Online edition of Sunday Observer

Myocardial Infarction (MI), more commonly known as a heart attack is the second highest killer worldwide, the first being cancer. 'Myo' means muscle; 'Cardio' deals with the heart; and 'Infarction' means

death of tissue due to a lack of blood supply. Being a condition that should be dealt with instantly, most deaths by heart attacks occur due to the lack of timeliness in which the patient is supplied with medication. Thus it is vital to know how a Myocardial Infarction occurs and how it should be treated.

High blood pressure, diabetes and smoking are few of the many causes that lead to heart attacks. They aid the build up of Athorosclerotic plaques, fatty deposits that block arteries, which are blood vessels that transport oxygen and nutrition in our body. These plaques have a hard shell, which in time ruptures and releases platelets, which aid the formation of blood clots. The heart muscle needs a constant supply of oxygen rich blood in order to function appropriately. This critical blood supply is provided by the coronary arteries. If a blood clot thus forms and completely blocks the coronary artery, the heart muscle, starved for oxygen, dies within a short period of time causing permanent damage. This is what we call a heart attack or a Myocardial Infarction.

Similarly a brain attack or stroke occurs when an artery, which supplies blood to the brain, is blocked by a thrombus. The lack of oxygen will damage the brain cells to which the artery provides blood. Such blockage would not immediately result on a massive stroke, but will lead to a 'mini stroke' where for an instant the blood flow in the vessel would stop and then continue without injuring the brain tissue.

But such initial harmless attacks are a warning sign of future massive brain attack.

Haemorrhagic strokes emerge when a blood vessel in the brain is damaged and blood is leaked. This could impose pressure upon other parts of the brain such as the brain stem and thus the patient could stop breathing.

Therefore it is vital to treat a brain attack as quickly as possible and take the patient to the nearest Emergency Unit, for doctors to insert a breathing tube and place the patient on a ventilator until brain surgery is performed to remove the leaked blood and relieve pressure on the brain. When a patient suffers a stroke he may experience the following symptoms:

* More often there is a sudden and dramatic onset with loss of consciousness; convulsions may occur. There are many symptoms that are visible prior to a heart attack.

Discomfort, pressure, heaviness, or pain in the chest, arm or below the breastbone.

According to Dr. S. R. de Silva the Senior Consultant Cardiologist of the Institute of Cardiology of the National Hospital, the time in which the symptoms will be visible prior to an attack may differ, for instance a patient can suffer a silent heart attack where no symptoms will be noted prior to the attack. He further pronounced this fact by stating that for symptoms of a heart attack to be visible it would take a 70% blockage of the artery whereas a heart attack could occur at a 30% blockage. "A patient with such symptoms should be dealt with least possible delay, preferably within the next 30 minutes," says Dr. de Silva.

Since each coronary artery supplies blood to a section of the heart muscle, the damage caused by MI would depend on the amount of muscle mass to which the artery supplies blood, and the time between the injury and treatment. Dr de Silva states that the most common form of treatment is to dissolve the blood clots 'clot busters' or Thrombolytic drugs such as streptokinase. The patient should be provided with this drug within the next 30 minutes following an attack. Therefore a patient showing symptoms of either a heart attack or stroke should be taken to the nearest Emergency Unit without delay. He further says that a patient brought in to the Emergency Unit will be given initial treatment at the OPD of the National Hospital and thereafter transferred to the Coronary Care Unit for further treatment.

When diagnosing an MI patient, he will undergo many tests prior to the diagnosis. Electrocardiogram tests, blood tests, Echocardiography and Cardiac catheterisation are some of the many ways by which a heart attack is diagnosed. Following a heart attack a patient would be taken to a cardiac catheterization laboratory where the status of his heart and the damage caused to the tissue would be evaluated. In some cases, procedures such as angioplasty (more commonly known as stents) are used to open up the narrowed or blocked arteries. If necessary, bypass surgery may be performed to restore the heart muscle's supply of blood.

Dr. de Silva says that factors such as smoking, elevated cholesterol, obesity and diabetes can aid the prevalence of heart and brain attacks. A complete change of lifestyle is a great necessity.

Exercising, controlling stress, avoiding saturated fats, red meats, rich food and reducing your daily intake of salt are essential according to the Senior Cardiologist. A diet free from cholesterol and high in foods such as vegetables and fruits is a must. When asked Dr de Silva strictly advised against the consumption of coconut oil.

No exercise doubles chances of heart disease

Physical inactivity doubles your chance of developing cardiovascular disease (CVD) warns the World Heart Federation, an NGO dedicated to the global prevention of CVD in the lead up to World Heart Day which falls today (Sunday 29) more than two million deaths every year are directly attributable to physical inactivity. To put the health risk in context, lack of exercise may be as dangerous for the heart as smoking a packet of cigarettes every day.

The World Heart Day slogan, "A Heart for Life", encourages healthy lifestyles through increased physical activity, amongst other measures. Around 90 countries are expected to participate in this year's World Heart Day, with World Heart Federation Members organising events including carnivals, walks and health checks, stage shows, public talks, meetings with politicians, scientific forums, exhibitions, sport tournaments, charity galas and concerts.

"Even moderate exercise, such as a brisk walk for 30 minutes most days helps control weight, cuts stress, anxiety and depression. We also strongly recommend adopting a diet with lots of variety, fresh fruit, whole grains and vegetables, to drink alcohol only in moderation and to reduce the levels of saturated fat and cholesterol in your diet to keep your heart healthy," said Professor Mario Marandhao, President of the World Heart Federation.

Lack of exercise increases the risk of hypertension by one third and type II diabetes by half. Both are major risk factors of CVD. Between 65 and 85 cent of the world's population fail to take enough exercise and this has a major implication for healthcare costs.

Inactivity is especially a problem for women, who exercise less than men on average. "Personal recommendations from doctors and health professionals do not seem to be enough to change behaviour," said Professor Maranhao. Results of a recent survey, Euroaspire II conducted across 15 European countries, showed that although 67 per cent of all patients interviewed reported that they had been given advice about the beneficial effects of exercise, 61 per cent still remained physically inactive.

Simple steps to get into better shape

* Get off the bus or train a few stops earlier and walk the rest of the way

* Walk around during the workday break or at lunch time

* Take the stairs instead of the elevator

* Go and speak to someone instead of using the phone or e-mail

* Stand while on the phone

* Schedule exercise time in your calendar

For more information on events being organised worldwide visit: www.worldheartday.com

It is a sad fact that eighty per cent of us will have back pain at some time during our lifetime. Some of this discomfort will be so-called postural pain, and later in life it will be called degenerative pain. If it becomes severe it may cause leg pain or sciatica.

Those who have become afflicted with the sedentary disease known as sititis and have become allergic to exercise will find their backs have taken the brunt of the resulting slumped posture. Because we spend half of our lives sitting, standing or slumping, our big back muscle have been allowed to grow flabby and soft. If you doubt this statement, analyze how much time you spend sitting, without using your back muscles except to keep you upright. You sit to eat, you sit to do your office work, you sit to drive your car, you sit to watch sporting events, you sit or slump in a soft chair to listen to your radio. Because of all this sitting and very little walking, swimming, bicycling, or other activity that puts your big back muscles to work, your back suffers. As the large antigravity muscles, the erectors spinae muscle groups alongside the vertebrae, lie down on the job, swayback follows. If the lumber curve becomes too great, actual slippage of the last lumbar vertebra may occur in some patients. This is called spondylolisthesis.

You can strengthen your back muscles. Do not allow the weight of the body to fall on the ligamentous structures, the discs, or the nerves as they emerge from the spine. Weak back muscles are the precursor to herniated lumber discs, also the back that is unaccustomed to exercise, when asked to bear an extra strain such as a load of groceries, has trouble supporting the body weight and the groceries too, and lumbosacral strain may occur.

Your back is made like a string of blocks, one riding upon the other, with little discs to act as shock absorbers between. It is shaped like the letter S but must act like a rod to support the body. To do so, certain muscles serve as guy-wires to support the spinal pole. They are the strong back muscles of the sacrospinalis group, which are balanced against the abdominal muscles in front.

Anything you can do to co-operate with gravity in keeping your back erect will take the strain off the ligaments, discs, and nerves, thereby relieving pain.

The ligaments and nerves are the prime pain tissues of the spine. The secret of eliminating low-back pain, then, is proper posture and strong back muscles.

Look at posture first. Stand in your bedroom tonight in front of a full-length mirror.

Now turn to the side. Do you have a sway in your back? A normal curve is natural. If it is increased, however, it contributes to shortened and tightened back muscles a protruding abdomen, and a forward-tilted pelvis.

If you have back pain and swayback, the pelvic-tuck exercises will help correct this tendency and relieve your back pain. Here they are:

Stand against a wall. Try to make your back as straight as possible by squeezing the gluteal (buttocks) muscles tightly. Push your head toward the ceiling.

Note how this stance rolls the pelvis under and flattens the abdomen and the low back. It feels good too.

2. The Back Bridge. Lie face up on the floor with knees flexed. Raise your back from the floor as high as you can. Slowly roll back to the floor and rest with your back as flat as possible.

Note how this exercise rocks the pelvis upwards toward your navel and tightens stomach muscles as well as back and buttocks.

3. The Leg Flexor. Draw your knees up to your chest. Roll back and forth, making a rocker of your back.

This exercise stretches lumbar muscles that have been shortened by standing in a swayback posture.

4. The Lumbar Roll. Lying flat on the floor, draw your knees up and then roll to a sitting position. This movement puts a strain on the abdominal muscles without putting a strain on the back iliopsoas muscle. Because a tight abdomen takes strain off the low back, this exercise is a real help in eliminating back pain.

5. The Tummy Tightener. If you wish an easier exercise with which to begin, raise only head and shoulders from the floor without sitting up completely. To prevent strain, avoid initiating the exercise with your head. Let it follow the shoulders.

6. The Flat Floor Strengthens: Relax with your arms above your head and your knees bent. Tighten the muscles of your lower abdomen and of your buttocks at the same time so as to flatten your back against the mat. Hold for the count of ten. Relax and repeat the exercise.

Health-care products maker Johnson Johnson (JNJ.N) on Tuesday said its experimental device to treat clogged heart arteries performed significantly better than current technology in a large clinical trial. The company said its drug-eluting stent - a tiny, medicine coated tube that props open once-clogged coronary arteries - was more effective in keeping arteries from becoming reclogged.

Tuesday's results support earlier data that showed the device cut rates of reclogging to less than 10 per cent of cases.

Drug-eluting stents are designed to replace bare-metal stents, which result in arteries reclogging with scar tissue in about a third of the stenting procedures performed in the United States each year.

Doctors and analysts expect the new technology to revolutionise the treatment of coronary artery disease, reducing the number of heart procedures, including coronary bypass surgeries, performed in the United States.

Pain-numbing narcotics such as morphine are still the standard of care after a trip to the operating theatre, but alternatives are emerging as doctors and hospitals look to improve treatment and possibly cut costs at the same time.

Narcotics, which suppress pain signals to the brain, can disrupt normal activity, prolong hospital stays and lead to an uncomfortable, slow recovery. The side effects of these drugs drowsiness, nausea, constipation, difficulty in breathing and potential addiction - are well known.

"In a lot of cases, it's not the surgery that most impacts the patient its the side effects of the narcotics they take afterward," said Dr. Stephen Zimberg, a gynaecologist at Cleveland Clinic Florida in Weston, Florida. According to researchers giving patients anti-inflammatory drugs before surgery, such as Merck Co's Vioxx, can curb pain by blocking pain pathways before, during and after an operation.

Drugs can be combined with nerve-blocking anaesthetics, such as the epidurals used to mute the pain of childbirth, or after surgery with self-contained devices that deliver a local anaesthetic directly to incision sites over a period of days.

In one study, 43 per cent of hysterectomy patients given the ON-Q pain relief system a balloon-shaped pump that drips a steady amount of anaesthetic through a 'soaker hose' sewn inside an incision, did not need narcotics for pain after surgery, resulting in shorter hospital stays and lower overall costs.

The study of the device in hysterectomy patients showed that it cut overall costs by 30 per cent.

The London Times said researchers in London had asked a sample of men and women to plunge their arms into buckets of freezing cold water and keep them there as long as they could. They then gave the volunteers coffee in the expectation that it would ease the pain. Caffeine increases blood pressure which usually, according to the paper, leads to a lowering in the perception of pain.

The study found that while the caffeine did little for the men it had 'a strong impact' on the women.

"A double espresso probably would make the pain of something like leg-waxing more bearable," the paper quoted one of the researchers as saying.

The chemical name for salt is sodium chloride. Salt provides our bodies with the minerals "sodium" and "chloride" which are both essential for us to function normally.

Salt is found in almost in every food we eat and most of the salt consumed by people in urban areas comes from processed foods such as soy sauce, processed meats, canned soups, sausages, anchovies, butter, margarine and cheese. A full list of high salt dietary items consumed by Sri Lankans will be given later. About 15 to 30 per cent of the salt we eat comes from the salt we use for cooking. Most of the fresh foods such as vegetables, fruits, nuts and unprocessed meats are low in salt.

All of us need salt to live. Amount of the salt in the food is usually measured in milligrams (mg) of sodium and the current recommendation is that an adult has to eat about 2300 mg of sodium per day and we can easily get our requirement from the salt in fresh foods.

Most of the Sri Lankans eat more salt than they need and eating too much salt can lead to hypertension in people who are salt sensitive. It is common knowledge that hypertension increases your risk of strokes (brain attacks), heart attacks and kidney disease. If you are already suffering from hypertension eating too much salt may make the hypertension worse. If you have a strong family history of hypertension it is advisable for you to reduce salt consumption.

In the West high blood pressure affects almost a third of the people who are over the age of 50 years and hypertension is called a "silent killer" and majority of Sri Lankans suffering from hypertension do not know that they have hypertension as routine medical checks are not done by majority of Sri Lankans. Elderly people are more sensitive to changes in salt intake than young people.

If you are overweight, reduce the excessive weight. Be physically active, limit alcohol intake and start healthy eating habits by eating mainly plant based foods such as bread, cereal, rice, pasta, vegetables, fruits, legumes (peas, beans and lentils) and moderate amounts of lean meat, paultry, fish, reduced fat dairy products.

Monounsaturated oils (olive oil) and polyunsaturated oils such as gingerly oil. People who are salt sensitive experience an exaggerated blood pressure elevation when they are given a salt load. Salt sensitivity is a risk factor for developing hypertension. Many salt sensitive people are in fact not hypertensive at all. The Indiana study suggests that it is not hypertension that causes early death in salt sensitive people. It is the salt-sensitively itself.

That is, in these individuals high dietary salt causes cardiovascular disease even if their blood pressure remain normal.

Dr. Aviv from the University of Medicine and Dentistry of New Jersey says that salt increases the reactivity of the platelets. He says that high dietary salt intake leads to cardiovascular events like stroke and heart attacks and kidney disease directly in the absence of hypertension.

You can cut down your salt consumption by avoiding processed foods such as processed meats, commercial potato chips, sausages, crisps, high salt pastries, cutlets, rolls, pizza, cheese bits, salted nuts such as roasted peanuts, salted gram and roasted cashewnuts and "papadam".

You must avoid salt in cooking and this includes salt, onion salt, celery salt, garlic salt, beef and chicken cubes, gravy powder, soup cubes, "Lunudehi" and sprats.

Use acidic flavours such as vinegar, fruit juices such as lime and lemon, tamarind and pineapple juices, curry spices such as cumin, cardamom, cinnamon, ginger, tumerin, chilies, clove, coriander pepper and mustard.

People with kidney disease or those taking medication such as lithium or diuretics like fursemide, should consult their family physician before changing the amount of salt they eat. Pregnant mothers should consult their obstetricians before making any changes in salt intake.

Some people believe that in hot weather or when exercising or after heavy sweating, you have to take extra salt: This is not correct. Your body makes automatic adjustments by making sweat less salty and passing less salt in the urine.

It is very unlikely that you will ever need extra salt unless advised by your family physician.