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Monthly Archives: March 2017

Managing Hypertension

Dietary Restrictions

1) Low sodium intake: The main source of sodium in Western diets is processed food, for instance, excessive quantities of salt are contained in packaged food and in food eaten outside the home. The DASH trial evaluated the effects of varying sodium intake in addition to the DASH diet and found that lowering sodium intake reduces blood pressure levels. Mean sodium intake is approximately 4,100 mg per day for men and 2,750 mg per day for women, 75% of which comes from processed foods.

Recommended Daily Sodium Intake Dietary sodium should be reduced to no more than 100 mmol per day (2.4 g of sodium).

2) Alcohol: Alcohol intake should be limited to no more than 1 oz (30 mL) of ethanol, the equivalent of two drinks per day for most men and no more than 0.5 oz of ethanol (one drink) per day for women and lighter-weight persons. A single drink is equivalent to 12 oz of beer, 5 oz of wine, or 1.5 oz of 80-proof liquor.

3) Caffeine: Caffeine may result in high blood pressure; however, this effect is usually temporary. Moderate intake of caffeine per day does not significantly increase blood pressure.

Recommended Daily Coffee Intake Coffee intake should be less than two cups per day.

Dietary Supplements

1) Potassium supplementation: Lower potassium intake (i.e., below 40 mEq) is thought to be associated with high blood pressure.

2) Fish Oil: According to a meta-analysis of 36 trials of fish oil, the consumption of high doses of fish oil with a median dose of 3.7 g per day provided a significant reduction in systemic blood pressure. Fish oil consumption has also shown to reduce triglycerides.

Recommended Daily Fish Oil Intake A median dose of 3.7 g per day provided a significant reduction in systemic blood pressure.

3) Folate: A small randomized study reported that short-term folic acid supplementation could reduce blood pressure significantly. It has been suggested that a daily intake of 5 mg of folic acid could be beneficial in reducing systolic pressure.

4) Flavonoids: A Cochrane meta-analysis looking at multiple randomized controlled trials reported that flavanol-rich chocolate and cocoa products may have a small but significant effect in lowering blood pressure by 2-3 mm/Hg in the short term.

5) Coenzyme Q10 (CoQ10): Some studies suggest that CoQ10 may have the potential to reduce systolic pressure by up to 17 mm Hg and diastolic pressure by up to 10 mm Hg without any significant side effects. The average dosage used in these studies were around 217 mg/day.

Information of Angiogram

It didn’t go away. In fact, it got worse. It got so he had to pause on his way up the stairs to catch his breath. He also had to pause more than once just to get from his car to his office. It was time to see the doctor.

The doctor couldn’t find anything wrong, but just to be safe he was referred to a cardiologist. The cardiologist didn’t see anything, either. To be safe he was instructed to have an angiogram.

Apparently this did not scare him. It scared the rest of the family, especially those with enough medical knowledge to know exactly what was to be done. He just wanted to get it over with, especially since everyone was walking on eggshells… eggshells he didn’t think were necessary.

The family was right to be afraid. Three arteries were blocked almost completely. 76, 93 and 98%. The pain came from the one artery doing all the work for the other three. He had angioplasty and three stents inserted into his coronary arteries.

A lot of changes happened after this. What the entire family ate changed. Exercise during the week days started. Ways to relieve stress were sought.

It wasn’t enough.

At his next checkup he was ordered to have another angiogram and it resulted in another angioplasty. The third checkup requires another stent besides the angioplasty.

Here is the scary part. The doctor was very firm when he visited the patient. The next time there wouldn’t be any angioplasty and stents. The next time it would be open heart.

Robotic Heart Surgery

Today, robotically assisted heart surgery has changed the way certain heart surgeries are being performed.

Robotic heart surgery, also called closed-chest heart surgery, is a type of minimally invasive heart surgery that allows cardiac surgeons to perform complex heart operations through a smaller opening. The surgery also helps decrease surgical stress and minimizes blood loss, as well as offers patients a shorter hospital stay and faster recovery.

In this technically advanced heart surgery, the cardiac surgeons use a specially designed surgical robotic system which consists three parts- a console, robotic arms and an instrument tower containing tiny camera.

While performing the surgery, the surgeon sits at the computer console to remotely control thin robotic arms outfitted with surgical equipment and a tiny camera (endoscope) through which the surgeons view a three-dimensional image of the area being operated on.

The robotic arms mimic the surgeon’s hand, wrists, and finger movements as the surgeon controls them remotely from the system console.

The da Vinci machine, built by Intuitive Surgical Inc., and the Zeus Surgical System, by Computer Motion, California, USA, are the two surgical robotic systems that are currently used in place of hand-operating instruments.

Robotically Assisted Heart Surgery Procedures

The cardiac conditions that can be treated with the use of robotic assistance include:

Endoscopic coronary artery bypass grafting (CABG)
Totally endoscopic coronary artery bypass grafting (TECAB)
Tricuspid valve repair and replacement
Mitral valve repair or replacement
Combined mitral and tricuspid valve surgery
Atrial septal defect (ASD)
Atrial myxoma and thrombi
Patent foramen ovale (PFO) repair
Removal of cardiac tumors
Lead placement on the surface of the left ventricle during a biventricular pacemaker
Ablation for the treatment of atrial fibrillation
Cardiac and thoracic tumors
Mediastinal mass excision
Epicardial lead placement

Benefits

Less post-operative pains
Substantially smaller and less-traumatic incisions
Less scarring
Reduced trauma to the body
Low risk of wound infection
Eliminates the need for splitting the breastbone (sternum) and spreading the ribs
Reduced blood loss and fewer transfusions
Shorter hospital stays (3 to 5 days)
Faster recovery and quicker return to daily activities and lifestyles

Heart Bypass Recovery

1 – The need for bed rest and minimization of stress. This period may take anywhere from a week to four weeks depending on the health of the patient before the surgery and how the surgery goes. The loss of blood from the procedure will mean that the body is anemic and this will cause the patient to tire easily during the initial days of bypass recovery period, so bed rest is compulsory and important.

2 – Infection prevention. Heart bypass is a major procedure requiring a number of incisions and stitches. The risk of infection is very real and proper wound care is absolutely essential to ensure complete recovery. For this, the services of a private nurse may be necessary to ensure that the wound is regularly cleaned, the gauge regularly replaced, and the medication regularly administered to promote healing in the shortest possible time.

3 – Heart health. The heart of the patient should not be subjected to any extra physical work early on in the heart bypass surgery recovery period. The heart will not be strong enough to handle the increased flow of blood and the increased heart rate during this period. Thus, absolute care must be taken to manage the patient’s condition, never allowing them to do much physical exertion until about 3 to 4 weeks after the surgery.

4 – Physical exercise. Once all the incisions have properly healed, it is time to re-condition the heart so it can deal with the normal stresses of everyday living. To do this, patients should have regular walking exercises out on the street or on a treadmill. However, the level of physical intensity should be kept at a minimum at first and then only gradually increased as the patient gains more physical strength. It is very important to watch the routine to be certain exercise is done but kept within reasonable boundaries.