Posts Tagged ‘CHF’

Eat veggies to lower your blood pressure

Monday, July 20th, 2009

I am a vegetarian.

Often people are surprised and they ask me – “How do you get your proteins (i.e. without eating meat)?”

My answer – “Vegetables also contain proteins.”

451px-Arcimboldo_Vegetables.jpg
Image Source: Wikipedia

Now a new study published in Circulation compared the blood pressure between individuals who ate vegetable protein (specifically glutamic acid along with 4 other amino acids which are relatively higher in vegetable than animal protein) with people who ate non-vegetable protein (read animal meat).

They found a difference of about -2.7/-2.0 mm Hg in blood pressure in people eating more vegetables. Although that may sound small, individual results may be different (and maybe higher for you).

Reference: Glutamic Acid, the Main Dietary Amino Acid, and Blood Pressure (The INTERMAP Study)

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The best blood pressure medicine!

Wednesday, May 20th, 2009

A recent meta-analysis published in the British Medical Journal compared the efficacy of different classes of blood pressure medications in preventing coronary artery disease (CAD) and stroke.

The investigators found that all blood pressure medicines are equally effective in preventing CAD and stroke.

Beta Blockers (e.g. metoprolol, carvedilol) were more effective in preventing future episodes of heart attacks in people who already had one. For primary prevention of CAD beta blockers were no more effective than other blood pressure lowering medications.

For 10mm reduction in systolic BP and 5mm diastolic BP:-

Risk reduction in CAD = 22%

Risk reduction in stroke = 41%

Calcium channel blockers (e.g. amlodipine) were slightly more effective in preventing stroke than other classes of medicines.

Reference: Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies

High Blood Pressure Education Videos

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Regenerating heart muscles to treat heart failure

Saturday, April 4th, 2009

Traditional medical teaching is that humans die with the heart muscles that they are born with.

Therefore, heart muscles that die when a person has a heart attack, will never regenerate and result in permanent injury akin to formation of scar tissue on skin (although skin does have a limited capacity to regenerate which is why scars do not form after minor skin trauma).

An article published in the Journal, Science seeks to overthrow this concept.

The researchers in their article have demonstrated that there is limited regeneration of heart muscle after birth.

“We have taken advantage of the integration of carbon-14, generated by nuclear bomb tests during the Cold War, into DNA to establish the age of cardiomyocytes in humans. We report that cardiomyocytes renew, with a gradual decrease from 1% turning over annually at the age of 25 to 0.45% at the age of 75. Fewer than 50% of cardiomyocytes are exchanged during a normal life span.”

This finding opens up possibilities of targeting medications to regenerating the heart muscle that is destroyed in a heart attack, thereby preventing a host of complications including heart failure (post myocardial infarction congestive heart failure is the number one cause of heart failure in the United States and is the major contributer of morbidity & mortality after heart attack).

Reference: Science, US News

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Comfort measures for congestive heart failure

Sunday, July 6th, 2008

This case has been on my mind for some time and I thought that I would share it with the world and get some opinions.

A very elderly lady, Mrs. Y presented to the ER for worsening congestive heart failure (CHF). She was diagnosed with CHF about 2 years ago. She had decompensated in the past 4-5 months and had been in and out of the hospital and rehab facility for CHF exacerbations. In the ER, she said that she does not want any treatment and wants to die since she cannot live with her family and is tired of being sick. Therefore in consultation with the family (who were present in the ER) she was changed to comfort measures and admitted to the medical floor.

When I saw the patient, I thought she was depressed and most likely did not have the capacity to take her own decisions. The family supported the patients decision for comfort measures although they admitted that they would like the patient to be treated for CHF.

It was a difficult situation for me, as I clearly knew that the patient’s CHF was easily reversible and the patient was depressed and most likely unable to take decisions. Also I was unable to reverse the patients code status.

I decided to take the midline approach i.e. treat the patient for CHF with high dose diuretics and give her morphine for difficulty in breathing (which is also a treatment for pulmonary edema and CHF) along with an antidepressant. I hoped that if she responds to the diuretics (and morphine) her breathing would get better and by 2-4 weeks her depression would be under control by the anti-depressants. On the other hand if she does not improve or deteriorates, she would be on morphine which would keep her comfortable and thus honor her desire to be on comfort measures.

What would you do?

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