our genetic makeup – there is no doubt that a family history is important for many conditions, including heart disease. Know your family history well and take appropriate action.
  • Smoking – cigarette smoking approximately doubles your risk of heart attack. If you smoke, stop. The good news is that your risk of heart attack drops rapidly if you do stop.
  • High blood pressure
  • High cholesterol levels
  • A ‘Western diet’ – typically a diet high in saturated fat
  • Age – none of us can turn back the clock, but the risk of heart attack increases after the age of 40.
  • Lack of exercise – the sedentary ‘couch potato’ lifestyle
  • Diabetes
  • High levels of stress/distress
  • Heavy alcohol intake
  • Obesity
By admin on September 16, 2014 | Health Care, Heart Disease

Sexuality and Sexual Health Throughout the Childhood and Teenage Years

Professional practice

The idea that children are sexual beings breaks strong taboos in many cultures and can cause unease among parents and professionals. Teenagers’ sexuality can be presented as inherently problematic, with the focus on unwanted pregnancy and STIs causing a blight upon society as a result of ‘promiscuity’.

The only universally accepted sexual activity is that which is seen to take place for reproductive purposes within marriage: this is explicit in most religions and many societies and implicit in others. Sexual deviance is often measured in terms of how far away an activity is from this norm. If children and young people receive negative reactions about their sexuality from adults, they soon learn not to mention sexual matters. Similarly, the sexuality of children and young people is often disregarded by professionals.

Ignoring or avoiding the sexuality of children and young people means missing a whole dimension of important issues and information. Here I return to the two questions introduced at the beginning of this chapter:

  1. How is this young person’s sexuality affecting his or her behaviour, including what he or she is telling me about symptoms, feelings and relationships?
  2. How is the way that I am dealing with this young person going to affect his or her future sexual health, sexual feelings and sexual relationships?

As already indicated, even quite young children may be shy about nakedness and concerned about physical privacy. Children and young people of all ages may fail to disclose symptoms if they fear that disclosure could prompt an unwanted physical examination. Symptoms may be relocated to more ‘public’ parts of the body and some ‘disgusting’ symptoms such as discharges not reported at all. Any discussion of menstruation may be experienced as intensely embarrassing, especially with an adult of the opposite sex. Children may feel the need to keep secret their knowledge about sex and reproduction so discussion about future fertility may need to include reassurance and permission to be knowledgeable, together with sufficient explanation to cover gaps and misinformation. Children and young people are often self-conscious about their physical appearance. They may well be ashamed and confused about sexual feelings and embarrassed about romantic attractions, so these may also be kept secret. Their ideas about their future identity as a man or a woman in a relationship, perhaps being a mother or a father, may be too complex to disclose. One of the greatest drivers to secrecy can be if there is any confusion in the child or young person over their sexual buy levitra online in australia  orientation or an awareness that they are gay or lesbian. Another is if they have experienced sexual abuse. Any previous experience of professionals being insensitive or disrespectful, especially if confidentiality has not been respected, is also more likely to lead to reluctance to discuss sexual matters.

By admin on September 10, 2014 | Sexual Health

Atypical antipsychotics

Strategies supported by scientific evidence

Lithium salts: This is the most investigated and docu­mented strategy. Lithium must be added without discontinuing the antidepressant treatment, and should be maintained for the same time period as the antidepressant drug throughout the initial and continuation treatments. If prophylactic treatment is required. the use of lithium alone may be considered on account of its efficacy in preventing recurrences. Efficacy estimates are 40-60%. While improvement may start within 24-48 hours, the available data advise to extend the potentiating attempt up to the 3rd or 4th week before deciding on its uselessness (Alvarez et al., 1997). The metaanalysis published by Bauer (Bauer and Depfmer, 1999) concludes that lithium potentiation is the treatment of choice in depressed patients not responding to monotherapy, with a minimum waiting time of 7 days with lithemias 0.5 mmo1/1.

Triiodothyronine (T3): T3 improves central NA activity by increasing postsynaptic receptor sensitivity. Recom­mended doses are 25-50 pg/day. with response assessment after 3 weeks. Treatments longer than 8-12 weeks must be avoided due to a withdrawal-related risk of hypothyroidism. The most frequent side-effects are nervousness and insomnia. Viagra canadian pharmacy A controlled clinical trial versus placebo and lithium (Joffe et al.. 1993) found no differences between the two procedures. both being higher than placebo.

Atypical antipsychotics: While more data are needed, this is a safe, well tolerated combination. particularly indicated to cover the hyperarousal symptoms of depression (insomnia, weight loss, anxiety. agitation). Although efficacy data in treatment-resistant depression are available for most atypicals. the most studied and proven drug for this indication is olanzapine (Thase. 2002).

By Health Care on September 5, 2014 | Medications