Why exercise is advised in diabetic patients

Diabetes mellitus is a condition characterized by elevated blood sugar value. Apart from that there is alterations in blood lipid value and blood pressure. In diabetic patients exercise will help to decrease the blood sugar and also increases the sensitivity to insulin.

Other positive effect of exercise in diabetic patients

1. Decrease the heart attack risk

2. Decrease the blood pressure.

3. Exercise will help to reduce the muscle mass.

4. Reduce the body fat.

5. Produce weight loss.

Recommend exercise in diabetes

Diabetic people are advised exercise 150 minutes/week that is distributed at least over 3 days, moderate aerobic physical activity and resistance training.

Precaution before starting exercise in diabetic patients.

Since  diabetic patients are at high risk for heart disease without pain exercise tolerance test may be done in the following situations.

1. Age  more than 35 yrs

2. Duration of diabetes more than 15 yrs in type 1 diabetes and more than 10 yrs in type 2 diabetes.

3. If the patient has complications of diabetes such as kidney disease ,eye disease

4. Blood vessel occlusion in limbs.

5. Other risk factors for heart disease.

Those patients who have proliferative diabetic retinopathy should avoid vigorous exercise because of the chance of bleeding in to eye. 

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What is sudden cardiac death and its management

Sudden cardiac death is defined as Natural death due to cardiac causes, heralded by abrupt loss of consciousness, within 1 hour of the onset of a/c symptoms. Preexisting heart disease may or may not have been known to be present, but the time and mode of death are unexpected. It is due to direct consequence of cardiac arrest

Risk factors of  sudden cardiac death

Age.elderly at risk.

Male Gender.

Familial factors.Positive family history may be present.

Structural and functional factors.

Heart attack and chest pain - 80%.

Cardiomyopathies - 10 to 15%.

Other causes - 5 to 10 %.

Management of sudden cardiac arrest

Confirm cardiac arrest.

Call for help.

Give Chest compression.

Maintain airway –with  head tilt , chin lift, clear passage.

Look, listen and feel   the breathing.

Hospitalize the patient as early as possible. 

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Diet for Heart disease - A must read for every one

Coronary artery disease (Heart attack) is  a multi factorial disease. Here the strongest environmental factor is diet. Basic abnormality that lead to coronary artery disease is  is atherosclerosis. Major constituent of atherosclerosis is cholesterol esters,which  are carried by LDL (Law Density Lipoproteins ) in the blood. LDL cholesterol is affected by the type of  dietary fat.
Saturated fatty acid raise the blood cholesterol,while polyunsaturated fatty acid decreases the cholesterol. Cholesterol is found only in  animal food.

Following are the dietary recommendation in patients with coronary artery disease.

• Balanced diet is recommended.
• High fiber content (Complex carbohydrates) - Effect is determined by the type of dietary fiber. Soluble fibers such as pectin, guar and oat fibers can produce moderate reduction of cholesterol. Wheat fibers (wholemeal breads or bran) wont reduce the plasma cholesterol, but those who consume more wheat fibers and whole grain food the incidence of CAD  is decreased.
• Weight reduction to achieve optimal BMI (Body Mass Index) - Overweight, especially abdominal obesity is an independent risk factor for CAD. Weight reduction will reduce the cholesterol.
• More vegetables and fruits - Soya protein if included in the diet help to reduce the total and LDL cholesterol. Vegetables and fruits are law in fat and contain pectin other dietary fibers ,flavanoids and antioxidants. Five servings of different vegetables and fruit per day (400 g/day average weight)  is recommended.
• Avoid excessive caffeine intake - Coffee contains small amounts of diterpenes (lipids), cafestol and kahweol - not caffeine - it raise plasma total and LDL cholesterol. Since the diterpenes are removed  filtered or instant coffee does not raise the cholesterol.
• Avoid junk food.
• Avoid  foods with high fat content especially MUFA, excess salt ,cholesterol.
• Fish oil (omega 3 PUFA), garlic, plant sterols, antioxidants all help in reducing the cholesterol.
• Salt (NaCl)   should be restricted to 6 gram/day for the general population this is more important for CAD  patients.
• Fish  at least twice a week preferably fatty fish is recommended, it should not be fried in saturated fat. EPA (eicosapentanoic acid) help in reducing  CAD.
• Alcohol one or two drinks per day may be beneficial in middle aged people at risk for CAD, because of complications of over intake not recommended in general population.
• The following dietary components reduce the risk of coronary heart disease. Fruits and vegetables, cereal fiber,  PUFA, linolenic  acid, alcohol and fish, nuts, vitamin E, folate.

Glossary

1. BMI - Body mass index
2. CAD - Coronary artery disease
3. LDL - Law density lipoproteins
4. MUFA - Monounsaturated fatty acids, plant-based fats found in avocado, nuts and seeds, oils, olives, and dark chocolate
5. PUFA - Cutting off all vegetable oils except coconut oil, olive oil and palm oil. 

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Drugs used for treatment of heart attack patients.

Heart attack occurs when there is reduced blood supply to heart. It is an emergency situation and immediate medical care is required. Here in this article we will tell you some of the drugs and their aims. It is always good to have these in your mind

Following are the aims of treatment.

1.Immediate stabilization of patient.

2.longterm symptom control.

3.Cure of the condition if possible.

Drugs used for the treatment are given below.

1. Antiplatelet drugs –Aspirin and Clopidogrel, it is a group of powerful drugs that will prevent the blood clotting.

2. Nitrates will help to reduce the pain

3. Betablockers decrease the heart rate, blood pressure and improve the oxygen supply to heart.

4. Statin will reduce the blood cholesterol. Stabilize the plaque so prevent further attack.

5. ACE Inhibitors- role is to reduce the blood pressure, dilate the blood vessels and increases the blood supply.

6. Angiotensin II Receptor Blockers will increase the blood supply to heart.

7. Clot lysis with streptokinase give immediate improvement.

8. Diuretics remove excess salt and water from the body so help the heart to work properly.

9. Digoxin improve the function of heart.

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Statin a cholesterol lowering agent - Reduce cholesterol in 4 weeks

The problem of high cholesterol is increasing in the society. This will lead to atherosclerosis and increased risk for heart attack and stroke. Statin's will help to reduce the cholesterol level and thus will help to reduce heart attack and stroke in the community. Statin's are the most efficacious and best tolerated lipid lowering drug. They will reduce both primary and secondary hypercholesterolemia. Statin's can reduce the total cholesterol in 4 to 6 weeks. All the statin's are given at bedtime to get maximum effect.

Statins include the following

1. Atorvastatin­ dose 10 to 80 mg/day.

2. Lovastatin­ 10 to 40 mg/day,this is the first used statin.

3. Simvastatin ­5 to 20 mg/day.

4. Fluvastatin.

5. Pravastatin.

Adverse effects of statins

1. Headache.

2. Nausea and bowel upset.

3. Rash.

4. Sleep disturbance.

5. Muscle pain and rise in CPK level.

6. Increase in serum transaminase,but liver damage is not seen.

Uses of Statins

1.Reduce  cholesterol level.

2.Decrease heart attack rate

3.Decrease  stroke rate.

4.Help in plaque stabilization in atherosclerosis.

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Prevention of recurrent heart attack

Prevention of heart attack is very important because the chance of second attack is high in known heart patient. Repeated attacks are dangerous because it will increase the  risk of death in a given patient. The interesting factor is that the recurrent attack can be prevented with control of risk factors along with certain drugs. This will improve the long term survival.

Following are the measures to prevent recurrent heart attack

1.Drugs

2.Control blood pressure

3.Control blood glucose

4.Regular exercise

5.Balanced diet

6.Control blood cholesterol

7.Stop smoking

8.Avoid excessive alcohol intake

9.Reduce mental and physical stress.

Drugs that will reduce recurrent heart attack

Antiplatelets such as Aspirin and Clopidogrel will produce a 25%reduction in recurrent attack and increase the survival.

ACE inhibitors and ARBS (Angiotensin II receptor antagonists) are also useful in prevention.

Beta blockers will reduce the heart rate and help to  improve the long term survival.

Regular exercise will help to reduce weight ,cholesterol ,control of hypertension and diabetes.

Diet should be low in fat and rich in calories.

Quitting of smoking is very important as it will help to increase the Oxygen supply to heart and decrease the atherosclerosis.

Note : In diabetic patients apart from control of blood glucose control of blood pressure to 120/80 mm of mercury and LDL cholesterol to less than 70mg /dl is advised. 

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Medicinal effect of garlic in heart patients.

Medicinal effects of Garlic (Allium sativum) is known from the ancient days itself. It is used for treatment and prevention of many disease. Heart attack patients get several benefits with garlic intake. 

Active ingredient is Allicin which is an odorous sulfurous compound that has several medicinal effect. Following are the benefit of Garlic in heart attack patients. The main abnormality in blood vessels in heart attack patients is atherosclerosis. 

• It helps to reduce the blood clotting. It produce irreversible inhibition of platelet aggregation ,which is a blood component. Major action of drugs given in heart attack patients is to inhibit the platelet, which is responsible for blood clotting.
• Reduction of cholesterol and triglycerides levels which is responsible for formation of atherosclerosis and plaque in blood vessels leading to reduction in blood supply.Several studies showed 9 to 12% reduction in cholesterol and moderate reduction of triglycerides levels with its use.
• Help to reduce blood pressure which is also a risk factor for heart attack .There will be an average reduction of 11mm of Hg in systolic and 6.5 mm of Hg diastolic blood pressure.
• Garlic has anti atherosclerosis action,which help to reduce the formation of new atherosclerosis lesion and prevent the progression of older lesions.

Garlic is available as fresh cloves, powders, extract, tablets. At least one-half garlic clove per day  is required for medicinal effects.Although the tablets and powders are convenient, the amount of active ingredient is insufficient.

Some people may experience gut (gastrointestinal system ) symptoms such as flatulence(gas), chest pain and abdominal pain after garlic intake.

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Heart failure classification, risk factors and precipitating events

Heart failure:Clinical syndrome that occurs in patients due to any STRUCTURAL OR FUNCTIONAL CARDIAC DISORDER, so that patient develop a constellation of symptoms (DYSPNOEA and FATIGUE) and signs (OEDEMA and RALES) which lead to frequent hospitalizations, poor quality of life and a shortened life expectancy. It is the end result of various disease of heart. In cardiac failure heart fails to maintain an adequate blood supply to meet the metabolic demand of body. In mild to moderate disease heart maintain adequate cardiac output at rest but cant meet the increased demand such as exercise. Prevalence of heart failure increases with age. It carries a poor prognosis. Sudden death can occur due to malignant ventricular arrythmias or heart attack. Coronary artery disease is the leading cause of heart failure in western world.

Nyha classification.

Class I : Patients with cardiac disease but no limitation of physical activity; there are no symptoms from ordinary activities.

Class II : Slight limitation of physical activity; the patient is comfortable at rest.

Class III : Marked limitation of physical activity; the patient is comfortable only at rest.

Class IV : Any physical activity brings on discomfort and symptoms occur even at rest.

Following are the risk factors of heart failure

1. Coronary artery disease.
2. Hypertension.
3. Diabetes Mellitus.
4. Dilated and Hypertrophic cardiomyopathy.
5. Valvular heart disease.
6. Cigarette smoking.
7. Alcohol intake.
8. High output failure - Anaemia, thyrotoxicosis, arteriovenous fistulae,Paget’s disease
9. Pericardial disease - Constrictive pericarditis,Pericardial effusion
10. Primary right heart failure- Pulmonary hypertension

Preecipitating or aggrevating factor are those increases the oxygen demand of body.

Preecipitating factors

1. Myocardial ischemia or heart attack.
2. Infection.
3. Arrythmia.
4. Increased salt intake.
5. Non compliance with anti CHF medications.
6. Acute myocardial infarction.
7. Aggravation of Hypertension.
8. Administration of drugs with negative ionotropic properties(beta blockers) or fluid retaining properties(NSAIDS, steroids).
9. Pulmonary embolism.
10. Conditions associated with increased metabolic demand - Pregnancy, thyrotoxicosis, anemia.
11. Intravenous fluid overload – post operative iv infusion.
12. Rheumatic, Viral, and Other Forms of Myocarditis.
13. Infective Endocarditis.
14. Physical, Environmental, and Emotional Excesses.

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